St. Clair Hospital_HouseCall Vol X Issue 1

VOLUME X ISSUE 1

HouseCall

UNDERSTANDING DIABETES

UNDERSTANDING

DIABETES

WHAT YOU SHOULD KNOW

2 I HouseCall I Volume X Issue 1

There is simply no way to gloss over it: getting a diagnosis of diabetes is tough. Diabetes is a serious, complex, chronic, and progressive condition and there is no cure for it. It demands a great deal of discipline and lifelong medical care to keep it under control and prevent its many complications. That’s the reality. But there is a positive side: those who learn to manage their disease can live well with it, enjoying good health, full lives and longevity. Fortunately there are countless resources available to help people successfully make the transition to living with diabetes, including many at St. Clair Hospital. t St. Clair, a multidisciplinary team of highly

attacks itself. People with Type 1 have to take insulin.

A

qualified diabetes experts are ready to help; they

Type 1 diabetes used to be called juvenile diabetes because

are internists, endocrinologists, pharmacists,

it is most often diagnosed in children, but adults can develop

dietitians, diabetes educators, as well as sub-

it, too. Type 2 diabetes means that the body does not use

specialists in cardiology, ophthalmology, obstetrics and

insulin well and cannot maintain the blood sugar within the

nephrology. According to St. Clair’s Wayne A. Evron, M.D.,

normal range. It develops more slowly and is more common

FAACE, who is board-certified in internal medicine and

in adults over 40. Type 2 is not an autoimmune disease;

endocrinology, “Our Diabetes Center has many program

95 percent of people with diabetes have Type 2. Gestational

options and excellent diabetes educators with a lot of

diabetes is a form of diabetes that occurs during pregnancy.

experience. St. Clair is a one-stop shop for diabetes

It is temporary but it can cause problems for the mother and

care and education.”

the baby, and it raises the risk of developing Type 2 diabetes

Diabetes mellitus affects the way the body turns food

later in life for both. Pre-diabetes is an intermediate type of

into energy to fuel physiologic functions. Normally, the

diabetes that progresses to Type 2; that progression can be

pancreas makes insulin, a hormone which acts like a key

prevented or delayed with lifestyle modifications.

that allows sugar to enter our cells. In diabetes, the body

There is a strong correlation between diabetes and

is not making enough insulin, or it is unable to properly

heart disease. Diabetes greatly increases the risk of heart

use insulin. When there isn’t enough insulin, or when the

attack and stroke, even when blood sugar levels are well

cells stop responding to insulin (insulin resistance), excess

controlled. According to the American Heart Association, at

sugar remains in the bloodstream and may cause serious

least 68 percent of people with diabetes who are 65 or older

and disabling health problems.

die of some form of heart disease; 16 percent die from

There are three main types of diabetes. according to

stroke. Adults with diabetes are two to four times more

St. Clair endocrinologist Douha Safar, M.D. Type 1 is an

likely to die of heart disease than adults who do not

autoimmune disease, meaning that the body mistakenly

have diabetes.

Continued on page 4

OVER

30

MILLION

PEOPLE IN THE U.S. HAVE DIABETES

THAT’S OUT

1 OF 10 AMERICANS

1 OF 4 OUT

DON’T KNOW THEY EVEN HAVE IT

Source: Centers for Disease Control and Prevention (CDC)

Volume X Issue 1 I HouseCall I 3

UNDERSTANDING DIABETES Continued from page 3

A major public health problem

risk factors

Diabetes mellitus has been recognized as a disease since

for Type 2 diabetes

ancient times. As early as 1500 B.C., physicians wrote of “sweet urine disease,” but they had no insight into its causes. The diagnosis was made with the help of ants: if ants were attracted to a person’s urine, it was assumed that the urine was sweet. Primitive treatment consisted of hydration, but most of those afflicted died. It wasn’t until the end of the 19th century that progress was made in understanding diabetes. Today diabetes is one of the most prevalent diseases on the planet.

Family history of diabetes

Overweight

Consider these facts from the CDC: more than 30 million adults in the U.S. have diabetes, and one in four of them are unaware of it.

More than 84 million adults, over a third of us, have pre-diabetes, and 90 percent don’t know it. In the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the American population has aged and grown obese. Diabetes is the seventh leading cause of death in the U.S. and it costs over $245 billion annually.

Physical inactivity

Smoking

According to the American Journal of Preventive Medicine, if current trends continue, one in three Americans will have diabetes by 2050.

The reasons for this are complex, but Dr. Evron cites obesity and the aging of the population as factors. “We’ve seen an exponential rise in diabetes in western Pennsylvania,” he says.

“There are more people diagnosed in part because the definition was changed.

A fasting blood sugar of 140 used to be the standard and it was decreased to 126.

This was done because of the risk of complications.”

Despite the data, it is not all doom and gloom, according to Adrian Vella, M.D., Mayo Clinic endocrinologist and Chair for Research in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at

Adrian Vella, M.D., Endocrinologist, Mayo Clinic

DOUHA SAFAR, M.D.

Mayo Clinic. The CDC’s 2017 Diabetes

Dr. Safar specializes in endocrinology.

She earned her medical degree at the University of Aleppo, Aleppo, Syria.

She completed an internship at The Pennsylvania State University College of Medicine and a fellowship at University of Pittsburgh School of Medicine. Dr. Safar is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C.

Report Card showed a decrease in the rate of new cases among

To contact Dr. Safar, please call 412.942.2140.

adults. “Most of the initiatives that would change this picture are at the public health level,” Dr. Vella says. “In 2017 we saw a flattening in new cases among adults. This is encouraging, but there are ongoing challenges. Diabetes is a major public health concern that requires preventive care programs to improve outcomes. It’s largely about patient education and the development of healthy habits. The American Diabetes Association and the American Heart Association have developed multiple joint programs to address the link between diabetes and heart disease. At Mayo Clinic, and at St. Clair and other members of the Mayo Clinic Care Network, we are working to integrate healthy living advice into all of our care.”

4 I HouseCall I Volume X Issue 1

Diagnosing the disease Camille M. Buonocore, M.D., a board-certified endocrinologist at St. Clair, says that for many of her patients, a diagnosis of diabetes confirms their worst fear. “For many, the diagnosis comes as a shock; for others, it may have been anticipated but is still upsetting. What helps is diabetes education and a trusting relationship with their physician. A relationship makes people more receptive to learning and taking action.”

There are no remissions, no days off or vacations from diabetes — not without consequences. And, the worst consequences of uncontrolled diabetes can be dreadful: blindness, amputation, kidney failure and heart disease. It’s stressful, but people with diabetes learn to manage it and to live healthy lives when they understand their disease and make the modifications it requires. It can be a wake-up call that motivates them. “You can manage diabetes without losing your quality of life,” says Dr. Buonocore. “Simple things, like learning to read a food label, eating protein at every meal, and understanding the importance of portion size go a long way. Diabetes is doable: you have choices.”

“ ”

YOU CAN MANAGE DIABETES WITHOUT

LOSING YOUR QUALITY OF LIFE.

CAMILLE M. BUONOCORE, M.D., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL Dr. Buonocore examines patient David Zebroski of McMurray.

minimize your risk

Eat healthfully

Be more active

Lose weight

Quit smoking

Get a check up

Volume X Issue 1 I HouseCall I 5

UNDERSTANDING DIABETES Continued from page 5

For the future: A focus on prevention Despite the gravity of diabetes and the challenges it poses for patients and physicians, great progress has been made in its treatment. St Clair’s Bridget K. Beier, D.O., who is board-certified in internal medicine and endocrinology, describes some of these advances: “New and more effective medications and technology are changing things. Continuous glucose monitoring (CGM) systems enable people to check their blood without a finger stick. There is a CGM system with an integrated insulin pump; it functions like an automatic insulin delivery system. There has been an enormous expansion of resources for diabetes education and support. Thanks to these advances, we are seeing a reduction in diabetes complications.” However, diabetes is an expensive disease, Dr. Beier says. “The cost of medications is a major issue, and there are few generics.

Compliance with your regimen is essential to good diabetes management, but for many people, cost is a barrier to compliance.”

Dr. Evron examines patient Carla Roehner.

recognizing the signs of diabetes major complications if untreated, diabetes can cause serious complications, such as:

•• •• •• •• •• ••

Heart disease

Unusual weight loss

Extreme fatigue

Numbness or tingling in hands or feet

Vision loss Dental problems Kidney failure Nerve damage Loss of limbs

Increased thirst

6 I HouseCall I Volume X Issue 1

Frequent urination

Blurred vision

DIABETES COMPLICATIONS:

Dr. Beier envisions a future in which diabetes prevention is emphasized. “We definitely need to focus on prevention and increasing public awareness. Diabetes education makes a difference, but it is after the fact. Health insurance should reimburse for all diabetes education, including pre-diabetes prevention. I’d like to see pre-diabetes education in the schools. Obesity keeps getting younger and there are kids with pre-diabetes.”

serious but avoidable A

wareness of the potential complications of diabetes is an essential aspect of self-management. When diabetes is not well controlled and

blood sugar levels are high or erratic, there is a risk of developing

serious complications in many organ systems. Many of these complications are life-changing and disabling, and some may even result in death. In general, high blood sugar can damage the tiny blood vessels throughout the body. The

Sharing their stories

sugar “sticks” to these vessels, making them narrow; as a result, blood cannot

In these pages, HouseCall presents profiles of six adults who

flow freely through them to organs they supply. This happens most often in the

have each created their own unique way to live with diabetes.

eyes, nerves, lower limbs, kidneys and cardiovascular system.

Each was faced with navigating a new world, unexpectedly,

High blood sugar harms the tiny blood vessels in the eyes, causing

and they have done so with intelligence,

swelling of the vessel walls and leakage of fluid into the retina. This can lead

creativity and discipline. They are the

to blurred vision, vision loss and blindness. In addition, people with diabetes

embodiment of the resilient human

have a higher incidence of cataracts and glaucoma.

spirit that perseveres against

High levels of blood sugar damage the nerves so that they stop sending

daunting challenges.

essential signals between the brain and the body, including pain signals.

Hopefully, their stories

This is known as diabetic neuropathy, and it includes peripheral

will educate, encourage

neuropathy that affects the arms and legs. Peripheral neuropathy

and perhaps even

can cause pain, numbness or weakness.

inspire. n

There are several ways that feet are damaged by high blood sugar. Damage to blood vessels causes poor circulation so that sores and infections on the feet can’t heal. This can lead to amputations

Dr. Beier examines patient Mary Ann O’Neill of South Fayette.

of toes, feet and legs. Nerve damage prevents you from feeling the pain signals that tell you there is a problem. The nerve damage can also deform the feet, leading to pressure points that create sores.

The kidneys, the vital organs that filter the blood, keep the good substances inside the body and discard waste products and excess fluid.

“

High blood sugar clogs the tiny blood vessels that fill the kidneys so that they gradually receive less blood and waste products build up. When the kidneys

WE DEFINITELY NEED TO FOCUS ON PREVENTION AND INCREASING

PUBLIC AWARENESS.

”

BRIDGET K. BEIER, D.O., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL

fail, dialysis is necessary to filter the blood, and sometimes a kidney transplant is needed. High blood sugar, along with fat, builds up in the blood vessels that bring essential oxygen to the heart and brain. This can lead to a heart attack or stroke.

As bad as this sounds, the complications of diabetes are preventable, says St. Clair Hospital Endocrinologist Wayne A. Evron, M.D. , FAACE. “The incidence of severe complications is way down due to better education, better medical management and self-care, and better drugs, including statins (used for controlling high cholesterol). The numbers are getting better and the dire consequences of diabetes are not as common. Amputations are entirely avoidable, as is blindness. Monitoring your blood sugar, keeping it as normal as possible and avoiding variability in your levels slows the onset and severity of complications.” n

Volume X Issue 1 I HouseCall I 7

UNDERSTANDING DIABETES Continued from page 7

A Patient’s Story

Maureen: A new way of life.

Maureen Linkosky reaches high and grasps firmly.

She is an achiever, a woman of many accomplishments: she is a highly skilled Physician Assistant to an orthopedic surgeon, assisting with as many as six to eight complex surgeries every day. She has a home and three children: Sara, Kate and John; she loves to travel; and she lives an active, healthful lifestyle.

On Saturday mornings when the weather is nice, Maureen, 55, and her husband John can often be found on the “Jail Trail,” the segment of the Three Rivers Heritage Trail that runs parallel to the Monongahela River. It’s an activity that Maureen loves; it gets her outdoors and it provides great exercise.

Biking also helps to keep her blood sugar stable and, for Maureen, that is a primary concern, as she has Type 1 diabetes.

“ ”

I was not going to be a victim.

MAUREEN LINKOSKY, PATIENT

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When Maureen learned of her diagnosis 10 years ago, she was shocked. She had an autoimmune condition since childhood and, at 45, it had inexplicably attacked her pancreas, causing her to develop diabetes. “My first thought was, ‘Oh no!’ It’s a life-altering diagnosis and at first, it’s difficult to grasp,” she says. “But there was no time for ‘Woe is me’ — I told myself, this can be managed; I knew that I could have been handed something worse. Fortunately, I’ve had life experiences that gave me perspective; my husband had open heart surgery at 43.

It came down to, what do I have to do? Watch what I eat, very carefully?

Okay, I can do that. I had to accept a new way of life, not the end of my life.” Maureen accepted her diagnosis with poise and resolve. “I was not going to be a victim,” she explains. “The options are simple: do what you should or face dire consequences. I do exactly what my endocrinologist, St. Clair Hospital’s Camille M. Buonocore, M.D., tells me to do to keep

Type 1 diabetic Maureen Linkosky in the kitchen of her Mt. Lebanon home.

my blood sugar in control, including following a low carb/no carb eating plan. Dr. Buonocore is an expert in her field. She has compassion and empathy and listens well to her patients. This makes her a special provider and I’m glad that I found her.”

Diabetes is complicated, but there are many resources to educate and support you, Maureen says. “I had the added benefit of my education

complications are far off. They can happen now. It’s essential to pay attention to what you eat. I cut my carbs in half and then in half again. I read labels. Protein goes into effect in four hours, carbs in two

as a health care professional. It helps me to remember that I’m needed;

hours, so if you eat carbs, you get hungry quickly. You have to learn how

people depend on me. I have to take care of myself for me, but also for

to choose the healthiest food: the difference between an orange and a

my family and others. It isn’t their problem, but it affects them because

clementine matters when you are diabetic.” Maureen loves to cook

it affects me.” Maureen did research and educated herself, but also took

and is creative in adapting her cooking to diabetes; steak Diane and a

advantage of the patient education offered by the Diabetes Center at

flourless chocolate cake are among her specialties. “I do everything I

St. Clair. “St Clair has a great program,” she says. “Their approach is,

did before, but now I tweak it. I have salad for lunch every day, but that

‘What do you need? How can we help?’ St. Clair is the only hospital that

doesn’t mean I just eat lettuce every day; I have variety and I put chicken

has a needle drop-off program; that may seem like a small thing, but

or seafood in the salad. I make skinny tacos — lettuce leaves make a

it makes a huge difference. It’s practical and it helps the community.”

great tortilla shell.”

There are some aspects of managing diabetes that can only come

Maureen’s work is demanding and strenuous, but deeply satisfying.

from experience, and Maureen has plenty of experience that she is

“In orthopedic surgery, we transform lives. We relieve pain and give

eager to share. For one thing, she says that there is a “street smart”

people back their mobility. Most of the patients do very well. At work,

aspect to living with diabetes. “Living with diabetes is nuanced. There

I am on the move all the time, and I had to figure out what works for me.

are many aspects to it; it’s like a science project sometimes, keeping

Your plan has to be individualized: when and what to eat and exercise;

everything in a state of balance. The practicalities are what matter

how to deal with stress, illness, travel and other things that impact

most. No one has time for extreme planning, so you have to make it

diabetes. The key is regular routines and nothing in excess.”

as simple as possible. If it’s simple, it’s easier to stick to it.”

Dr. Buonocore praises Maureen for her ability to maintain balance.

Whether she is spending her work day in the Operating Room,

“The best scenario is a very regular routine, and Maureen has done this

making rounds at a hospital or seeing patients in the office, her days

well. She is a highly motivated patient, plus she was already in excellent

begin early; she gets up at 4:30 a.m. and is at the hospital by 6:15.

health. Her diabetes is tightly controlled. Lifestyle is a major factor

As an orthopedic physician assistant, Maureen works with amputees

with Type 1 and Type 2 and simple changes go a long way. Eat balanced

on a regular basis and is well aware of the severe consequences of

meals and include protein at every meal; take your medication; and

uncontrolled diabetes. “Diabetes can get very bad very quickly; many

add exercise to your life. You can manage diabetes without losing your

people fail to understand this. You can’t let yourself think that

quality of life.” n

Volume X Issue 1 I HouseCall I 9

UNDERSTANDING DIABETES Continued from page 97

A Patient’s Story

Carla: Knowledge is power.

Carla Roehner, 57, of Upper St. Clair, is devoted to her family, and now that her own two children are young adults, she is looking forward to the next life stage: being a grandmother. She wants to live a healthy lifestyle so she can enjoy the grandchildren that she is hoping for, and she is determined that her Type 2 diabetes will not be an obstacle.

Carla always believed that she was probably going to get diabetes.

Her mother, father and an aunt had diabetes before her, as did three of her grandparents. Carla had gestational diabetes with her second pregnancy, and sure enough, she was diagnosed at age 43 with Type 2 diabetes. She was able to manage her diabetes with diet and oral medications, under the guidance of John E. Popovich, M.D., her primary care physician, and she speaks with refreshing candor about her experience: “For a long time, my A1Cs (blood tests for sugar levels) were okay and I pretty much ate whatever I wanted and I felt fine. I didn’t give my diabetes a lot of attention.” But a few years ago, Carla had her first wake-up call, an A1C of 8.4, and Dr. Popovich decided it was time to see a specialist. Carla went to diabetes classes and began to exercise more; as a result, her A1C went down to 6.5. In subsequent blood work, however, she found her A1C gradually rising. She would increase her exercise and it would drop a bit. In the meantime, she decided to switch to a new

“

WE’RE GOING TO WORK HARD AT THIS.

HELP ME HELP YOU.

”

WAYNE A. EVRON, M.D., FAACE, ENDOCRIOLOGIST, ST. CLAIR HOSPITAL

Wayne A. Evron, M.D., FAACE

WAYNE A. EVRON, M.D., FAACE Dr. Evron specializes in endocrinology. He earned his medical degree at University of Pennsylvania. He completed an internship at University of Florida, as well as a residency in internal medicine and a fellowship in endocrinology at the University of Pittsburgh Medical Center. Dr. Evron is board-certified by the American Board of Internal Medicine.

He practices with Evron Endocrinology Associates, a division of St. Clair Medical Services.

To contact Dr. Evron, please call 412.942.7295 .

10 I HouseCall I Volume X Issue 1

Excellent

Good

Poor

HbA1C Test Score

4.0

5.0

6.0

7.0 8.0

9.0

Mean Blood mg/dl

50

80

115

150 180

215 250 280

350

380

Glucose mmol/L

2.6

4.7

6.3

8.2 10.0

11.9 13.7 15.6 17.4 19.3

21.1

10.0 11.0 12.0 13.0 315

endocrinologist and Dr. Popovich recommended St. Clair Hospital’s

14.0

KEEPING BLOOD SUGAR LEVELS IN CHECK A glucose chart acts as a reference guide for blood sugar test results and is an important tool for diabetes

management. Most diabetes treatment plans involve keeping blood sugar levels as close to normal or target goals as possible. Frequent at-home and doctor-ordered testing, along with an understanding of how results compare to target levels allow patients to assess and self-monitor blood sugar test results.

Recently Dr. Evron had Carla begin using a continuous glucose

Wayne A. Evron, M.D., FAACE. Carla saw him for the first time in March.

monitor (CGM) and that has provided an entirely different level of

He did an A1C in the office and the result was her all time high of 8.5.

information to her about how her blood sugar level responds to food

Carla hadn’t realized she had slipped that much.

and exercise. The sensor gives her accurate readings and information

Seeing Dr. Evron has made a big difference, and now she’s getting

about her blood sugar patterns. “It’s easy to use and it frees me from

a better handle on her diabetes. “When I do what I should, my blood

finger sticks,” she says. “Now I know exactly what my blood sugar is

sugar is stable,” she says. “I know how to choose food well, measure

after an hour of exercise or after a meal. I’ve been able to reduce my

portions, count carbs, pay attention to my weight and monitor my

medication since I began using it.”

blood sugar, but I went back to the Diabetes Educator at St. Clair for

With Dr. Evron, Carla believes she is making a fresh start.

a refresher course and that was helpful. Knowledge is power; I may

“Dr. Evron said to me at my first visit, ‘We’re going to work hard at this.

not know all the science but I know what works.”

Help me help you.’ His words made me feel confident and supported.

Carla has a son, Clay, 28 and a daughter, Julie, 24, and she works

For 11 years, I neglected my health, and I waited a long time before

part-time at the Upper St. Clair Library. In the early years of her

I truly cared about my diabetes. Fortunately, I’ve had no complications;

marriage, Carla and her husband Ken lived in San Francisco, and

my eyes and my feet are fine.” Carla feels

their home was within walking distance of many wonderful restaurants.

hopeful and motivated, and says that

It was hard to resist all that great food, and with her first pregnancy,

life is better now that she is back

she gained more than the recommended amount of weight. It was

on track, managing her diabetes

difficult to lose the pregnancy weight, as many mothers find, and she

better than ever. n

developed gestational diabetes with her second pregnancy. Carla wonders if she could have prevented both her gestational diabetes and her Type 2 diabetes, and she worries about the risk to her kids.

But according to Dr. Evron, the development of diabetes is largely a matter of genetics, and given Carla’s family history, it was probably inevitable. “The risk of developing diabetes is higher for the child born of a gestational diabetic pregnancy, but mostly because of genetics,” he explains. “The risk to the child is anywhere from 10 percent to 50 percent.”

Life with diabetes requires a lot of planning and constant learning, Carla says. “I read Diabetic Living magazine and I’m always learning. I’m especially successful when I walk every day. I walk my dogs and those walks definitely help control my

Carla says staying active helps her control her blood sugar.

blood sugar.”

Volume X Issue 1 I HouseCall I 11

UNDERSTANDING DIABETES Continued from page 11 7

A Patient’s Story

Jayne: Even with diabetes, it’s a wonderful life.

Jayne Sterling is a woman in love with life. She lives life to the fullest, enjoying every moment as a wife, mother and grandmother, and seeing as much of the world as she possibly can. “There is no way

that she see an endocrinologist, and she made an appointment with St. Clair Hospital’s Bridget K. Beier, D.O. The diagnosis of Type 2 diabetes did not come as a complete

that diabetes is going to get me down,” declares Jayne, and the tone

surprise; Jayne’s mother and one of her brothers have diabetes.

of her voice makes you believe her. This lively, energetic world traveler

“Dr. Beier gave me the diagnosis. I liked her from the very first

has a zest for life that keeps her constantly active and engaged.

moment I met her. She’s personable, takes time with me and always

“I’m a young 71,” she says, “and I am always on the go. I was a

gets back to me when I call her. I take (prescription medication)

physical education major and I am not a sitter. I work out; I have

Metformin and I’ve had to change my eating habits, but I did not need

energy.” That characteristic made her sudden development of severe,

to lose weight. I was never overweight; I’m a size 2, but I have not

late afternoon fatigue quite out of the norm 12 years ago when she

been the healthiest eater. I never knew a vegetable! I was a sugar

was working at her job in the jewelry industry. Jayne was at work

addict all my life and I love candy. Luckily something in the

when she began experiencing the desire to lie down and nap around

Metformin killed my huge appetite for sweets.”

three every afternoon. She would eat candy to spark her energy, and it would give her a quick but short-lived boost. A co-worker suggested

Jayne’s approach to diabetes management is to rely on her doctors, follow their recommendations, and find ways to enjoy

A HEALTHY-EATING PLAN A healthy-eating plan is one that’s naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables, fish and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. Embracing a healthy-eating plan is the best way to keep blood glucose levels under control and prevent diabetes complications.

Source: www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295

12 I HouseCall I Volume X Issue 1

eating within the limits of diabetes. “You have to find food that you

diabetics is to accept it and take it one day at a time. “I believe that

really like. You will want the wrong things if you are eating food that

anyone can adapt to diabetes. You adapt to it because you have to —

you don’t enjoy. I avoid pasta and have it maybe once a week, and

that’s really all there is to it. My mother’s diabetes was not well

there is no bread in my house! I was never a big eater, so what works

controlled and I saw how that affected her. I’m not perfect; I have a

for me is a breakfast of scrambled egg and bacon and some fruit; for

cookie now and then. But most of the time I do very well and I have

lunch I have a packet of crackers and my main meal is dinner. I eat

managed my diabetes for 12 years now. I respect my doctors and

lots of fish. This is what works for me, and I enjoy what I eat.” Dr. Beier

I listen to them; I have two brothers who are doctors.

praises Jayne for her positive attitude. “Jayne has Type 2 diabetes

“I believe in enjoying and celebrating your life because it can be

which can be a discouraging diagnosis for many people. Jayne remains upbeat and realizes that leading a healthful lifestyle can have a huge

cut short. You can live with diabetes; you can even live a wonderful

life with diabetes. I do!” n

impact on achieving and maintaining excellent diabetes control.

She travels frequently, but makes sure to exercise regularly and watch her diet even when away from home.”

Jayne and her husband Tom have been married for 50 years.

They love to spend time with their daughter Tess, son T. L., and three grandchildren. Jayne travels often and loves to go to Europe, especially

Bridget K. Beier, D.O.

to Krakow, Poland and to Italy. Jayne’s advice to newly diagnosed

“

A HEALTHFUL LIFESTYLE

CAN HAVE A HUGE IMPACT ON ACHIEVING AND MAINTAINING EXCELLENT DIABETES CONTROL.

”

BRIDGET K. BEIER, D.O., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL

BRIDGET K. BEIER, D.O. Dr. Beier specializes in endocrinology. She earned her medical degree at Lake Erie College of Osteopathic Medicine and completed her internship and residency at the University of Connecticut Health Center and a fellowship at Virginia Commonwealth University Health System. Dr. Beier is board-certified by the American Board of Internal Medicine.

She practices with Associates in Endocrinology, P.C. To contact Dr. Beier, please call 412.942.2140.

Volume X Issue 1 I HouseCall I 13

UNDERSTANDING DIABETES Continued from page 13

A Patient’s Story

Scott: Freedom fighter.

Scott Kleinhans is a warrior with an intrepid spirit and June 1, 2015 was a personal D-Day for him. On that day, the 64-year-old Upper St. Clair resident had a heart attack, underwent heart surgery, and was told that he had diabetes. It would be an understatement to say that a single day changed his life; it essentially sliced it into Before and After.

Scott had to learn a new way of life, within the dual constraints of heart disease and diabetes. He has done that, and done it exceptionally well by making the most of his motivations, educating himself, and fighting for his health. It is a battle that he is winning.

He contends that the most significant lesson he has learned on this unexpected journey is that self-care is paramount. “Long before my own diagnosis, I saw firsthand what the lack of self-care can do to a person with diabetes,” he explains.

14 I HouseCall I Volume X Issue 1

“I had a relative with diabetes who did not manage it well. Her

sticks. I’m making enough insulin for the way I eat.”

He attributes his success in part to the supportive partnership

attitude was, ‘I’ll eat what I want and just take more insulin.’

he has with Linda. Their mutual interests in improving their health

Her blood sugars were unstable, and would go from 60 to 600.

converged in a radical change in their eating habits. “We’ve based

I helped care for her and she had many complications.”

our diet on a book about reversing heart disease. Eating healthy

Motivated by this experience, and wanting to stay healthy to enjoy life with his beloved family — wife Linda; two sons, William,

has changed our lives. No dairy, no gluten, no processed food or

28, and Stephen, 24; and dog Butterscotch — Scott was resolute

preservatives. Lots of fresh vegetables! I do much of the cooking

in his effort to get a handle on diabetes. Endocrinologist Camille M.

and we eat well, plus we eat as much as we want. I miss pizza,

Buonocore, M.D., saw him while he was

but we’re amazed at how happy we are and how good we feel. Our

at St. Clair, recovering from heart surgery;

“

she started him on insulin immediately. “It was very hard, mentally, at first,” he says.

“After I was discharged I went to the classes; I had two one-on-one sessions and then a group. It was helpful. I had to learn how to eat with diabetes. I was on insulin four times a day, and I had to check my blood sugar with finger sticks three times a day. I did research

allergies have improved. My cardiologist says my heart sounds great.” Scott’s work as a custodian is physically active, and he and Linda also exercise

I’m proof that it is possible to get freedom from diabetes.

and went to my doctors, including my primary care physicians Richard J. Egan, Jr., M.D., and Joshua B. Goldman, D.O., with my questions.

I knew it was going to be hard, but I had to try.”

”

Scott says that at times, he has felt impris-

where they like to walk in the resistance stream in the pool.

Dr. Buonocore says that Scott is fortunate to have been able to come off insulin, although this will not be possible for every diabetic. “Scott has done very well and his case demonstrates the benefits of restricting high calorie foods, watching

SCOTT KLEINHANS, PATIENT

oned by his condition. It’s a common feeling among those with

regularly at the Upper St. Clair Recreation Center,

portion size and exercising. It also emphasizes the importance of family support to a diabetic.

Although I don’t support following gluten-free

or dairy-free diets when they are not medically necessary, they do

diabetes. He wanted, above all, to be free of insulin shots and he

impose dietary restrictions, which help some patients control

resolved to do whatever it took to achieve that freedom, including

their caloric intake. Improving diet and adding daily exercise will

losing weight. “I’m not fat, but I’m a big guy,” he explains. “I wanted

help diabetic control, blood pressure and cholesterol.”

to lose weight to get better control, and after my heart attack my

Scott acknowledges that it takes enormous discipline to

weight was inching up. As I lost weight, my blood sugar kept falling

maintain his regimen. “I’m motivated because I don’t want to

and I worked with Dr. Buonocore’s nurse practitioners, Deborah

be trapped by diabetes. When you’re diabetic, you have to think

Meriney and Antoinette Thalman, to reduce my insulin to correspond

about diabetes constantly and your life revolves around it. But

to eating less. My wife, who is pre-diabetic, and I went on a diet and,

it doesn’t have to be miserable. If you learn about diabetes and

after three months, my blood sugars were in the low 90s.

nutrition, you can get some control over it and still enjoy life.

I felt great and I was able to cut back on insulin. Later, my blood

My blood sugar is rock steady and I am free of insulin shots.

sugar stabilized further and I stopped insulin altogether. I take

I’m proof that it is possible to get freedom from diabetes.” n

(prescription medication) Metformin every day now and I do finger

Volume X Issue 1 I HouseCall I 15

UNDERSTANDING DIABETES Continued from page 15

A Patient’s Story

Jamie: Controlling diabetes, the key to a healthy pregnancy.

With three active children under age 10, plus a new baby born at St. Clair Hospital’s Family Birth Center, Jamie Andreola, 39, has her hands full. But she and her husband Tony, children’s pastor at South Hills Assembly Church, keep their Bethel Park household running smoothly and happily, and Jamie’s skills have translated well to her self-management of gestational diabetes. Jamie is a pro, having had the condition with her third and fourth pregnancies; she is masterful in choosing healthy foods that nurtured her and the growing fetuses, kept her blood sugar stable and her weight in a healthy range. It isn’t simple, but Jamie has it down, and she has some advice for expectant mothers with gestational diabetes. “My diagnosis was not entirely a surprise, because my sister had gestational diabetes. Still, it felt like boot camp at first.

I needed to learn the basics of nutrition and adjust my habits. Fortunately, I had great help from the dietitian at St. Clair’s Diabetes Center. My OB/GYN doctor, Deborah A. Lenart, M.D., referred me to her and she was excellent; she gave me menu ideas and recipes.”

One of the most important principles that Jamie learned was that she needs to eat protein at every meal. “Protein helps to stabilize my blood sugar; it levels out my mood and keeps me from having cravings. Most snack foods are carbohydrates and they are the easiest thing to grab when you are hungry. I know now to snack on protein. My favorite snacks are peanut butter on apple slices; unsalted peanuts; Colby Jack cheese sticks and turkey pepperoni. I know to always have them cut up and ready.” Readiness is a key for anyone who is managing diabetes, Jamie says. “I can’t leave anything to chance. Everywhere I go, I have protein bars and peanut butter crackers with me. The key to healthy eating with diabetes is to shop well and often so that you always have the right foods on hand. Failing to plan is what will get you into trouble.”

“

Jamie Andreola and her beautiful and healthy baby boy, Joshua.

Dr. Beier and Dr. Buonocore are amazing. They give me encouragement and confidence.

JAMIE ANDREOLA, PATIENT

16 I HouseCall I Volume X Issue 1

”

Dr. Lenart also encourages women

Although some women with gestational diabetes need insulin,

who are hoping to have a baby to begin

Jamie kept her blood sugar stable with diet alone. “I eat a good breakfast of eggs and sausage plus one piece of high grain bread; I can have toast because of all the protein. As long as I watch my carbs and have protein at every meal, I’m

pre-conception planning for a healthy

Tony and Jamie Andreola with their growing family.

pregnancy. “Get in shape first, before you conceive. If you need to lose weight or eat healthier, get into a

okay. I’ve learned to avoid pasta, rice and chips; I eat more veggies and if I crave sweets, I have a few

routine of healthful eating and

grapes. For exercise, I swim. Exercise brings my

exercise well ahead of becoming

blood sugar down, helps me manage my weight, and

pregnant. Pregnancy is an opportunity to create a foundation for

makes me feel better.”

the long term health of the child,

Gestational diabetes is the most common compli-

but also for the mother,” she says.

cation of pregnancy, affecting four percent of pregnancies

St. Clair offers a lifestyle management

in the U.S. According to Dr. Lenart, Chair of the Depart-

program called Fit for Two, designed to

ment of Obstetrics and Gynecology at St. Clair, screening for gestational diabetes is a routine part of good prenatal care.

help obese women better manage their

“Gestational diabetes simply means glucose intolerance during

weight through good self-care and nutrition.

A woman who has had diabetes and becomes

pregnancy. It is usually asymptomatic. All pregnant women should have a glucose tolerance test at 24 weeks, or earlier if there are risk factors.

pregnant has a completely different situation from a gestational diabetic,

We give them a glucose challenge with a sugary drink and check the blood

Dr. Lenart explains. “The diabetic patient may need to be managed

sugar an hour later; if the one-hour test is abnormal, then we proceed to

with a high risk perinatologist plus an endocrinologist. She will require

a three-hour glucose tolerance test, and that clinches the diagnosis. The

absolutely tight control before and during pregnancy.”

first step is to see a dietitian, to learn what and how to eat and try to stay

Dr. Lenart referred Jamie to endocrinologists Bridget K. Beier, D.O.,

diet-controlled. We want the glucose to be tightly controlled, so there

and Camille M. Buonocore, M.D., of Associates in Endocrinology, P.C.

may be a need for medication. We will do more frequent stress testing

once the diagnosis of gestational diabetes was made. They taught her

and ultrasounds, we encourage exercise and we monitor weight gain

how to self-monitor her blood sugar levels. “Dr. Beier and Dr. Buonocore

carefully. Gestational diabetics are at increased risk to need a C-section.”

are amazing,” Jamie says. “They give me encouragement and confidence.

Most women who develop gestational diabetes, says Dr. Lenart, will have

I prick my finger four times a day: first thing in the morning, then again

a healthy pregnancy and a healthy baby. In some cases, a medically

after each main meal, and I report my numbers to them.”

indicated early induction may be needed.

Risk factors for gestational diabetes include a previous pregnancy

Jamie Andreola and her healthy children are living proof that with

with the condition; a previous infant with a birthweight of nine or 10

good prenatal care and support

pounds; maternal obesity and high BMI; and family history of diabetes.

from diabetes experts, a woman

Older mothers have a higher risk. For both mother and baby, there is

with gestational diabetes can

an increased risk of developing Type 2 diabetes later in life, so follow-up is essential. Dr. Lenart recommends having a glucose tolerance test

have a healthy pregnancy and

a healthy baby. n

within 4-6 weeks post-partum.

Camille M. Buonocore, M.D.

CAMILLE M. BUONOCORE, M.D. Dr. Buonocore specializes in endocrinology. She earned her medical degree at State University of New York at Buffalo and completed her internship and residency in internal medicine, as well as a fellowship in endocrinology, at the University of Pittsburgh Medical Center. Dr. Buonocore is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Buonocore, please call 412.942.2140.

Volume X Issue 1 I HouseCall I 17

UNDERSTANDING DIABETES Continued from page 17

“

Diabetes is not devastating, you can live a full life.

”

JIM DEVATY, PATIENT

Jim Devaty, at home with son, Aiden.

18 I HouseCall I Volume X Issue 1

A Patient’s Story

Jim: The balancing act of managing diabetes.

Jim Devaty makes a killer strawberry rhubarb pie, he says. He is an

sentence. I knew I could manage it.” The toughest part of living with

entrepreneur and software engineer, now a stay-at-home Dad. For him,

diabetes, he says, is the regimentation. “Regimented eating is tough.

good food is a passion, and he shines in the kitchen. “I love food and I love

A few years in, I slacked a bit. But I got back on track and now I under-

to cook. I enjoy going to new restaurants and I love to try new recipes,

stand that it comes down to balance and portion control. I strive to keep

especially desserts.” The fact that he has Type 1 diabetes makes this a

my blood sugar levels really tight, because it’s actually easier when you

challenge, but Jim has applied his considerable resourcefulness and

keep it tightly controlled. My goal is to keep my A1C (blood sugar level)

creativity to the limits imposed by the condition: “I eat what I love, but

below 7 and so far I have had no complications.”

not like I once did. Pasta is not typically an entrée but a side dish; dessert is occasional, not daily. Dining out is tough because I don’t know what’s

Six years into diabetes, Jim chose to switch to an insulin pump with an integrated continuous glucose monitoring system (CGM), even though

in the food. If my blood sugar is up, it’s usually after eating out. So, we

he says it requires discipline. “With a pump you have greater flexibility

mostly eat at home, but we eat very well.”

and less regimentation, but you have to think about things more. It’s easy

Jim’s family includes husband Stephen Miller, a high school math

to be ‘bad’ and then give yourself a bolus (a dose of insulin). I’ve been on

teacher, and their son Aiden, 10. A native of the South Hills, Jim went

a pump now for 10 years. My continuous glucose monitor is amazing

to Upper St. Clair High School and then to Virginia Tech; he founded a

and I love it; the sensors are incredibly accurate.”

software engineering company with friends and lived in the D.C. area

Jim credits the strong support he has had from health care profes-

and southwestern Virginia for years. The couple returned to Pittsburgh to

sionals, especially Dr. Beier, for his success.“ Dr. Beier is great. She’s an

raise their son, and they now reside in Whitehall. Jim was always healthy,

osteopath and they have a slightly different approach. My sister referred

but the diagnosis of diabetes at 38 was not a complete surprise, because

me to her practice when we moved to Pittsburgh and I love the rapport

he has a sister who has had Type 1 diabetes for years. “I developed symptoms

I have with her. She’s incredibly caring and a top notch physician. I feel

of thirst and lethargy, and because I was familiar with diabetes, I quickly

that we have a partnership in my care.”

recognized what was happening,” he recalls. “Though I had a routine physical already scheduled with my primary care physician, I called the

Dr. Beier views Jim as a role model. “Jim is very inspirational. He has Type 1 diabetes, which is a challenging disease to live with, but

office and described my symptoms. They saw me the next morning.

he has found a way to have balance in his life. He is careful and

My glucose was 435. I was still producing insulin and it wasn’t that difficult

conscientious and has made lifestyle modifications to keep his blood

to manage. I started injecting insulin and saw a dietitian, and that helped

sugars under good control. Yet he still enjoys food and has found a

a lot; we got it under control pretty quickly. At first, I was incredibly strict

way to integrate healthy living into his daily life.”

with myself, even a bit Draconian. I wasn’t fat, but I needed to lose a few

With 16 years of experience as a Type 1 diabetic, Jim has hard-earned

pounds and I went overboard. I learned to moderate my diet and things

wisdom to share with newly diagnosed diabetics. “Don’t be concerned

finally stabilized. From this experience, I learned the importance of

that you can’t deal with this. You can. You’re going to be fine. You have to

balance. All diabetics have to find a balance: that is what allows you

pay attention to how you’re taking care of yourself and listen to your doctor.

to manage your diabetes.”

The key is to be good most of the time; you can’t splurge every day.

People with diabetes do have some control, says St. Clair Hospital

People want to control diabetes and you cannot; diabetes controls you.

endocrinologist Bridget K. Beier, D.O., who treats Jim. “It’s important

But diabetes is not devastating, you can live a full life.” As proof of that,

to understand diabetes as soon as possible after diagnosis,” she says.

Jim and his family recently spent 10 days vacationing in Hawaii. “You can

“That’s a critical time for diabetes education. It isn’t simple, but if you

splurge when you're on vacation. We dined out for every meal and I indulged

focus on a few things, you can manage it: learn to make meal plans;

in the delicious fruit of the islands, tropical drinks and some desserts.

do your cooking on the weekend; find an exercise that you enjoy and

My glucose levels were elevated and I used more insulin than I typically

make it part of your routine.”

do, but I kept my glucose levels in check. Now that I'm home I'm back

Jim says his attitude toward his diabetes is one of acceptance. “The first year after you are diagnosed, you have to settle in to the diagnosis and new lifestyle. I’d rather not have diabetes, but it was not a death

to my normal routine.”

And that routine includes the occasional new restaurant and a piece

of homemade strawberry rhubarb pie. n

Volume X Issue 1 I HouseCall I 19

UNDERSTANDING DIABETES Continued from page 19

Living with

DIABETES

Preventing complications with patient education

Pennsylvania has the dubious distinction of having one of the highest diabetes rates in the nation. According to the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA), Pennsylvania has 1,456,000 residents who are diagnosed with diabetes, which is nearly 13 percent of the adult population. Every year in the state, 71,000 people are diagnosed with the disease. In addition, 36 percent of adults in Pennsylvania have pre-diabetes and most are unaware of this.

I

n response to these trends, St. Clair Hospital has established a

Despite the strong evidence of its benefits, diabetes education is

comprehensive Diabetes Center to educate and counsel persons

underutilized, Cindy says. “The ADA reports that 56 percent of all persons

with diabetes and pre-diabetes. At the Diabetes Center, an expert

with diabetes have never had diabetes education; there are many more who

team of specially certified diabetes educators and registered dietitians,

had it decades ago, and have never gone back to update their knowledge.

in coordination with physicians, are thoroughly prepared to help anyone

People may underestimate the value of it, and some physicians do, too.

who is in need of diabetes education: the newly diagnosed, those who

Not all physicians make referrals or tell their patients with diabetes that

have a change in their condition, and those who have had diabetes

“

for a long time but are in need of a refresher course.

Family members are encouraged to participate.

WE WANT TO HELP YOU

Diabetes education at St. Clair is personal and comprehensive.

It consists of individual appointments and several classes that cover the basics of diabetes self-care and management:

LIVE A GOOD, LONG AND HEALTHY LIFE.

basic physiology, nutrition, blood glucose testing, insulin administration, medication management, exercise, weight management and the prevention of complications.

St. Clair Hospital’s Cindy Donovan, M.A., R.D.N., Certified Diabetes Educator, has been a diabetes educator for 25+ years. She says that ideally, a person newly diagnosed with diabetes should be given an immediate and automatic referral for classes. “Diabetes education should be regarded as essential.

Patients should be seen individually, followed by group classes at the beginning, and then an annual refresher to reinforce what they have learned and to bring them new information. In addition, the ADA recommends that education be provided when there is a change in treatment or the development of a complication. Studies have shown that those who come for education are more likely to take their medication as prescribed and to follow their doctor’s recommendations; they are more motivated. Diabetes education prevents costly and often catastrophic complications.”

20 I HouseCall I Volume X Issue 1

”

CINDY DONOVAN, M.A., R.D.N., CERTIFIED DIABETES EDUCATOR, ST. CLAIR HOSPITAL

the Diabetes Center is available to them. In addition, not all health

to accept the diagnosis and may not be receptive to education. If they

insurance policies cover it completely, although Medicare has an annual

are very distressed, we may make a referral for counseling and we will

benefit for diabetes which includes both medical nutrition therapy and

let the referring physician know.”

diabetes self-management education.”

Cindy believes that those with diabetes should take advantage of the

Antonio M. Riccelli, M.D., a primary care physician with St. Clair Medical Services, values diabetes education and refers all of his patients with

training as soon as possible after diagnosis. “We meet with clients one on

diabetes to the Diabetes Center at St. Clair as soon as they are diagnosed.

one for diabetes education and the appointments are approximately one

“Diabetes education should be the very first thing the patient does after

hour long. A lot of information all at once is overwhelming, so we break it

getting the diagnosis. Diabetes is hard to understand and many people are

up. We try to meet them wherever they are in their acceptance of the

overwhelmed by it. It’s a difficult disease to manage; to be successful, you

diagnosis; we assess what stage they are in, along with their willingness

have to understand the disease, the importance of taking your medications

to make lifestyle changes. We help them set goals and assist them to meet

and keeping follow up appointments. It’s critically important that the patients

the goals.” St. Clair Endocrinologist Monica A. Gomberg, M.D., concurs:

be educated in all aspects of diabetes and St. Clair does this very well.

“It’s important to get educated about diabetes as soon as possible. You need a lot of support, and you can get that from the Diabetes Center.

The diabetes educators do an excellent job. I find that I have better luck at getting patients to attend classes when they are first diagnosed. If patients don’t go at diagnosis when motivation is typically at its peak, they may not make time to attend classes later on and can miss out on this valuable opportunity for learning. Having a more thorough understanding of diabetes can only help patients later on, and hopefully they can take away tools to help them manage their diabetes later on.”

Cindy acknowledges that for some people, a little more time is needed. “When a person is diagnosed, they may need time to adjust and let the surge of emotions subside before they are ready for classes.

Shock, anger and denial are common reactions; some are not ready

Continued on page 22

STEPS FOR

BETTER LIVING WITH DIABETES 1 Eat healthfully 2 Be active 3 Monitor A1C 4 Take medication 5 Reduce risks

RESOURCES AT ST. CLAIR HOSPITAL FOR PEOPLE WITH DIABETES Individual Nutrition Counseling

Group Diabetes Education

Individual meetings with a registered dietitian for nutrition counseling to develop a personalized meal plan and learn about carb counting, portion control, weight management and other concerns.

An interactive learning experience that covers all the basics, including strategies for managing the daily challenges of diabetes.

Diabetes Wellness Group Individual Diabetes Self-Management Individual meetings with a certified diabetes educator to assess your learning needs or help you acquire a new skill, such as how to test your blood glucose or administer insulin.

Gestational Diabetes Education Individual appointments for women who develop diabetes during pregnancy, with a certified diabetes educator, to teach you healthful eating and managing your blood sugar.

A free class that is open to the public and does not require a physician referral. Various experts present topics related to diabetes care and management.

Additional Information Individual and group diabetes education sessions and nutrition counseling require a physician referral. Please ask your primary care physician or endocrinologist for a referral, or call the Diabetes Center for assistance.

The Diabetes Center at St. Clair Hospital is located at the Outpatient Center–Village Square in Bethel Park. Call 412.942.2151 to schedule an appointment for diabetes education or to ask about upcoming events. There are day and evening options.

Please note: Registration is required for all classes.

Volume X Issue 1 I HouseCall I 21

UNDERSTANDING DIABETES Continued from page 21

Living with

DIABETES

Dr. Riccelli notes a difference in his patients

Cindy envisions continued growth for the

who participate in diabetes education. “The

Diabetes Center as it meets the challenges

patients who go to the Diabetes Center tend to

of the growing population

have better A1C (sugar) levels and to be more

affected by diabetes.

compliant in seeing the ophthalmologist and

“At St. Clair, we are

other specialists. About half of my patients go

looking at new, more

Many patients think diabetes means no more

willingly; others need to be coaxed. Diabetes

consumer-friendly

sugar; they need the classes to learn the basics

demands a total team effort from patients and

models, including online resources and providing

Continued from page 21

of nutrition: what is a carbohydrate and how

all the medical experts involved, including the

does it become sugar in your body; what does

dietitian and diabetes educator, who are critical

classes in physicians’

a diabetic diet mean?”

to the process.”

offices. Doctors have

Continued on page 23

Diabetes Glossary A1C > A blood test that measures average blood sugar over the past

Diabetes education > The basics of diabetes self-care and

two-three months. It is different from the blood sugar checks that

management, including nutrition, blood glucose testing, medication

people with diabetes do every day. Most often it should be below

management, exercise and the prevention of complications; usually

5.7, but it may be different for some individuals.

taught by a specially certified dietitian or registered nurse.

Carbohydrate > A major class of food that includes starches,

Fasting blood sugar > A measure of blood glucose level taken

pasta, bread, potatoes, and sweets. Carbohydrates have the greatest

before one eats; measured in milligrams per deciliter (mg/dl).

effect on blood sugar, compared to protein and fat.

Gestational diabetes > A temporary form of diabetes that

Carb counting > A meal planning tool in which you keep track of

develops during pregnancy and may cause complications for the

the amount of carbohydrate grams in the food you eat. Carb counting

mother and baby.

can help people with diabetes manage their blood sugar levels.

Glycemic index > A measure of the rate at which ingested food

Continuous glucose monitor (CGM) > An FDA-approved device that provides and displays continuous information about your blood

causes the blood sugar to rise. Also refers to a ranking of foods according to the glycemic index.

sugar levels, 24/7. It tells you if your blood sugar is rising or falling,

Hyperglycemia > An excess of sugar in the blood, causing high

and how fast it is changing, so that you can better manage your

blood glucose levels.

blood sugar.

Diabetes > A chronic disease in which the body is unable to properly use and store glucose (sugar) so that it collects in the bloodstream and rises above a healthy, normal level.

Hypoglycemia > An abnormally low level of sugar in the blood.

Insulin > A hormone secreted normally by the beta cells of the pancreas that is essential for regulating glucose levels in the blood.

Insulin moves sugar from the blood into the cells to be converted

Diabetes Type 1 > A condition in which your pancreas stops

to energy. Without it, the blood sugar rises and diabetes results.

producing insulin, the hormone that your body needs every day

Insulin resistance > Reduced sensitivity to insulin that is

to take sugar from the food you eat and convert it to energy.

common in Type 2 diabetes.

Diabetes Type 2 > A condition in which the body does not

Pre-diabetes > An asymptomatic, abnormal state that precedes

make enough insulin or is unable to use insulin correctly. This is

the development of clinically evident diabetes. It means your blood

also known as insulin resistance. Type 2 is the most common

sugar is higher than normal but not high enough for a diagnosis

type of diabetes.

of diabetes.

22 I HouseCall I Volume X Issue 1

THE CDC PRE-DIABETES SCREENING TEST

tight schedules and little time to teach, but

COULD YOU HAVE PRE-DIABETES?

primary care physicians are most often the initial

Pre-diabetes means your blood glucose (sugar) is higher than normal, but not yet diabetes.

diagnosticians and they do most of the medical

Type 2 diabetes can be delayed or prevented in people with pre-diabetes through

effective lifestyle programs. Find out your risk for prediabetes.

TAKE THE FIRST STEP — KNOW YOUR SCORE!

For each “Yes” answer, add the number of points listed. All “No” answers are 0 points.

YES NO

management of diabetes. Education needs to become more geared to younger people, too, as the incidence of diabetes is skyrocketing among that group.”

With her extensive experience, Cindy has witnessed a sea change in diabetes care. “In the

1

0

Are you a woman who has had a baby weighing more than 9 lbs. at birth?

1

0

Do you have a sister or brother with diabetes?

1

0

Do you have a parent with diabetes?

to finger sticks as home glucose meters became

5

0

Do you weigh as much or more than listed for your height on the chart?

available in the 80s. Now we are moving past that

5

0

Are you younger than 65 and get little or no exercise in a typical day?

5

0

Are you between 45 and 64 years of age?

9

0

Are you 65 years of age or older?

AT RISK WEIGHT CHART WEIGHT (lbs)

HEIGHT

WEIGHT (lbs)

4’10”

129

5’8”

177

4’11”

133

5’9”

182

5’0”

138

5’10”

188

5’1”

143

5’11”

193

5’2”

147

6’0”

199

5’3”

152

6’1”

204

5’4”

157

6’2”

210

5’5”

162

6’3”

216

5’6”

167

6’4”

221

5’7”

172

were acting on old information. Then we progressed

with amazing advanced technology and new insulin and medication products. I‘ve learned so much from patients and I understand that many people feel trapped by diabetes, but some are more positive

IF YOUR SCORE IS 3 - 8 POINTS

HEIGHT

old days, we tested urine for glucose levels, but we

This means your risk is probably low for having pre-diabetes now. Keep your risk low. If you’re overweight, lose weight.

Be active most days, and don’t use tobacco. Eat low-fat meals with fruits, vegetables, and whole-grain foods. If you have high cholesterol or high blood pressure, talk to your health care provider about your risk for Type 2 diabetes.

IF YOUR SCORE IS 9 OR MORE

This means your risk is high for having pre-diabetes now. Please make an appointment with your health care provider soon.

and eventually see it as an opportunity because it can lead them toward a healthier lifestyle.

“We want to make sure that people throughout the community know that we are here and our diabetes education programs have great value.

Diabetes education is one of the most significant factors in how well you manage your disease and avoid complications. Your primary care physician can refer you to the St. Clair Diabetes Center, but you might have to ask for it. We’re here, close to home, and we want to help you live a good, long and healthy life.” n

Source: www.cdc.gov/diabetes

“

IT’S IMPORTANT TO GET EDUCATED. . .

YOU NEED A LOT OF SUPPORT, AND YOU CAN GET THAT FROM THE DIABETES CENTER. MONICA A. GOMBERG, M.D., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL

”

MONICA A. GOMBERG, M.D. Dr. Gomberg specializes in endocrinology. She earned her medical degree at Chicago Medical School and completed her internship at UPMC Medical Education-Internal Medicine Program and a fellowship at UPMC Medical Education Program in Endocrinology. She is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Gomberg, please call 412.942.2140.

Volume X Issue 1 I HouseCall I 23

ASK THE DOCTOR

Ask the Doctor EDWARD J. RUANE, JR., M.D.

Q A

What’s the difference between types of dermal fillers?

Is there one that would last longer or work better for me?

As we age, our faces naturally lose the fat just below the

None of these hyaluronic acid-based fillers are

skin; smile lines, worry lines and creases appear and the

permanent though, and how long they last relates to

skin stretches a bit, adding to a loss of facial volume.

the thickness of the filler used. Most last in the range

Dermal fillers play an important role in helping to

of 6 months to 12 months, but some are reported to

diminish these and other signs of aging. In addition to

offer results up to 18 months.

Botox, injectable dermal fillers can help to reduce fine

If you’re looking for a more permanent filler, the

lines and wrinkles and restore volume and fullness to the

perfect choice might be fat injections, using your own

face. They can add volume to thin lips or hollow cheeks;

fat. After determining a "donor area," such as your

they can enhance shallow contours, soften creases, and

thighs or abdomen, fat is extracted by liposuction.

improve the appearance of scars. Dermal fillers produce

The suctioned fat is then transferred to the face as a

natural results and have minimal risks and side effects.

graft. About 50 percent to 60 percent of what’s

The majority of fillers are made up of hyaluronic acid,

injected will survive, but the surviving fat will last

a natural substance found in your own body. Hyaluronic

forever. Dermal filler injections can be performed in

acid is found in high concentrations in your skin and connective soft tissues.

the office; however, fat grafting requires a minor surgical procedure.

Dermal fillers vary mostly in terms of their

Despite all of the options above, if you begin to

viscosity, or thickness. The main consideration

have lower facial jowling or sagging neck skin, then

when choosing the filler that’s right for you is

it might be time to stop fillers and Botox and consider

your own goal for treatment. If you desire fuller

a surgical facial rejuvenation procedure. When

lips, then a thinner filler that will still keep your

considering facial rejuvenation, it is essential to have

lips soft and supple would be recommended. If,

a partnership with a plastic surgeon who understands

however, your goal is restoring volume to your

facial anatomy and the science of facial aging, and is an

cheeks, then a thicker, firmer filler should be used.

expert in facial surgery. This surgeon can best determine

And if the goal is treating smile lines on your face, then the right product might be something in

whether a noninvasive or invasive procedure will be

required to achieve your desired results. n

between. Your surgeon will determine the best option for you.

Edward J. Ruane, Jr., M.D.

EDWARD J. RUANE, JR., M.D. Dr. Ruane specializes in all aspects of plastic surgery, ranging from reconstructive to cosmetic.

He earned his medical degree at Duke University School of Medicine and completed a residency in Plastic Surgery at the University of Pittsburgh Medical Center, where he served as Administrative Chief Resident in the Department of Plastic Surgery. Along with Dr. Robert W. Bragdon, Dr. Ruane practices with St. Clair Plastic Surgery Associates, a division of St. Clair Medical Services.

To contact Dr. Ruane, please call 412.572.6164.

24 I HouseCall I Volume X Issue 1

Frank A. Civitarese, D.O.

GOOD FOR US. BETTER FOR YOU. St. Clair Hospital has once again been recognized as one of the nation’s 100 Top Hospitals®. This marks the third time St. Clair has achieved this prestigious honor since 2012. It affirms St. Clair’s commitment to exceptional patient safety, clinical outcomes, patient satisfaction, and value. St. Clair is proud of the excellent care we provide our patients. We salute our outstanding physicians, employees, and volunteers for this notable achievement. To learn more about our award-winning care, please visit stclair.org.

100 Top Hospitals© is a registered trademark of IBM Watson Health™

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Volume X Issue 1 I HouseCall I 25

SUMMER SWING

ST. C L A I R H O S P I TA L 2 1 ST A N N UA L

More than 600 guests were transported to “A Night In

Old Havana” at St. Clair Hospital’s 21st Annual Summer Swing, conducted Friday, July 20 at St. Clair Country Club. Guests of

Summer Swing enjoyed the sights, sounds and tastes inspired by

Havana’s vibrant culture, including a Latin band, salsa dancers, conga drums, vintage cars, hand-rolled cigar demonstrations, plates of tamales, empanadas, jerk shrimp, Cuban Ropa Vieja

Sliders, and much, much more. Two days later, Summer Swing’s always popular golf outing attracted 124 golfers to the club’s championship course.

A special thank you to guests and sponsors who helped us raise

more than $320,000 for the Hospital’s growth and expansion,

including the construction of a six-story, comprehensive outpatient

center adjacent to the Hospital. n

THANK YOU TO OUR EVENT COMMITTEE Beth Evron, Co-Chair & Wayne Evron, M.D.

Tricia Hammel, Co-Chair & Bob Hammel

Katherine Biggs & Jason Biggs, M.D.

Laina & Brian Hammel

Bunny Bragdon & Bob Bragdon, M.D. Susan Bradley Brown & Steven Williams Katie & Dan Caste Nicolette E. Chiesa, M.D., FACP Wendy & Steve Denenberg Beth Erlanger & Daniel Erlanger, D.O. Nina Fatigati, M.D. & Christopher Pray, M.D. Tara Grahovac, M.D. & Erik Grahovac Wayne Evron, M.D. and Beth Evron with Tricia and Bob Hammel, Event Co-Chairs

26 I HouseCall I Volume X Issue 1

Veronica & Louis A. Guarino, Jr. Emily & Michael Hammel

Tara & Rob Hammel Vicki & Mark McKenna Julie Perricelli & Brett Perricelli, M.D. Carla Capozzi Riccelli, D.M.D. & Antonio Riccelli, M.D. Megan Shilling Suzy & Rich Sieber Marilynn Shogry & Robert N. Shogry, M.D. Gail & Andy Vater JoEllen Yeasted & G. Alan Yeasted, M.D. Michelle & Ron Yost Anne & Sam Zacharias

Angela & Ben Karcz, Gallagher Home Health, Presenting Sponsor

Jack, Renee & Lucas Piatt, Millcraft, Bronze Sponsor

Joseph Aracri, D.O. and Katherine Aracri

Vincent Reyes, M.D. and Kathleen Reyes

John Gibbons, M.D., & Simona Pautler, M.D., Partner Sponsor

St. Clair Hospital Breast Care Center Staff and Guests: Heidi Buzzelli, Tara Grahovac, M.D., Trevor Scott, Kelly Barry, Raye Budway, M.D., Chelsea Rodino

Veronica & Louis A. Guarino, Jr., Louis Anthony Jewelers, Bronze Sponsor

Dan and Katie Caste, Event Committee Members

Volume X Issue 1 I HouseCall I 27

1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org

General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400

THE IN HOSPITAL PATIENT

SAFETY

The Leapfrog Group, a national, independent, patient-safety watchdog, awarded St. Clair special recognition for the twelfth consecutive period, making St. Clair the region’s only hospital to consistently earn an ‘A’ grade for patient safety for six years running. The grades rate how well hospitals protect patients from preventable medical errors, injuries and infections. To learn more about our Hospital Safety Score, or St. Clair Hospital’s performance as a national leader in quality and patient satisfaction, please visit stclair.org.

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is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.

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