Diabetes: Evaluation and Management

Continuing Blood Glucose Monitoring and Interpretation of Blood Sugar Trends

The Continuous Glucose Monitoring System (CGMS) can provide our patients with a better analysis of their blood sugar levels throughout the day and can reveal hidden patterns, such as frequent episodes of hypoglycemia (low blood sugar). The sensor system provides an average blood sugar measurement every five minutes, for up to three days. Our diabetes care management team will go over the data with each patient, providing them with valuable information and a more complete glucose profile.

Diabetes Screening and Prevention

The American Diabetes Association recommends diabetes testing for people who: are 40 years of age and older; are overweight; have diabetes in their family; are members of a high risk ethnic group (Native American, Hispanic, African American, Asian); had gestational diabetes mellitus or a baby weighing more than 9 pounds at birth; have high blood pressure; have abnormal blood fat (cholesterol, triglyceride); have a history of abnormal glucose tests; and/or have impaired glucose tolerance or fasting glucose (previously called borderline diabetes). For these at-risk individuals, early detection is key and with proper nutrition and exercise, prevention may even be achieved. Our endocrinologists are available to screen patients for diabetes and heart disease risk and to utilize the latest therapies for the prevention of these conditions.

Downloading and Analysis of Blood Glucose Meters

Our diabetes care management team helps patients download blood sugar records from the Internet and provides careful analysis of blood glucose trends. Analysis of blood glucose levels allows patients to work with the diabetes team to fine-tune their medication, diet, and exercise routines to achieve optimal glucose control.

Individual Diabetes Self-Management Education

Individual diabetes self-management involves education on the use of meters, oral medications, insulin, and other tools for treating diabetes. The USC Center for Diabetes and Metabolic Diseases offers individual self-management training to help patients self-manage their diabetes. Training occurs one-on-one with certified diabetes educators with extensive experience in diabetes self-management.

Insulin Pump Therapy Initiation and Follow-up

Working closely with our diabetes care team, patients can use insulin pumps to help keep their blood glucose levels within target ranges. Our diabetes care team assists patients with the initiation of pump therapy and follows-up frequently to ensure that the patient understands insulin pump therapy and blood sugar management.

Intensive Insulin Therapy

Studies have shown that three or four injections of insulin per day or use of an insulin infusion pump can improve glucose control and prevent or delay diabetes-induced eye, kidney, and nerve damage. The USC diabetes care team can help patients manage their insulin therapy for optimal blood glucose control.

Medical Nutrition Therapy, Weight Loss Program, and Exercise Therapy

Medical nutrition therapy, a weight loss program, and exercise therapy are integral components of diabetes management. These programs are individually developed based on each patient’s health and lifestyle. USC nutritionists and diabetes educators can help patients design a customized lifestyle plan tailored to fit their individual needs.

Pre-pregnancy Management, Management of Gestational Diabetes, and Diabetes-complicated Pregnancy

For women with diabetes, a successful pregnancy requires pre-conception counseling and optimal diabetic control before, during, and after pregnancy. Our diabetes team is available to closely manage these cases. Gestational diabetes mellitus (GDM) is most commonly diagnosed around the 24th – 28th week of gestation and can be treated with nutrition therapy alone or with the addition of insulin. Women with a history of gestational diabetes are also at risk for developing type 2 diabetes and should be tested periodically after delivery. Good control of diabetes at conception and throughout pregnancy is important for optimal maternal and neonatal outcome. Our endocrinologists, diabetes team, and staff have helped hundreds of women with gestational diabetes deliver healthy babies. Our endocrinology educators and nutritionists are especially sensitive to the needs of pregnant women and can offer postpartum support.

Support Groups

The USC Center for Diabetes offers diabetes support groups for adults on intensive insulin management (individuals taking three or more insulin shots or on pump therapy) the second Thursday of every month at 7:00 p.m. Adults with type 2 diabetes meet the fourth Thursday of every month at 6:30 p.m. Meetings are held at Keck Hospital of USC. These support groups are offered as a community service and participation is free. Our “Healthy Living with Diabetes” symposium is also offered to individuals with diabetes and their families. Discussion topics at this informative and motivational seminar include current developments in diabetes treatment and research. For more information on our support groups and symposiums, please call (323) 442-5100.

Treatment of Hypertension and Abnormal Cholesterol Levels

For patients with diabetes, managing blood pressure and cholesterol levels is just as important as lowering blood sugar levels. To control blood pressure and cholesterol, USC endocrinologists design therapies that maximize benefit for diabetes patients and complement the many medications required to treat this complex disease state.

Treatment of Pre-diabetes

Before developing type 2 diabetes, most patients have “pre-diabetes” – blood glucose levels that are higher than normal, but not high enough to merit a diagnosis of diabetes. Research has shown that in this pre-diabetes stage, some long-term damage may already be occurring to the body. Research has also indicated that if blood glucose levels are managed during pre-diabetes, patients can delay or even prevent the onset of type 2 diabetes.

Thyroid Disease: Evaluation and Management

Disorders of the Thyroid

• Assessment and Management of Hyperthyroidism
• Evaluation and Treatment of Hypothyroidism
• Diagnosis of Thyroiditis, Goiters, Thyroid Nodules and Thyroid Cancer
• Fine Needle Aspiration of the Thyroid

Pre-pregnancy Management, and Management of Pregnancies Complicated by Thyroid Diseases

It is not uncommon to encounter thyroid disease in pregnancy. In fact, thyroid disorders are the second most common endocrine disease complicating pregnancy after diabetes mellitus. Overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function is more common in women and can occur during pregnancy, after pregnancy (post-partum thyroiditis), or may be the cause of infertility. Preconception counseling, good control of thyroid function at the time of conception and throughout pregnancy is important for optimal maternal and neonatal outcome.

Endocrine Disorders

Disorders of the Adrenal and Pituitary Glands

• Cushings Disease and Hypercortisolism
• Hypo and Hyperaldosteronism
• Pituitary Tumors (Micro and Macoradenomas, Acromegaly)
• Disorders of Bone and Mineral Metabolism
• Osteopenia and Osteoporosis
• Hypo and Hyperparathyroidism
• Measurement of Bone Density (Dexiscan)

Full Hormonal Testing

USC endocrinologists can perform a complete endocrinologic workup to determine a patient’s proper hormonal balance. If hormones are not stable, recommendations for restoring hormonal balance can be made. Our endocrinologists also perform fine needle aspiration biopsies.

Resources

• American Association of Diabetes Educators
• American Diabetes Association
• Academy of Nutrition and Dietetics
• Children with Diabetes
• Juvenile Diabetes Research Foundation
• Take Control of Your Diabetes
• American Association of Endocrinologists
• American Thyroid Association
• Hormone Foundation
• National Osteoporosis Foundation
• Pituitary Network Association
• Thyroid Foundation of America