Dr. Hien Tran speaks about pre-diabetes.

Our very own, Dr. Hien Tran, spoke to @SilverSneakers about what it means to have pre-diabetes. “Once you have prediabetes, the chances of progressing to diabetes are quite high, and it also raises your risk of developing heart disease, stroke, and kidney disease,” says Hien Tran, M.D. “So lifestyle changes that address your prediabetes are crucial for overall health.” At Texas Diabetes, our goal is to help people gain better control over their health, so contact us if you have any questions about prediabetes.

Read the entire article here:https://www.silversneakers.com/blog/your-doc-says-you-have-prediabetes-now-what/

Insulin infusion technology

The pace of diabetes innovation has sped up tremendously over the past two decades. While there is still no cure, there are a plethora of new medications, therapies, tools and technologies that make living with diabetes more manageable and easier. Let’s take a look back at how far we have come.

Portable subcutaneous continuous insulin infusion (CSII) pumps  made their first appearance in the early 1970s. Research studies in early 2000s supported the change in guidelines by demonstrating that switching from multiple daily injections to CSII pump therapy could make a significant impact on the HbA1c by 0.25%-0.75% reduction after 1 year of pump therapy. It also improves fasting blood glucose, episodes of hypoglycemia, and blood glucose variability.

 Current players in the market include, Insulet OmniPod, Medtronic MiniMed, Roche, and Tandem t:slim. It was Medtronic in 2013 that changed the playing field by launching the first FDA-Approved Artificial Pancreas Device System with Hypoglycemia Threshold Suspend Automation. This was the first time patients with diabetes were able to have their fears of hypoglycemia reduced. This system automatically shut the pump off if a patient’s blood sugar was dropping too low and would resume activity once the sugar was trending back up.

In 2015 Tandem t:slim, paired with the Dexcom G4, offered a predictive low suspend feature with a touch screen.

In 2017, Medtronic launched the World’s First Hybrid Closed Loop System for Type 1 Diabetes called Minimed 670G. This new system was a step towards the “artificial pancreas”. This pump predictively adjusted insulin doses to address  both lows and highs.

Not to be left behind, Tandem released in  2020 the Tandem t:slim X2 Hybrid Closed Loop system with integration of Dexcom’s latest CGM model called G6.

These hybrid closed loop systems provide patients more flexibility, less worry, and more time in range. It is estimated that only 20-30% of type 1 diabetes patients and <1% of type 2 diabetes patients currently use insulin pumps. The often mentioned disadvantages  of using an insulin pump  include cost, body image, and some find them to be burdensome.

Glucose testing technology

Glucose testing has come a long way since using urine glucose testing in 1908, to the first blood glucose strip in 1965, and the first glucometer in the 1970s. It wasn’t until the National Institute of Health conducted a trial in the 1980s to confirm the need to monitor and control diabetes.


By Dr. Tira Chaicha-Brom

Osteoporosis is a condition of weak bones and carries a high fracture risk and in turn increased mortality. Unfortunately, this condition typically goes undiagnosed because it is typically asymptomatic, unless someone was to have a fracture. 10.2 million Americans have osteoporosis and 43.4 million have the precursor osteopenia. Often, people will assume that having a “hunchback” is a sign of osteoporosis, but that is not always the case. If someone were to have lost some height, this could indicate a vertebral fracture which would be diagnostic for osteoporosis.  Sometimes people will assume that because they are old and have hip or back pain, that they have osteoporosis. However, osteoporosis does not hurt and the pain that patients complain about is more likely related to arthritis which is due to joint pain. Osteoporosis typically affects women more than men due to menopause but it is often underdiagnosed in men since they are not usually screened for the disease.

How is osteoporosis diagnosed if it is asymptomatic?  We typically order a bone density. A bone mineral density (BMD) is a painless procedure where one is laying on his/her back and x-rays are taken of the spine and hip and sometimes, the wrist.  A BMD can help predict the risk of fractures but it is not used to diagnose fractures, which would require a different imaging study such as a plain film X-rays.  For post- menopausal women and men above the age of 70 a T-score of -2.5 or lower on a BMD is diagnostic for osteoporosis.  Interestingly, though, most fractures occur in the osteopenia range since more patients will be in this category.  Another way a patient could be diagnosed with osteoporosis is to have an osteoporotic, or fragility, fracture. This type of fracture occurs from a fall from a standing position and results in a fracture of a large bone such as the hip, spine, or arm and often excludes fractures of the feet or fingers.

Our bones are the strongest when we are in our 30s and after that we start to lose bone density.  Some people will lose bone density at a faster rate than others due to changes in sex hormones (estrogen and testosterone) among other factors such as weight, medications (especially long term steroid use), or smoking. Other risk factors for bone loss include being thin, diabetes, inflammatory bowel disease, and a family history of osteoporosis.  If you are diagnosed with osteoporosis, typically your doctor or endocrinologist will evaluate your blood or urine to look for causes to explain the bone loss, but oftentimes there are no underlying reasons.

The United States Task Force recommends starting to screen women at the age of 65 years old for osteoporosis with a bone density. Even though they do not recommend screening for men, the National Osteoporosis Foundation recommends for men to be screened starting at years old.  Patients with certain risk factors may be screened before these ages.

There are several treatments available for osteoporosis which are offered based on a patients risk for fracture.  Typically, if a patient is of high risk for fracture then oral medications can be used but for those who are very high risk, it oftentimes requires medications that are injected. Most of the options will help prevent further loss of bone (bisphosphonates and denosumab). One class of medications will help develop new bone (PTH analogs) and another class can do both – increase bone and also stop it from declining (romosumab).  Each of these medications has its own side effect profile and your doctor can help you determine which treatment is appropriate for you. 

            Oftentimes, patients will be scared to start a medication due to the potential side effects. One of the more commonly prescribed medications for osteoporosis is the bisphosphonates (e.g. Fosamax/alendronate, Boniva/ibandronate, Actonel/risedronate). This class of medication has been around since 1990 and is very effective.  The two main side effects are osteonecrosis of the jaw (ONJ) and atypical femur fractures (AFF).  ONJ refers to exposed jaw bone that does not heal within 8 weeks.  AFF is a mid-thigh fracture after low or no trauma.  Both of these side effects are very rare and can be seen in <0.01% of patients.  Typically the bisphosphonates are used for 3-5 years before considering stopping the medication. The time limit on these medications is in order to prevent these side effects from happening. If the BMD shows it is improving after a certain amount time on the medication, then the medication may be held for 1-2 years (drug holiday) and if the BMD declines again, then the medication can be resumed.

            Some patients wonder if osteoporosis can be prevented. Weight bearing exercise and an adequate intake of calcium and vit D can help, but these may not be enough.  The recommended amount of calcium is 1200mg daily, in combination of diet and supplements, for all adults over the age of 50, as per American Association of Clinical Endocrinology (AACE 2020) guidelines.  The recommended vit D for adults over 50yo is 1000-4000 I.U. daily.  There are currently no guidelines for recommending vit K although many supplements on the market already sell vit D with vit K.  Limiting caffeine and alcohol consumption and smoking cessation can also prevent further bone loss.  There are no over the counter treatments that have been shown to be adequate to treat osteoporosis.

            Another very important factor that is often overlooked is to consider fall risks.  As we age, our eye sight, hearing, and proprioception may not be as good as they were when we were younger so we are more likely to fall. We need to look around the house and consider rugs, poor lighting, pets, and certain shoes as trip/fall hazards.

Osteoporosis is a very serious condition that is associated with a high fracture and mortality risk. It affects men, women, and every ethnicity/race and advancing age is a risk factor. A BMD is a simple tool that can be used to screen for this disease and very effective treatment options are available to prevent fractures.  

Thyroid Conditions

Thyroid.  For many of us, the word conjures up a sense of curiosity, wonderment, even awe!  What is the thyroid gland and what exactly does it do?  How do you know if you’ve got a thyroid problem? 

Let’s start with the basics. The thyroid gland is a small, butterfly shaped gland that sits in the base of your neck.  It makes thyroid hormones (thyroxine and triiodothyronine) which regulate your metabolism.  Metabolism is a series of processes that control how your body creates and uses energy.  So…why do we hear so much about thyroid and thyroid dysfunction?  Well, it turns out that there are some pretty common illnesses that can affect thyroid health.   

A thyroid hormone deficiency is a state called HYPOTHYROIDISM.  You may have this if your thyroid gland is the target of an autoimmune attack (this is called Hashimoto’s disease) or if you’ve had your thyroid gland irradiated or surgically removed.  Since thyroid hormone is your source of metabolism, untreated hypothyroidism can cause a multitude of symptoms: fatigue, lethargy, weight gain, dry skin, depression,  constipation, hair loss, cold intolerance, irregular menstrual cycles in women-these are all symptoms of slowed metabolism. The solution is simple-take thyroid hormone replacement which comes as an oral supplement.

A thyroid hormone excess is a state called HYPERTHYROIDISM. You may have this if your gland is the target of an autoimmune attack (this is called Graves disease) or if you thyroid gland grows renegade chunks of thyroid tissue that lose the ability to regulate the amount of thyroid hormone they produce.  These so called “hot nodules” manufacture extra thyroid hormone without your body’s permission.  Finally, you can develop hyperthyroidism if your thyroid gland becomes acutely injured – an injured thyroid gland sheds pre-formed thyroid hormone.   This is called a thyroiditis. Medications, autoimmune attacks, viruses and pregnancy can cause thyroiditis.   Hyperthyroidism can also cause of multitude of symptoms: rapid heart rate, weight loss, tremors, palpitations, frequent and loose stools, anxiety, irregular menstrual cycles in women-these are all symptoms of accelerated metabolism.  The solution is not quite as straightforward as it is for a hypothyroid state but a hyperthyroid state can certainly be treated. Depending on the underlying cause, a hyperthyroid state can be treated with surgery (removal of the thyroid gland), medications, or irradiation. In some cases of thyroiditis, the thyroid gland heals on its own.

The thyroid gland is also prone to structural illnesses. Thyroid glands often grow NODULES – a thyroid nodule is an abnormal growth of thyroid cells that forms a lump within the thyroid gland.  While the  vast majority of nodules (probably more than 95%) are benign, some nodules do contain cancers within them so timely evaluation is important.  Thyroid ultrasound is an important tool used to assess nodule size and characteristics.  If necessary, a thyroid fine needle aspiration biopsy can be done to assess the potential for malignancy.  This is a relatively easy and straightforward procedure that can done in the physician’s office with the aid of an ultrasound machine.

Finally…a word about thyroid hormone replacement.  Oral thyroid hormone supplementation comes in various forms:

One synthetic version of thyroid hormone is called Levothyroxine-this is synthetic thyroxine also known as T4. There are several branded versions of Levothyroxine: Synthroid, Levoxyl, Unithroid, Tirosint are some common ones.  Generally speaking, branded levothyroxine preparations are usually consistent in terms of potency from batch to batch. Generic formulations may not be as consistent so your provider may specify a branded version.

Another synthetic version of thyroid hormone is called Liothyronine.  This is synthetic triiodothyronine also known as T3. The most common branded version of Liothyronine is called Cytomel.  Liothyronine is absorbed in a more rapid fashion and some patients report an increased sense of well-being when it is used in combination with Levothyroxine.  Although the guidelines published by the ATA (American Thyroid Association) conclude that Levothyroxine should remain the standard of treatment for hypothyroidism, many physicians do prescribe combination therapy with Levothyroxine and Liothyronine in patients who may not feel as well on Levothyroxine monotherapy.

The nonsynthetic version of thyroid hormone is dessicated animal thyroid extract.  This is exactly what it sounds like-it’s thyroid hormone extracted from the thyroid glands of animals-most commonly, pigs. Animal thyroid extracts were first used to treat hypothyroidism in the late 19th century but became largely replaced by synthetic versions.  One concern: animal thyroid extracts have more T3 in relation to T4 compared to the ratio produced by a healthy human gland.  T3 may place a more potent metabolic demand on the heart and in some individuals can precipitate dangerous heart rhythms. For this reason, your provider may be reluctant to prescribe this type of thyroid hormone if you are older and/or have an underlying heart condition.

In addition to thyroid health, there are numerous factors that contribute to a person’s physical and mental sense of well-being, or lack thereof.  Among these factors: diet and sleep patterns, coexisting disease states, relationships with other human beings, the quality of the surrounding environment, the ability to navigate stress, etc…. When we feel unwell, we are best served to step back and take a look at the big picture.  Because while the thyroid gland is indeed a powerful factory of thyroid hormone production and thyroid hormone itself is an incredibly capable hormone, the thyroid is only one small part of a much more complex and sophisticated piece of machinery we call the human body. 

If you have been thinking of having your thyroid levels checked out the endocrinologists at Texas Diabetes can help walk you through the process. When you trust Texas Diabetes & Endocrinology with your thyroid condition, you are assigned your own, personal team of carers who will get to know you and tailor a treatment plan that fits your individual needs.

Schedule your appointment with us today.

NextStepMD with Muscle Wise

At Texas Diabetes & Endocrinology, the doctors, advanced practice providers and staff are committed to helping our patients lose weight, maintain weight loss and gain better control of their health. Obesity and carrying excess weight are increasingly common, which can lead to high blood pressure, elevated cholesterol and diabetes as well as other health conditions. People with and without diabetes struggle to lose weight and may have to take multiple medications for medical problems related to the excess weight. Take the Next Step with Texas Diabetes & Endocrinology!

If you have struggled with weight maintenance for a long time, or if you haven’t been able to lose weight through personal efforts, lifestyle changes, or through a structured weight loss program, our new offering is for you!

The NextStep program incorporates weekly visits with one of our experienced coaches into a medically managed program where monthly meetings with one of our healthcare providers supplements the program through the use of expert advice, guidance, and –if indicated- medications.

We have evaluated and tested a number of different weight loss solutions and work closely with our patients to recommend the methods that offer the greatest opportunities for success. We focus not only on weight loss, but work with our patients to maintain that weight loss long-term. People with diabetes frequently can reduce their blood-sugar-lowering medication, including insulin, by losing weight.

Our programs are medically supervised for our patients with diabetes, but are also open to people who have pre-diabetes or don’t have diabetes at all. As your health and wellness coaches, we offer one-on-one sessions. Our goal is to educate, motivate and support you through your weight loss journey. Our programs are medically designed with two components – sensible weight loss and sustainable, stable weight maintenance. Our weight loss strategies include the use of nutrition education, diet and exercise plans as well as FDA-approved weight loss medications if necessary.

One of the exclusive weight loss methods that we work with is Muscle Wise. The Muscle Wise protocol offers structured weight loss while supporting muscle mass and understanding of how food affects and is utilized by the body, including what causes fat storage, utilization of stored fat for energy, improved energy, appetite control and reduced cravings. It is proven that losing weight can improve blood sugar, cholesterol levels and reduce blood pressure. While following the Muscle Wise protocol, your pancreas will get a well-deserved break by limiting simple and complex carbs until your weight loss goal is achieved. The emphasis here again is weight maintenance once a healthy balance is achieved.

MuscleWise is differentiated from other similar programs by the ability to maintain an exercise regimen, the ability to maintain greater flexibility and much more.

Through the one-on-one coaching sessions, we will help you navigate the world of contradictory nutrition advice. We will help you determine what changes are necessary while on the Muscle Wise program in order to establish new eating habits and form long term success. Each coach brings vast nutrition knowledge and experience to the table ensuring you are receiving the best support a

New Private Pay Policy

To Our Patients: 

We have implemented a policy requiring a credit card on file for all Self-Pay (Private Pay) patients. Effective July 15, 2020, we now kindly require a credit card to be on file with our office so that your payment can be automatically drafted the day of or after your appointment. If you decline to place a credit card on file, you may pre-pay your visit in full prior to the appointment date. Please call our billing office to receive your estimate for services at (512)458-8400, option 6.

When do I give you my credit card?
We prefer that you enter your credit card information while confirming/pre-registering for your appointment through our secure platform, Phreesia. Please pay close attention to your appointment reminders sent via text & email to complete pre-registration.You can also deliver your credit card information over the phone, by mail, or in person, but the most secure way is online during pre-registration. 

But wait, I’m nervous about leaving you my credit card information. 
Phreesia’s secure PCI-DSS compliant system never stores sensitive credit card information in our office system or Phreesia’s, it is stored with the merchant. 

What is PCI-DSS compliant?
Payment Card Industry (PCI) Security Standards Council offers robust and comprehensive standards to enhance payment card data security and reduce exposure to credit card fraud. PCI Data Security Standard (DSS) provides an actionable framework for developing a robust payment card data security process, including prevention, detection, and appropriate reaction to security incidents. 

How will I know how much you are going to charge me?
Upon storing your credit card information in Phreesia, you will sign the card-on-file policy, including the maximum amount we can charge to your card. You will never be charged more than the agreed-upon maximum amount. On the day of or after your appointment, your card will be automatically drafted for the amount due and a receipt will be emailed to you. 

What if I have more questions?
Our staff is happy to speak with you about your account at any time. Please call our billing department at (512)458-8400, option 6. 

Texas Diabetes & Endocrinology, P.A. 

Update on Diabetes and Covid-19 Studies show the impact of diabetes control on Covid 19 outcomes

Two studies, one from China and one from England, offer similar messages to people with diabetes.

The first study, from Hubei Province, China, evaluated nearly 1000 patients with Covid 19 and pre-existing diabetes (published in Cell Metabolism). The patients who were better controlled upon entry to the hospital (average A1c 7.3%) had a significantly higher survival rate than those who had an average A1c of 8.1%.

The second study, from England, noted that one in four people who have died of Covid 19 also had diabetes. Weight and higher A1c correlated to a higher death rate.

Overall, the data shows that people who go to the hospital for Coronavirus and also have poorly managed diabetes, have a higher risk of dying.

What does this mean for people with diabetes?

First, there is no evidence that people with diabetes have a higher risk of contracting Coronavirus, and most people with the infection will not need hospital care at all.

Secondly, the best approach to reducing the risk of complications due to Coronavirus is to manage diabetes carefully and keep blood sugars controlled.

Prevention of Coronavirus by wearing masks and social distancing is the best approach for everyone.

If you have diabetes, be sure to monitor your blood sugars and keep all medical appointments. If your blood sugars are not well controlled, please seek medical care. Our endocrinologists and mid-level practitioners are here to help.

This update is brought to you by the doctors and mid levels at Texas Diabetes and Endocrinology, where helping you be successful in managing your diabetes is our priority.

Austin TypeOneNation Summit

Dr. Tira Chaicha-Brom, MD ECNU, of Texas Diabetes and Endocrinology, has joined a panel of experts who will be discussing Type 1 diabetes (T1D) and pregnancy at the upcoming Austin TypeOneNation Summit on Sunday, March 1, 2020.  

This educational conference is a great opportunity for those living with T1D, parents, caregivers, siblings and anyone interested in learning more about T1D. Topics include advancements in the treatment of T1D,  T1D and pregnancy and will showcase learning tracks for children and teens as well. Please join Dr. Chaicha-Brom at this important event.

Learn more and register today at bit.ly/TON2020


When a diagnosis of Diabetes is given it can be scary and overwhelming for most people. At Texas Diabetes and Endocrinology we are here to help you navigate a path to achieving a healthier life. We will work alongside you and your family members to gain a better understanding of both the disease as well as the treatment options.

  • In the last 20 years, the number of people diagnosed with diabetes has doubled
  • Diabetes is the 7th leading cause of death in the US
  • Diabetes is the #1 cause of kidney failure, lower-limb amputations as well as adult blindness
  • There are many types of diabetes: Type 1, Type 2, gestational diabetes and prediabetes

Risk Factors For Diabetes:

  • For Type 2 Diabetes:
    • if you have a parent or sibling with diabetes,
    • are overweight,
    • > 45 y.o,
    • history of gestational diabetes,
    • history of prediabetes,
    • and African Americans and Latinos are at a higher risk
  • For Type 1 Diabetes:
    • family history with a parent or sibling with Type 1 diabetes

What is the difference between Type 1 and Type 2 Diabetes?

Type 1 diabetes is an autoimmune disease where the pancreas is not functioning and treatment requires insulin. Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance. The risk of type 2 diabetes is both a combination of lifestyle and genetic factors. Studies show that type 2 diabetes can be delayed or prevented with exercise and weight loss.

Treatment options:

There are many treatment options available and each person needs a plan specific to them and their needs. There are multiple options with oral medication, non-insulin injectables, as well as insulin and lifestyle modification to aid in treatment. Treatment options also include a variety of insulin pumps and we can help you in deciding the one that would be the best fit for you.

There are also numerous options available on how to monitor your blood sugars including continuous glucose monitors, traditional finger stick glucometers and even implantable monitors.

We are fortunate to have multiple treatment options for diabetes and recommend you schedule a visit so we can come up with an INDIVIDUALIZED plan for you or your loved ones.

At any given time we also have multiple research trials going on for weight loss, type 1 and type 2 diabetes. Please refer to our research page(https://texasdiabetes.com/sponsors-and-cro/currently-enrolling-trials/) for ongoing studies.

We look forward to working with you. Please do not hesitate to contact the office with any questions or concerns.


Do you have irregular periods? There are several reasons for missing periods, but one of the most common reasons is PCOS, polycystic ovarian syndrome.  

Symptoms of PCOS include:

  • Missing periods (usually having less than 9 periods per year)
  • Excess testosterone on blood work or on exam (excess hair growth, acne)
  • Ovarian cysts

PCOS is a diagnosis of exclusion so other diseases like thyroid or other hormone problems should be ruled out before making the diagnosis of PCOS.  The diagnosis is based on symptoms, laboratory findings, and sometimes imaging studies.

The risk of having PCOS is that it can be associated with diabetes or insulin resistance, sleep apnea, cardiovascular disease, weight issues, uterine cancer, infertility, and sleep apnea.

The cause of PCOS is unknown and treatment involves controlling the symptoms.  A healthy lifestyle with weight loss can oftentimes improve symptoms and prevent associated medical complications.  Birth control pills are typically used to help regulate periods and can sometimes decrease facial hair or acne. Metformin is another medication that is typically used to help control the blood sugar.

When a woman has regular periods, this is a good indication that her hormones are appropriate. 

You should let your healthcare provider know if you have irregular periods or excess hair growth or acne in order to do a proper evaluation.

The following references:




Obesity (defined as a body mass index (BMI) >30kg/m2) is a chronic disease that is increasing in prevalence in adults, adolescents, and children and is now considered to be a global epidemic. The National Health and Nutrition Examination Survey (NHANES) in 2016 showed the prevalence of obesity in the United States to be 39.6% (37.9% in men and 41.1% of women), up from 22.9% in 1994.

At Texas Diabetes and Endocrinology we investigate many aspects of this disease. We rule out any possible secondary causes (such as pituitary, thyroid, adrenal or ovarian abnormalities) as clinically indicated, discuss contributing medications, and obtain a thorough weight gain/weight loss history. Obesity is associated with a significant increase in morbidity (including diabetes mellitus, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer) and we assess these and come up with a comprehensive plan to manage them.

Weight loss itself is associated with a reduction in obesity-associated morbidity and we are committed to helping our patients achieve these benefits. We counsel all patients on lifestyle and behavioral modification. We also offer medically supervised programs to assist with individual goals. Muscle Wise is one program we utilize: it provides structure and one-on-one coaching that can help achieve not only weight loss but also reduction in comorbidities and often medications. We also use FDA-approved weight loss medications as needed to help our patients achieve their goals.

Finally we conduct clinical trials at all of our locations and these often involve obesity treatments. Currently at the south office we are conducting a study on a medication (semaglutide) to evaluate weight loss and long-term cardiovascular outcomes.

Advanced Lipid Tests

Fish Oil (Omega 3 fatty acids has been touted as a having heart and vascular protective effects for many years.  In 2018, a number of large clinical studies including studies in people with diabetes showed that fish oil had little to no effect in reducing cardiovascular events.  This was quite disappointing to doctors and patients alike and many stopped taking fish oil.


  • Then in 1/19 a large study called the Reduce-It Trial was published in the New England Journal of Medicine.  It looked at the effect of an Omega 3 fatty which was a specific component of fish oil—EPA or icosapent ethyl in people with known heart disease and/or diabetes.   Let me tell you a bit about the people enrolled in the study.  The study included people who were 45 years of age or older with known heart disease OR who were 50 years of age or older and diabetes mellitus and at least 1 additional heart risk factor.
  • They had to have a fasting triglyceride of 150-499 mg/dl and their cholesterol had to be already well controlled on a statin.  The LDL cholesterol at the start of the study was really very controlled and was in the mid 70’s.
  • The study went on for 5 years.  The remarkable finding was that the icosapent ethyl reduced cardiovascular death, heart attack and stroke considerably.  This was phenomenal news to those of us who every day, treat people with heart disease and heart disease risk.


In summary, in the past year, we learned that regular fish oil doesn’t have the heart disease reduction effect that was claimed but that a specific derivation of fish oil, the omega 3 fatty acid icosapent ethyl (only available by prescription) reduces cardiovascular death and heart attacks and strokes in the people described above.


We at Texas Diabetes and Endocrinology continually strive to be current and at the forefront of using interventions to reduce heart attack and stroke risk.  We are experts in diabetes and heart risk factor management.  One of our doctors and one of our clinical nurse specialists, Ashley Davila CNS, are boarded in Lipidology.  We are also members of the National Lipid Association.   We perform noninvasive heart disease risk assessments with an easy ultrasound based arterial assessment called Carotid Intimal Medial Thickness (CIMT).  We also obtain “advanced lipid tests” in many individuals to help in their cardiovascular risk reduction/prevention.


We have participated in many clinical research studies evaluating a number of medications used to lower cholesterol.  We are soon enrolling a study to evaluate the effect of a medication on lowering Lp(a) also called lipoprotein little a, which is an important indicator of heart attack and stroke risk.  If you or any of your family has been told that you have an elevated Lp(a), please call our office and ask for the research department.


What is the pituitary?

The pituitary is a hormone-producing gland that sits just beneath the base of the brain. It is very small – only about the size of a pea. The pituitary gland has two parts. The front portion of the gland makes hormones that affect the breasts, adrenals, thyroid, ovaries and testes, as well as several other hormones. The main glands affected by the back portion of the gland are the kidneys. It plays a major role in regulating vital body functions and general wellbeing. It is referred to as the body’s ‘master gland’ because it controls the activity of most other hormone-secreting glands.

What could go wrong with my pituitary gland?
Conditions that affect the pituitary gland directly can be divided into three main categories:

• Conditions that cause the pituitary gland to produce too much of one or more hormone(s). Examples include acromegaly, Cushing’s disease and prolactinoma.

• Conditions that cause the pituitary gland to produce too little of one or more hormone(s). Examples include adult-onset growth hormone deficiency, diabetes insipidus and hypopituitarism.

• Conditions that alter the size and/or shape of the pituitary gland. Examples include empty sella syndrome.

What are the symptoms of pituitary conditions that produce too much of one or more hormones?

A prolactinoma is a tumor of the pituitary gland that produces too much of the hormone prolactin. High prolactin levels can cause women to have irregular or absent periods, infertility, or abnormal breast milk production. In men, high prolactin levels cause low testosterone which leads to fatigue, decreased muscle strength, low libido, erectile dysfunction, and infertility.

Cushing’s Disease is a hormonal disorder caused by a tumor of the pituitary gland. The tumor makes too much of a hormone called ACTH (adrenocorticotropic hormone). ACTH causes an increase in the stress hormone cortisol. Cortisol is a hormone that regulates blood pressure, blood sugar, and the immune system.

Acromegaly is caused by a tumor in the pituitary gland that makes too much growth hormone. Common symptoms of acromegaly are abnormal growth of the hands and feet, joint pain, face changes (enlarging forehead, nose, tongue, lips, widened space between teeth, and underbite), carpal tunnel syndrome, sleep apnea, diabetes, high blood pressure.

What are the symptoms of pituitary conditions that produce too little of one or more hormone(s)?

Hypopituitarism is a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn’t produce enough hormones. This can cause a variety of different symptoms depending on which hormone has been affected.

Growth hormone (GH) deficiency
In children, GH deficiency may cause growth problems and short stature. Most adults who have GH deficiency don’t have any symptoms, but for some adults it can cause fatigue, changes in body fat and muscle weakness.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency
Deficiency of these hormones affect the body’s reproductive system. In women, the deficiency can cause irregular periods, hot flashes, low libido and the inability to produce milk for breast feeding. Men may also have symptoms such as erectile dysfunction, decreased facial or body hair, low libido and mood changes.

Thyroid-stimulating hormone (TSH) deficiency
This hormone controls the thyroid gland. A TSH deficiency leads to low levels of thyroid hormones (hypothyroidism). Symptoms include fatigue, weight gain, dry skin, constipation, hair loss and feeling unusually cold.

Adrenocorticotropic hormone (ACTH) deficiency
This hormone helps your adrenal glands work properly, and helps your body react to stress. Symptoms of ACTH deficiency include severe fatigue, nausea or abdominal pain, and low blood pressure, which may lead to fainting.

Anti-diuretic hormone (ADH) deficiency
This hormone helps your body balance its fluid levels. Symptoms of ADH deficiency can cause a disorder called diabetes insipidus, which can cause excessive urination and thirst.

Prolactin deficiency
Prolactin is the hormone that tells the body when to start making breast milk. Low levels of prolactin can cause women to have problems making milk for breast-feeding.

What are the symptoms of pituitary conditions that alter the size and/or shape of the pituitary gland?

Empty Sella
Most individuals with empty sella syndrome do not have any associated symptoms, but the finding raises concerns about hormone deficiencies.

What is the treatment?

The treatment for pituitary problems are vast. Sometimes only monitoring the patient is needed. Other times a simple medication can resolve problems; however, in some cases surgery is required.

Why you should contact TD&E?

Pituitary disorders are often complex, and successful diagnosis and treatment can be a challenge. The physicians at TD&E offer an integrated, comprehensive approach to all pituitary problems. To ensure the best chances for successful treatment, you should be cared for by experts who specialize in pituitary diseases.


1. http://pituitarysociety.org/patient-education/pituitary-disorders
2. http://www.yourhormones.info/glands/pituitary-gland/
3. https://www.hormone.org/diseases-and-conditions/pituitary-tumors
4. https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

Low testosterone (hypogonadism) in men

What is testosterone?

Testosterone is the most important androgen (male hormone) that men make. It helps regulate muscle mass and strength, it can effect sex drive and sexual function, and it helps maintain bone strength.

What is “low T”?

Low testosterone is when the body does not produce sufficient testosterone. With age, it is normal for levels of testosterone to get a bit lower. When the levels of testosterone get too low, men can have symptoms.

What are the symptoms?

The symptoms may change from person to person.
If someone has had low testosterone for a relatively short period of time, he may experience: fatigue, low libido (little or no interest in sex), or he may feel sad or depressed
If low T goes unnoticed for a long time, some people experience loss of bone and / or muscle mass, loss of facial or body hair, increase in breast size (gynecomastia)

What are the causes?

  • Normal aging
  • Diseases affecting the testicles (which produce testosterone in men)
  • Certain treatments for cancer, including radiation, chemotherapy or certain types of hormone therapy
  • Disorders that affect the pituitary gland, a gland at the base of the brain that regulates all other hormones in the body

Other medical problems: liver and kidney disease, obesity, diabetes, AIDS, and some relatively rare hereditary conditions

Why should you see us for this?

There are many things that can cause these symptoms. Your provider can try to find out what might be causing them. A blood test can show whether you have low T, but you might not need that test if something else is causing your symptoms. Also finding the cause of low T is important, since treatment may change depending on the cause.

What is the treatment?

Low testosterone can be treated with testosterone replacement, which comes in patches, gels, injections, and other options. It is very important to pick the treatment that will work best for you and to monitor your testosterone levels to optimize the results. The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!

Why you should contact TD&E

  • It is very important to evaluate and understand the specific cause of low T before starting treatment for it. Treatment depends on the cause, and sometimes starting treatment before detailed evaluation can make it harder to understand the underlying cause
  • Getting your testosterone levels to optimal has health benefits including improved muscle mass, increased bone density, better energy levels, and improved sexual function.
  • The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!


What you need to know about Osteoporosis

Osteoporosis is a growing public health concern. It is characterized by low bone mass and decreased bone strength which results in an increased risk for fracture. This disease can affect both men and women. Current estimates are that 5.1% of men and 24.5% of women age 65 years and older have osteoporosis of the hip or spine.

Osteoporosis can be diagnosed with a BMD (bone mineral density) assessment.

Most experts recommend a BMD assessment in all postmenopausal women 65 years and older.

Many experts also recommend a BMD assessment in women younger than 65 who are at increased risk for osteoporosis.

Some experts recommend a BMD assessment for men over the age of 70.

Osteoporosis is a silent disease. As such, there are no clinical manifestations until the affected individual suffers a fracture. This is why early diagnosis is important -we have therapies that can slow or even reverse the progression of osteoporosis so that fracture risk is reduced. One of our goals at Texas Diabetes and Endocrinology is to deliver interventional therapies that will maintain quality of life for an aging population. If you have osteoporosis, we can perform a thorough evaluation and offer an individualized treatment plan.

Here are things you can do on your own to preserve bone mass:

  • Limit alcohol consumption to <2 drinks daily
  • Avoid smoking
  • Take a daily walk for at least 30-45 minutes
  • Consume foods containing vitamin D (dairy and fish from the ocean) and/or take a supplement
  • Consume foods containing calcium (dairy, green leafy vegetables) and/or take a supplement.

Links for more information:

Hashimoto’s…What the heck is that?

Looking online about a medical diagnosis can be overwhelming. A quick Google search about your thyroid condition might lead you down a rabbit hole where things get pretty grim, pretty fast. So what is this mystery diagnosis of Hashimoto’s? Simply put, it’s the name of the condition where your immune system turns against you and attacks your thyroid. It is the most common cause for someone to need to take a thyroid supplement – hypothyroidism.
Your immune system normally does a fantastic job of keeping your body safe from foreign “attacks” like bacterias and viruses. In some individuals, their immune system is tricked into attacking their own body. As a result, the target organ can be destroyed to the point that it no longer works properly. There are a number of conditions that follow this pattern but seem different because different organs are attacked. For instance, if the immune system targets your joints, you get rheumatoid arthritis, your pancreas – type 1 diabetes. All of these “autoimmune diseases” are interrelated and often times hereditary. This is why various members of the same family can present with a variety of autoimmune diseases. Experts do not know why or how the immune system gets activated but the gradual and eventual destruction of the thyroid can lead to devastating consequences for the patient.
The thyroid gland sits in the lower, front part of your neck and its purpose is to make thyroid hormone. This hormone serves to control the metabolic rate of almost all of the organs in your body. It controls processes as diverse as the rate at which the heart beats, the stomach digests food, the brain processes memories and learning, to the condition of your skin, hair and nails. When the thyroid is partially or completely destroyed, the lack of thyroid hormone will make an individual feel tired, constipated, forgetful, have dry skin or brittle nails. Each individual will present in their own unique way. The symptoms can be subtle or get worse gradually. This makes the diagnosis difficult to come by at times.
Your doctor at Texas Diabetes and Endocrinology can run a series of blood tests to see the status of your thyroid levels. At times, we can determine if your immune system is making antibodies that are attacking your thyroid. Lastly, an ultrasound of your thyroid can sometimes be useful to see if your thyroid is healthy or if there is a problem.
Sometimes, Hashimoto’s can flare up and seemingly get worse. When this occurs, patients can experience the fatigue and other symptoms that first alerted them to the condition. Your doctor might need to increase or adjust your medication so that you can return to feeling back to normal again.