Continuous glucose monitoring (CGM) technology provides real-time glucose readings to people with diabetes. CGMs help diabetics track their glucose levels throughout the day and make informed decisions about their food, exercise, and medication intake. This advancement in technology can make living with diabetes easier to manage.
What are continuous glucose monitors (CGMs)?
A CGM is a small device that uses a sensor placed under the skin to check blood glucose levels every 5-15 minutes, providing real-time updates to a receiver or smartphone app.
Benefits of CGMs
CGMs offer many benefits for people with diabetes to help them live more independently. Board certified endocrinologist Dr. Srujana Yada says the real-time updates on blood sugar trends can not only provide guidance on treatment decisions, but also help patients make healthy choices.
“CGMs can tell patients how their blood sugar changes when eating different kinds of foods,” says Dr. Yada. “This can help them make appropriate changes in their diet and create an even more personalized treatment plan.”
CGMs can also help reduce the risk of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).
“Patients are notified by an alarm when they have high or low glucose levels, which helps them make treatment decisions rather than waiting too long,” explains Dr. Yada.
The instant data from CGMs can also improve patient care. “It helps doctors to see where exactly the blood sugars are running high – either fasting or mealtime sugars – and lets us change the regimen accordingly. CGMs help improve HbA1c and reduce variability.”
Who should have a CGM?
Patients who are candidates for a CGM include:
All type 1 diabetes patients;
Type 2 diabetes patients who are on multiple insulin injections; and
Patients with hypoglycemic unawareness.
Patients who are not on insulin do not need a CGM.
Continuous glucose monitors are a valuable tool for people with diabetes. If you’re interested in learning more, talk with your doctor to decide if it is right for you.
Consult with an Endocrinologist in Austin, TX
At Texas Diabetes & Endocrinology, we are committed to helping people gain better control of their health and working with patients to develop personalized treatment plans that work best for their lifestyle. To schedule an appointment with one of our board certified endocrinologist, call (512) 458-8400 or request an appointment online.
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Osteoporosis is a common and potentially debilitating disease that affects an estimated 54 million Americans. Often referred to as a silent disease, osteoporosis can progress with no symptoms or warning signs until a fracture occurs. At Texas Diabetes and Endocrinology, we believe that preventing bone fractures is a priority.
In honor of Osteoporosis Awareness and Prevention Month, endocrinologist Dr. Keta Pandit is sharing everything you need to know about the condition.
What are the most common signs of osteoporosis?
Osteoporosis is characterized by low bone mass that results in microarchitectural disruption which causes decreased bone strength and increased risk of fracture. Some people may develop small microfractures in the vertebral spine, which may result in loss of height or hunched posture, known as kyphosis. Unfortunately, osteoporosis has no clinical manifestations until there is a fracture.
What risk factors raise a person’s chances of getting osteoporosis?
Women are much more likely to develop osteoporosis compared to men. Upon menopause women are not exposed to Estrogen, which is responsible for promoting bone growth. Therefore, postmenopausal women are at an increased risk of getting osteoporosis. Those with a family history of hip fractures or osteoporosis are also at an increased risk and should inform their doctor so that screening can be done appropriately.
Other factors that can increase osteoporosis risk can include:
smoking
daily use of alcohol
history of steroid use
early menopause in women
low testosterone in men
excessive use of thyroid hormones or history of hyperthyroidism
hypercalciuria
chronic medical conditions like diabetes and HIV
At what age should patients start thinking about osteoporosis prevention?
The National Bone Health & Osteoporosis Foundation (NBOF) and the U.S. Preventive Services Task Force(USPSTF) both recommend screening for osteoporosis in women of age 65 and above. NBOF also recommends screening early for all postmenopausal women with known risk factors. Regardless, all women of postmenopausal age are recommended to have adequate calcium and vitamin D to prevent bone loss.
For men, the recommendations have varied. NBOF recommends screening for all men over age 70 and as early as 50 years or older for men with risk factors. On the other hand, USPSTF has not provided a set guidance for what age men should be screened for osteoporosis.
What is one of the most common misconceptions patients have about osteoporosis?
One of the most common misconceptions about osteoporosis is that it presents pain in your bones or joints. Osteoporosis is a silent disease, and it does not present with any pain, unless there is a fracture or a bone deformity that comes from a previous history of fracture.
Many people believe that adequate intake of dairy in their diet is sufficient to prevent bone loss. However, you may not necessarily have adequate calcium despite daily use of dairy products.
Does osteoporosis affect men and women differently?
Women tend to have younger onset of bone loss and lose bone at a faster rate compared to men. Estrogen deficiency plays an important role in osteoporosis development, which is one of the factors that makes women more susceptible to osteoporosis compared to men.
How can someone best protect themselves from osteoporosis?
Prevention of osteoporosis begins with ensuring you have enough calcium and Vitamin D in your diet. Other steps you can take to maintain bone density include:
eating a well-balanced diet
regular exercise with weights
avoiding alcohol and smoking
How is osteoporosis treated?
The landscape of medications for osteoporosis has changed in the last two decades. All medications work in a different pathophysiology, but the goal is to build bone and reduce fracture rates.
Oral bisphosphonates, IV bisphosphonates and denosumab work by reducing the rate at which bones break down. Oral bisphosphonates including weekly Alendronate (Fosamax) or monthly Residronate (Actonel) and Ibandronate (Boniva) are the standard of treatment for osteoporosis in the beginning stages. However, these medications are known to cause reflux.
Those that cannot take the oral bisphosphonates can resort to annual IV zoledronic acid (brand name Reclast), which is also a bisophosnate. Alternatively, denosaumab (Prolia) can also be utilized which is an injection given every 6 months.
For patients that have severe osteoporosis, which is defined as a history of a fracture in the hip or spine or wrist, or very low scores on their bone density scans, stronger medications can be used. These medications belong to a class of medications called anabolic treatment, known as Teriparatide (Forteo), Abaloparatide (tymlos) or Romosozumab (Evenity). These medications build stronger bone by speeding up the bone building process. Teriparatide and Abalopartide are daily injections approved for two years and Romosozumab is a monthly injection approved for one year. After their recommended time frames, patients will generally switch to either IV Reclast or Prolia depending on how they respond to the treatment.
Long term use of osteoporosis medications is discouraged as there is a risk for developing atypical femoral fracture or osteonecrosis of the jaw. Therefore, we recommend stopping medications temporarily, known as a drug holiday. After 3-5 years of treatment (or up to 8-10 years of treatment in some cases), a drug holiday is recommended. During the ‘drug holiday’, bone density is measured annually or every two years, and treatment can begin after 2-3 years of drug holiday if bone loss progresses.
Dr. Keta Pandit is a board certified endocrinologist and obesity medicine specialist with a special interest in the treatment of adrenal and pituitary disorders. She sees patients at our Central Austin office.
If you’d like to learn more about our osteoporosis and fracture treatment services, please call Texas Diabetes and Endocrinology at (512) 458-8400 or request an appointment online.
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If you have been diagnosed with a lipid disorder, you are at an increased risk for developing heart disease, which is the leading cause of death worldwide. At Texas Diabetes and Endocrinology, we believe that cardiovascular risk reduction and prevention is one of our most important jobs.
Cardiovascular risk assessments help our patients gain better control of their health by identifying underlying conditions that can cause a heart attack or stroke. We offer advanced lipid and Carotid-Intima-Media Thickness (CIMT) testing and treatments designed to prevent cardiovascular disease.
In this blog, advanced practice provider and clinical lipid specialist Ashley Davila, MSN, ACNS-BC answers some frequently asked questions about lipid disorders and heart disease prevention.
What does it mean to have a lipid disorder?
A lipid disorder is a broad term that encompasses patients who have abnormalities in their cholesterol or lipoprotein profiles and often these disorders place patients at increased risk for cardiovascular disease.
Who is a candidate for advanced lipid testing?
Advanced lipid testing is very informative for patients with metabolic issues (i.e., diabetes, insulin resistance) as it measures lipoprotein particles instead of just cholesterol. There are often abnormalities in lipoproteins that would not be readily identifiable with just a standard cholesterol panel. Advanced lipid testing is also very useful in patients with significant artery disease or strong family history of significant artery disease.
Who is a candidate for Carotid Intima-Media Thickness (CIMT) testing?
CIMT is a non-invasive test to assess the health of the arteries. It can detect the earliest changes seen in the arteries – thickening in the intima-medial space. CIMT is recommended for younger patients who have significant family histories related to heart disease.
Heart Disease Prevention
By following these preventative measures, you can greatly lower your risk of developing heart disease.
Exercise regularly
One of the most important things you can do to prevent heart disease is to exercise regularly. Getting your heart rate up and breaking a sweat helps to strengthen your heart and cardiovascular system. Aim for at least thirty minutes of moderate exercise most days of the week.
Maintain a healthy diet
A diet low in saturated and trans fats, added sugars, and salt can help lower blood pressure and cholesterol, two major risk factors for heart disease. Focus on eating plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats like those found in nuts, seeds, and fish.
Quit smoking
Smoking damages the lining of blood vessels and increases the risk of blood clots. If you smoke, quitting is one of the best things you can do for your heart health.
Manage stress
Stress can take a toll on your heart health, as chronic stress can lead to high blood pressure and inflammation, both of which increase the risk of heart disease. Take steps to manage your stress levels, such as practicing relaxation techniques like meditation or yoga, getting regular exercise, and getting enough sleep.
Regular check-ups and screenings
Regular check-ups with a doctor can help identify and manage risk factors for heart disease. Your doctor can measure your blood pressure, cholesterol, and blood sugar levels to ensure that they are within healthy ranges.
Limit alcohol consumption
While moderate alcohol consumption has been linked to a lower risk of heart disease, excessive drinking can have the opposite effect. Drinking too much alcohol can lead to high blood pressure, heart failure, and stroke.
Lipid Disorder Treatment
Lipid disorder treatment is determined by a patients’ underlying health conditions, cholesterol levels and age. Lifestyle changes are the first line of defense in fighting lipid disorders. In some cases, medication and supplements for cholesterol management may be recommended. Remember to always consult with your doctor before making any major lifestyle changes or beginning a treatment regimen.
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If you’re living with diabetes, you know that managing your blood sugar levels can be a challenge and a chore, especially if you are taking multiple insulin injections a day. If you are ready to consider switching to an insulin pump, it’s important to weigh the pros and cons and remember, the choice is up to you.
An insulin pump is a small, computerized device that you wear to deliver insulin automatically – either in small continuous doses or close to mealtime. In this blog, we’re sharing some insights from endocrinologist Dr. Tira Chaicha-Brom about the benefits of insulin pumps and what to consider prior to use.
Benefits and Types of Insulin Pumps
There are many different insulin pumps available on the market. Patch pumps have no electronic component and do not have a feature for automatically adjusting the insulin delivery – you must manually press a button to deliver the insulin. However, Dr. Chaicha-Brom says they tend to be more discrete and are convenient for patients who do not want to carry the insulin pens and needles around.
If you are comfortable using technology and are already using multiple daily injections, you can consider a closed loop pump. With a closed loop pump, there is a level of manual skill needed to manage the pump, as well as a need to be able to read a screen. As a safety benefit, the closed loop pumps will suspend the delivery of insulin if your blood sugars are trending low or give more insulin if your blood sugars are too elevated. This adjustable insulin delivery can improve consistent blood sugar levels while offering flexibility for patients. Closed loop pumps also deliver bolus insulin with meals, which requires patients to enter information and push a button to deliver the insulin.
Insulin Pump Considerations
Insulin pumps are not permanent, but if you decide to get an insulin pump, you will always be required to wear the device. While some types of pumps can be placed discretely on the body, it is often difficult to conceal it, especially if it has a cord or tube for the insulin to flow through.
“Patients need to consider that they will have a device attached to their skin at all times,” emphasizes Dr. Chaicha-Brom. “Most patients should be on a sensor as well, so that typically means having two devices to manage.”
Dr. Chaicha-Brom also explains that carb counting is a major component of using an insulin pump. The amount of insulin you need is calculated by entering how many carbs you are consuming along with your current blood sugar.
“Prior to starting on a pump, patients should have a solid understanding of carb counting. If you do not already know how to count carbs, it is recommended that you meet with a registered dietician for training.”
Cost is another factor to consider. In addition to the cost of the pump itself, you will need to purchase supplies that are changed several times a week. In short, insulin pumps are more expensive than injections.
Finally, it’s important to remember that an insulin pump is not something you can get and then forget about. You will need to engage with the pump regularly throughout the day and continue to check your blood glucose.
An insulin pump can be a great way to help you manage your diabetes while increasing your flexibility and freedom. If you’re interested in getting an insulin pump, talk with your doctor about the risks and benefits to decide if it is right for you.
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