ASK THE EXPERT
Dr. Constantine "Dean" Kroustos
Dr. Constantine "Dean" Kroustos, a Delaware endocrinologist, was kind enough to share his knowledge in honor of November being National Diabetes Month.
What is an endocrinologist? "A specialist who diagnoses and treats disease of the glands, such as diabetes, thyroid function, osteoporosis, cholesterol disorders and hormonal conditions, to name just a few."
Why is diabetes on the rise? "Our Western lifestyle of high-calorie foods and sedentary activities has contributed to an increase in obesity. Risk factors are often related to race, age and family history."
What are the most common complications of diabetes? "When the A1C remains high, this affects the small blood vessels, causing (1) damage to nerves, which leads to burning pain and numbness in the feet; (2) protein loss in the urine from kidney damage; (3) bleeds in your eyes that can lead to blindness. Keeping that A1C between 6.5 and 7.0 and not smoking (because nicotine damages those same small vessels) are the top priority."
How do you know if you are diabetic vs. pre-diabetic? "If your fasting blood sugar (FBS) is over 126 (at least twice) and/or your hemoglobin A1C is 6.5 or higher, you are considered diabetic, although you might not need medication yet. A pre-diabetic has an FBS of 100-126 and/or A1C of 5.8-6.5."
Can a pre-diabetic reverse this condition? "Yes!" Dr. Kroustos happily answers. But he also cautions that 10-20 percent of pre-diabetics will have full-blown diabetes within a year if no change is made in their lifestyle. It doesn't have to be a big change - a weight loss of 10-15 pounds can make a difference.
Are screening tests important? "Early detection is the key. If you work overtime for many years, you will likely have a burnout. Just like your pancreas after responding to increased sugar levels for years has lost function that could have been prevented by lower sugar levels with early medication."
Should every diabetic own a glucometer? Testing your blood-sugar level is an important part of treating the disease, and here are the reasons:
- "Diabetes is a progressive disease. If you're tested only every 3-6 months, you won't know that your sugars are creeping up and you can do something to lower them sooner."
- "Testing allows you to learn how your body reacts to different situations. If you go to Olive Garden and see a dramatic spike in your sugar level, this tells you that was a bad meal choice for you. Or if you exercise and your level drops 30 points, that gives you positive reinforcement to continue."
Dr. Kroustos recommends that even a diabetic patient taking oral medication should do a finger stick 2-3 times a day for that first week - and vary the time of day - then maybe several times a month. Remember to check more frequently 1-2 weeks before your appointment and the same after a change in your medication. Most insurance plans cover the cost of a meter. Dr. Kroustos likes OneTouch and FreeStyle, but TRUEtrack and Kroger's are reasonably priced. Just make sure they have memory to store your results. Make sure you keep the time and date accurate on your meter and bring results to your appointments.
Central Ohio has a mortality rate (29 percent) more than two times the national average (13.4 percent) due to diabetes. How can we improve on this? The number one cause of death in diabetics is cardiovascular disease, including heart attack and stroke. Dr. Kroustos says a diabetic has the same risk of a heart attack as a person who has already suffered a heart attack, so it is very important to discontinue smoking, keep blood pressure down and lower your cholesterol levels.
What are the newest innovations in diabetic treatment?
- "A new class of medication called SGLT2 inhibitors that dump glucose into the urine instead of it staying in your bloodstream, without hurting your kidneys."
- "Continuous glucose monitoring involves wearing a device on your skin that detects your glucose level every few minutes."
- "The new glucagon/insulin pump that can increase or decrease blood glucose levels."
- "Bariatric surgery, when successful."
What is your method for motivating patients toward better control? "First, I evaluate how much the patient knows about diabetes. If you take someone who has never ridden a bike and say, 'Here is your $2,000 10-speed to ride!' that just doesn't work. Offering diabetes education on an ongoing basis is important; after all, patients can't remember everything. I start with fundamentals: Taking your medications 90 percent of the time and getting some finger sticks. Most diabetics avoid sugar but are still eating too many carbohydrates - such as pasta, potatoes and breads - that also turn into sugar. The American Diabetes Association says keep carbs under 200 grams per day. We encourage the team approach: I will help you the best I can, but you need to help me and yourself. Without sugar readings I might as well use a Magic 8 Ball to determine your treatment."
How can I get an appointment with you? "Patients must be referred by a family doctor, internist, podiatrist, or even a chiropractor when there is a "high suspicion" of an endocrine disorder. Due to a shortage (of endocrinologists) your wait time can be 3-4 months for a visit."
Any final words of advice? "First, lack of symptoms does not mean that something bad isn't happening. Second, if it sounds too good to be true, it probably is, so don't waste your money on supplements that promise a cure. Third, don't let lack of finances stop you! Check the website www.needymeds.org or Google your medication and go to the manufacturer's website for co-pay cards and discount programs. Finally, when you are first diagnosed with diabetes, get an annual dilated eye exam from an ophthalmologist and a foot exam from a podiatrist or your PCP. Education is a must, so sign up for a diabetes class as quickly as possible."
NUMBERS THAT CARRY WEIGHT
According to the Centers for Disease Control and Prevention, we are eating ourselves into a diabetes epidemic. The International Diabetes Foundation says, "Diabetes and obesity are the biggest public health challenge of the 21st century." Among the supporting statistics:
- Every three seconds someone is diagnosed with diabetes.
- About 30 percent of overweight people have diabetes, and 85 percent of diabetics are overweight.
- In 2012, 29.1 million Americans (9.3 percent) had diabetes. Of those, 8.1 million (27.8 percent) didn't even know they had it.
- Deaths from diabetes are projected to rise by more than 80 percent in the next 10 years in upper-middle-income countries.