Diabetes & Thyroid (Endocrinology)

An endocrinologist is a specially trained doctor who can diagnose diseases that affect your glands. They know how to treat conditions that are often complex and involve many systems within your body. Your primary-care physician refers you to an endocrinologist when you have a problem with your endocrine system.

The endocrine system is a complex group of glands. Glands are organs that make hormones. These are substances that help to control activities in your body. Different types of hormones control reproduction, metabolism (food burning and waste elimination) and growth and development. Hormones also control the way you respond to your surroundings, and they help to provide the proper amount of energy and nutrition your body needs to function. The glands that make up the endocrine system include the thyroid, parathyroid, pancreas, ovaries, testes, adrenal, pituitary and hypothalamus.

Endocrinologists are trained to diagnose and treat hormone imbalances and problems by helping to restore the normal balance of hormones in your system. They take care of many conditions, including:

• Diabetes
• Thyroid disorders
• Metabolic disorders
• Adrenal disorders
• Over- or under-production of hormones
• Menopause
• Osteoporosis
• Hypertension (high blood pressure)
• Cholesterol (lipid) disorders
• Lack of growth (short stature)
• Cancers of the endocrine glands

Endocrinologists also conduct basic research to learn the way glands work and clinical research to learn the best methods to treat patients with a hormone imbalance. Through research, endocrinologists develop new drugs and treatments for hormone problems.

Diabetes is a complex disease that requires daily self-management, making healthy food choices, staying physically active, monitoring your blood sugar and taking medications as prescribed. It is also important to talk regularly with your diabetes care team to problem solve, reduce risks for complications and cope with lifestyle changes.

Successful self-management will help you feel better and can reduce your chance of developing complications including heart disease, dental disease, eye disorders, kidney disease, nerve damage and lower leg amputation.

Diabetes management can feel overwhelming at times as you manage food, physical activity, blood sugar monitoring and medications at the same time. It is not uncommon to experience fear, anger, or stress. Our team of Registered Dietitians and Diabetes Educators can partner with you and help you navigate barriers along the way. 

 
The program is designed to help you learn how to take care of yourself, guide you through your treatment and help you with any fears, issues and problems you encounter along the way.

During initial visits, your diabetes educator will spend time with you developing a plan that helps you overcome the barriers you face in managing your diabetes, develop problem-solving and coping skills and adopt healthy behaviors. 

Some examples of the many activities you may work on together are:

• Helping you understand exactly what diabetes is and how it affects your body
• Explaining how diabetes medications work
• Figuring out what types of food are best for you and how to plan meals that fit your life and budget
• Teaching you how to use a glucometer to check your blood sugar and how to understand the results
• Introducing you to apps, on-line resources and other tools to support your diabetes management
• Offering tips to help you cope with stress and solve problems as they arise
• Explaining the value of your care team in managing your health

Meeting with a diabetes educator is a great first step. Effective diabetes education is a process and takes time. It’s important to attend your diabetes education appointments. If you need to miss an appointment, be sure to reschedule. Follow up can be individualized, however we believe our support best serves you if we can connect a minimum of twice a year. Initially, it is often helpful to follow-up monthly and in some instances more frequently. Lifestyle Medicine helps you put together all the pieces as you begin this new journey. As you want to become more active our team of Physical Therapists & Exercise Specialists will ensure you get started on the right foot and avoid injury. 

Any food can be worked into your meal plan, but it’s important to consider how you eat in addition to what you eat. For example, try not to skip meals. Your body needs foods containing carbohydrates every 4 to 5 hours during the day.

When you’re hungry, eat a snack, 2 to 3 hours before or after your meal. Try to choose low-fat, high-fiber snacks, such as fresh fruits or raw vegetables.

Even though you don’t have to completely avoid foods high in sugar, it is best to limit portions of high-sugar foods.

Eat lots of high-fiber foods.

If you are overweight, even a modest weight loss, say 10 to 15 pounds, is helpful in controlling your blood sugar level.

Eat less fat, especially saturated fat.

Increase physical activity.

Learn how many grams of carbohydrate to eat per meal. This amount varies depending on activity level, body size, and age. Blood sugar monitoring will help you determine how your body is processing carbohydrates. Your diabetes educator can help you determine this as well.

Carbohydrates are the foods that the body turns to blood sugar. Diabetics need to eat carbohydrates, just not too much. Examples of carbohydrates are as follows:

• Starches — bread, English muffin, bagel, waffle, pancake, crackers, cereal, potatoes, rice, pasta, popcorn, corn, green peas, winter squash, beans (navy, pinto, black, kidney), lentils
• Fruits — fresh fruit, unsweetened canned fruit, frozen fruit, and fruit juice
• Milk — milk, light yogurt
• Sugar—white table sugar, brown sugar, molasses, and honey

Sample Menu

Breakfast (7 am)
1 cup oatmeal (Splenda to sweeten)
¼ cup nonfat milk
½ cup berries, coffee or tea as desired

Snack (9:30 am)
Optional—light yogurt

Lunch (noon)
2 slices of whole wheat bread (3-4 ounces of turkey or other lean meat, tomato,
onion, lettuce, light mayo, and mustard)
1 small apple
1 cup baby carrots, 2 tbs. light ranch dressing dip
Diet soda or water

Snack (3pm)
Optional—fresh fruit or 3 cups popcorn

Dinner (6 pm)
3-4 ounces baked chicken breast
1 cup rice
2 cups steamed broccoli
Tossed green salad, 2 tbs. light dressing

Evening Snack
(Optional—talk to your diabetes educator about your snack needs.)
6 wheat crackers
1 ounce low-fat mozzarella cheese

*Drink lots of water throughout the day.

Take care of your diabetes.

• Keeping blood sugar in recommended targets decreases risk of nerve damage—peripheral neuropathy—to the feet.

Wash and check your feet daily.

• Inspect your feet for cuts, calluses, blisters, red spots, and swelling. Notify your doctor if these problems persist.
• If you have difficulty seeing the bottom of your feet, use a mirror or ask a family member to help you inspect your feet.
• Wash your feet in warm water and dry well, especially between the toes.
• Trim your toenails straight across and file the edges with an emery board or nail file.

Keep the skin on your feet soft and smooth. Calluses can lead to breaks in the skin, increasing the risk of foot ulcers.

• Moisturize feet with lotion. Avoid getting lotion between the toes.
• Soften calluses by soaking your feet in warm water, or by applying diabetic foot cream containing the ingredient “urea.” Gently smooth softened calluses with a pumice stone.
• Significant callusing or other persistent foot problems may require evaluation by a foot specialist to determine and treat the cause.

Wear shoes and socks.

• Wear comfortable shoes that fit well and protect your feet.
• Check for objects inside your shoes before putting them on.

Follow up with your doctor.

• Have your feet checked at least annually, including a thorough visual exam, evaluation of sensation using a monofilament, and evaluation of pulses and circulation.
• Notify your doctor if you notice a cut, sore, or blister that is not healing or if you have other concerns about your feet.

American Diabetes Association
Washington State Chapter
557 Roy St
Lower Level
Seattle, WA 98109
1.888.DIABETES
206.282.4616

Juvenile Diabetes Foundation-Northwest Chapter
1215 4th Avenue Suite 1400
Seattle, WA  98161
206.838.5153

New York Online Access to Health (NOAH), in English and Spanish.

Washington Association of Diabetes Educators.

A comprehensive list of diabetes education programs and support groups. Adult Support Group takes place the first Wednesday of the month from 7:30 to 8:30 am. Call 206.215.2440.Teen Support Group, held at Children's Hospital in Seattle. This class is led by Gillian Levine/American Diabetes Association Youth Program Director. To learn more, email glevine@diabetes.org or phone 206.282.4616, ext. 7207.

Cultural Resources

Center for MultiCultural Health
105 14th Ave, Ste 2C
Seattle, WA
206.461.6910, ext. 218

Country Doctor Community Health Centers
at Carolyn Downs Family Medical Center
2101 E Yesler
Seattle, WA
206.299.1900, ext. 432

Asian/Pacific Islander Americans

Association of Asian Pacific Community Health Organizations for Asians with diabetes

International Community Health Services
Program Coordinator: Melissa Ponder, 206.461.3617, ext. 2248
Chinese Community Educator: May Lo, 206.918.1013
Korean Community Educator: Nicole Lee, 206.918.3941
Vietnamese Community Educator: Peter Quenguyen, 206.615.8815

National Diabetes Education Program  

Hispanic/Latinos
Sea Mar Community Health Centers
1040 S Henderson St
Seattle, WA
206.764.4700, ext. 6303

Native Americans

Seattle Indian Health Board
606 12th Ave S
Seattle, WA
Contact: Dawn Giberson, Diabetes Coordinator, 206.324.2646

Washington State Department of Public Health
Diabetes Prevention & Control Program
7211 Cleanwater Lane
Olympia, WA 98504
253.395.6758

Center for Children with Special Needs

Save time when you arrive—print, complete and bring your assessment form with you!

Individual diabetes appointment / class
Initial Assessment Form

Gestational diabetes appointment / class
Gestational Diabetes Assessment Form

Diabetes is a metabolic disorder where the pancreas produces little or no insulin, causing blood sugar to rise.  

The most common symptoms are frequent urination, blurred vision, wounds that don’t heal, frequent infections, increased thirst and chronic fatigue. If you have these symptoms or a family history of diabetes, see your doctor for a blood test.  

Type 1 diabetes (about 10 percent of people with diabetes) is an autoimmune disease in which the immune system attacks the cells of the pancreas that produce insulin. Type 2 diabetes (about 80 to 90 percent of persons with diabetes) is a progressive chronic disease that affects insulin production and utilization. Generally, individuals who have Type 2 diabetes still produce insulin, though not as efficiently.  

Insulin is a hormone produced by the pancreas. Insulin allows sugar to move from the blood stream into the cells of the body where glucose is used for energy. Insulin helps to maintain a balance of sugar in the blood. If there is little or no insulin available, as in Type 1 diabetes, or if it does not work normally, as in Type 2 diabetes, blood sugar levels increase. Over time, elevated blood sugar levels can damage different organs in the body, resulting in medical complications.  

Medical treatment centers on controlling blood sugar as well as preventing and monitoring for complications. Teaching people how to manage their diabetes and regular follow-up with their healthcare provider is essential for long-term wellness. People learn to monitor their blood sugar and are treated medically for blood sugar control. Persons with Type 1 diabetes require insulin injections for blood sugar control and ultimately for their survival. Persons with Type 2 diabetes may be able to control blood sugar by making lifestyle changes and/or through oral medications. Insulin may be required depending on the person’s ability to manage their blood sugar by other means.  

Commonly Type 1 diabetes manifests in childhood and teenage years, though it can occur at anytime of the life cycle. Type 2 diabetes previously was called adult-onset diabetes. We are now seeing Type 2 manifesting at all ages, even in children.  

An HbA1c is a measure of the average blood glucose levels during the last 3 months. This value is heavily weighted for the last 30 days before the lab test and is used as a marker for tracking diabetes management.

The Valley Diabetes Network is a collaborative effort among Valley Medical Center physicians, nurses, and diabetes educators. It was formed for the purpose of monitoring and tracking patient health through the system.  

Complications associated with diabetes include increased risk for heart disease and stroke, damage to small blood vessels of the eyes and kidneys, and damage to the nervous system. Persons with diabetes should see their healthcare provider regularly, every 3 to 6 months. Patients are monitored for blood sugar and blood pressure control and evaluated and/or treated for underlying cardiovascular disease. Exams or tests done annually include dilated eye exam, foot exam, blood cholesterol, and urinalysis to monitor for kidney changes.  

A blood test called the hemoglobin A1c is used to determine blood sugar control. This test measures the percentage of hemoglobin (a blood protein) that has sugar or glucose attached. The higher the percentage, the higher the blood sugar has been over the previous 2 to 3 months. The results more closely reflect blood sugar levels occurring within the month prior to the blood draw.  

Individuals who have Type 1 diabetes require insulin injections for survival. Patients with Type 2 diabetes may require insulin, depending on how well they are able to control their blood sugar by other means.  

Elevated blood sugar levels contribute to an increased risk of health complications. Individuals who are unable to control blood sugar levels through lifestyle or oral medications may benefit from insulin injections.  

The diagnosis of diabetes means an increased risk for sleep apnea. People with sleep apnea have episodes in their sleep cycle when they do not get enough oxygen. Sleep apnea increases risk for a number of health problems, including high blood pressure, heart disease, and stroke. Symptoms include chronic fatigue and diminished ability to concentrate. Individuals at increased risk include persons who have diabetes, are overweight, or have a family history of sleep apnea. Valley Medical Center has a Sleep Center that specializes in diagnosing and treating individuals with sleep apnea.

The factors that contribute to patients being at risk for diabetes are a family history of diabetes, being overweight or obese, and inactivity or a sedentary lifestyle.  

Heart attacks and strokes are the leading causes of diabetes-related deaths. Both result from an underlying disease of the arteries. The good news is that by following a heart healthy lifestyle, the risk for heart attack and stroke can be significantly decreased. Not using tobacco, getting regular exercise, maintaining healthy eating habits and a healthy weight, and keeping your blood pressure and blood cholesterol levels within target ranges are all important lifestyle factors that significantly reduce risk of heart disease and stroke.  

Following a healthy lifestyle will decrease the risk of heart disease and stroke. Blood sugar and blood pressure control play an important role in significantly reducing the risk of complications. One of the most important things individuals with diabetes can do is to become educated about managing their diabetes. The Diabetes Center at Valley Medical Center offers classes that empower individuals to make lifestyle choices that will promote their health and well-being.  

The results of a 3-year national study on diabetes prevention showed a 60 percent reduction in risk among individuals who followed recommended lifestyle practices such as regular exercise (a minimum of 30 minutes, 5 days per week); a “heart healthy” low-fat diet; maintenance of normal body weight and/or moderate weight loss (10–15 pounds).  

No. Sugar increases blood sugar levels but so do other carbohydrates. Carbohydrates are both sugars and starches, including breads, cereals, grains, fruit, starchy vegetables, milk/yogurts, and of course desserts. A person with diabetes can control blood sugar levels by consuming moderate amounts of carbs with each meal. Small amounts of sugar can be included in meal plans.  

Most mortality risk among persons with diabetes is associated with cardiovascular disease. Regular exercise and physical fitness are associated with decreased heart disease risk as well as a decrease in Type 2 diabetes. The best kind of exercise for a diabetic patient is any activity the patient enjoys, such as walking, jogging, or gardening. For the most benefit, it should vary between weight-bearing or resistance activities and cardiovascular activities.  

There is a strong relationship between diabetes and obesity. Research shows that overweight or obese individuals are at elevated risk for developing Type 2 diabetes. Obesity causes insulin resistance, which means that the insulin produced in the pancreas is not being used efficiently and the insulin cannot help glucose enter the cells. Blood sugar levels then remain elevated. Moderate weight loss decreases insulin resistance and increases insulin sensitivity.  

Typically most insurance companies cover diabetes education to some extent if the deductible has been met. We recommend that you check with your insurance company to verify coverage of diabetes education classes. Medicare typically covers 80 percent of the cost of diabetes education classes.  

Typically, diets that eliminate certain food groups do not provide people with adequate nutrition. For diabetics, a diet that is moderate in carbohydrates, protein, and fat is the best solution.  

See your family medicine doctor, who will test your fasting blood sugar or random blood sugar levels.  

The American Diabetes Association guidelines state that fasting blood sugar levels should be 90–130, and 2 hours post-meal blood sugars should be less than 140.  

In addition to taking medication, you can lower blood sugar levels by educating yourself, making healthy food choices, increasing activity levels, and decreasing stress levels.  

Yes, a diet that is moderately low in fat will reduce your risk for cardiovascular disease. Cardiovascular disease is a complication of diabetes.  

All kinds of foods are available as long as you maintain the right balance of carbohydrate, protein, and fat. We recommend that 50 percent of your calories should come from carbohydrates, 20 percent from protein, and 30 percent from fat.