Endocrinology | Diabetes Care | MaineHealth Memorial Hospital

Our body produces blood sugar from the foods we eat. Insulin, a hormone produced by our body in the pancreas, takes blood sugar into the cells where it can then be used as energy we need. This process normally keeps the blood sugar levels from going to high or too low.

Prediabetes is a condition in which the blood glucose levels are higher than normal but not high enough to meet the criteria for diabetes. Each year, about 1 in 10 people who have prediabetes go on to develop Type 2 diabetes. Having prediabetes increases your risk of heart disease and stroke.

Who is at risk for developing prediabetes?

• Age 45 or older
• Being overweight or obese
• Not getting enough exercise
• Being of African American, Latino/Hispanic, or American Indian background
• Having had gestational diabetes or giving birth to a baby weighing more than 9 pounds
• Women diagnosed with polycystic ovarian syndrome
• Having hypertension or taking medications for hypertension
• Having a low HDL cholesterol and/or a high triglyceride level
• Having a family history of type 2 diabetes

How do you know if you have prediabetes?

Prediabetes has no signs or symptoms. Three blood tests can check for abnormal blood glucose levels in the blood. A fasting blood glucose level is a glucose level checked after you have been fasting overnight or for at least 8 hours. An oral glucose tolerance test is a test in which you fast for 8 hours, a blood level is drawn, then you are given a sugary drink and a blood level is checked again 2 hours later. A third test is a hemoglobin A1c. This test gives you a three month average of your blood sugar levels. Your primary care provider can best evaluate if you are at risk for or have prediabetes.

How can you prevent or manage prediabetes?

Prevention and management of prediabetes both involve making healthy lifestyle changes. Eating a healthy, balanced diet high in whole grains, fruits and vegetables can help. Exercising for 30 minutes up to 5 times a week will increase physical activity to help the body use blood sugar better. Studies show if you are overweight or obese, a weight loss of 5-10% will help lower your chance of developing type 2 diabetes. Medications may be prescribed for prediabetes in an effort to help prevent progression to type 2 diabetes.

Diabetes is a condition in which there is too much glucose (sugar) in the blood. Insulin, a hormone produced by our body in the pancreas, takes blood sugar into the cells where it can then be used as energy we need. This process normally keeps the blood sugar levels from going too high or too low. 

In Type 2 diabetes, the body does not respond to insulin as well as it should, so the pancreas initially tries to produce more insulin. Over time, the cells that produce insulin cannot keep up with the demand and the blood sugar levels go too high.

Who is at risk for developing Type 2 Diabetes?

• Age 45 or older
• Being overweight or obese
• Not getting enough exercise
• Being of African American, Latino/Hispanic, or American Indian background
• Having had gestational diabetes or giving birth to a baby weighing more than 9 pounds
• Having hypertension or taking medications for hypertension
• Having a low HDL cholesterol and/or a high triglyceride level
• Having a family history of type 2 diabetes
• History of having elevated blood sugar or prediabetes

How do you know if you have Type 2 Diabetes?

Some people with Type 2 diabetes have symptoms so mild that they go undetected for a period of time. The most common symptoms of Type 2 diabetes are:

• Frequent urination
• Increased thirst
• Increased hunger
• Unexplained weight loss
• Blurry vision
• Fatigue, feeling tired
• If you experience these symptoms, contact your primary care provider, who can order blood tests to diagnose Type 2 diabetes.

How can you prevent or manage Type 2 Diabetes?

Prevention and management of Type 2 diabetes both involve making healthy lifestyle changes. Eating a healthy, balanced diet high in whole grains, fruits and vegetables can help. Exercising for 30 minutes up to 5 times a week will increase physical activity to help the body use blood sugar better. Oral medications prescribed for Type 2 diabetes work in several different ways to help bring blood sugars into range. Some people may need insulin for Type 2 diabetes if their cells no longer produce enough insulin. Others may need a combination of insulin and oral agents to control the blood sugars.

Diabetes is a condition in which there is too much glucose (sugar) in the blood. Insulin, a hormone produced by our body in the pancreas, takes blood sugar into the cells where it can then be used as energy we need. This process normally keeps the blood sugar levels from going too high or too low.

Type 1 diabetes is a condition in which the pancreas produces little or no insulin. When there is not enough insulin, the blood sugar levels go too high. Type 1 diabetes is often called insulin dependent diabetes or juvenile diabetes because it occurs more frequently in children and young adults.

Causes of Type 1 Diabetes

The causes of Type 1 diabetes are not fully understood. In most people with diabetes, the body’s immune system attacks the cells in the pancreas that produce insulin and the cells no longer work. This is called an “autoimmune disease”. People with other autoimmune conditions such as Hashimoto’s disease or Addison’s disease have an increased risk of developing Type 1 diabetes. In 10-15% of people with Type 1 diabetes, there is a family history of the disease.

How do you know if you have Type 1 diabetes?

If you or your child have the following symptoms, you should contact with your primary care provider as soon as possible.

• Frequent urination
• Increased thirst
• Increased hunger
• Unexplained weight loss
• Blurry vision
• Fatigue, feeling tired

Your primary care provider can order blood tests to diagnose Type 1 diabetes.

How can you manage Type 1 diabetes?

With Type 1 diabetes, insulin is needed for a person’s lifetime because the pancreas no longer makes enough insulin or produces no insulin at all. Type 1 diabetes is a condition that you must manage daily by balancing medication (insulin), food and exercise.

Making an appointment for diabetes education is essential when an adult or child is newly diagnosed with diabetes. A diabetes education team will provide you with the education and tools you need to best manage you or your child’s blood sugar levels. Education on insulin, blood sugar testing, ketone testing, meal planning, exercise and coping will help prevent long-term complications by keeping blood sugar readings within target range.

Gestational diabetes is diabetes that occurs during pregnancy. During pregnancy, the placenta produces hormones that help the baby grow & develop. These hormones also block the effects of insulin in the woman’s body, increasing her blood glucose levels. The increased blood sugar levels in the mother’s body can result in:

• Premature delivery
• Pregnancy-induced high blood pressure
• Preterm birth (baby born before 37 weeks)
• Delivery of a large baby ( > 9 lbs) which can cause the baby to have birth injuries or need a C-section
• Stillbirth
• After birth- low blood sugar in the baby
• Baby has increased risk of being overweight or having obesity later in life

Our care team has years of experience in helping women with gestational diabetes. We will provide you with the education you need to help manage your blood sugar levels during your pregnancy and will monitor your progress closely.

What to expect

We will work with your obstetrician closely to care for you throughout your pregnancy. You will meet with our registered dietitian who will provide you with education on use of the blood glucose meter, how to check ketone levels, how to record the information and how to send the information to us for review once a week. We will provide you with meal planning education specific to your needs.

You will also be scheduled to meet with the nurse practitioner for a medical visit. If you need a medication to manage the blood sugars, the nurse practitioner will adjust the medication and monitor this. You will see the nurse practitioner every two through six weeks depending on how your blood glucose control is doing.

Your blood sugar control may change throughout the pregnancy therefore it is important to keep in close contact with our office if there are any problems or if you have questions. We expect our patients to send blood glucose/ketone results at least once a week or sooner if problems.

At six to eight weeks after you deliver, we will have you repeat an oral glucose tolerance test (oGTT) to see if you have developed diabetes. The nurse practitioner will see you 6 weeks after you deliver and review the results of the oGTT with you.

Our Diabetes Self-Management & Education program is Certified by the American Diabetes Association. Most insurance plans, including Medicare, will pay for most or all of the cost of the classes with a physician referral. Class members are encouraged to bring a family member or support person with them to any of the classes.

Who may participate?

Anyone with a diabetes diagnosis is eligible for these programs. Before attending class, you should first meet with the Registered Dietitian to develop an individualized meal plan, assess your knowledge of diabetes and set goals for your education.

This is an 8 hour program that meets two hours a week for four weeks. It is held four times a year. Topics covered include: 

• Overview of diabetes Meal planning
• Low blood sugar High blood sugar
• Blood glucose monitoring Managing Sick Days
• Preventing Complications Medications and Side Effects
• Exercise Stress management
• Coping Skills Goal Setting

Diagnostic Continuous Glucose Monitoring

Your health care provider may refer you to wear a continuous glucose monitor (CGM). When you are scheduled for this, a tiny, disposable sensor is inserted under the skin. There, the sensor is able to measure the glucose or sugar level in the fluid between cells every few minutes. A small recorder attaches to the sensor and sits on top of the skin. It records and stores all of the glucose readings for several days.

You will wear the glucose monitor for several days while keeping a record of blood glucose meter readings, meals, exercise and medications. After wearing the sensor for a set number of days, you will return to the clinic for removal of the sensor. Reports will be printed from your sensor information. You will be given a copy of reports and a nurse practitioner experienced in interpreting these reports will review the reports with you and can help you or your provider make changes to your diabetes management plan to improve your glucose control.

Wearing the continuous glucose monitor can help people better understand the trends in their glucose levels.

CGM is not right for every person with diabetes and insurance coverage varies.