Diabetes Month with Rachel Francis, PA-C.

November is American Diabetes Month and we heard from Primary Care Provider Rachel Francis, PA-C. about diabetes prevention and risks.

If you're at risk for diabetes, talk to your SIMEDHealth primary care provider, or make an appointment here.


1.) What is the difference between type 1 and type 2 diabetes? 

The most common types of diabetes you hear about are Type 1 and Type 2.  In Type 1 diabetes a person's body becomes unable to produce enough of its own insulin. Since insulin is required to process the body's blood sugar (glucose), this leads to high levels of sugar circulating in the bloodstream.  In type 2 diabetes, the body is able to produce some or all of the insulin it needs; however the cells within the body are resistant to the insulin and therefore are unable to use it effectively. 


2.) Who is most at risk for type 2 diabetes? 

Although diabetes is present across all patient populations, the risk is higher in some more so than others. There is higher risk amongst those who are obese, live sedentary lifestyles, with strong family histories of diabetes, and who had elevated blood sugar problems during pregnancy (gestational diabetes).  Also, those who have chronic mildly elevated blood sugars otherwise known as "pre-diabetes," are at higher risk of progressing to Type 2 diabetes, as well as certain ethnicities. 


3.) What are some things a person can do to prevent development of diabetes? 

Although one cannot change certain risk factors like family history, age or ethnicity; there are things you can do to help reduce the likelihood of developing diabetes or possibly prevent it all together! Take action by improving your lifestyle habits such as eating a healthy diet, getting regular physical exercise, and getting regular preventative checks with your health care provider. 


4.) Why is it important to treat diabetes early? 

You might be wondering, "Why should I be concerned about my blood sugar? I feel fine!" In the early stages of type 2 diabetes, there may be few or no symptoms. However, over time high levels of blood sugar, either from Type1 or 2, can cause damage to small blood vessels in the eyes, kidneys, brain, and heart; eventually leading to complications like stroke, heart attack, neuropathy, kidney failure, loss of vision, and loss of arterial circulation leading to higher risk of wounds and amputations.  Early control of elevated blood sugar slows the progression and even prevents some of these complications. Talk to your healthcare provider about what is best for you. 



SIMEDHealth Contributes to Improved Diabetes Care for More than 1 Million People

On Monday, January 13th, SIMEDHealth announced that we contributed to improved diabetes care for more than 1 million people through our involvement in AMGA’s national diabetes campaign, Together 2 Goal®. As a participating group, SIMEDHealth helped this initiative exceed its goal of 1 million lives improved.

Over the past three years, we implemented best practices identified by Together 2 Goal® (called “campaign planks”) to improve the quality of diabetes care we deliver to our patients. 
“Our participation in the Together 2 Goal® campaign has further driven SIMEDHealth’s efforts towards providing the areas highest quality healthcare. Diabetes is associated with multiple adverse health outcomes, and these complications are mostly preventable with adequate care. Our ability to compare our patients’ data with the other participating groups throughout the country has resulted in measurable improvement in our patients’ outcomes.” Said Dr. Daniel Duncanson, CEO of SIMEDHealth.

Dr. Gregory Geiger, Population Health Medical Director for SIMEDHealth, reports “over 90% of our patients with Type 2 Diabetes Mellitus have their blood pressure under good control. This will greatly reduce the risk of complications from diabetes for many years to come. We also know our patients are some of the best taken care of in the country when compared to others that have good diabetes control, blood pressure control, cholesterol management, and screening for kidney complications.”

Launched in 2016, Together 2 Goal® challenged leading healthcare organizations to work together to transform diabetes care for Americans across the country. To date, more than 150 medical groups and health systems have joined the effort and improved outcomes for their patient populations, resulting in more people with safer ranges for critical diabetes measures, like blood sugar and blood pressure.

“Thanks to the commitment of groups like SIMEDHealth, we were able to achieve a remarkable goal,” said John Kennedy, M.D., AMGA chief medical officer, and AMGA Foundation president. SIMEDHealth has helped us move the needle in combatting one of the nation’s most pressing chronic conditions.”
Originally scheduled to conclude in 2019, the Together 2 Goal® campaign announced in April that it would extend the initiative to run through March 2021. SIMEDHealth will use this additional time to refine and hardwire care process improvements.

Diabetes Symptoms, Treatment, and Prevention

Diabetes fact with woman holding hands up like a question

More than 1 in every 10 adults 20 years and older have diabetes. Unfortunately, about one-fourth of adults with diabetes go undiagnosed. Learn the symptoms, risk factors, and treatment for diabetes and find out how you can prevent it with SIMED Primary Care Dr. Timothy Elder on World Diabetes Day (Nov. 14).

What is Diabetes?

Diabetes is a disease you can get when your blood glucose level is too high. The person has above normal blood sugar levels and might have difficulty managing their blood glucose levels.

There are two types of diabetes: Type 1 and Type 2. Type 1 diabetes is typically an insulin dependent diabetes and usually has a younger onset. Type 2 diabetes is more common and usually diagnosed in adulthood. We will be focusing on Type 2 diabetes.

What are the common symptoms of Type 2 diabetes?

The most common symptom Dr. Elder sees is fatigue or people coming in and saying they’re “just not feeling right.” A lot of people feel poorly and can’t explain why.

Other symptoms called the 3Ps include:

1. Polydipsia – increased thirst and fluid intake
2. Polyphagia – increased appetite
3. Polyuria – the need to urinate frequently

People might think they’re urinating a lot because they’re drinking more, but usually both happen as a result of diabetes. When the blood stream has too much glucose, the glucose can spill into the urine. To balance it out, the body will add more water to the urine. As a result, the person then needs to urinate more and feels more dehydrated.

How can I prevent or regulate diabetes?Infographic 5 common symptoms of type 2 diabetes

People can prevent Type 2 diabetes by:

1. Improving their diet and eating a low carb diet

Eating a low carb diet is one of the biggest issues. People with diabetes potential or who have diabetes should avoid foods that break down easily into simple sugars. When the carbs break down, they add to the sugar problem that already exists. 

2. Exercising

You can do any prolonged endurance cardio exercise. Current guidelines recommend at least 150 minutes of exercise a week which ends up being about 30 minutes a day. If you have decreased activity, you could develop acute metabolic syndrome which increases your risk of heart disease, stroke, and diabetes.

Something as simple as fast walking can be very good exercise. Your muscles will actually take sugar out of your bloodstream and won’t need insulin to do that. Your biggest muscles are your glutes and your thighs; if you’re walking, you’re making those muscles work and using up excess the sugar in your body.

3.Maintaining an ideal body weight

Fat affects your insulin’s ability to work as it should. With less fat, your insulin should work better.

What are the risk factors for Type 2 diabetes?

People usually get Type 2 diabetes as a result of lifestyle choices, and Type 2 diabetes can usually be prevented by changes in diet and exercise. More people are getting diabetes at a younger age because of the obesity epidemic in the United States.

Risk factors include:

  • Being overweight
  • Family history with diabetes
  • High blood pressure
  • Sedentary lifestyle
  • High cholesterol

What should I do if I think I have diabetes?

If you’re showing signs of diabetes, you should let your doctor know. Your doctor might do a basic glucose test or a urine dipstick to see if there is glucose in your body. The tests are easy, quick, and affordable. You can get them done right in the office.

What happens if I’m diagnosed?

When you’re first diagnosed, you’ll usually do baseline labs to make sure your kidneys are functioning well and can tolerate the medicines you’d need to start. You might also get another lab done called the hemoglobin A1C test which we consider a vital sign for diabetes. This lab test can tell us the average glucose level over the past three months.

You’ll also receive basic diabetes education from your SIMED doctor. The doctor will set you up so you can do your own glucose level tests at home. You will usually then be started on basic medicine. You will need to visit your physician to try to make your goal and keep your hemoglobin A1C at less than 7 percent. At SIMED, we typically see a patient back as soon as a few weeks after being diagnosed to review how the patient is adjusting and address new questions they’ll have accumulated since the initial visit.

What is a good glucose level?

A normal glucose level is between 80 and 100. Usually, diabetes is diagnosed with a hemoglobin A1C. In that situation, if the person’s level is over 6.5%, they can be diagnosed with diabetes.

What medication will I need to take when I’m diagnosed?

Usually you will start off taking oral medication. The medication amount depends on your glucose level. The biggest fear patients have is that they’ll have to be on insulin, but initially that’s not usually the case. The oral medications currently available work very well, and if people make appropriate diet and lifestyle changes, they may never need to be on insulin. Some oral medications are generic, and one of them is actually free at a lot of drug stores.

If I’m diagnosed, can I eventually get rid of the disease?

While you can’t entirely remove the disease, it can go into remission if you control your glucose levels with weight loss, lifestyle modifications, diet, and exercise. A few patients of Dr. Elder have been successful at keeping their diabetes in remission.

What happens if I don’t regulate my diabetes?

Left untreated or unmanaged, people with diabetes can have increased risk for heart disease, stroke, blocked arteries in the legs, nerve damage in the hands/legs which limits sensation or causes burning pain, and damage to the retina causing vision loss. Untreated diabetics can also develop damage to their kidneys leading to the need for dialysis. It’s best to get tested and start treating the diabetes if you show symptoms.

What else should I know if I have diabetes?

If you have diabetes, you should see your doctor every 3 months or as recommended. Also, make sure you are up to date on your vaccines.

If you believe you might have diabetes, visit a SIMED Primary Care doctor today in Gainesville, Ocala, Chiefland, Lady Lake, or McIntosh to get tested. You can call 352-224-2225 or request an appointment online.To schedule an appointment with Dr. Elder in Gainesville, call 352-372-8202 or fill out an appointment form online.

Read More: Healthy Eating Tips with a diabetes diet
Read More: Cooking Hacks for a Healthy Heart  with recipe resources for diabetics
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Dr. Cuesta to Present on Foot Care at Diabetes Support Group

Foot with Pain from Diabetes Complications

If you live in the Gainesville area and you or someone you know has diabetes, we invite you to attend a presentation on the diabetic foot.

SIMED Dr. Angel Cuesta will be presenting at the Diabetes Support Group meeting Thursday July 20, 2017. His presentation "The Diabetic Foot: Care and Complications" will focus on maintaining a healthy foot as a diabetic and common problems that might occur.

The meeting is scheduled to take place from 6:00 PM to 7:00 PM at the Medical Arts Building, Suite 104, 6400 Newberry Road, Gainesville. The event is free, and no registration is needed.

For the presentation, SIMED partnered with North Florida Regional Healthcare and the American Diabetes Assocation.

Dr. Cuesta is a podiatrist at the SIMED Foot Center. He is on the American Board of Podiatric Surgery. To schedule an appointment with Dr. Cuesta, call 352-331-3077 or request an appointment online.

Dr. Angel Cuesta presents at the Gainesville Diabetes Support Group on Diabetic Foot Care