Diabetes, Endocrinology and Metabolism Treatment Programs

Treatment options and approaches for diabetes and endocrinology are more plentiful than ever.  Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
 
Continuous Glucose Monitoring (CGM)
Monitoring blood glucose over several days can help determine and individual’s blood glucose patterns and trends.  Your diabetologist may determine that placing you on a short term continuous glucose monitor will provide information that can be used to better manage your diabetes.

Continuous glucose monitoring device (CGM) is an FDA-approved system that records blood glucose levels throughout the day and night. It can provide up to 288 blood glucose measurements in a period of 24 hours. The system is used to monitor blood glucose changes through a given period of time, while the person with diabetes continues daily activities. The major advantage of CGM is to identify fluctuations and trends that would otherwise go unnoticed with intermittent finger stick measurements, especially blood glucose levels during sleep or first thing in the morning.

A small glucose-sensing device called a "sensor" will be inserted under the skin of abdomen. Tape is used to hold it in place. The blood glucose readings will be transmitted to an external receiver capable of graphing and trending your glucose readings.  However, at least  two finger stick blood glucose readings taken with a standard glucose meter every 12 hours are required for calibration and safety.

For the short-term use of CGM, there are up to four visits included in the program:
  • Initial consultation with a diabetologist to define the goal, need, and expectations of CGM
  • Placement of CGM sensor and instructions provided by a certified diabetes educator
  • Removal of CGM and download of readings provided by a certified diabetes educator
  • Follow-up visit with a diabetologist for data interpretation and adjustment of diabetes regimen
 
Insulin Therapy
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes.  Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. Now, recombinant human insulin is the standard treatment, and may be administered in several ways, such as:
 
Daily injections
Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
 
Insulin infusion
In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
 
Insulin Pump Therapy
City of Hope offers a comprehensive insulin pump program for patients interested in insulin pump therapy.  Our team of very dedicated health care professionals with extensive experience in both adult and pediatric insulin pump therapy are here to help you determine if insulin pump therapy is right for you.
 
An insulin pump is an FDA-approved device used as an alternative method of insulin delivery that provides a much smoother insulin profile with some flexibility to meet individual needs, and can be used in patients with both type 1 and type 2 diabetes as well as diabetes from other causes, such as total removal of the pancreas for various reasons.  Patients with a very strong motivation in improving glycemic control, diligent in their daily management, and a capacity and willingness for frequent blood glucose testing are best suited for using the insulin pump.  In order to master the skills for insulin pump therapy, you must be confident and compliant with your diabetes self-care skills on a daily basis. Furthermore, the eligibility of insulin pump is highly variable depending upon insurance policies.
 
At City of Hope, the diabetologist will meet with you in consultation before entering the insulin pump program to decide if insulin pump therapy is the best treatment to meet your personal needs and goals.  If you decide that insulin pump therapy is for you, you will begin the three step process.
 
Step One: Pre-pump Assessment and Counseling
To be successful with insulin pump therapy, we emphasize these pre-requisitions that are required before initiation of insulin pump therapy:
  • Assessing your general knowledge of diabetes
  • Education on the benefits and risks of using an insulin pump
  • Discussing how the insulin pump will change your life, and the lives of your significant others
  • Determine your ability to meet the demands of pump therapy, financially, physically, and psychologically
  • Assessment of your ability to handle situations such as hypoglycemia, hyperglycemia, exercising with the insulin pump, temporary pump removal, and sick days, as well as any dietary changes
  • Instructing you on how to make insulin dose adjustments based on prevailing blood glucose, carbohydrate intake, and anticipated activity
Once you have completed the pre-pump assessment and counseling, we will help you obtain your insulin pump through your insurance plan, if eligible.
 
Step Two: Initiation of Insulin Pump Training
You will be trained by an insulin pump nurse, who is specialized in the type of insulin pump recommended by the team and chosen by you, for pump operation, catheter insertion, and daily care of your insulin pump. Then, you will meet with a certified diabetes educator to ensure the competency of insulin pump operation and to determine the daily insulin requirement. Insulin pump therapy will be started after your visit with an experienced diabetologist to determine the initial insulin pump setting.

Step Three: Insulin Pump Therapy Optimization
After initiation of insulin pump therapy, intense blood glucose monitoring, up to 6 to 12 times a day, is required.  Intense telephone follow-up for fine tuning of your insulin regimen with the members of the insulin pump program is essential to ensure a successful insulin pump therapy.  In addition, we recommend weekly follow-up visits with the certified diabetes educators and diabetologists for the first few months. We will provide 24-hour access and frequent phone contact after starting and using the insulin pump.  We will continue to provide this support depending on your individual need.
 
Male and Female Sexual Dysfunction (primary and secondary)
  • Management of male and female sexual dysfunction in premature gonadal/ovarian failure patients
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 
Neuroendocrine Tumors (carcinoids, pancreatic endocrine tumors, etc.)
These tumors present a significant challenge both at diagnosis and in treatment. Research efforts include:
  • Advancing the management of neuroendocrine tumors with the use of radioactive iodine MIBG
 
Non-Endocrine Cancers
  • Investigation of endocrine complications as a result of chemotherapy, radiation therapy and bone marrow transplant in cancer patients.
  • Management of immunosuppressive therapy-related endocrine complications.
  • Development of clinical practice guidelines for the management of hypothalamic-pituitary endocrine complications after bone marrow transplant.
  • Aggressive prevention and treatment of bone marrow transplant osteoporosis in both men and women.
 
Thyroid Cancer
After thyroid cancer surgery, standard treatment consists of radioiodine to ablate residual tumor cells.  However, we have been exploring methods of augmenting or supplanting this therapy. Initiatives include:
  • Continued clinical research in thyroid cancer exploring new diagnostic and therapeutic alternatives to radioactive iodine therapy
  • Providing compassionate use of recombinant human thyroid stimulating hormone (Thyrogen) for thyroid cancer therapy
 
 
For more information, please contact us at 626-256-HOPE (4673), ext. 62251.