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Target: Diabetes

NorthShore Offers Comprehensive Care and Expertise from All Angles

Angela Jordan-Patton

Angela Jordan-Patton was shocked to learn she had Type 2 diabetes, which is now under control thanks to lifestyle changes and bariatric surgery at NorthShore.

Foot Care: A Critical Component of Diabetes Treatment

Diabetes is the leading cause of non-traumatic limb amputations in the United States. People with the disease are at higher risk for developing foot complications because of the effect that diabetes may have on nerves and small blood vessels in the lower extremities. Common foot problems that rarely pose a long-term threat to the average individual, such as corns, calluses, bunions and hammertoes, may take on much greater significance in the patient who is diabetic. At NorthShore, podiatrists offer comprehensive evaluation and care to prevent serious foot complications, including amputation.

“We’ve saved toes, feet, legs and, ultimately, lives through our multidisciplinary approach to care,” said NorthShore-affiliated podiatrist Michael Weisman, DPM. “The success rate is the result of patient education, awareness and advanced technologies.”

The American Diabetes Association recommends comprehensive foot care with a podiatrist annually. Podiatrists help patients identify symptoms that could lead to more serious problems, including redness, swelling and non-healing wounds. Working with infectious disease specialists, vascular experts, endocrinologists and primary care physicians, podiatrists can help prevent complications through early intervention.

At 5’9” and 260 pounds, Chicagoan Angela Jordan-Patton, 48, knew she was overweight, but otherwise considered herself healthy. Struggling with the weight she had gained during and after her pregnancy, Jordan-Patton was determined to do something about it. She began to investigate bariatric surgery at NorthShore and met with surgeon Woody Denham, MD. He referred Jordan-Patton to her primary care physician for medical testing, which indicated that she had prediabetes and high blood pressure.

“It was a shock!” Jordan-Patton recalled. Type 2 diabetes, a progressive, lifelong disease, occurs either when the body doesn’t produce enough insulin or when its cells can't use insulin properly. The body needs insulin to convert blood sugar—glucose—to fuel cells for energy. When insulin can’t do its job, cells don’t get the energy they need and too much sugar builds up in the blood. This can cause complications that affect the eyes, heart, blood vessels, nerves and kidneys. Approximately 79 million adults over age 20 in the United States have prediabetes. According to the American Diabetes Association (ADA), 26 million adults over the age of 20, or 11 percent of all people in this age group, have diabetes.

Jordan-Patton’s physician referred her to NorthShore’s ADA-recognized Diabetes Education Center. The Center offers a full range of care at multiple locations. Its 11 registered dietitians and registered nurses are “certified diabetes educators” who provide critical education and support to help patients manage their condition and improve their health.

The NorthShore Diabetes Education Center is often the first step for patients to learn more about monitoring blood glucose, using blood glucose meters, taking medications, and creating a meal plan designed to control calories and carbohydrates. Patients must be referred by their physicians, who collaborate with the Center’s staff to offer comprehensive diabetes management.

“The Center helps patients become empowered,” said Mary Bennett, RD, CDE, Manager, Diabetes Education. “Once they know how to cope with diabetes, they can lead happy, healthy lives.” By changing their diet and physical activity, the Center’s patients shed excess weight and put their diabetes into remission. After visiting the Center, Jordan-Patton lost weight and lowered her blood sugar.

For patients needing inpatient care, NorthShore Evanston Hospital is one of only three hospitals in Illinois with The Joint Commission’s Certificate of Distinction for Inpatient Diabetes Care. This recognizes excellence in medication management, and protocols for monitoring and controlling diabetes.

Bariatric Surgery—A Viable Option for Diabetes Management

Some patients diagnosed with diabetes or prediabetes, like Jordan-Patton, also pursue bariatric—or gastric bypass—surgery to lose excess weight. This advanced surgical procedure is designed to promote weight loss and reduce complications associated with morbid obesity, including diabetes.

“Our comprehensive program has been accredited by the American College of Surgeons as a Bariatric Center of Excellence,” said Dr. Denham, who holds an academic appointment at the University of Chicago Pritzker School of Medicine.

To undergo gastric bypass surgery, patients must be approximately 100 pounds overweight with a body mass index (BMI) greater than 40. Those with diabetes, high blood pressure or severe sleep apnea may qualify if they are 75 pounds overweight and their BMI is 35. Patients receive counseling for diet and exercise, and a psychological evaluation. They also work both before and after surgery with a bariatric nurse for a supervised medical weight-loss program and follow-up.

Focus on Eye Care

Diabetic retinopathy is a leading cause of blindness in American adults. It is the most common form of diabetic eye disease and is caused from damage to the blood vessels inside the eye. Early diagnosis, prompt intervention, state-of-the-art treatments and research help NorthShore ophthalmologists provide comprehensive diabetic eye care for patients.

“We have better diagnostics and more treatment options than ever before,” said NorthShore ophthalmologist Manvi Maker, MD, who trained at Harvard’s Joslin Diabetes Center and specialized in diabetic eye disease. “The earlier we can intervene with patients, the more sight we can save.” Dr. Maker is the principal investigator on several clinical trials available at NorthShore through the Diabetic Retinopathy Clinical Research Network, funded by the National Eye Institute (NEI) and National Institutes of Health (NIH).

“My role is to support patients,” said Liz Farwell, RN, MS, APN-CNS, CBN, bariatric coordinator. “We’re establishing a lifetime relationship to help them be successful.”

Jordan-Patton lost the weight required of her before surgery. “People losing weight prior to surgery do better in the long term, and the surgery itself is also safer as a result,” said Dr. Denham.

During laparoscopic gastric bypass surgery, surgeons use minimally invasive techniques to create a smaller stomach about the size of an egg. The nature of the surgery requires that patients eat smaller amounts, which results in about 70 to 80 percent of their excess weight loss in the first year.

Jordan-Patton weighed 245 pounds the day of her surgery in December 2011, and now weighs 170 pounds. “There is no way I would ever let this fail,” she said. Her diabetes medications have been decreased, and her blood glucose levels are normal – both signs of improvements in her diabetes. NorthShoreConnect helps her manage her care by enabling her to check the results of her blood sugar tests online 24/7.

“When I see patients one year out, and they’re off their diabetes medication, enjoying time with their kids and family, that’s the rewarding part,” said Dr. Denham.

“Nothing can compare to how I feel now!” exclaimed Jordan-Patton, who received the award for “looking the most like she did in high school” at her recent 30th high school reunion.

NorthShore offers free informational sessions to patients interested in bariatric surgery. Sessions are held the third Tuesday of each month from 6 - 7 p.m. at the Medical Group Office Building at 501 N. Skokie Blvd. in Northbrook. Visit Bariatric Services for more information.