John and Marnie Nicholson own a flower shop. Mr. Nicholson is working hard to control his diabetes.

John Nicholson is a 71-year-old Washington, DC resident and retired journalist who now owns a flower shop with his wife Marnie. He has managed his diabetes with daily insulin injections for the past 25 years, but he admits that until recently, he pretty much ate what he wanted. "I slowly gained weight while allowing my blood sugar level to hover around 150 mg/dl, even though it should have been below 100 mg/dl," he said.

His lifestyle took a toll, impairing his eyesight, kidneys and perhaps most alarmingly, his heart. In the last 10 years, he has had two heart attacks. He realized he needed help. Fortunately, the physicians at The GW Medical Faculty Associates Diabetes Center have been providing Mr. Nicholson with expert care and support.

"Whether you've been newly diagnosed with diabetes, or, like Mr. Nicholson, you've been working with your primary care physician for years to control your diabetes, the Center can help," says Joshua L. Cohen, MD, Director of the Center and Associate Professor of Medicine in the Division of Endocrinology and Metabolism. "Our core team includes endocrinologists, nurse practitioners, physician assistants, diabetes educators, dietitians and podiatrists, all focused on diabetes management," he says. "We provide a multitude of services and resources, including helping patients with persistently high blood sugar get their levels under control and teaching in-depth classes on how to integrate diabetes management into daily life."

Joshua L. Cohen, MD Director, GW Medical Faculty Associates Diabetes Center Roy H. Leiboff, MD Co-Director, Cardiac Catheterization Laboratory

Diabetes and Your Heart
The link between diabetes and heart disease has long been known, but it is not fully understood, according to cardiologist Roy H. Leiboff, MD, Co-Director of the Cardiac Catheterization Laboratory. "People with diabetes are predisposed to atherosclerosis [plaque buildup in the arteries] and tend to have abnormal levels of lipids [fats] in their blood, but we don't know why," he says.

People with diabetes also display fewer symptoms of major cardiac events, including heart attacks, and the reason for this is clearer. "Diabetes damages the nervous system, causing a loss of sensation throughout the body," Dr. Leiboff notes. "Therefore, a person with diabetes might experience a heart attack as profound weakness, nausea or vomiting, instead of more typical chest or shoulder pain."

"Even if diabetes is your only risk factor, your primary care physician should screen you for cardiovascular disease using yearly cardiac stress and blood tests," Dr. Leiboff says. "If heart disease is suspected, you might need to see a cardiologist for an in-depth imaging exam, such as a CT angiogram, which provides a clear picture of the heart and blood vessels."

Dr. Cohen agrees that early intensive treatment to reduce the risk of complications from diabetes, as well as coordinated management of the many possible complications, is key. "In addition to the core diabetes treatment team, the Center offers access to a range of other physicians, including cardiologists, ophthalmologists and kidney specialists," he says. "Together, we provide multidisciplinary, comprehensive care."

Mr. Nicholson says he is finally getting his diabetes under control as a result of the close supervision he receives at the Center. He is participating in a research trial for diabetes-related kidney disease, and he is taking a new diabetes medication that increases the effectiveness of his insulin injections and helps to manage his appetite. The result? In the last six months, he lost 40 pounds and has kept his blood sugar levels below 120 mg/dl. Mr. Nicholson is living proof that it is never too late to take control of diabetes.

Types of Diabetes
Type 1 diabetes
occurs when the pancreas is unable to produce insulin, a hormone that controls glucose levels in the blood and regulates carbohydrate, protein and fat metabolism. It most often begins during childhood, adolescence or in young adulthood.

Type 2 diabetes
occurs when the body's normal responses to insulin are impaired (insulin resistance), and insulin production is reduced. About 90% to 95% of people with diabetes are type 2, which generally develops in adults. Obesity is an important factor underlying development of type 2 diabetes. Traditionally, type 2 diabetes was rare in children and adolescents. However, in recent years, as obesity has increased, type 2 diabetes is becoming more common in young adults, adolescents and even children.

Gestational diabetes
occurs in pregnancy and usually resolves after a woman gives birth. About 2% to 5% of all pregnant women develop gestational diabetes. Most pregnant women are screened for gestational diabetes during their second or third trimesters. Uncontrolled gestational diabetes increases risks for both baby and mother. Women with a history of gestational diabetes are at greater risk for subsequently developing type 2 diabetes.

When You Have Type 2 Diabetes

Illustration ŠKrames. All rights reserved.

Early in type 2 diabetes, your cells don't respond properly to insulin. Because of this, less glucose than normal moves into cells. This is called insulin resistance. In response, the pancreas makes more insulin. But eventually, the pancreas can't produce enough insulin to overcome insulin resistance. As less and less glucose enters cells, it builds up to a harmful level in the bloodstream. This is known as high blood sugar or hyperglycemia. This result is type 2 diabetes. The cells become starved for energy, which can leave you feeling tired and rundown.

Services at The Diabetes Center
According to the American Diabetes Association, diabetes is the fifth-deadliest disease in the U.S. and it can have serious complications, including heart disease, blindness and kidney failure.

Although diabetes cannot be cured as yet, it can be controlled. The GW Diabetes Center offers the following services:

• Comprehensive evaluation and treatment of diabetes and its complications
• Diabetes education including individual counseling and group classes
• Diabetic foot care including care for acute foot complications, preventive care, orthotics and corrective surgery
• Nutritional counseling
• Management of diabetes in pregnancy (including pre-existing and gestational diabetes)
• Insulin pump therapy
• Clinical research trials

Do you need help managing your diabetes?
To take advantage of the comprehensive services at the Diabetes Center, please call 202-741-3333. For an appointment with a cardiologist, please call 1-888-4GW-DOCS.

900 23rd St., NW, Washington, DC 20037 (202) 715-4000