Reducing Risks From Diabetes

April 15, 2009
By Dr. Jennifer Loh

Dr. Jennifer Loh
Endocrinologist

Interviewed By Melissa Moniz

Where did you receive your schooling and training?

I grew up in Honolulu and attended Punahou School. I went to college at University of Pennsylvania and medical school at George Washington University. I did my internship and residency in internal medicine at Hospital of the

University of Pennsylvania, where I also completed a chief residency in internal medicine . My fellowship training was at Georgetown University and Washington Hospital Center.

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What exactly is an endocrinologist?

An endocrinologist diagnoses and treats hormonal disorders. We take care of a wide variety of illnesses, including diabetes, thyroid, pituitary, bone and adrenal disorders.

Do you have an area of specialty?

I’ve always been interested in thyroid disorders and diabetes. I enjoy working with diabetes patients because it’s satisfying to educate and help them deal with a chronic disease. And I enjoy treating thyroid disorders because many are curable. Here in Hawaii, a lot of people have endocrine problems.

What are some of the problems you see associated with diabetes?

Patients who have had diabetes for many years are at risk for problems like retinopathy (eye problems), kidney failure, neuropathy (nerve problems), heart attacks and strokes. If diabetes is poorly controlled for several years, patients can ultimately become blind, need dialysis for kidney failure, or need an amputation due to foot infections.

How can patients reduce their risks?

The good news is that patients can slow or prevent many of these complications. The main way to reduce risk is for patients to have good control of their diabetes by trying to keep blood sugars at normal levels. Some of the ways they can do that are by eating a healthy diet, exercising regularly, maintaining a healthy weight, checking blood sugars daily, and making sure their hemoglobin A1c is measured every three to six months. Other ways to decrease the chance of heart attacks and strokes are to maintain a normal blood pressure, and lower cholesterol levels through diet and medications. It’s also helpful for some patients with diabetes to be on a daily baby aspirin.

You mentioned foot problems. Can you discuss prevention?

There are several things people with diabetes can do to prevent foot problems. The first thing is to maintain blood-sugar levels in the normal range. High blood-sugar levels can damage blood vessels, which leads to decreased circulation to the feet. When there is poor circulation, infections do not heal as effectively. Also, high blood-sugar levels can damage nerves in the foot, so patients might not be able to feel or sense cuts or early wounds. These patients can be more prone to developing calluses or foot deformities that make ulcers more likely.

It is also very important for patients with diabetes to inspect their feet daily for any skin breaks, cuts, swelling or redness. Any problems should be reported to their doctor so treatment can be started early. This helps prevent the spread of infection or the development of gangrene.

There also are a few simple things people can do to prevent foot complications, such as avoiding walking barefoot, especially outside. Patients should have their toenails trimmed to the shape of their toe and filed to remove sharp edges. Avoid tight shoes that can rub and create blisters and ulcers. Patients should wash their feet daily and use a moisturizing cream on dry skin. It is also very important to avoid smoking, as smoking can damage blood vessels and impair circulation to the feet.

Finally patients should have a comprehensive foot exam performed annually by their doctor.

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Do you find that a lot of patients don’t follow the plan adequately, even knowing the risks involved?

Yes. It can be difficult for anyone to live with a chronic disease such as diabetes. I think part of the problem may be that many people do not feel sick when their sugars are running slightly high, just like how many people feel fine even if their blood pressure is high. That’s why it is so important for patients with diabetes to know that even though they may feel well from day to day, it is still very important to try to aim for normal sugar levels to prevent the complications from diabetes from happening down the road.

For more information on diabetes and foot health, visit: www.kp.org/foothealth.