Endocrinology

Being told you have diabetes can be overwhelming, but the certified educators at Central Maine Healthcare are here to help you manage your condition with confidence. We’re here to help you live your healthiest life with:

• All the latest information on diabetes
• Guidance on blood glucose monitoring
• Lifestyle support, such as managing sick days, managing stress and psychological adjustments you might experience
• Help preventing complications, such as foot and vision problems
• Healthy eating and exercise plans, personalized to your tastes and activities

Hands-On Support for Every Step

You’ll first meet individually with one of our certified diabetes educators, so we can be sure you understand diabetes. We’ll assess your current lifestyle and show you how we think you can be even healthier. We’ll make sure you know how to set blood sugar goals, how to use your meter, when to test your blood and what to do when your blood sugar is too high or too low.

Get Answers from the Experts

We know you’ll have questions about managing your diabetes. You might be wondering, for instance:

• What can I order in a restaurant?
• I have my lab results—but what do they mean? What numbers should I be looking for?
• How much do I have to exercise?
• I have bad knees, and can’t walk long distances (or run at all). What are my exercise alternatives?
• Do I really have to count carbs every day?

Our skilled diabetes educators are always available to answer these and any other questions you may have.  We also have social workers on staff to help with financial, emotional or mental health needs. We can help you find resources and assistance right in your community. And every year, we offer a free Diabetes Fair, featuring vendors who can highlight the latest in diabetes management technology.

Self-Management Program

One of our most popular resources is the outpatient Diabetes Self-Management Program, an intensive program on effectively managing your diabetes. You’ll be shown in-depth strategies for setting goals, solving problems, how to spot complications, and making sure your social life doesn’t include obstacles to your healthier lifestyle.

Diabetes Prevention Program

As part of the CDC-led National Diabetes Prevention Program (DPP), the CMH DPP lifestyle change program helps people with prediabetes make healthy, long-term changes to prevent or delay the onset of type 2 diabetes.

Participants meet in a small group led by a trained lifestyle coach. Individuals receive group support and learn how to get on a healthy track and stay there.

Full Recognition from the CDC Diabetes Prevention Recognition Program Since March 2016

The Lifestyle Change Program

Participants in the Lifestyle Change Program meet for about one hour once a week for eight weeks, every two weeks for eight more sessions, then once a month for six months to complete the year-long program.

During each session, your lifestyle coach will present health information and then lead a group discussion. You will learn to:

• Eat healthy
• Add physical activity to your life
• Manage stress
• Stay on track when eating out

For more information about the CMH DPP lifestyle change program, go to www.cdc.gov/diabetes/prevention.

The Benefits of a Diabetes Prevention Program

Follow-up studies show that following this lifestyle change program has helped many people with prediabetes cut their risk of developing type 2 diabetes in half.

Participants can achieve weight loss by making healthier food choices, becoming more physically active and learning to manage stress. The Diabetes Prevention Program research reveals that even modest behavior changes can lead to great results: for example, if a person weighing 200 pounds lost 5 to 7 percent of their body weight (10 to 14 lbs.), they could reduce their risk of developing type 2 diabetes by more than half.

Studies also show that when people have the support of others working towards the same goals they have more success. Group members celebrate successes and encourage each other to overcome challenges.

Lifestyle Coaches

Central Maine Healthcare Diabetes Prevention Program Lifestyle Coaches Offer Information and Support. Lifestyle coaches are an essential part of the Central Maine Healthcare Diabetes Prevention Program.

CMH lifestyle coaches have all been trained by a Master Trainer or Master Trainer Select, certified by the Diabetes Training and Technical Assistance Center at Emory University.  Our coaches are skilled in helping people who have been diagnosed with prediabetes achieve lifestyle changes that will enable them to prevent or delay the onset of type 2 diabetes.

Our coaches help people:

• Learn the facts about healthy eating and physical activity and explain how these behaviors will help reduce risk for type 2 diabetes
• Set and meet goals
• Build relationships with other participants
• Work as a group to meet challenges
• Understand and respond to food cues
• Stay motivated
• Solve problems that get in the way of making healthy changes

Nutritional Counseling for Diabetes

With diabetes, what you eat matters. That doesn’t mean all patients follow the same strict food plan — we know there’s no such thing as a one-size-fits-all diet. At Central Maine Healthcare, our registered dietitians will work with you to design a personalized nutrition plan, based on your unique goals, tastes and medical history. More than anything, we want you to be able to eat healthy and enjoy your favorite foods. To us, that’s the essence of meal planning.

Tools to Help You Eat and Live Well

Your one-on-one sessions with your Central Maine dietitian will cover a wide range of topics to inform and empower you, such as:

• Insulin—what it does, how much you need, what happens when you don’t make enough, and how your insulin levels are affected by certain types of foods
• Other food outcomes, good and bad: cholesterol, triglycerides, blood pressure and more
• Food allergies and intolerances; what’s the difference and how to identify foods you should avoid
• Eating to build muscle
• Losing and gaining pounds, and how the endocrine system affects your weight
• Eating with your family: do they need a new meal plan, too?
• Sports nutrition: how to eat if you’re an athlete (or just a weekend warrior)
• Vegetarian choices; some are insulin-friendly, some aren’t
• Functional nutrition, looking at food as medicine to improve your health
• Alcohol and how it affects your insulin levels

Once you understand food and diabetes, making the best choices will become second nature, whether you’re at home or eating out.

Meet Our Providers

Central Maine Healthcare offers everything you need to take control. Our skilled team — including board-certified endocrinologists, certified diabetes educators, registered dietitians and more — will work closely with you to create a personalized wellness plan. You’ll also find a variety of empowering programs, from prevention through ongoing lifestyle support. So, no matter what you’re dealing with, we can help you live the active and healthy life you deserve.

Expert Care for a Full Range of Conditions

We’re experienced in diagnosing and treating a full range of endocrine conditions, including:

Prediabetes Type 1 and 2 diabetes Adrenal disorders

Pituitary disorders Thyroid disorders

Gestational diabetes and reproductive issues

People with diabetes sometimes experience complications from their condition, such as heart, kidney or eye disease, or disorders of the nervous system. Central Maine’s integrated approach allows our diabetes specialists to collaborate with our experts to provide optimal care and the most effective diabetes management strategy.

Education to Empower You: All our efforts are aimed at your wellness and helping you manage your condition on your own. Our team of certified diabetes educators will show you how to boost your self-care skills with hands-on diabetes training and support. Whether you prefer group learning or one-on-one sessions, you’ll learn:

• Glucose monitoring and insulin pump training
• A special 8-hour self-management program in Bridgton
• Stress reduction, relaxation and exercise programs
• Nutrition and meal planning
• In-depth medication information
• Foot and eye care information specifically for diabetes
• Strategies for feeling and living your healthiest life

Conditions We Treat

If you have an endocrine disorder, it means your body is producing either too many hormones, or too few. Getting your body back in balance is key to your long-term health and wellness. Our board-certified endocrinologists provide specialized care for conditions, including all forms of diabetes. We combine the latest tests and treatment options with the education and day-to-day skills you need to take total control of your health.

Adrenal Disorders

Your adrenal glands are some of the tiniest glands in your body (about the size of a pea), but they’re hard workers. Their job is to produce a variety of hormones that you need to live and function. When the adrenals aren’t working right, you’ll feel the symptoms, but matching the symptom to the right hormone disorder is a complicated process. Fortunately, our endocrinology team at Central Maine Healthcare is highly skilled at identifying adrenal problems and finding the right treatment.

Conditions We Treat: Your adrenal glands sit on top of your kidneys and produce several different hormones, including cortisol, aldosterone and sex hormones called androgens. Adrenal disorders signal that your body is producing either too much or too little of some hormone, and the remedies are different for each hormone and disorder.

Cortisol and Cushing’s Syndrome: The most important hormone produced by the adrenal glands, cortisol helps you to burn protein and fat, control your blood sugar, manage stress and regulate your blood pressure. When your body produces too much cortisol, you may develop a disease called Cushing’s syndrome. Symptoms of high cortisol levels include:

Depression Fatigue Thin skin

Swelling of hands and feet Difficulty concentrating

Weight gain, especially around abdomen

Cushing’s syndrome can be caused by taking cortisol-like drugs used to treat asthma and rheumatic arthritis; left untreated, it can lead to diabetes, high blood pressure, osteoporosis and other disorders. Diagnosing Cushing’s usually involves testing your saliva or urine. The most effective treatment is surgery to remove the adrenal glands, but sometimes treating the symptoms (such as medicine for high blood pressure) is sufficient.

Aldosterone Disorders: Aldosterone is a hormone that helps regulate your sodium and water balance, so when you produce too much or too little, your blood pressure is affected. We need it to help our salivary glands, sweat glands, colon and kidneys work properly; an imbalance can lead to a stroke, heart attack or kidney failure. There are medications to stop overproduction of aldosterone (and some other adrenal hormones), and under-producing usually can be treated with hormone replacement.

Addison’s Disease and Adrenal Insufficiency: With Addison’s disease, the adrenal glands are producing too little cortisol. (Some people are born unable to produce cortisol.) The term “adrenal insufficiency” sometimes points to too little cortisol or aldosterone. Symptoms can be fatigue, muscle weakness, nausea, vomiting or diarrhea. It’s identified with a blood test, and hormone replacement usually is the best treatment. Your adrenal glands also can develop tumors, detected with a blood test, CT scan or other diagnostic tests. Usually they are treated by surgically removing the adrenals.

Gestational Diabetes Care

Gestational diabetes only happens during pregnancy. The placenta makes hormones that can create a buildup of sugar in your blood. Most of the time, your pancreas makes enough of the hormone insulin to help control this issue. If not, higher blood sugar levels may cause gestational diabetes. It’s usually a temporary condition that, but left untreated, it can affect the health of both mother and baby. If you’re pregnant, it’s a good idea to contact your prenatal provider or one of our board-certified endocrinologists and have your glucose tested.

About Gestational Diabetes: There are no outward symptoms of gestational diabetes, but there are a number of factors that can put you at risk:

You are over 25 years old Diabetes runs in your family Overweight before pregnancy High blood sugars without diabetes

History of gestational diabetes African American, Native American, Asian American or Hispanic

Gestational diabetes happens during the first three months of pregnancy, so it’s vital that you and your provider begin monitoring your glucose as early in the pregnancy as possible. Like other types of diabetes, diagnosing gestational diabetes involves one of several simple and painless blood tests.

Ensuring Your Healthiest Pregnancy: The best way to avoid gestational diabetes is to be as healthy as possible before you get pregnant, including being at a healthy weight. If you’re diagnosed with gestational diabetes, your team at Central Maine Healthcare — including your prenatal provider, an endocrinologist, a dietitian and a diabetes educator—will work with you to get it under control.

For most new mothers, glucose levels return to normal very soon after delivery—however, having gestational diabetes puts you at risk for developing type 2 diabetes. As a precaution, your team will check your glucose levels right after you deliver your baby, and again in six weeks to make sure they’re still in the “normal” range and you aren’t developing prediabetes.

Pituitary Disorders

Your pituitary gland is the conductor of your endocrine system, signaling to other glands that they should produce more hormones or slow down. In many cases, it produces hormones for those other glands, and sometimes it gets its signals crossed – often because of a pituitary tumor.

The pituitary is no larger than a pea, sitting at the base of the brain, but with its many functions, identifying a problem calls for experienced professionals. At Central Maine Healthcare, our experts understand the complex connections and balances of the gland to help diagnose any problems you may be having and, if needed, put you on the fast track to treatment.

The Pituitary’s Many Jobs: The pituitary gland communicates with the entire endocrine system, producing hormones that:

Stimulate the adrenal glands Stimulate the thyroid Control growth of bones and tissues

Control sexual function Influence female breasts/milk production Regulate water loss by the kidneys

Not surprisingly, with so many diverse functions, defects in the pituitary realm create a wide range of symptoms, including:

Weight gain or loss Constipation Fatigue Weakness Depression

Nausea Body hair loss or increase Infertility Erectile dysfunction Joint pain

Enlarged hands and feet Headaches Loss of vision

Diagnosis and Treatment: To diagnose the problem, your Central Maine Endocrinologist will likely perform a simple blood or urine test to assess hormone levels. Depending on your specific symptoms, we may also recommend an imaging test of the brain, such as CT or MRI.

When the pituitary stops sending signals to other glands to produce their hormones, treatment almost always involves replacing those hormones with medication. The most common types of hormone replacement therapy (HRT) are:

• Cortisol replacement in the form of hydrocortisone or similar meds, if the adrenal gland isn’t producing cortisol on its own. We need this hormone on a lot of fronts, most importantly to help us manage our stress.
• Thyroid hormone replacement. The generic form of this medication is levothyroxine, also sold under the brand name Synthroid.
• If you have a sex hormone deficiency, your provider may prescribe hormone therapy to replace either testosterone or estrogen, whichever is lacking.
• Your body needs growth hormone to stimulate height and the growth of your muscles and organs. Children with too little growth hormone need to supplement it so their bodies will reach their full potential in shape and size. Adults also are prescribed growth hormone for muscle and organ development, but it won’t help them grow taller.

If your provider diagnoses a pituitary tumor, surgery may be the first treatment of choice.

Prediabetes

If you have prediabetes, you’re far from alone: more than 85 million Americans have been diagnosed. It’s easy to define — it simply means your blood sugar (glucose) levels are higher than normal — but not so easy to notice because there often aren’t any symptoms. Left untreated, many people develop full diabetes, a chronic condition that can lead to heart disease and other serious complications.

The good news? Through early testing and even simple lifestyle changes, you can prevent or delay prediabetes from progressing. And the experts at Central Maine Healthcare are ready to help you every step of the way.

About Prediabetes: Prediabetes occurs when you have too much glucose in your bloodstream, but your levels aren’t high yet enough to qualify as diabetes. With high glucose, your body isn’t producing enough insulin to process the sugar you’re taking in, so instead of carrying it to your muscles and other tissues for fuel, the sugar is accumulating in your blood.

Should I Get Tested? Your biggest clues to prediabetes are your own general health and personal risk. If any of these risk factors apply to you, it’s a good idea to be tested:

• Family history: If your parents, siblings or other relatives have been diagnosed with diabetes or prediabetes, you’re at risk for developing it yourself.
• Excess weight: Being overweight is a major risk factor for prediabetes, especially if you have fatty tissue around your waist and lower abdomen.
• Dietary choices: Eating red meat and processed meat, and drinking sugar-sweetened beverages, is associated with a higher risk of prediabetes.
• Lack of exercise: The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Age: There can be a cumulative effect to prediabetes, with the risk increasing after age 45. The longer you carry risk factors, the greater your chances of having the disorder.
• Sleep: If you don’t get enough sleep, or your sleep habits are unusual due to work shifts, you may be at higher risk. Do you snore? If so, you might have obstructive sleep apnea, a condition that prevents your organs from getting enough oxygen while you sleep and puts you at even higher risk for prediabetes (among other conditions). The sleep medicine specialists at Central Maine Healthcare offer sleep studies.
• Cholesterol-related diagnoses: If you have high blood pressure, low HDL (“good”) cholesterol, or high triglycerides (“blood fat”), you also should be tested for prediabetes.

Diagnosing & Treating Prediabetes: If you find that you’re at a risk for prediabetes, our endocrinologists can rule out or confirm a diagnosis. We offer a variety of blood tests and glucose screenings at locations close to home. The best treatment for prediabetes is healthy living. Central Maine’s certified diabetes educators and registered dietitians provide hands-on guidance, with strategies to help you be more active, maintain a healthy weight, eat right and more.

Thyroid Disorders

Your thyroid is the small, butterfly-shaped gland at the base of the neck. It acts as your body’s ignition, producing hormones that everything in you, from your hair to your vision, your weight, your ability to relax and concentrate, even whether you feel chilly. Thyroid disorders happen when the gland produces too much or too little hormones. Although the effects can be unpleasant or uncomfortable, most thyroid problems can be managed. The experts at Central Maine Healthcare specialize in diagnosing all types of these conditions and helping restore balance to your hormones, health and life.

Conditions We Treat: Your provider often can tell just by feeling your neck that it’s enlarged or shrunken, indicating that it’s not working properly. That manual exam is always followed up by a blood test to measure your hormone levels and identify which thyroid disorder you might have. They fall into four general categories:

• Hashimoto’s disease, or hypothyroidism – an underactive thyroid, when you’re not producing enough hormones.
• Graves’ disease, a form of hyperthyroidism, meaning you’re producing too much thyroid hormone.
• Goiter, a small growth on your thyroid with symptoms of hyperthyroidism.
• Thyroid nodules, growths on your thyroid that can secrete thyroid hormone (in addition to the hormones your thyroid already is producing), upsetting your hormonal balance.

When your thyroid isn’t working up to par – in other words, when it’s hypo, or underactive—you’re likely to be the coldest person in the room. Your hair may fall out more than usual, your vision can get blurry and your skin might feel dry even when you use lotion. You may find it difficult to memorize simple facts, lose weight or get up the energy to work or have fun. Symptoms of depression can appear.

If you have hyperthyroidism, or an overactive thyroid, your symptoms will be the opposite: you will feel hot, perspire without exerting yourself, lose weight and you may feel restless and have difficulty sleeping. You may notice your eyes bulging. These symptoms show that your thyroid is producing too much hormone, and can indicate Graves’ disease, a goiter or nodules. If you have a goiter, you may also notice hoarseness in your voice or difficulty swallowing.

Full Range of Treatments: Our endocrine specialists will work with you to create a treatment plan based on your specific condition and needs.

Hashimoto’s is often treated with a simple medication called Levothyroxine. Your provider probably will start you on a low dosage to see how your symptoms have improved after a few weeks, so it may take some months before the correct dosage can be determined. Anyone with thyroid disorders need to have their hormone levels tested periodically to see if their dosage needs to be increased or scaled back.

For hyperactive disorders, treatment depends on your situation. Thyroid nodules rarely become cancerous, but if a nodule or goiter interferes with your breathing or eating, your provider will recommend iodine to shrink the thyroid, or possibly surgery. If the growth is large enough or malignant, you may need your thyroid removed, in which case you may be prescribed hormone replacement medication. Because the disorders are connected, treatments may overlap.

Type 1 and Type 2 Diabetes Care

Most people think of type 1 diabetes as a childhood disease, but the reality is, more adults than children have it, according to the American Diabetes Association. And while type 1 and type 2 behave differently in your body, their symptoms, testing and treatments are almost identical. Both are serious diseases and need to be treated right away—but they also are manageable. Our dedicated team of endocrinologists, certified diabetes educators, nutritionists and more combine expert clinical care with hands-on support to keep you healthy and well.

About Diabetes: More than a million Americans have been diagnosed with type 1 diabetes, a chronic (ongoing) condition in which your pancreas has stopped making insulin, which you need to carry glucose (sugar) to the cells throughout your body so it can be used as energy. With type 2 diabetes, your body either resists the effects of insulin, or it doesn’t make enough. In either case, your organs aren’t getting the fuel they need to run properly. Common diabetes symptoms include:

Constant thirst Extreme hunger Frequent need to urinate

Unexplained weight loss Irritability

Fatigue Blurred vision

Two other symptoms can also indicate possible type 2 diabetes: darkened skin where your skin creases, such as in the crook of your elbow or around your neck, and “fruity”-smelling breath. If you’re injured, you might also notice that the injuries take longer than usual to heal. Like prediabetes, type 1 and type 1 are diagnosed with a variety of blood tests, and your endocrinologist at Central Maine Healthcare can recommend the best screening for you.

Personalized Treatment & Lifestyle Support: If you are diagnosed with diabetes, our team will work with you to find the best care plan. Central Maine’s certified diabetes educators and nutritionists will arm you with all the information and skills you need to monitor and manage your diabetes with confidence. We also offer number of support groups and classes to keep you up-to-date on the latest advancements.

Your personalized treatment plan may include insulin intake, either by injections or pump — a small, computerized device (about the size of a cell phone) that continually sends insulin into your body. It’s inserted under the skin of your abdomen with a small, flexible tube called a catheter, and you can wear the pump itself on your belt or in a pocket. A lot of patients enjoy using a pump; they don’t have to worry about injecting themselves during the day, the dose is precise and it allows more flexibility in their lifestyle. We’ll also support you with blood sugar monitoring, an eating and exercise plan based on your own tastes and activities you enjoy, and possibly medications, such as a cholesterol-lowering drug.

Empowering You to Live Your Best: A special feature of our treatment program is our Self-Management Program, offered throughout the year. This seminar covers every aspect of diabetes self-care, from recognizing risk factors and symptoms to blood glucose monitoring, foot care and preventing complications.

Contact Us

Central Maine Endocrinology & Diabetes Center
76 High St.
Lewiston, ME
207-795-7520