“If you have diabetes, you either need a cardiologist now or you likely will need one in the future,” said Catrina R. Hancock, PA-C, physician assistant with Norton Heart & Vascular Institute. “Diabetes has the potential to affect nearly every part of the body, but its impact on the heart is especially serious. The good news is that with proper cardiac care, we can significantly reduce your risk of heart complications.”

How diabetes causes heart disease

People with diabetes are two to four times more likely to develop heart disease and often have other conditions that increase heart disease risks: high blood pressure, high cholesterol, kidney and liver disease, and obesity.

Diabetes affects how your body processes sugar. Over time, high blood sugar acts like sandpaper in your bloodstream, causing damage to arteries. High glucose levels can also cause inflammation throughout the body, making it easier for cholesterol to stick to artery walls and block blood flow to your heart.

Diabetes also can damage the nerves that control your heart rate and blood pressure. This condition, called diabetic neuropathy, can mask typical warning signs of heart issues. Diabetes-related heart damage often happens silently and slowly, making it difficult to detect without regular cardiac monitoring.

Symptoms of diabetes and heart disease

Not everyone with diabetes experiences clear warning signs of heart issues. While chest pain can still occur, many symptoms of diabetes with heart disease can be subtle or mistaken for fatigue, aging or other conditions.

Important symptoms to watch for include:

• Shortness of breath, especially with normal activities
• Chest discomfort, pressure or tightness
• Swelling in the feet, ankles or legs
• Unexplained fatigue or weakness
• Irregular heartbeat or palpitations
• Dizziness or lightheadedness

If you have diabetes and are experiencing any of these symptoms, even occasionally, it’s time to talk to a cardiologist about your risks related to diabetes and heart disease.

Benefits of a cardiologist in diabetes care

Managing heart disease in people who have diabetes extends beyond glucose control. A cardiologist plays an essential role in identifying and helping to control silent cardiovascular risks before they can become major, life-threatening complications.

“Many patients don’t realize how significantly a cardiologist can enhance their overall diabetes management and provide peace of mind regarding their cardiovascular health,” Catrina said.

When you consult with a cardiologist at Norton Heart & Vascular Institute, they will evaluate your cardiovascular health using advanced screenings, imaging and lab tests, specifically designed for diabetes patients.

More advanced diagnostic testing: Cardiologists use specialized tests that can detect cardiovascular issues before a person shows symptoms. These might include coronary artery calcium scoring, advanced lipid panels or cardiac imaging that can reveal early signs of heart disease in patients with diabetes.

Personalized treatment plans: Every person with diabetes has a unique risk profile. A cardiologist can develop a customized treatment plan that considers how long you’ve had diabetes, glycemic control, family history and other individual factors that influence cardiovascular disease development.

Based on your condition, a cardiologist may recommend:

• Medicine that protects the heart and complements your diabetes treatments
• Lifestyle modifications specifically designed to reduce your cardiovascular risk
• Regular monitoring with cardiac imaging or stress testing
• Blood pressure and cholesterol management to address risk factors
• Coordination with your diabetes care team for comprehensive treatment

With appropriate cardiac care, people living with diabetes can dramatically reduce their risk of heart attack, stroke or other long-term disability. Early detection and preventive treatment can minimize diabetes-related cardiovascular complications and improve your overall quality of life.

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Prediabetes vs. Type 1 and Type 2 diabetes

In a healthy body, when sugar enters the bloodstream, the body releases insulin from the pancreas. The insulin unlocks the cells so they can accept the sugar as fuel. Chronically high blood sugar levels (hyperglycemia) cause damage to your veins and arteries, and over time can lead to kidney failure, loss of limbs or blindness, as well as contribute to metabolic syndrome. 

Prediabetes occurs when blood sugar levels are elevated but not high enough for a diabetes diagnosis. This is a sign that your body is having difficulty processing glucose efficiently, requiring more insulin to convert food into energy. Type 1 diabetes is an autoimmune disorder that affects the pancreas, the organ that produces the hormone insulin. People who have Type 2 diabetes either do not produce enough insulin or their bodies cannot use the insulin effectively.

How common is a prediabetes diagnosis?

According to the National Institutes of Health, more than 1 in 3 American adults over age 18 years had prediabetes in 2021. Prediabetes is more common in men (41%) than women (32%). Factors that may increase your risk for persistently abnormal high blood sugar levels include:

• Weight: Those at a higher weight may have insulin resistance, which means the cells in the body aren’t able to accept blood glucose for energy as easily.
• Family history: Those with a family history of diabetes, especially Type 2, have higher risk.
• Diet: Red meat, ultra-processed foods and sugar-sweetened beverages increase your risk.

Misdiagnosed diabetes

Studies in 2023 estimated that up to 40% of adults over 30 with Type 1 diabetes may have been misdiagnosed with Type 2 diabetes. While Type 1 diabetes usually is diagnosed in children, it can develop at any age. Since adults are more likely to be diagnosed with Type 2 diabetes, doctors may mistakenly assume that any new diabetes diagnosis in older adults is Type 2 — leading to serious consequences if the wrong treatment is given.

One major risk of this misdiagnosis is diabetic ketoacidosis (DKA) a dangerous condition that happens when the body doesn’t have enough insulin. Without insulin, blood sugar levels rise too high, and the body begins to break down fat for energy, creating harmful acids called ketones. If left untreated, the buildup of ketones in the blood can lead to DKA — which requires hospitalization and intensive care. This is why getting the correct diabetes diagnosis is crucial — to prevent life-threatening complications like DKA and ensure the right treatment is given from the start. DKA most commonly happens to people with Type 1 diabetes, but it also can occur in people with Type 2 diabetes in rare cases. If an adult with Type 1 diabetes is mistakenly diagnosed with Type 2, they may not be prescribed insulin right away. This can lead to DKA, since their body can’t make insulin at all.

The American Diabetes Association specifies three diagnostic tests for prediabetes; these can  help you and your doctor determine the best course of treatment for you:

• Fasting plasma glucose between 100 to 125 milligrams per deciliter
• Hemoglobin A1C between 5.7% and 6.4%
• Two-hour oral glucose tolerance test between 140 to 199 milligrams per deciliter

To prevent diabetes misdiagnosis, doctors confirm your results with a second test, either the same day or on a different day. When following this guideline, misdiagnosis is unlikely.

“There shouldn’t be any debate about how to make a diabetes diagnosis, but it is true that different tests can be different in different people,” said Lisal J. Folsom, M.D., adult and pediatric endocrinologist with Wendy Novak Diabetes Institute, a part of Norton Healthcare and Norton Children’s.

According to Dr. Folsom, who sees her adult patients at Norton Community Medical Associates – Endocrinology, it’s important to have the appropriate testing and typically confirm an abnormal result so the patient gets the right information about their health.

Treatment of prediabetes

Early detection is crucial, since 25% percent of people with a prediabetes diagnosis develop Type 2 diabetes within three to five years. 

Treatment focuses on lifestyle changes:

• Eating whole foods and vegetables
• Choosing whole grains
• Limiting ultra-processed foods, simple and added sugars, and alcohol
• Regular physical activity (150 minutes weekly)
• Taking walks after eating meals

According to Dr. Folsom, accurate prediabetes and diabetes diagnosis enables timely intervention and better health outcomes.

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In the United States, 1% to 2% of pregnant women have Type 1 or Type 2 diabetes — an increase of 37% between 2000 and 2010. Gestational diabetes, which develops during pregnancy, affects between 5% and 9% of women, which is an increase of 56%. In Kentucky, nearly 10% of pregnancies are complicated by diabetes.

The Wendy Novak Diabetes Institute Perinatal Program will be integrated within the Norton Children’s Maternal-Fetal Medicine Perinatal Center, leveraging expertise in managing complex pregnancies.

“Diabetes poses many risks to both the expectant mother as well as the baby,” said Kristine Y. Lain, M.D., maternal-fetal medicine specialist and medical director of Norton Children’s Maternal-Fetal Medicine. “Our program will provide services for family planning, pregnancy care and postpartum care to give families the resources they need for the healthiest pregnancies and beyond.”

The Wendy Novak Diabetes Institute Perinatal Program is made possible thanks to $623,000 in funding through the Norton Children’s Hospital Foundation. It will build on services already offered to patients with diabetes, adding a focus on health living, including pre-pregnancy counseling, pregnancy monitoring and education, care planning, and coordination of care with maternal-fetal medicine specialists, primary care providers, endocrinologists and Wendy Novak Diabetes Institute educators. It also will prioritize health equity, health care provider education and research related to the care of patients with diabetes who are pregnant.

“Adding special resources to help pregnant patients manage their disease — whether they are living with Type 1 or Type 2 diabetes or developed gestational diabetes — is key to helping patients have healthy pregnancies and live long, active, healthy lives,” said Kupper A. Wintergerst, M.D., Wendy L. Novak Endowed Chair of Pediatric Diabetes Care and Clinical Research, and pediatric endocrinologist with Norton Children’s Endocrinology.

“Wendy Novak Diabetes Institute is quickly working to become the premier national location for the treatment, education and research of diabetes,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “This new program will bring yet another level of care that patients need. It’s part of our plans to continue expanding diabetes services. We appreciate the Novak family and the community for getting behind this institute.”

Wendy Novak Diabetes Institute services are offered in both adult and pediatric inpatient and outpatient settings. Norton Children’s Hospital is recognized as having one of the nation’s top diabetes and endocrinology programs. The hospital is listed 14th in U.S. News & World Report’s 2024-2025 rankings for pediatric diabetes and endocrinology, fueled by funding from the Lift a Life Novak Family Foundation.

The Lift a Life Novak Family Foundation was established in 1999 through a charitable trust by David and Wendy Novak. It funds innovative, high-impact projects that are led by passionate leaders committed to outstanding execution. It first gave $5 million to the Norton Children’s Hospital Foundation in March 2013 to establish Wendy Novak Diabetes Center as part of a $12 million initiative to create a comprehensive diabetes care center offering education and treatment for Type 1 diabetes to thousands of children and young adults. A gift of $15 million in 2022 elevated the program to Wendy Novak Diabetes Institute with a goal to become a national center of excellence by expanding diabetes care services across the region, while helping children and adults with diabetes manage their condition. This includes a program that facilitates the transition from pediatric to adult care.

Patients needing care by specialists who are part of the Wendy Novak Diabetes Institute Perinatal Program should speak with their obstetrician/gynecologist provider for a referral.

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Balamurugan N. Appakalai, Ph.D., also known as Dr. Bala, is leading research around islet cell transplants. Dr. Bala, widely considered one of the most skilled islet isolation specialists in the world, is transitioning his team and research from Nationwide Children’s in Ohio to Louisville.

“This work will impact patients locally, nationally and around the world,” Dr. Bala said. “I believe we have a real opportunity to find an eventual cure for Type 1 diabetes. My team and I look forward to what we will accomplish in the years to come.”

Islets are clusters of cells in the pancreas that help make insulin. In people with Type 1 diabetes, the immune system attacks islet cells, making the body unable to produce insulin.

Thanks in part to Dr. Bala’s research, it’s now possible to replace those islet cells by taking them from a donor pancreas and transplanting them into the liver of someone with diabetes. The goal is for the healthy islets to start managing blood glucose in the recipient. With manageable blood glucose, the patient no longer needs insulin injections. However, transplanted islet cells currently don’t last a patient’s lifetime, so more research is needed to create longer-lasting transplants.

As an “isletologist” for the past 30 years, Dr. Bala’s research has focused on advancing pancreatic islet cell isolation and transplantation not only in patients with Type 1, but also for those with surgery-induced diabetes. The methods he developed have shown to improve short- and long-term outcomes in patients and have been incorporated into transplantation programs across the country.

To support Dr. Bala and his team’s efforts, Norton Healthcare and Norton Children’s will build a 1,500-square-foot lab to house an islet clinical transplant program. The lab, one of only 11 in the country, will allow the team to isolate and prepare the cells for transplant, pioneer new islet treatments and lead clinical studies. The research part of the lab is expected to be completed this fall, with the cell production space expected to open next year.

The new islet cell research program and Dr. Bala’s team were funded with grants of more than $2 million from the Norton Children’s Hospital Foundation, thanks to generous donations from the community with lead gifts from the James and Judith K. Dimon Foundation and the Lift a Life Novak Family Foundation.

“We’re excited to be able to bring this groundbreaking program to patients who are part of Wendy Novak Diabetes Institute,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “The Novak family and many other donors are passionate about seeing research into therapies for Type 1 diabetes progress, potentially bringing a cure to patients throughout the world. Dr. Bala’s work is truly groundbreaking, and he and his team will be an integral part of research at Wendy Novak Diabetes Institute.”

Wendy Novak Diabetes Institute treats more than 9,000 people with Type 1 diabetes, including about 2,000 children, and provides care to patients from 137 counties in Kentucky and Southern Indiana.

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How do I know if I have hypothyroidism?

“Thyroid problems in general can be difficult to diagnose, because the symptoms can be so mild they are unnoticeable, and because they mimic other conditions,” said Joshua H. Brandon, M.D., family medicine physician with Norton Community Medical Associates. Some common symptoms include:

• Often feeling cold 
• Fatigue or muscle weakness
• Constipation
• Dry skin.
• Weight gain
• High cholesterol
• Depression

Thyroid issues and heart function

Thyroid hormones affect almost every organ system in the body, from your bones to your central nervous system. With hypothyroidism, you can experience:

• Bradycardia, or a low heart rate  
• Cardiomyopathy: enlargement of the heart  
• Dizziness

When should I see a doctor?

It can be difficult to link some of the above symptoms to a thyroid issue. Your health care provider may run some blood tests to check your hormone levels.

“Make sure your primary care provider has all your health information, including symptoms and family history,” Dr. Brandon said. 

Thyroid tests

Thyroid function can be determined with a blood test. Thyroxine (T3) and triiodothyronine (T4) are the hormones the thyroid makes. Blood tests can show if you have an underactive thyroid (hypothyroidism). 

Thyroid stimulating hormone (TSH) is a hormone made in the pituitary gland that tells the thyroid how much T4 and T3 to make.

A high TSH level may mean you have hypothyroidism, or an underactive thyroid. This means that your thyroid isn’t making enough hormone. As a result, the pituitary system keeps making and releasing TSH into your blood.

If the TSH test results are not normal, your doctor may perform least one other test to help find the cause of the issue.

T4 test

A high blood level of T4 may mean you have hyperthyroidism. A low level of T4 may mean you have hypothyroidism.

In some cases, very high or low T4 levels may not mean you have thyroid problems. If you are pregnant or are taking oral contraceptives, your thyroid hormone levels will be higher. Severe illness or the use of corticosteroids (medicines to treat asthma, arthritis, skin conditions, and other health issues) can lower T4 levels. 

T3 testing

With hyperthyroidism, your T4 level may be normal, but you may have a T3 test to confirm the diagnosis. Sometimes T4 is normal but T3 is high, so measuring both T4 and T3 levels can be useful in diagnosing thyroid issues.

Thyroid antibody test

Measuring levels of thyroid antibodies may help diagnose an autoimmune thyroid disorder like Hashimoto disease, the most common cause of hypothyroidism. Thyroid antibodies are made when your immune system attacks the thyroid gland. 

Other tests may include imaging, such as a thyroid scan, which uses radioactive iodine to help the doctor see your thyroid clearly. This test can show thyroid nodules, which are small, often harmless lumps on the gland. It can also detect inflammation, an enlarged thyroid and other abnormalities.

Testing also can show signs of thyroiditis, or an inflammation of the gland. There are several types of thyroiditis, but the most common is Hashimoto disease. 

Treating hypothyroidism

An underactive thyroid gland affects your whole body. There is no cure for thyroid disorders, so the symptoms are treated as needed. Treatment for hypothyroidism symptoms usually includes taking a levothyroxine pill (Levo-T, Synthroid) every day. It boosts thyroid hormone production, keeps hormones in a healthy range and relieves symptoms of hypothyroidism. Most patients feel better one to two weeks after starting treatment.

Your health care provider usually will test you every year to check thyroid function. 

You’ll likely start to feel better one or two weeks after you begin treatment. Treatment with levothyroxine likely will be lifelong. Because the dosage you need may change, your health care provider may check your TSH level every year.

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Type 1 diabetes is also called juvenile diabetes or insulin-dependent diabetes. It can develop at any time, but typically this condition presents before age 40 and usually in children or adolescents. In people with Type 1 diabetes, the pancreas makes little to no insulin. Insulin is a hormone that helps the body use sugar (glucose).

“When your body can’t produce insulin, sugar builds up in the blood,” said Joshua H. Brandon, M.D., family medicine physician with Norton Community Medical Associates. “Over time, this does damage to your organs, tissues and blood vessels.”

RELATED ARTICLE: Can diabetes be misdiagnosed? Here’s what patients should know.

Type 1 diabetes symptoms

Excessive thirst is a common symptom of diabetes. Here are some other typical signs:

• Increased thirst (the medical term is polydipsia) even with increased water intake
• Excessive urination
• Feeling very hungry
• Weight loss without trying
• Feeling irritable or having other mood changes
• Feeling tired and weak
• Having blurry vision

Causes of Type 1 diabetes

Researchers do not know the exact cause of diabetes. In many cases, the body’s own immune system — which normally fights harmful bacteria and viruses — destroys the insulin-producing (islet) cells in the pancreas.

“We know genetics and environmental factors play a role,” Dr. Brandon said. 

Why does Type 1 diabetes cause increased thirst?

If your blood sugar level is high and there is not enough insulin to reduce the amount of sugar in the blood, the kidneys will work harder to filter and absorb the sugar. In order to flush sugar out of the body, the kidneys pull fluid from your tissue. You then will pass the sugar through your urine.

“That’s why we see symptoms such as dry mouth, excessive thirst and frequent urination associated with diabetes,” Dr. Brandon said.

Complications of Type 1 diabetes

Left untreated, Type 1 diabetes can cause:

• Heart disease or blood vessel disease. This includes coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Too much sugar in the blood (hyperglycemia) can damage the walls of the tiny blood vessels (capillaries) that feed the nerves. This often happens in the legs, since the heart has to work hard to pump the blood to the extremities. Poorly controlled blood sugar can cause you to lose all sense of feeling in certain parts of your body. 
• Kidney damage (nephropathy). Millions of tiny blood vessels in the kidneys keep waste from entering the blood. Diabetes can damage these blood vessels. Over time, this can lead to kidney failure or end-stage kidney disease that can’t be reversed. Advanced kidney disease is treated by filtering the blood with a machine (dialysis) or with a kidney transplant.
• Eye damage (diabetic retinopathy). Diabetes can damage any of the body’s blood vessels, including those of the retina (part of the eye that senses light). Left untreated, this may cause blindness. 
• Foot damage. Nerve damage and poor blood flow in the feet increases the risk of complications. You gradually can lose feeling in the feet, so you don’t notice cuts and blisters. These can become serious infections. Very severe infections may result in removal of toes, feet, or parts of the leg (amputation).

Diabetes also can be an issue for pregnant people. If the person has a high blood sugar level, it can be dangerous for both parent and baby. Uncontrolled high blood sugar can increase the risk of miscarriage, stillbirth and birth defects. 

How is diabetes diagnosed?

A simple blood test can tell your primary care provider if you have diabetes. This test is called an A1C test. It measures the average amount of glucose in your blood over about the past three months. A1C results fall into normal, prediabetic, and diabetic ranges. 

• Normal A1C level is below 5.7%.
• Prediabetes is between 5.7% to 6.4%.
• A level of 6.5% or more indicates diabetes.

Seeing your provider every year for a general checkup that includes bloodwork will help your health care team establish a baseline for you and ensure you get your A1C level tested. Drastic changes in your A1C from year to year can be a sign that you are headed toward prediabetes or diabetes. 

“If you have some of these symptoms that get worse over time — excessive thirst, dry mouth, excessive urination or unexplained weight loss — see your general physician for bloodwork,” Dr. Brandon said. “Or if you have a parent or sibling with any type of diabetes, remember that is a risk factor. It is easier to treat diabetes the sooner it’s caught.”

Routine bloodwork to determine your diabetes status typically is covered by most insurance plans. You can make an appointment online via Norton MyChart. Blood test results usually are returned from the lab in a few days.

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Don’t take poor blood circulation lightly. Your primary care provider can determine whether simple treatment options like regular massages, compression socks, putting your feet up and eating better will remedy the condition.

Some cases of poor blood circulation can be a sign of peripheral artery disease, which if left untreated can damage your feet to the point of amputation and death.

Peripheral artery disease happens when plaque from high cholesterol builds up in arteries in your extremities, usually the legs or feet, making the blood vessel narrow and rigid. Blood clots can break from the plaque buildups causing complications. When this happens close to the heart or brain it can cause heart disease, heart attack and stroke.

Peripheral artery disease can advance to chronic limb-threatening ischemia (CLTI), where poor leg circulation has deteriorated to the point that your foot or part of your leg is at risk of needing amputation.

New treatment can help save limbs at risk of amputation

A new treatment, recently approved by the Food and Drug Administration (FDA), can restore blood flow and reduce risk of amputation for patients who have run out of other options, such as medication or surgery for CLTI. An estimated 1 in 5 patients with CLTI fit this description. CLTI affects up to 4 million Americans, resulting in more than 150,000 major amputations annually in the United States.

CLTI is the most serious form of peripheral artery disease and typically occurs in patients experiencing diabetes, coronary artery disease, obesity, high cholesterol and/or high blood pressure.

The primary surgical treatments to address CLTI symptoms are angioplasty or bypass surgery. In many patients, neither option is feasible because of extensive disease in the target arteries.

The treatment redirects blood flow around a blocked artery in the lower leg so blood can reach the feet. Norton Vascular Surgery, part of Norton Heart & Vascular Institute, is the first provider in Kentucky to offer the procedure.

“We’re thrilled to be able to offer our patients this first-of-its-kind procedure,” said Lauren M. Strait, M.D., vascular surgeon with Norton Heart & Vascular Institute. “It has the potential to greatly improve quality of life by reducing pain, enabling wound healing and, most important of all, preventing amputation.”

With the LimFlow System for transcatheter arterialization of deep veins, catheters are inserted from opposite directions — through a vein on the bottom of the foot, and an artery in the groin. Each is threaded through the blood vessels until they reach the area of the blood clot or other blockage.

At that point, the catheter in the artery pierces the vein, and the LimFlow device connects the two blood vessels. The vein carries oxygenated blood to the foot, then blood flow resumes its normal path back to the heart for recirculation.

Self-expanding stent grafts create a permanent conduit for blood flow from the artery into the vein.

The FDA approved LimFlow in September 2023 following a successful clinical trial.

In that study, published in the New England Journal of Medicine, 105 patients with CLTI underwent the LimFlow procedure. At six months, 76% avoided above-ankle amputation. Wounds were completely healed in 25% of patients and in the process of healing in 51%. No unexpected adverse events were reported.

Peripheral artery disease versus other vascular conditions

Peripheral artery disease and varicose veins are different conditions. Arteries carry oxygen-rich blood away from the heart out to the body, while veins return the depleted blood back to the lungs and heart for recirculation.

While peripheral artery disease is associated with blocked arteries, varicose veins typically are tied to leaking valves in the veins of the legs. Deep vein thrombosis is another condition affecting blood vessels, where clots form in veins far from the heart.

Because peripheral artery disease is caused by an underlying condition of cholesterol plaque buildup, or arteriosclerosis, treatment also means taking care of your risk for heart attack and stroke. If diagnosed early, peripheral artery disease can be managed by quitting smoking, managing diabetes and high blood pressure, lowering cholesterol and triglyceride levels in your blood, taking medication to prevent blood clots and exercising.

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The 21,000-square-foot space — a $9.5 million investment — includes Norton Healthcare’s first same-day orthopedic injury care center and the first multidisciplinary office to house both pediatric and adult orthopedic and endocrinology care under the same roof.

“Norton Healthcare is committed to expanding access to health care,” said Russell F. Cox, president and CEO, Norton Healthcare. “The comprehensive and specialized services that will be provided in this new space will make it easier for children and adults of all ages to receive the care they need.”

The orthopedic injury care center will be staffed by seven specialists from Norton Orthopedic Institute and Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine. X-ray capability will help providers accurately diagnose a variety of injuries, while on-site physical therapists from KORT and a unique turf area will allow for better assessments after injury or surgery. More specialists are expected to join the center in the future.

“This is a huge step forward for patients and athletes of all ages,” said Nathan L. McKinney, D.O., orthopedic sports medicine physician, Norton Orthopedic Institute. “This new space creates a seamless operation for athletes who can now receive their diagnoses, receive physical therapy and return to training all in the same location. Even more, providing care on the same day someone suffers an injury can alleviate fear and confusion from patients and families who are desperately awaiting results.”

The new office also will house Wendy Novak Diabetes Institute, a Part of Norton Healthcare and Norton Children’s, for patients with diabetes and other endocrinology needs. Dedicated endocrinologists will provide family-centered care as well as offer a Transition to Adult Diabetes Program to assist adolescents as they move to adult-based care. Diabetes education and pediatric virtual behavioral health services also will be available to patients.

Norton Sports Health Performance & Wellness Center, adjacent to the new space, will offer a Wendy Novak Diabetes Institute Sports & Activity Program. This new sports lab, staffed by a dedicated research scientist and exercise physiologist, will allow for state-of-the-art fitness and metabolic evaluations. The program was made possible thanks to generous donations to the Norton Children’s Hospital Foundation and is expected to take shape in the coming weeks.

“Not only are we looking out for the best interests of patients with diabetes to ensure they can maintain healthy and active lifestyles, but we’re also gathering data on the relationship between diabetes and how the body reacts to exercise,” said Kupper A. Wintergerst, M.D., pediatric endocrinologist and executive director, Wendy Novak Diabetes Institute. “This facility will allow us to personalize the care we provide to improve health outcomes for our patients and participate in cutting-edge research in diabetes and exercise science.”

The Norton Children’s Hospital Foundation contributed $350,000 toward Wendy Novak Diabetes Institute services.

“This comprehensive approach can only be made possible through donations,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “It will help countless children and their families navigate life to the fullest with diabetes.”

Wendy Novak Diabetes Institute is supported by the “Just Imagine” campaign, a visionary journey that will help bring better health care to patients throughout Kentucky, Southern Indiana and beyond. Just imagine what your help can do. Learn more or make a donation at JustImagineCampaign.com.

Along with orthopedic and endocrinology services, the new space also will house an adult primary care office, timeshare space for several specialty practices and a Norton Prompt Care clinic, which will offer same-day appointments for minor illnesses and injuries for patients ages 2 and older.

Schedule an appointment for a child by calling (502) 629-5437 (KIDS).

Adult patients can schedule an appointment by calling (502) 629-1234.

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This medication may be especially helpful if you’ve had high cholesterol throughout your life or if you have a genetic condition called hypercholesterolemia that is causing high cholesterol.

PCSK9 inhibitors reduce your low-density lipoprotein cholesterol, also known as LDL or “bad” cholesterol. Too much LDL cholesterol in the bloodstream can clog your arteries with plaque, increasing your risk of heart attack and stroke.

Research has shown PCSK9 inhibitors reduce LDL cholesterol levels by an average of 50% to 60% and cut your risk of heart attack by almost one-third. There are two Food and Drug Administration-approved PCSK9 inhibitors, which sell under the brand names Praluent and Repatha.

“Most people don’t need PCKS9 inhibitors, because they are able to control their high cholesterol either through dietary interventions or other medications. Statin drugs are typically the first-line medication for patients with high LDL cholesterol, said Loyal W. Walker, M.D., family medicine provider at Norton Community Medical Associates primary care offices in Middletown and Taylorsville.

Statins were first introduced in the 1980s and have been shown to be safe and effective for most people.

PCSK9 inhibitors are relatively new medications, approved by the FDA in 2015. They are also more expensive than statins.

If you are prescribed PCSK9 inhibitors, you’ll receive an injection under the skin every two weeks or every month, depending on the dose. You can receive the injection in the abdomen, thigh or upper arm.

The injections can be done by your provider, or you can do them yourself. You also will receive periodic blood tests so your provider can see how well the medication is working.

If you are injecting the medication yourself, your provider will teach you how to prepare and inject the medication. Praluent can be self-injected using an autoinjector, which is a single-dose pre-filled pen, or a single-dose pre-filled syringe. Repatha comes in three forms: an autoinjector, pre-filled pen and single-use Pushtronex system, which is an on-body infuser with a pre-filled cartridge.

Read more

What’s considered good cholesterol for women?

African Americans and cholesterol: Should I get my cholesterol checked?

What’s the link between cholesterol and heart disease

If PSCK9 inhibitors are effective in lowering your LDL, your provider may prescribe the drugs long term. You should continue taking the medication as long as your provider prescribes them.

Common side effects of PCSK9 inhibitors include fatigue and muscle pain. Rarer side effects include kidney or liver issues.

PCSK9 inhibitors work by increasing the body’s natural ability to clear LDL cholesterol from the bloodstream.

Typically, PCSK9 inhibitors are one part of an overall treatment plan that includes healthy lifestyle habits. This includes eating a healthy diet, exercising, managing stress and quitting smoking if you smoke. You may be prescribed a statin drug in addition to PCSK9 inhibitors.

Talk to your primary care provider to get tested for high cholesterol as part of an annual visit or discuss how to manage high cholesterol. Test results are always available via a free Norton MyChart account, and Norton Healthcare Express Services offers drive-thru lab work with a provider’s lab order.

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Some of the first warning signs of diabetic ketoacidosis can include extreme thirst and frequent urination with high blood sugar levels.

These symptoms can quickly be followed by additional symptoms which may include rapid, deep breathing; a higher-than-normal heart rate; dry skin and dry mouth; fatigue; stomach pain; nausea; vomiting; a flushed face; headache or confusion; and muscle weakness.

“DKA occurs when a person has less insulin than their body needs to process the amount of sugar in the blood. Low insulin levels lead to DKA,” said Lisal J. Folsom, M.D., M.S., adult and pediatric endocrinologist with Wendy Novak Diabetes Institute, a part of Norton Healthcare and Norton Children’s Medical Group.

Insulin allows us to convert blood sugar into energy. Without enough insulin the body cannot produce enough energy from blood sugar. Because of this the blood sugar becomes very high, and the body needs to find a different source of energy.

As a backup, the liver turns fat into ketones which supply some energy, a process called ketosis. Ketones are a less effective energy source, but they can less effectively fuel our cells. Ketones are filtered by the kidneys and leave the body through urination.

Ketosis is not always dangerous, and it’s not always the result of insulin deficiency. Ketosis can occur during sleep, exercise, or fasting.

DKA occurs when a person doesn’t have enough insulin to convert blood sugar into energy, and too many ketones build up in the blood. High ketone levels can make your blood too acidic, which is dangerous.

As a result of blood becoming acidic, several important electrolytes and minerals, including potassium and magnesium, are lost from the body through urine. It’s important to get these back to normal levels so the heart maintains a proper rhythm. Abnormal levels of potassium and magnesium can cause cardiac arrythmias.

“Diabetic ketoacidosis is potentially life-threatening, so it’s important to get medical help right away if you are experiencing the warning signs,” Dr. Folsom said.

Diagnosis and treatment

Diagnosis of DKA involves blood tests to measure acid levels, blood sugar, and ketones.

Treatment for DKA is complex, and patients with DKA need to be admitted to the hospital, often the intensive care unit, for careful monitoring for serious side effects. In general, patients with DKA are very dehydrated and have a fluid deficit of 5% to 10% of their body weight. These fluids need to be replaced with intravenous (IV) fluids.

A person with DKA requires treatment with insulin to allow the body to resume making energy from glucose rather than ketones. This fuels the cells and prevents more ketones from being produced.

Other rare but serious complications

One serious complication of DKA is cerebral edema, or swelling of the brain. This can cause a temporary change in mental status or become much more serious and even result in death.

DKA also can cause rhabdomyolysis, sometimes called rhabdo, which occurs when damaged muscle tissues release proteins and electrolytes into the blood. This can cause damage to the heart and kidneys, potentially resulting in permanent disability or death.

In addition, malignant hyperthermia can occur with DKA. Malignant hyperthermia can cause symptoms that include a dangerously high temperature, rigid muscles, muscle spasms and a rapid heart rate resulting in heart damage.

The post Some of the first signs of diabetic ketoacidosis (DKA) can be extreme thirst and frequent urination with high blood sugar levels appeared first on Norton Healthcare.