Hayes Endocrine and Diabetes functions as a consultative practice for endocrine and diabetes care. We work in tandem with primary care physicians and other specialists. We require that all of our patients maintain a relationship with their primary care doctors so that we can focus solely on patient's individual metabolic needs. Along with diabetes care, we focus on prevention and attention to micro and macrovascular risk factors with treatment of hypertension, dyslipidemia, and cardiovascular risk reduction. We are strong promoters of proper nutrition and physical activity.
In addition to providing medical care through routine office visits, we also provide other services in order to maximize the care that we can give to our patients. Listed below are several of the services that patients may receive through our office.
Ultrasound guided Fine Needle Aspiration Biopsy
Thyroid nodules are very common today in both women and men. A fine needle aspiration biopsy gives us more information of whether the nodule is a benign finding or a cancer. We utilize on-site thyroid ultrasound and perform fine needle biopsies on the first office visit for patients with nodules in need of cytologic evaluation. We use AFIRMA lab for diagnostic specimens, utilizing the most advanced genetic technology in determining if a nodule is benign or malignant. This technology has reduced unnecessary thyroid surgeries by 50%, a dramatic improvement in diagnostic testing.
Peripheral Vascular Disease Screening
Patients with diabetes are at risk for developing blockages to the arteries supplying blood flow to the feet and legs. An ABI (ankle brachial index) test allows us to determine if there is decreased blood flow to the lower extremities. With this knowledge, we can reduce risk factors that impede vascular flow. Our goal is to prevent amputation and take measures to allow normal blood flow in this area. We routinely refer patients to vascular surgeons if necessary.
Diabetic Kidney Disease Screening
Diabetic kidney disease is a leading cause of renal failure in our country. We screen for kidney disease by testing for small amounts of protein in the urine. We can prevent progression to kidney failure by using certain medications, controlling blood sugars and controlling blood pressure. It is much easier to prevent decline in kidney function if detection occurs early in the course of the disease.
Diabetic Neuropathy Screening
Diabetic neuropathy can cause burning, numbness and tingling in the toes and feet. If an individual has decreased sensation in the legs and feet, the person is at increased risk for foot injury and foot ulcer. In order to detect early neuropathy we perform annual foot exams on our patients and more often when there is a problem. Many of our patients wear diabetic foot gear in order to protect the feet from improper pressure points that occur with conventional shoes.
Blood draws and Hemoglobin A1C Testing
We are fortunate to have an on-site lab with our own full time phlebotomist to assist us with our blood collections and lab processing. Our specimens are sent to Quest Diagnostics, a national lab recognized for it's excellence in endocrine laboratory tests. We routinely check A1Cs every three months to assess the blood sugar average of the previous three months. This serves as a diabetes "report card" and allows us to make medication changes in part due to this result.
Continuous Subcutaneous Insulin Infusion (i.e. CSII/insulin pump)
Dr. Hayes has worn an insulin pump for 35 years. She strongly believes that her good state of health is, in large part, due to the continuous supply of insulin that is afforded through pump therapy. Dr. Hayes and her staff are experts in insulin pumps. She and her staff will recommend which pump is most appropriate for the patient based on lifestyles and preferences. After the approval process through insurance companies, the pump is shipped to the office with supplies. The patients then comes in for a two hour training session in order to begin pump therapy. It is extremely helpful if patients are very familiar with carbohydrate counting or at least carbohydrate "exchanges" prior to initiating pump therapy. The pump training session covers a huge amount of material in a very short time. When Dr. Hayes started an insulin pump, she was hospitalized for two weeks! These days insurance companies will not cover a hospitalization for pump training. Learning to live with an insulin pump is a process. Dr. Hayes team provides the tools and support but the patient is ultimately the one who manages his/her own disease.
Continuous Glucose Monitoring (CGM)
CGM, wearing either an internal or external glucose sensor, is invaluable to many people living with diabetes. The sensor checks the blood sugar every five minutes. The resultant glucose level is then transmitted to either a hand held receiver or a phone. The receiver can be set to alarm when the blood sugar is high or low. Reminders can be set as well as events such as exercise or a meal. This affords the patient with the luxury of knowing his/her blood sugar at all times and allows for corrective action to be taken for more or less insulin delivery, activity and food alterations. Some people who have "hypoglycemia unawareness" have greatly benefited by CGM. This technology have saved some from frequent ambulance rides, hospitalizations, car wrecks and even death. Patients at HEDC are prescribed sensors based on their particular needs; these devices are taught in office.
Technology is advancing rapidly in the field of diabetes. There are many groups working on integrating the insulin pump with sensor therapy as a "closed loop" or "hybrid closed loop" system. This technology aims to simulate what a normal pancreas would do if it was working properly. We have one such hybrid system available today and more will be coming. HEDC prides itself on being some of the first to embrace and prescribe new technology. One example is the implanted glucose sensor, the Eversense sensor, made by Sensionics. Dr. Hayes was the first doctor in Tennessee to be certified in prescribing and implanting such sensors and she also enjoys the benefits of one herself!