Bangkok Diabetes & Endocrine Center

The Diabetes Center at Bangkok Hospital has one singular mission: to bring lasting improvements in quality of life to diabetes patients, both type 1 and type 2. This common goal unites the clinical and education arms of the Diabetes Center into a comprehensive program that is unique among diabetes facilities.

Our clinical staff of dedicated professionals provides our patients with the highest standards of diabetes care : a highly qualified, multidisciplinary team approach offering the latest treatments, tailored to fit the individual needs of each patient.

Services

1. Our goal is to help our patients integrate optimal diabetes management into their everyday lives. We strive to remove all the barriers which may make it hard for people to take care of their diabetes. Because people with diabetes may have to see a range of health specialists, "Total Diabetes Care" at the Diabetes Center includes endocrinologists specializing in adult and childhood diabetes, as well as nurse educators, nutritionists and exercise physiologists.

2. Our patients also have access to a wide range of other consultants here, including ophthalmologists, cardiologists, nephrologists, surgeons and podiatrists. Patients' records are kept in one unified chart, and case managers help coordinate the care -- all in the interest of simplifying management of this complicated disease. Quick Lab assessment include: HbA1c, fasting blood sugar, cholesterol level, triglyceride level, blood urea nitrogen, serum creatinine and uric acid.

3. To assess the peripheral vascular disease in patients with diabetes, the ABI is a reproducible and reasonably accurate, noninvasive measurement for the detection of PAD and the determination of disease severity. The tools required to perform the ABI measurement include a hand-held 5–10 MHz Doppler probe and a blood pressure cuff. The ABI is measured by placing the patient in a supine position for 5 min. Systolic blood pressure is measured in both arms, and the higher value is used as the denominator of the ABI. Systolic blood pressure is then measured in the dorsalis pedis and posterior tibial arteries by placing the cuff just above the ankle. The higher value is the numerator of the ABI in each limb.

4. Diabetic complications can be divided usefully into short-term and long-term complications. It is because of the risk of complications that diabetes needs regular monitoring - both by the patient and by the doctors and nurses looking after them. Short-term complications are caused mainly by imbalance of the sugar level. Long-term complications are the main reason for holding diabetic clinics. After some controversy a few years ago it is now widely accepted that good diabetic control plus control of blood pressure and cholesterol has a vital role to play in reducing the long term consequences of being diabetic.

5. There are two different tests used to determine whether you have pre-diabetes : the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have metabolic syndrome or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).

6. Gestational diabetes mellitus is a type of diabetes that arises during pregnancy, usually during the second or third trimester. In some women, GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In other women, GDM may be found during the first trimester of pregnancy. In these women, the condition most likely existed before the pregnancy. Because pregnancy affects blood glucose levels in all women, even those without diabetes, it is currently debated how high blood glucose has to be before making a diagnosis of GDM. All pregnant women are given urine and blood tests to check for the presence of glucose.

7. New Technology :

Better blood glucose control has been the focus of a lot of attention since the release of the results of the landmark Diabetes Control and Complications Trials (DCCT) in 1993. The DCCT was the largest long-term research study on the effects of glucose control ever conducted .

The DCCT showed clearly that those who achieved a better blood sugar control with an average 2% lower glycohemoglobin value had a tremendous decrease in their risk for the long-term complications of diabetes.

An insulin pump is a great way to achieve the degree of control we now know is your best defense against long-term health problems.

An insulin pump is made up of a pump reservoir (like a regular syringe) filled with insulin, a small battery operated pump and a computer chip that allows the user to control exactly how much insulin the pump delivers. It is all contained in a plastic case about the size of a beeper.

The pump is intended to be used continuously and delivers insulin 24 hours a day according to a programmed plan unique to each pump wearer. A small amount of insulin is given continually (the "basal rate"). This insulin keeps blood glucose in the desired range between meals and over night. When food is eaten, the user programs the pump to deliver a "bolus dose" of insulin matched to the amount of food that will be consumed.

Absorption of injected long-acting insulin is extremely unpredictable. In fact, it has a variability of up to 52%. This is a key reason your blood sugar can vary so much from one day to the next. That single factor probably accounts for why most people on injections can't control their blood sugars well.

Pumps use faster-acting insulin which is much more predictable than long-acting insulin. It's variability is less than 3%. Quite a difference. And it works. That's why a pancreas only puts out fast-acting insulin.

With injections, the insulin just sits there... in a little pool. Your level of activity directly affects when that insulin goes into your bloodstream. If you're just sitting at a desk, it will go into your system more slowly. But if you go for a walk or a run, it will go into your system much more quickly. This makes blood sugars even harder to control with injections!

Pumps continuously send a little bit of insulin every few minutes (like a pancreas) so you don't have this inconsistency problem. And it's a different insulin - fast-acting, predictable insulin!

Because you can control your insulin on a pump, YOU (not your injections) get to decide when you want to eat. You can eat when you are hungry - or not - delay or skip a meal. Have that extra piece of pie if you like - on a pump you can handle it - no problem.

7.2. Continuous Glucose Monitoring System Overview

A more complete picture

Fingersticks are important - you've got to know what your blood glucose level is. But even frequent testing may not allow you to see what's really going on with your blood sugars 24-hours a day.

Fingerstick measurements are taken at points in time. They cannot indicate the direction or trend of blood sugar levels. So even the most motivated diabetes patients performing frequent tests may miss reoccurring highs or lows, particularly at night.

Healthcare professionals prescribe the CGMS System Gold for their diabetes patients because it can give them a clearer picture of blood sugars throughout the day. The CGMS system fills in the gaps left by fingersticks and can reveal hidden patterns, like frequent episodes of hypoglycemia (low blood sugars).

The sensor system provides an average blood sugar measurement every five minutes, for up to three days at a time. That's 288 readings a day - up to 864 readings in 72 hours. At the end of your test period, you return to your healthcare professional with the CGMS sensor and monitor so you can go over the data the system has collected.

And for the first time, you and your physician can see what happens between fingersticks — giving you a more complete picture of your glucose profile.

8. ther endocrinology problems : Thyroid disease, Adrenal disease, Pituitary disease, Lipid, Obesity, Growth problems, Calcium with Osteoporotic etc;

9. Clinical trial :

• Participates in clinical trials research aid all patients with Diabetes and Endocrine problems.
• Please call the center if interested in participating in a research study