Diabetes | Westbury Integrated Medical

The Wellness Centers have a special interest and unique management program for diabetic patients and for those with insulin resistance. Thousands of patients have been treated at the Center with great success and improvement in their general health and wellness. The following outlines the Wellness Center’s protocol for diabetes management.

The Wellness Centers’ Criteria for Diabetes Management

An Initial History and Physical is performed
- Electrocardiogram
- Blood Chemistries including:
  - Lipid Profile
  - C-Peptide Levels
  - Female/Male Hormonal Profile
  - Homocysteine
  - Growth Hormone
  - Fibrinogen
  - Fasting Plasma Glucose
- Glycohemoglobin
  - Urinanalysis
  - Microalbumin
  - 24 hr. Creatinine Clearance
  - Protein
  - Ketones
- Physical Examination
  - Special attention to circulatory system
  - Blood Pressure determined
  - Ophthalmoscopic examination
  - Thyroid palpation
  - Abdominal examination
  - Foot examination
  - Evaluation of pulses (palpation)
  - Hand/Finger examination
  - Skin examination
  - Height and Weight
- Body Mass Index Evaluation
- Body Composition Measurements
- Glucose Tolerance Test with Insulin Levels when deemed necessary
- Referral for Optomathology evaluation
Recommendation of a Cardiac Evaluation
- Evaluation of Valvular Status
- Stress Echo Cardiography
- Echocardiogram
- High Resolution Multi-Site Imaging
- Carotid arteries
- Aorta
- Femoral arteries
Individual Meeting with the Doctor and the Certified Nutritionist
- Evaluation of the clinical studies and the laboratory chemistries performed
- Evaluation of symptoms, prior glycohemoglobin records, and home glucose monitoring results
- Review of eating patterns, nutritional status and weight history
- Review of exercise history
- Medical Management Program developed
The Program
- Control the Hypertension
- Introduce an individual Smoking Cessation protocol
- Develop a Weight Reduction Profile
- Establish appropriate weight loss profile
- Establish a tailored exercise program
- Utilization of aerobic activity combined with weight resistance training
- Behavior Modification
- Food Logs when indicated
- Introduction of Short and Long term Goals
- Normalization of Blood Lipids
- Stabilization of Glucose and Insulin Levels
Establish Individual Patient Oriented Dietary Goals
Incorporate Appropriate Vitamin and Mineral Therapy for Controlling Glucose and Lipid Abnormalities
- Cholesterol and Lipid Lowering
  - Magnesium
  - Niacin (with caution)
  - Pantathene
  - Essential Oils
  - Fiber Complex
  - Guggalipids
  - Phytosterols
  - Garlic
  - N-acetyl cysteine
  - Soy Protein
  - Choline
- Insulin and Glucose Regulating
  - Chromium
  - Lipoic Acid
  - Magnesium
  - Ginseng
  - Fiber Complex
  - Probiotics
  - Vanadium
  - DHEA
  - B-Vitamins
  - Selenium
  - Fiber Complex
Introduce Pharmacological Therapy when necessary for controlling:
- Hypertension
- Hyperlipidernia
- Hypertriglyceridemia
- Glycemic Control
Management of Type 2 Diabetes Mellitus
- Introduction of Short and Long term Goals
- Evaluate appropriate medication necessary
- Develop Medical Nutrition Program
- Encourage Lifestyle Changes
- Review and Incorporate Self Management Education
- Education on new glucose monitoring machines
- Evaluate individual technique
- Obtain Agreement on Continuing Support and Follow up
Review of Management Plan
- Evaluate each visit
  - Short and Long Term Goals
  - Glycemia
  - Medications
  - Weight
  - Frequency and Severity of Hypoglycemia
  - Self Blood Glucose Monitoring Results
  - Complications
  - Control of Dyslipidemia
  - Blood Pressure
  - Nutrition Program
  - Exercise Program
  - Adherence to Self-Management Training
Management of Type I Diabetes Mellitus
- Evaluation of Dietary Guidelines
- Review of Self Blood Glucose Monitoring
- Review of Dietary and Lifestyle Factors
- Review of Type of Insulin Used and Frequency of Use
- Evaluate if Oral Therapy is Appropriate in Conjunction with Insulin Therapy
- Management of Hypo/Hyper glycemia
- Establish an Appropriate Exercise Program
- Schedule Monthly Conferences with the Doctor and the Certified Nutritionist
- See Review of Management Plan For Type 2 Diabetes Mellitus