Advertisement Her father, Stanley Korducki, was an obstetrician-gynecologist at St. Francis Hospital in Milwaukee. After graduating from St. Mary’s Academy in Milwaukee, Korducki majored in piano performance at Lawrence University in Appleton, Wis., but that lasted only a year.
“I was really interested in medicine but enjoyed music,” Korducki said.
She transferred to Marquette University, where she received a biology degree in 1981, and then got her medical degree from the Medical College of Wisconsin in Milwaukee in 1985. In medical school, she decided to pursue endocrinology, the study of the function and pathology of the endocrine glands such as the thyroid gland and pituitary gland.
“I loved working with patients with diabetes and endocrine problems,” Korducki said.
She had a three-year internal medicine residency at Cleveland Clinic and then a three-year endocrinology fellowship at Mayo Clinic. Korducki, 47, has been seeing patients with diabetes and other endocrine problems at Franciscan Skemp Healthcare for 151/2 years.
In college, Korducki said, she was a nurses’ aide at her father’s hospital. She said she has seen a lot changes in the care of diabetes patients.
“There was no blood glucose test, just a urine test when I was a nurses’ aide,” Korducki said. “Now we have a blood glucose test and have gone from 2 minutes to do to 15 seconds and some cases 5 seconds. Technology has gone through the roof.”
She and her husband of 16 years, Tom Miller, have two children, Andrew, 9, and Clare 7.
Korducki was asked to answer some questions about diabetes.
What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes occurs when the pancreas can no longer make insulin. Treatment requires insulin, usually in the form of injections. In type 2 diabetes, people can still make insulin, but the insulin does not work as well as it should. This is called insulin resistance.
Do the symptoms for the two types differ?
With type 1 diabetes, people usually have acute symptoms such as increased thirst, urination, weight loss and blurred vision. Individuals are usually of normal body weight. Type 1 diabetes usually occurs in children or young adults. Sometimes a condition called diabetic ketoacidosis is present which is life-threatening and results in hospitalization.
In contrast, people with type 2 diabetes often have no symptoms at diagnosis, though they could have any of the symptoms that people with type 1 experience. These people frequently have a strong family history of type 2 diabetes, are overweight, or have had a history of diabetes during pregnancy. Type 2 diabetes usually begins in adulthood, though we are seeing it more often in overweight children and teens. Diabetic ktoacidosis rarely occurs in type 2 diabetes.
Why is type 2 diabetes becoming an epidemic?
About 21 million people have diabetes in our country. About one-third do not know they have the disease. Diabetes affects 7 percent of our population. Type 2 diabetes is becoming more prevalent in adults and even children and is directly related to the increasing incidence of obesity.
What can be done to prevent the onset of type 2 diabetes?
Lifestyle change is still the best method to prevent type 2 diabetes.This includes diet and exercise. However, lifestyle change remains difficult for people to maintain. Studies have shown that some medications will decrease risk of developing diabetes. Medications are costly and have risks of side-effects therefore, doctors usually recommend lifestyle changes first.
What is the biggest challenge for the person with diabetes?
Diabetes is a challenge because it requires lifestyle changes that involve close attention to diet, meal schedules and exercise. Additionally people need to test their blood sugars regularly to achieve and maintain good control. For some people this will be four or more times per day. Good diabetes control requires effort by the patient. Some people experience “diabetes burnout” where they get frustrated and give up. Luckily, many resources are available to help people maintain their self-care efforts. These include sessions with certified diabetes educators, counseling, support groups and resources from the American Diabetes Association and help from a provider.
What new treatments and medications are there for diabetes?
Over the past few years, many new medications have become available for the treatment of diabetes, and others are in research and development. Of great interest are drugs that mimic or effect incretin hormones. Incretins are hormones secreted by the intestine in response to the absorption of glucose. They stimulate glucose-dependent insulin secretion and decrease glucagon (a hormone with actions opposite of insulin) secretion. The new drugs can be used alone or in conjunction with other drugs for Type 2 diabetes. These new drugs include exanetide which is given by injection and sitagliptin which is a pill. When I started practice 16 years ago we had only one type of pill to treat Type 2 diabetes. We now have seven different classes of oral agents plus many new types of insulin including inhaled insulin.
Any new technology that benefit those with diabetes?
Diabetes technology continues to advance. New blood glucose testing meters are small, require tiny amounts of blood and are quick. Some allow "alternate site testing" e.g. on the forearm instead of the fingers. Inhaled insulin is now available for patients who are fearful of injections. It is not indicated for children and is primarily used in people with type 2 diabetes.
For treatment of type 1 diabetes, insulin infusion pumps are becoming more sophisticated. Pumps deliver insulin subcutaneously (beneath the skin) in tiny amounts throughout the day with larger amounts being delivered at meals. New pumps have an additional feature that allows blood sugars to be monitored continuously. his is done via a sensor placed beneath the skin. This sensor is changed by the patient every several days.
Patients still need to check their blood sugars a couple of times per day, but they can easily see their blood sugar by looking at the pump and may be alerted if the blood sugar is dangerously low or high. Unfortunately, at this time, most insurance companies are not covering the cost of this new technology.
How do you track or follow patients with diabetics?
We track measures such as Hemoglobin A1C (a measure of blood sugar control), cholesterol levels, kidney function, eye exams among other items to help keep our patients under the best control possible. At Franciscan Skemp we have in place a diabetic registry. This allows our primary care providers at our La Crosse and regional sites to select patients who have not been in for appointments, or who have unusually high blood sugars to be contacted. Teams at each of our sites meet regularly to strategize best processes to improve diabetes control for our patients.
What is gestational diabetes? Who's at risk and how do we treat it?
Gestational diabetes is diabetes that is diagnosed during pregnancy and typically goes away after delivery. It typically occurs later in pregnancy and is partially due to the effects of hormones released by the placenta. Risk factors for diabetes include obesity, family history of diabetes, older age, certain ethnic groups (Hispanic, black, Asia-Pacific Islanders, American Indians), or history of previous large for gestational age infant.
Luckily, most women respond to changes in diet to control blood sugars during pregnancy. Some women require medication or insulin. It is important that women who have gestational diabetes meet with diabetes educators and check their blood sugars during the pregnancy. Women who have diabetes are at extremely high risk for developing type 2 diabetes later in life, so it is important for them to achieve or maintain a normal body weight and to stay physically active after pregnancy .
What role do high blood pressure, high cholesterol and other factors play in diabetes?
People with diabetes die from cardiovascular disease. It is extremely important for people with diabetes to have great blood pressure control and excellent cholesterol control. Tobbaco cessation is extremely important as well.
What role does exercise play in managing diabetes, and what are the new (ADA) exercise recommendations?
Exercise helps your insulin work better. The American Diabetes Association now has formal exercise guidelines. Individuals with diabetes should exercise a minimum of 150 minutes per week of moderate exercise, or 90 minutes per week of vigorous exercise and should not go more than two days in a row without exercising. Patients should always check with their providers before initiating a new exercise program.
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