St. Clair Health Is Helping Patients with Diabetes with Quality of Life

By Andrew Wilson

Imagine a long hallway with locked rooms on each side. You need to get into the rooms, but you don’t have a key. That’s the analogy that Talia Fragello, PA-C, St. Clair Medical Group Endocrinology, uses to describe what diabetes is like for newly diagnosed patients.

“The hallway is your bloodstream and the rooms off the hallway are the cells in your body. Without insulin, the cells won’t be able to get the energy and nutrients they need to survive,” she says. “Insulin is what unlocks the door to let glucose into the cells to allow them to work.”

Fragello has worked in endocrinology and diabetes care for the past 21 years, first at Children’s Hospital and then St. Clair Health for the last ten years. “It’s amazing the changes I’ve seen in those 21 years,” she said. “The most important thing is people with diabetes can live a normal life with as little complications as possible if they can keep good control of their blood sugars.”

Maintaining control can be a challenge for some because diabetes comes in different forms. The two most common types of diabetes are referred to as type 1 and type 2. In type 1, the person’s pancreas stops making insulin completely. In type 2, the person’s pancreas is still making some insulin but not enough to meet the needs of the body.

“Type 1 diabetes is an autoimmune disease. The body does not make insulin,” Fragello said. “In type 2, the body doesn’t recognize insulin, something referred to as insulin resistance.”

Type 1 used to be referred to as “juvenile diabetes” and type 2 was called “adult-onset diabetes,” but those names really don’t apply any longer because some adults will develop type 1 and some children can develop type 2. It’s what Fragello refers to as a “bit of a gray area.” The treatments for each type may differ too.

“Type 1 requires insulin injections because your body is not producing insulin at all,” she said. “For type 2, we start with diet, exercise, and lifestyle modifications, and oral medications, if they are needed. If it is caught early, type 2 can be treated with diet and exercise, and medications may not be needed. But some bodies with type 2 don’t respond to the medications and they will need insulin injections.”

People with undiagnosed diabetes of either type usually feel very sick, but once the insulin or medications are introduced, they start to feel much better. However, that is only the beginning treatment. The key to long term health for someone with diabetes is maintaining good control of their blood sugars. 

This starts with regular monitoring of the blood either through testing the blood multiple times a day with finger pricks, test strips, and a glucose monitor or – a more recent development – a continuous glucose monitor, which attaches to a person’s arm, abdomen, or back that, as the name implies, keeps constant track of the blood sugar.

“Blood sugar is variable throughout the day,” Fragello said. “So one glucose reading only reveals where the blood sugar is at a point in time.”

She emphasized that even a person with good control can have a really high or really low blood sugar once in a while. To get a better picture of how well a person is maintaining control of their blood sugars, endocrinologist rely on a metric known as the A1C reading.

“A1C is an average of the blood sugars of the past three months,” said Fragello. “A really high blood sugar can be balanced by a really low blood sugar and the A1C gives us a reading of how well the person has maintained control overall.”

Poor control can lead to life threatening complications like diabetic ketoacidosis, heart or kidney disease, blindness, amputation, and dementia – to name just a few. But good control can lead to a good quality life.

“Type 1 diabetes is a chronic disease. It’s not going to go away, so it’s about learning to deal with the diagnosis in the best manner possible, so you have the best quality of life you can,” said Fragello, who noted some of the people with type 1 diabetes who have achieved their dreams include professional athletes Mark Andrews of the Baltimore Ravens and pro golfer J.J. Spaun, who won the U.S. Open at Oakmont in June; celebrities like Nick Jonas and Halle Berry, and even a man who climbed Mt. Everest. “Diabetes is all around us, but with a little work people can function normally. If the patient is diligent and the providers are diligent, you can live a long healthy life.”

Talia Fragello, MPAS, PA-C, is board-certified by the National Commission on Certification of Physician Assistants. She practices with St. Clair Medical Group Endocrinology and sees patients at the practice office located in Suite 405 at 2000 Oxford Drive, Bethel Park, PA 15102

Fragello works alongside Wayne Evron, M.D., who is board-certified in Internal Medicine with a focus in Endocrinology and Diabetes, Fragello and their team are dedicated to diagnosing and treating conditions that are caused by or affect the body’s hormones with high quality, timely, and empathetic care that is close to home. To schedule an appointment, please call (412) 942-7295.