Management of Chronic Conditions



Diabetes is a disease where there is too much sugar in your blood, thus complicating how your body will use the blood sugar (also referred to as “blood glucose”). There are four types of diabetes: Type 1, Type 2 diabetes, pre-diabetes and gestational diabetes. Both pre-diabetes and gestational diabetes are preventable and sometimes reversible, unlike Type 1 and Type 2 diabetes, which are chronic types of diabetes.

Symptoms may vary depending on the type of diabetes one has, and may include increased hunger, excessive thirst, frequent urination, fatigue, unexpected weight loss, various infections, blurred vision or sores that are slow to heal. Pre-diabetes and gestational diabetes may not show any symptoms.

Types of Diabetes

  • Type 1 Diabetes can develop at any age; it most commonly appears during the childhood and teenage years. It occurs when your immune system attacks and destroys the insulin your body produces to allow sugar into your cells. This greatly reduces your insulin levels causing your blood sugar to build up in your blood stream. While the exact cause for Type 1 diabetes is still unknown, it is likely that family history may be a factor. This risk increases if a parent and/or sibling also has Type 1 diabetes.
  • Type 2 diabetes is often preventable and can occur at any age. It occurs when your cells begin rejecting the insulin and your liver is unable to produce enough insulin to overcome this problem. This will cause the blood sugar to build up in your bloodstream. It is still undetermined why Type 2 diabetes develops in some and not others, but there are some common risk factors that contribute, including: family history, weight, age, ethnicity, inactivity and gestational diabetes.
  • Pre-diabetes is a state of diabetes that occurs when a person’s blood sugar is higher than normal, but not high enough to be classified as Type 2 diabetes. It is important to seek treatment for pre-diabetes because the development of Type 2 diabetes can be avoided if the proper steps are taken to improve your health. However, if left untreated, pre-diabetes can develop into Type 2 diabetes within 10 years. The exact cause of pre-diabetes is unknown, but some contributing factors include: weight, age, ethnicity, family history and inactivity.
  • Gestational diabetes takes place during pregnancy. The hormones produced by your placenta can sometimes cause your cells to reject the insulin produced by your body, and can worsen as the pregnancy continues. For most, the pancreas counteracts by producing more insulin to overcome the rejection, but for some it’s not enough. While any pregnant woman can develop gestational diabetes, women 25 and older are usually at a higher risk for developing gestational diabetes, as well as black, Hispanic, Asian or American Indian women. Other contributing factors include being overweight, having pre-diabetes or having a family history of diabetes.


Treatment of diabetes will depend on the type of diabetes one has, and can vary from monitoring your blood sugar level and using insulin or oral medications to having a pancreas implant.

  • Lifestyle Changes: No matter what type of diabetes one has, it is important to maintain a healthy lifestyle, including a balanced diet, exercising and sustaining a healthy weight in order to properly manage your diabetes.
  • Glucose Monitoring: Monitoring your blood sugar and having insulin therapy will be the primary course of treatment for those with Type 1 and Type 2 diabetes. Your physician will determine how often you should check and record your blood sugar level. By monitoring this, you are able to ensure your blood sugar stays within your range set by your doctor.
  • Medications: Insulin, for example, is absolutely necessary for Type 1 diabetics. Insulin is often injected with a fine syringe needle or insulin pen. For some, an insulin pump may also be used to automatically dispense a pre-programmed dose of insulin based on your sugar level. For others, oral medications are used to encourage the pancreas to increase insulin production or to inhibit the liver from releasing glucose.

High Cholesterol

Cholesterol is the waxy matter in the blood lipids (fats) that is needed to build healthy cells; however, too much can increase a person’s risk for developing heart disease. High cholesterol is when there is an excessive amount of cholesterol build up in the fats found in your blood making it difficult for an adequate amount of blood to flow through your arteries. This could lead to a heart attack or a stroke.

High cholesterol is often preventable and is manageable. While it can be inherited, simple lifestyle changes like maintaining a healthy diet and exercise routine can help reduce one’s risk for developing high cholesterol. In some instances, certain medications can be used to reduce high cholesterol.

There are no symptoms for high cholesterol. It is only detectable by a blood test. Patients should receive a baseline cholesterol test at the age of 20 and then continue to have their cholesterol tested every five years. This will allow your internist to detect high cholesterol levels early and offer recommendations to bring your cholesterol back into the desirable range, if needed. If you have a family history of high cholesterol and heart disease, or if you smoke, have diabetes or high blood pressure, more frequent tests may be recommended.

High Blood Pressure

High blood pressure, also known as hypertension, is a common condition that can eventually lead to heart disease. It occurs when the force of the blood against the artery walls is too great. Blood pressure is determined by how much blood your heart pumps and the resistance it faces when flowing through your arteries.

A normal blood pressure is 120 over 80 (120/80). Blood pressure is considered high if it is constantly over 140 over 90 (140/90). The top number is your systolic pressure, which is the pressure your heart creates as it beats. The bottom number is your diastolic pressure, which is the pressure that is inside your blood vessels when your heart is at rest.

Typically, high blood pressure develops over several years. A person can go years without showing any signs or symptoms of high blood pressure. However, some common symptoms include: dizzy spells, tedious headaches and more frequent nosebleeds.

High blood pressure is easily detectable and very manageable if detected early. High blood pressure that is left untreated will rise out of control increasing one’s risk for developing serious health problems like stroke or a heart attack.

Treatment options will be determined by healthy you are. While 120/80 is the ideal blood pressure goal, factors like your age and lifestyle may alter what a healthy blood pressure goal should be. Simple lifestyle changes and medications may be used to control your blood pressure. A personalized treatment plan will be created by your internist to ensure optimal health.

Heart Disease

Heart disease also referred to as cardiovascular disease is the primary cause of death among men and women in the United States. It is a term used to describe a condition that involves blocked or narrowed blood vessels. There is a wide range of disorders that affect the heart and blood vessels that are considered heart disease. These disorders include: congenital heart defects, coronary artery disease and heart rhythm problems.

Coronary artery disease is the most common and occurs when there is a buildup of fatty plaques in your arteries causing damage to your blood vessels or heart. The arteries of your heart carry oxygen and nutrients to the rest of your body. When fats build up in your arteries, less oxygen can travel through your arteries causing them to become thick and stiff, thus restricting blood flow to your tissues and organs. When this happens, serious complications can occur such as a stroke or heart attack.

Symptoms vary depending on the type of heart disease, but may include chest pain (angina), pain and numbness in your legs and arms and shortness of breath. There are a number of risk factors that can increase your chance for developing heart disease such as: age, sex, family history, diabetes and obesity. Smoking, high blood pressure, high cholesterol, high stress and a poor diet can also be contributing risk factors to developing heart disease.

Depending on the type and severity of heart disease one has will determine the proper course of treatment needed. We will perform a thorough examination and develop a personalized treatment plan to meet your individual needs. Treatment options may include:

  • Lifestyle Changes: a change in diet and exercise, as well as quitting smoking and decreasing your alcohol intake may be recommended in treating your heart disease.
  • Medications: if simple lifestyle changes aren’t affective, prescription drugs may be used to control your heart disease and/or lower cholesterol.
  • Surgery: as a last resort, certain medical procedures or surgery may be necessary to clear the blockages in your heart.

Your physician will thoroughly explain the details of your heart disease, the risks involved, treatment options available and our recommendations.

If you or a loved one experience any of the symptoms mentioned above, please contact your physician immediately to have a comprehensive examination to detect any potential problems early.

Congestive Heart Failure

Congestive heart failure is a serious condition in which the heart is unable to adequately pump enough blood to the entire body to meet the body’s needs.

Heart failure is often successfully treated with medications that improve the signs and symptoms. Lifestyle changes can improve your quality of life. The American Heart Association recommends maintaining a healthy weight, eating healthy, getting your exercise and managing your level of stress. If you have certain risk factors for heart failure, it is critical that you appropriately manage those risk factors and conditions. People with chronic high blood pressure, coronary artery disease, chronic high cholesterol, diabetes or those who are obese are at the highest risk of suffering congestive heart failure.

Symptoms of Heart Failure

  • Shortness of breath
  • Irregular heartbeat
  • Fatigue
  • Swelling of the legs and feet
  • Fluid retention
  • Chest pains

Contact your doctor immediately if you experience symptoms associated with heart failure. If symptoms are severe, do not wait to call our office; go to the emergency room.


Asthma is a chronic disease that affects the airway causing coughing, wheezing, shortness of breath and tightness in the chest. Asthma can affect anyone at any age, and it varies from mild, moderate to severe causing symptoms to appear inconsistently. For some symptoms may occur repeatedly for a period of time, while others may have an episode and then it will be a while before another attack occurs.

The cause of asthma is still uncertain, but there are several factors that can trigger an asthma attack, such as:

  • Airborne allergens
  • Cold air
  • Air pollutants
  • Food allergies
  • Respiratory infections
  • Certain medications
  • Stress
  • GERD (Gastroesophageal reflux disease)
  • Menstrual cycle

These triggers irritate the lining of the airways causing them to become red and swollen. If this inflammation isn’t treated, it can eventually cause the surrounding muscles to spasm causing the airway to constrict making it difficult to breathe.

Generally, people with asthma can continue with their normal daily activities. The key to managing asthma is prevention and control. The first step to treating/managing your asthma is to avoid the triggers of the asthma attacks. Monitoring your breathing daily can also help you recognize symptoms early and treat them before an attack comes. Other treatment options that may be considered for managing your asthma includes medications, inhaled corticosteroids, immunotherapy and quick relief medications.

We will work with each patient individually to determine which treatment option will be most beneficial for their specific needs.


Chronic Obstructive Pulmonary Disease (COPD) is a chronic progressive disease in which you lose lung capacity, making it harder to breathe. As COPD progresses, normal activities such as cleaning the house or walking up stairs can make you out of breath.

COPD can be caused by several factors including long-term exposure to chemicals or fumes, and by an inherited disorder called Alpha-1 Antitrypsin Deficiency. However, the major contributing factor is smoking. Research shows that most patients with COPD have a history of smoking.

Symptoms of COPD:

  • Shortness of breath
  • Constant coughing
  • Wheezing and tightness in chest when you breathe in and out
  • Can’t take a deep breath
  • Excess mucus in your lungs

COPD can be diagnosed with a breathing test that your doctor can administer in his office. This test simply measures the amount of air your lungs can hold and how forcefully you can breathe that air out.


While there is no cure for COPD, there are medications that can help you manage the symptoms, and are inhaled using a nebulizer or metered-dose inhaler or come in pill form. Two types of medicine for COPD are rescue medication and maintenance medication. Rescue medication is fast-acting and is used when you experience sudden symptoms or are having trouble breathing. Maintenance medication is taken on a daily basis to help manage your COPD.

Quitting smoking, breathing exercises, a healthy diet and regular exercise are also recommended in managing COPD.

Peace Valley Internal Medicine, P.C.

  • Peace Valley Internal Medicine, P.C. - 5039 Swamp Rd., Suite 401, Fountainville, PA 18923 Phone: 215-230-8380

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