Karen Pulfer Focht
Dr. Kashif Latif is an endocrinologist in Bartlett, Tennessee.
Dr. Kashif Latif and his wife, Dr. Shazia Hussain, were looking forward to celebrating the first birthday of their son, but they knew something was wrong. “Ahmed would get glassy-eyed — that was the biggest thing,” says Latif, “and he would get irritable and cranky, and was always reaching for his bottle of water.” At such a young age, the boy couldn’t tell his anxious parents what was wrong, but tests confirmed their 11-month-old son had Type 1 diabetes mellitus, often known as juvenile diabetes.
“Ahmed was at such a young age that he couldn’t verbalize his symptoms,” says Latif. “He couldn’t tell us that he wasn’t feeling well from all the sugar he was getting.”
So began a daily — sometimes hourly — regimen of pricking the child’s fingers and toes, drawing blood for a glucose monitor, and then administering daily doses of insulin to replace that which was no longer being produced by his pancreas. “It was such a small surface area, with his tiny fingers, so then you would prick the great toe,” says Latif. Administering the life-saving insulin, by injection, was never easy. “Learning the practical aspect of all these things — how to manage this disease — that was a real eye-opener.”
Changing Direction
Karen Pulfer Focht
Patient areas of the AM Diabetes and Endocrinology Center are brightened with artwork created by patients, staff members, and their families. The center’s founder, Dr. Kashif Latif, stands in the lobby with members of his medical team (L-R), Sarah Pulliam, FNP; Belinda Hilliard, DNP; and Jennifer Jurado, FNP.
Born in Pakistan, Latif attended the Aga Khan Medical College in that country and moved to the United States in 1992 to practice internal medicine after his wife received a fellowship at Le Bonheur Children’s Hospital in pediatrics. But in 1997, the situation with their child changed their lives forever.
“We went through training at Le Bonheur about how to take care of a small child with diabetes, and I saw there was a need to address diabetes from a completely different level,” he says. “Being physicians, my wife and I were trained to be medical providers, but when you are on the other side of that fence, as a patient or a parent, you see there’s a big gap. There are so many practical aspects to it — how to store the insulin, how to measure the blood sugar, how to use the syringe. I saw a need to merge the practical part with the technological part.”
One day, Dr. Abbas Kitabchi, whom Latif considers his mentor, called and asked if Latif would join him for a juvenile diabetes fundraiser. Not only did he say yes to that request, he also told Kitabchi that he was thinking about returning to medical school to study endocrinology, the specialty that tackles diabetes, thyroid conditions, pituitary disorders, and other diseases affected by the human endocrine system. “Within four weeks he called back and said, ‘I’ve got a spot for you,’” says Latif. “That was unusual, but what he did was create an accredited training program at UT and got it funded.”
In 2003, with his new expertise, Latif opened the AM Diabetes and Endocrinology Center in the medical building at St. Francis Hospital - North. The initials honor his son, who has responded well to his treatment over the years, and today is a healthy student at Georgetown University, studying computer science. Four years ago, Latif moved into his present facility on Kate Bond Road, an ultra-modern complex across the street from St. Francis.
In simple terms, diabetes mellitus is a disorder of the pancreas, a small organ in the abdomen which, in addition to hormones that aid in digestion, produces insulin, necessary to control the body’s levels of sugar that are obtained from food. A precise level of sugar in the bloodstream is necessary for the proper function of nerves, muscles, and organs such as the brain, heart, kidneys, and eyes.
“The focus here has always been to span the entire spectrum of diabetes,” says Latif. The facility includes examination and treatment rooms, a laboratory, research departments specialized areas for eye exams, and an education center that the doctor proudly notes is the largest part of the building. Scheduled to open early this summer is an exercise center tailored to the special needs of diabetes patients. Adjacent to it will be a complete physical therapy department.
Memphis already has plenty of gyms and spas, “but there’s no place for diabetics,” says Latif. “Our goal is to have a place for them because their needs are different. If somebody has nerve damage to their feet, they can’t run on a regular treadmill. If they have problems with blood vessels in their eyes, they shouldn’t be lifting weights. If they have heart problems, they need to be monitored carefully. Each complication with diabetes brings with it a different need and capacity as far as exercise is concerned.”
Learning Curve
Diabetes is considered a whole-body disease since it can affect so many different organs — often at the same time. With that diagnosis of a lifelong condition comes psychological demands, such as anxiety and depression. Latif’s center includes a psychologist on staff to help patients deal with these issues.
“What brings about depression is the chronicity of the disease,” says Latif, explaining that monitoring blood sugar levels and maintaining a healthy lifestyle are lifelong concerns. “It also ends up being a very personal issue. If somebody is checking their glucose levels and still getting readings of 200 or more, then that number can be perceived as a feedback of failure.” The patient has a sense, he says, of feeling helpless — what else can I do?
And it doesn’t help if other members of the family are healthy. “If you have a household and only one person has diabetes, then it affects the others because of the food choices, or the activity choices. Everybody plays a role in it.”
For his part, Latif told his son that “diabetes is his test, and how well he does with it will be his report card. He is still expected to perform in school and sports.”
A positive mental outlook and the proper education are key elements to treating this disease. There is presently no cure for diabetes, but it can be maintained — if patients know what to do.
“What I’ve learned over the years is that the word ‘education’ has a negative connotation,” says Latif. “If you tell somebody they need diabetes education, at some level they find that offensive, saying, ‘We know how to eat, we know how to exercise.”
So what Latif does is give his patients very specific, individualized instruction: “I will say I need them to walk 15 miles a week, no matter how they do it — three miles five times a week, or five miles three days a week. I want 1,000 crunches a week. I want two yoga sessions a week. If you are more precise in your instructions, then patients are more likely to follow them.”
Education sessions presented by the staff include lessons on diet, medications, monitoring devices, and advances in technology. “Often health insurance doesn’t cover education or training, and we don’t break even on it, but that was my commitment from day one,” says Latif. “Our basic credo is to offer not only comprehensive diabetes and endocrine services, but to provide personalized care. That’s who we are.”
No Need for Needles
Karen Pulfer Focht
New medical devices, such as portable insulin pumps, are no larger than many smartphones.
Diabetes has been diagnosed, in its various forms, for centuries. Ancient manuscripts left behind by Egyptian, Greek, and other cultures referenced a disease that caused extreme thirst and excessive urination, along with a host of other maladies. Before the discovery of artificial insulin in the 1920's, that diagnosis usually carried with it the dread knowledge that the patient’s lifespan was half that of healthy men and women.
In more recent years, advances in technology have changed that outlook, but the condition still requires careful monitoring of blood sugar levels. Anyone with a friend or family member with diabetes knows about the spring-loaded lancets that prick a finger to draw a droplet of blood, which is carefully placed on a test trip inserted into a glucose monitor. These meters have become less expensive and more reliable, but still, drawing the blood hasn’t been a pleasant task. It doesn’t help that the meters and especially the disposable test strips can be quite expensive — not to mention the medication(s) required to treat the disease.
In a meeting room at his center, Latif picks up a black box half the size of an iPhone, passes it over his upper arm, and within a second his blood sugar level is displayed on a small screen. Tap a button, and a graph shows how it has fluctuated — within normal limits, since he doesn’t have the disease — throughout the day. No needle jabbed into a finger, no waiting for the machine to measure.
What he is wearing, only to see how well the device works, is a new form of glucose monitor that is taped to his arm. It’s about the size of a quarter, and has to be changed every few days, like a bandage. Coming soon, though, are implantable monitors — tucked into a pocket of skin on your arm — that read a patient’s blood sugar levels and send them directly to their iPhones or computers. The internal battery lasts up to 90 days, and the incision is small. That device, known as Professional Continuous Glucose Monitoring (CGM) therapy is still in the testing stages, and Latif’s center is one of the few places in this area where tests are being conducted.
That’s just one side of the technological spectrum. Administering the medicine — usually a form of insulin — is the newest challenge. Most patients, when they learn their blood sugar levels are too high, give themselves a shot — yes, with a needle. Some years ago, developers came out with a pump, which continually injects insulin into the body through a port, or tube.
“The pump is a more physiologic way of delivering insulin,” says Latif. “If you give yourself a shot, you’re putting that amount of insulin under the skin, and it gets released over time. With a pump, the insulin is trickled into the body a little at a time, so the level stays more constant.”
Pumps currently being developed monitor the insulin levels and adjust it according to need, because the need can change depending on activities, stress, and other factors. “It’s like an artificial pancreas,” says Latif, “but it is still not 100 percent there, because there are still things patients have to do manually. When you eat, you have to key in [on your computer] how much you are eating, and with a real pancreas obviously you wouldn’t have to do that.”
At the present time, there is no cure for diabetes. There is no surgery to repair a pancreas that is not producing, or measuring, the amount of insulin a patient needs. But Latif is hopeful for the future. “This new evolution in glucose monitoring techniques is going to bring about a huge change in patient and provider behavior,” he says. “I think it’s going to change how we take care of diabetes.”
