Diabetes Specialist

David R. Hotelling, MD, FACE, Specialist in Diabetes

According to Dr. Hotelling, a diabetes specialist, diabetes mellitus is a condition that occurs when the pancreas (located in the upper abdomen) does not produce enough insulin and/or the body’s tissues become resistant to insulin.  Type 1 diabetes occurs when the immune system destroys insulin-producing cells (beta cells) in the pancreas.  This usually (but not always) occurs at a younger age. Type 2 diabetes, which occurs when the body tissues become resistant to insulin and sometimes results in normal or high levels of insulin, usually occurs after youth (age 20+) but not always.  The end result of either type of diabetes is high blood sugar (hyperglycemia).

High blood sugar can cause symptoms of diabetes including increased thirst, urination, fatigue, weight loss and sometimes blurred vision.

Diagnosis of either type of diabetes is made by a fasting blood sugar (measured twice) greater than 126 or a random blood sugar greater than 200 in a person with symptoms of hyperglycemia.  A fasting blood sugar between 100 and 126 is termed impaired fasting glucose or “prediabetes” (This does not always mean that a person will progress to diabetes but they are at a higher risk.)

Complications of diabetes include visual (retinal) problems, kidney problems, neurological problems and increased risk for cardiovascular problems.  However, and most importantly, it has been clearly demonstrated that with treatment, risk for complications can be significantly reduced – sometimes by more than half.

Treatment includes insulin for people with type 1 diabetes and improved health style including weight maintenance, exercise and non-smoking.  Lifestyle improvements are also first-line treatment for patients with type 2 diabetes.  Because type 2 diabetics usually continue to make some insulin (although usually not adequate), there are several oral medications that help the pancreas to be more productive and also decrease peripheral resistance to insulin.  Sometimes, lifestyle modification alone is adequate treatment, but often oral medications and/or insulin are needed to maintain good control.

Importantly, in the past several decades, there has been tremendous improvement in the understanding of diabetes and its treatment.  Multiple medication regimes are now available as well as home blood sugar monitoring and even continuous insulin pumps and continuous glucose monitoring (when and if appropriate).  Important treatments for complications involving diabetes including retinal problems, kidney problems and foot problems are also available.  There are many resources for help including diabetes educators, group meetings, dieticians and diabetes associations and activities.

The office of Diabetes Specialist David R. Hotelling, MD, provides care for both type 1 and type 2 diabetes. We are able to monitor computerized home glucose monitoring and will also assist you with monitoring yourself.  We can refer you to community resources (and would encourage this) – as part of your routine.

Fortunately, these days, people with both type 1 and type 2 diabetes can lead full and productive lives and can much reduce risk for complications (with appropriate therapy) and can even have special occasion foods such as birthday cakes, pizza and ice cream.

Websites with more information:
• American Diabetes Association (www.diabetes.org)
• The Endocrine Society (www.endo-society.org)
• National Institute of Diabetes and Digestive and Kidney Diseases (www.niddk.nih.gov).

  • Thyroid and parathyroid ultrasound are available in our office, for your convenience.

• Office location: 477 Congress Street (the Time & Temperature Building), 5th floor, Portland, Maine 04101

• Parking: Free parking is available in our garage, reached from Cumberland Ave.

• Telephone: 207-773-6463

• Fax: 207-828-4587

Thyroid and parathyroid ultrasound are available in our office, for your convenience.
David R. Hotelling, MD, FACE, is on the medical staff at Maine Medical Center and is a consulting staff member at Mercy Hospital. Dr. Hotelling is board-certified and completed a fellowship in endocrinology at Beth Israel Hospital in Boston, a Harvard affiliate.