News & Views – Page 10 – from the division director

November 10, 2020September 5, 2021

Glucose Control and COVID Hospitalization Risk in Persons with Type 1 Diabetes

Yesterday, data were published indicating that among persons with type 1 diabetes, higher average glucose levels are associated with increased risk of requiring hospitalization for COVID infection. The peer reviewed data was published in the Journal of Clinical Endocrinology and Metabolism ( doi permanent link ; pubmed link ). The data were collected via the national T1D Exchange study consortium. Drs. Pinnaro and Tansey from our division are part of this consortium and helped author the article. The data indicate that if you have type 1 diabetes, you should keep your blood sugars in range as much as possible to help prevent severe COVID. We remain happy to help you achieve this goal; our contact information can be found by clicking on the “clinical website” at the top of our links page.

November 5, 2020July 13, 2021

Dr. Kanner named Assistant Clerkship Director of the Pediatrics Medical Student Education Team.

We congratulate Dr. Kanner on her recent appointment to become the Assistant Clerkship Director of the Pediatrics Medical Student Education team. Dr. Kanner has worked hard to gain this position, and we look forward to the enthusiasm she will bring to education of medical students as they rotate through Pediatrics.

October 6, 2020April 13, 2021

Electromagnetic Fields Can Treat Type 2 Diabetes

Our division director has contributed to new scientific work that has been published in Cell Metabolism showing that exposure to generated electromagnetic fields lowers blood sugar in rodents with type 2 diabetes. Dr. Norris helped design and interpret the glycemic clamp studies that were used to better understand the physiological mechanisms involved in the phenomenon. (Pubmed link; DOI link).

September 8, 2020September 5, 2021

A Tale of Two Pancreases

A graphical summary of exocrine-endocrine interactions in the pancreas

Fascinatingly, the pancreas is really two organs mixed together. The exocrine part of the pancreas produces digestive enzymes that are secreted into the small intestine. The endocrine part of the pancreas makes insulin and glucose, which are secreted into the blood stream. The endocrine parts of the pancreas are scattered like islands within the exocrine part. Although the function of endocrine part of the pancreas has long been considered to be fairly independent of the exocrine, it is increasingly being recognized that the health of the exocrine pancreas influences the endocrine portion. Our division director, Dr. Norris, just helped author a review article on this topic. The work was just published in the journal Diabetologia, which is the leading diabetes research journal published in Europe. The article reviews how diseases of the exocrine pancreas can lead to defects in insulin production and diabetes. (Pubmed link, DOI link)

August 31, 2020December 21, 2020

Primary Adrenal Insufficiency Might Worsen COVID-19 Risk

Post by
Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital

An important, timely question regards determining which co-existing conditions increase the severity of COVID-19 in youth. In adults, for example, obesity, metabolic syndrome, and type 2 diabetes are endocrine conditions that increase the risk of severe COVID-19. By contrast, it appears that diabetes in the young does not increase the risk of severe COVID-19 infection, as noted in our other blog post (link). In fact, most most pediatric endocrine conditions are not thought to induce immunosuppression. However, disorders of glucocorticoid secretion bear closer scrutiny. Excess glucocorticoid secretion, otherwise known as endogenous Cushing Syndrome, induces immunosuppression and may increase risk of severe COVID-19 (link). Thankfully, endogenous forms of Cushing Syndrome are very rare in children. However, deficiencies of glucocorticoid secretion (otherwise known as adrenal insufficiency) are not as rare and affect scores of youth in our region. The American Association of Clinical Endocrinologists (AACE) has published a position piece (link) warning that persons with adrenal insufficiency appear to be at higher risk of death from a wide swath of respiratory infections, and that there is no reason to suspect that this risk does not extend to COVID-19. Indeed, multiple large cohort / population studies have shown that persons with adrenal insufficiency have increased susceptibility to a wide swath of infections (example publications: 2020 JCEM ; 2013 JCEM ; 2016 JCEM ; 2006 JCEM ; 2017 EuJEndo ). It is important to note that there are at least two limitations to this “best available” evidence. (1) It has not involved youth with adrenal insufficiency. (2) Despite these studies being very large, they are largely retrospective. On the other hand, the observation is biologically plausible, since cortisol is a powerful immune modulating hormone that can not be replaced in a perfectly physiological manner. Thus, the related recommendations of the AACE appear important: briefly that persons with adrenal insufficiency should maintain precautions to avoid COVID-19 exposure, to maintain their adrenal replacement therapies, and to give stress dose steroids as instructed. The AACE recommendations can be found here. As always, our pediatric endocrinology team remains available 24/7 to support youth with adrenal disorders.

August 10, 2020November 11, 2020

Announcing New Faculty: Eirene Alexandrou, MD

We are pleased to announce that Dr. Eirene Alexandrou is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from Indiana University School of Medicine, completed a residency in pediatrics at the Medical College of Georgia, and just completed a fellowship in pediatric endocrinology at the prestigious Cincinnati Children’s Hospital. She has published expertise in the areas of growth research (link) and Turner Syndrome. In clinic, her initial practice will include general pediatric endocrinology and diabetes, as well as outreach services in Cedar Rapids and Dubuque.

August 3, 2020January 11, 2022

Announcing New Faculty: Akhila Ramakrishna, MD

We are pleased to announce that Dr. Akhila Ramakrishna is starting as a new pediatric endocrinologist in our division. She received her Medical Degree from the Armed Forces Medical College, then completed a residency in pediatrics at Case Western Reserve, and just completed a fellowship in pediatric endocrinology at the prestigious Mayo Clinic. She has published expertise in the area of thyroid dysfunction (link) and has studied rodent models of obesity as a fellow as well. In clinic, her practice will include general pediatric endocrinology and diabetes, as well as gender-related endocrine care, obesity-related endocrine care especially regarding bariatric surgery in adolescents, and outreach pediatric endocrine services in Cedar Falls.

July 17, 2020January 11, 2022

Announcing New Faculty: Catherina Pinnaro, MD

We are pleased to announce that Dr. Catherina “Cat” Pinnaro is starting as a new pediatric endocrinologist in our division. Her position will be on the tenure-track, meaning that she will be expected to be productive as a research physician. Dr. Pinnaro received her Medical Degree from New York Medical College where she successfully competed for a Doris Duke research year, which she spent at the University of Iowa. She then completed a residency in pediatrics at the University of Iowa, just completed a fellowship in pediatric endocrinology here as well, and is on track to earn a Master’s in Translational Biomedicine in late 2020. While a fellow, she has created several productive research projects, having already published on the genetics of 22q syndrome (link) and diabetes care simulation (link). Her research will focus on the etiology of diabetes in specific disease contexts, applying her genetics expertise. In clinic, her practice will include general pediatric endocrinology and diabetes.

July 13, 2020July 13, 2020

COVID-19, Type 1 Diabetes, and Diabetic Ketoacidosis (DKA)

“diabetic ketoacidosis (DKA) was a complication in almost half of cases among those with a positive COVID-19 test“

Very early during the COVID-19 pandemic it was reported that diabetes was an apparent risk factor for severe disease and poor outcomes. These data came from populations where most of those with diabetes had type 2. So one question was the effect of type 1 diabetes on COVID severity. Now a study has been published examining the effects of type 1 diabetes on COVID. A total of 33 persons across the United States with type 1 diabetes and COVID-19 confirmed by PCR test were surveyed. Another 31 with suspected COVID were also identified. The average age was 24.8 years. The symptoms of COVID were similar to expectations including fever, cough, fatigue, vomiting, shortness of breath, and aches. Interestingly, hyperglycemia was sometimes one of the earliest symptoms. Importantly, diabetic ketoacidosis (DKA) was a complication in almost half of cases among those with a positive COVID-19 test. This suggests that COVID-19, like some other viral infections such as severe influenza, can precipitate DKA. The research was published June 5th in the journal Diabetes Care (find the article at link1 or link2 ). If you or your loved one has type 1 diabetes, and develops symptoms of COVID-19, be sure to contact your diabetes doctor to help provide advice on how to prevent DKA. Fluids, carbohydrates, ketone checks, and extra insulin are very important in this regard. We remain on call 24×7 to assist.

July 1, 2020June 13, 2020

Announcing New Pediatric Endocrine Fellow: Dr. Tuttle

Today we are thrilled to announce that Dr. Alex Tuttle has joined our division as a pediatric endocrine fellow. He will serve three years in this role, after which he will be a full fledged board eligible pediatric endocrinologist. Dr. Tuttle received his Medical Degree from Indiana University. He then completed a pediatric residency at the University of Iowa Children’s Hospital. While a resident he demonstrated an aptitude for and interest in pediatric endocrinology, and was highly involved in diabetes camp (see picture below) at Camp Herkto Hollow and helped report an unusual pediatric endocrine case related to thyroid eye disease (link). Welcome Dr. Tuttle!!