Ask The Experts

The Doctor Is In: Chicago

Endocrinologist Disha Narang MD of Northwestern Medicine Lake Forest Hospital on the changing face of endocrinology

What initially drew you to endocrinology? 

I was born in India and moved to the US when I was five years old with my parents and younger brother. My dad is an engineer by training and decided to bring us to the US to pursue an MBA. I’ve had an interest in science and medicine for as long as I can remember. My dad would sit and read encyclopedias and kids' science books to us in the evenings after school. My mom is a high school math teacher, but was home with my brother and me until I was in high school. My brother and I credit our ability to succeed academically to the dedication of our parents. My parents instilled a strong work ethic and conviction that if I studied and worked hard, I would be able to reach my goals.

I was awarded the Ingram Scholarship at Vanderbilt University (for students to combine a professional career with a commitment to community service) and completed my undergraduate studies and medical training there. The Ingram Scholarship encouraged social engagement and community service work, which exposed me to the inherent health disparities that have long existed in our system. I became very involved in health disparities and health literacy research in relation to diabetes care as an undergraduate and continued to be into medical school.

When did you first notice racial disparities in medicine?

I matched at the University of Chicago for an internal medicine residency, and eventually my endocrinology fellowship as well. My time at the University of Chicago was eye-opening, as we were practicing right in the heart of the South Side of Chicago. A lot of the disparity we saw was certainly along racial lines, as our black patient population often came in much sicker or had no insurance and increased barriers to care (no preventive care, lack of transportation, decreased health literacy, and difficulty in affording medications).

My primary care clinic was off campus in the heart of the South Side, where we offered care to uninsured patients, and my patients were most often black or Latinx. From an endocrinology perspective, these patients often had much more difficult-to-control blood sugar and increased complications of diabetes (diabetic eye disease or retinopathy), nerve disease (neuropathy, including foot infections and amputations), and kidney disease (nephropathy, such as end-stage renal disease on dialysis), along with difficult-to-control hypertension and cholesterol, all which further contributed to heart disease. It was painfully evident that with the proper preventive care, a lot of these issues would not be as prevalent or severe.

What are your areas of interest and specialties within endocrinology?

While I have a busy general endocrinology practice, my true clinical interests lie within diabetes care and weight management. These are both epidemics worldwide at this time (not to mention increased risk factors for our current pandemic) that need addressing. Endocrinologists are often few and far between, but our specialized understanding of diabetes physiology and therapeutics can provide an entire change of quality of life for our patients.

Continuous glucose monitoring technology can help prevent patients from ever having to stick their fingers to check their blood sugar. We have medications that can help with both blood sugar reduction and significant weight loss, putting diabetes into remission status. Helping to make these kinds of life changes for my patients is what makes me so excited about what I do.

My interests in weight management and diabetes led me to pursue further training in culinary medicine. I figured, I talk about food all day, I love to cook and walk patients through meal planning, why not do it formally? Since weight management and diabetes are so tied to lifestyle, and so much of our life, socialization, and joy revolves around food, I aim to help patients develop a healthy relationship with food, rather than guilt around it or intimidation in preparing it. 

Why do you think representation is important in endocrinology?

The changing face of endocrinology experts helps us better relate to patients and their backgrounds, as our patient populations and their needs are also just as diverse. This offers a new perspective as well on managing work-life balance, and a changed definition as to what "success" may mean. Looking back at my own background, the way I grew up, the food we ate, and our understanding of health and medical care delivery at that time, I can better understand and empathize with patients' stories and situations. That helps me to provide more optimal care for my patients. 

Endocrinology is certainly not the only field of medicine that has increased diversity and representation of women. As Ruth Bader Ginsburg said, "Women belong in all places where decisions are being made." Over half of American medical graduates now are female, endocrinologists are now predominantly female, and I could not be more excited about that.

Looking back at my own life, being a woman never impacted my initial exposure to science, technology, and medicine. It's all exposure. It helps to have mentorships from others who look like you. I was lucky to have many such inspiring women to look up to along the way. In medical school, I had some amazing mentors (Dr. Ban Allos and Dr. Amy Fleming at Vanderbilt University) who personally showed me that having a family and being a successful physician were completely reasonable goals. They were leaders in their respective fields, and them taking me to lunch and introducing me to their worlds is something that has stuck with me to this day.

There are still many glass ceilings to break, however. Despite over half of our medical graduates being female, it is still infrequent to see a female physician in a leadership position in medical institutions. Also, female endocrinologists are still paid anywhere from $35-65K less than their male counterparts, which is clearly unacceptable.

I try to make it a point to continue to speak to college and medical students and residents about my career and training, and life outside of medicine too. I’m a mentor to young women pre-med undergrads at my alma mater, Vanderbilt, who received the same scholarship I did. I also give talks and hold Q&As for different organizations that reach out to me via social media. They’re mostly groups of women interested in medicine.  

How did you find your network of other endocrinologists who are women and people of color?

Social media has been such an opportunity to step out of my bubble. I have been lucky enough to "meet" several women of color and endocrinologists through social media, who I still learn from every day. These platforms are the new way of reaching patients for education, awareness, and advocacy. My own Instagram platform started as a hobby, a release, and a way of bringing culinary medicine topics under the umbrella of diabetes and weight management to my own patients. I was constantly having the same conversation in clinic with my patients about what to cook, how to cook it, what comprised a diabetic-friendly meal, what type of foods would be conducive to weight loss, and why certain foods would be beneficial. Social media has been a great way to spread that message.

What is it like to practice medicine in Chicago?

Chicago was an amazing place to do my residency and fellowship, and to start my practice. During each phase of my career growth, I have learned how complex our field can be. We are always learning. Chicago has also been a great place to connect with colleagues from all over the world, and it has a great representation of diversity in the field, in addition to opportunities to learn from some of our nation's experts first-hand. 

What's new in endocrinology that you're excited about? 

Where do I start? From the diabetes standpoint, we have so many great new therapeutics particularly for our type 2 diabetes population. One of the best ways to turn around diabetes control is from weight loss, and some of our new therapeutics aid in achieving weight loss comparable to bariatric surgery. It's the most satisfying thing in the world to see that. The other new developments are in continuous glucose monitoring and insulin pumps. We are getting closer and closer to a fully closed-loop system, which will be even more life-changing for our patients, particularly patients with type 1 diabetes who use insulin pumps to manage their blood sugar. We also have amazing new drug development in osteoporosis and metabolic bone disease, providing patients with many more therapeutic options than we previously had even a few years ago. 

Disha Narang MD is a board-certified endocrinologist at Northwestern Medicine Lake Forest Hospital. She completed her undergraduate and medical education at Vanderbilt University, prior to completing her internal medicine residency and fellowship at the University of Chicago. Dr. Narang has a general endocrinology practice, but she is especially interested in diabetes, medical weight management, and culinary medicine. 

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The Doctor Is In: New York City
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