1. Diabetes is a progressive disease.
To understand what diabetes is about, we need to understand how diabetes happens. Diabetes is a multifactorial disease. Today, we are going to talk about type 2 diabetes only.
Type 2 diabetes is not just insulin resistance or insulin deficiency as some might think.
Diabetes type 2, starts with insulin resistance. Our body produces insulin based on our body mass. Every cell in the body needs insulin in order to pick up glucose. Glucose is the primary source of energy. Patients who have a genetic tendency for insulin resistance tend to need more insulin. They also tend to gain weight a lot easier. When we gained weight our body does not make new fat cells. Our body basically stores all the fat in the same number of cells that you are born with. When there is an excessive number of fat stores in the cells fatty acids start to escape the cells into the bloodstream. Too many fatty acids in the bloodstream are toxic to the insulin receptors. Too much fatty acids in the blood start accumulating in muscle and other tissues such as the liver. Insulin receptors also get affected by these organs. As a result of insulin resistance, our body needs to make more insulin. Also, remember that insulin production capacity also is genetically determined. In time, insulin production capacity in the body becomes insufficient when insulin resistance overcomes the insulin supply. This happens faster when patients are genetically inclined to have diabetes. Those people may not be able to keep up with insulin needs especially when they gain weight.
In the initial stages such as metabolic syndrome or prediabetes, insulin resistance is the main problem. At this stage, glucose levels are still normal although insulin levels are very high in the body. Beta cells are the cells that make insulin in the pancreas. At some point, beta cells start to die due to excessive metabolic stress to make more insulin which leads to a reduction in insulin production. In combination with insulin resistance and reduction in insulin production leads to uncontrolled blood sugars. Uncontrolled blood sugar above 130 on average is defined as diabetes. But, damage to other organs can start even before this threshold is achieved.
Patients with diabetes generally start with one single oral diabetes medication. Most of the time diabetes doctors, diabetes specialists or endocrinologists will continue to add medications even though patients are trying their best with lifestyle changes. This occurs slowly in many many years. The reason for needing more and more medications is because the beta cells that produce insulin continue to die slowly in time. This is inevitable. But, this process can be slowed down if diabetes is controlled early on. That requires aggressive management in the beginning. We call that “legacy effect” which we will talk about shortly.
One sad effect is that primary care doctors wait too long to advance to treatment. When patients do not change her lifestyle and let the blood sugars stay high it causes even further damage. It is like keeping your engine light on in the car and not fixing the problem which may cause further damage down the road. So it is not a bad idea to get the opinion of an endocrinologist early on.
On the bright side, it is a lot easier to manage diabetes and keep it under control earlier rather than later. It is very important for you to consult with diabetes specialists to get treatment at the get-go before severe damage happens. When severe damage happens and you lose most of your insulin-producing cells, then you become insulin-dependent. To prevent being insulin-dependent, using the right diabetes medication and care plan is important. Remember, lifestyle changes are the best “medication”. Although lifestyle changes alone may not be enough to control progressing diabetes.
2. Diabetes is the most common reason for heart attacks and strokes.
Insulin resistance is the primary reason for cardiovascular disease. Insulin resistance is composed of high insulin levels, elevated lipids, and cholesterol in the bloodstream which inevitably lead to clogged arteries which leads to heart attacks and strokes. Ironically, this happens very early on in the early stages of diabetes. As a result, controlling diabetes at the early stages is extremely important. This is called the Legacy effect. Legacy effect means that if blood sugars are controlled at the very early stages complications from diabetes are much less likely in the future even if blood sugar control does not remain consistently under control later in life. So, if blood sugar is not controlled at the early stages of diabetes even if the blood sugar control gets better later in life complications will still happen.
That is why it’s important to have an endocrinologist or a diabetes specialist. Also, the support of a diabetes coach, at the early stages of diabetes which will give you success.
Even if a total cure is not possible for diabetes, staying in remission and not letting diabetes dominate your life and cause complications is possible.
How to stop insulin resistance, prevent the progression of diabetes and heart attacks and strokes?
Unfortunately, some people are born destined to have insulin resistance. But, you can change your destiny. You may be at a disadvantage because of your genetic inheritance, but defeating insulin resistance is very possible. The appropriate lifestyle changes and correct medications if needed, can lead to significant weight loss and improve your fitness. After these changes, insulin resistance will definitely improve. When there is less insulin resistance insulin or other medications may not be necessary. As a result, progression to diabetes and its complications also will not happen. Your diabetes specialist or endocrinologist will be the best person to get the correct advice. Along with the support of her diabetes coach, your diabetes doctor will create a diabetes care plan.
3. The Legacy Effect
The legacy effect in diabetes is defined as the early aggressive treatment and control of diabetes can have a Legacy in the long-term. Here is how it works;
When a patient is diagnosed with diabetes if the patient is aggressive and dedicated to controlling diabetes in the first 10 years the chances of complications are much lower even if the patient loses control after the first 10 years. But, if a patient is in denial or negligent for diabetes care in the first 10 years complications will settle in early on. After 10 years of uncontrolled diabetes even if the patient decides to do better and work hard to control diabetes, outcomes are not going to be near as good compared to the first patient example who has done well in the first 10 years. So my recommendation is…do not wait and take control of your diabetes. The time to take action is today, not tomorrow.
How do you know if your diabetes is under control in the first 10 years?
Most commonly A1c is used by many physicians as a benchmark for control. Provided that the patient did not have a lot of low blood sugars, A1c less than 7% is a reasonable goal for many patients. If you just got diagnosed with diabetes she can easily bring her A1c less than 6.5% or even less than 6%. At the early stages of diabetes lifestyle changes will have a very significant effect on the blood sugars. Such as simply quitting the regular Coke or juice or white bread may make a great improvement in blood sugars. On the other hand in the later stages of the disease, these simple life changes may not have a significant effect as the early stages of the disease. Even medications worked much better early on. For example, if you start taking Metformin you can bring your blood sugars twice lower in the early stages compared to later stages in the disease which is 10 to 15 years after diagnosis. The choice of medication is also very important. Although metformin is the most commonly prescribed medication that may not be the best medication for you. Every medication also has different side effects and merits. A well thought out plan, in the beginning, is very important.
Call us and get a free consultation from our endocrinologist and diabetes coach. Taking control of your diabetes is as easy as picking up your phone. Remember aggressive diabetes control does not mean you have to be on insulin.
There are so many medications if needed to bring diabetes under control conveniently. We will help you with your lifestyle changes. When the lifestyle changes are not enough we may use medications. There are weekly agents available such as Ozempic, Trulicity, and Bydureon. That allows your body to make insulin instead of taking insulin from outside. Today there are continuous glucose monitoring systems that do not need fingersticks. The most popular options are Dexcom or Freestyle Libre. There are also very sophisticated insulin pumps with closed-loop systems. These automatically deliver insulin when blood sugars are high. Choices include Medtronic 670 G or Tandem control IQ system. Use technology to your advantage and take control of your diabetes today.
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