Written by: Kheng Joe Lau, MD Endocrinologist

November is Diabetes awareness month. Diabetes is a serious health condition that affects millions of Americans. It is important to note signs and symptoms of type 1 and type 2 Diabetes. I will explain both through the course of this article, as well as provide information about what to do if you are experiencing these symptoms. When it comes to type 2 Diabetes, patients can exhibit warning signs of being ‘pre-diabetic’. For some patients, there can be work done to reverse acquiring this disease. Please ask your primary care provider for more information and what you can do to reverse the course of this disease.

Type 2 diabetes is a condition where your body does not make enough insulin, or your insulin does not work as well, sometimes a combination of both. When your insulin does not work well, it is called insulin resistance. Insulin promotes the use of sugar in your body. When you have decrease in insulin or insulin resistance, sugar will accumulate in your blood because it cannot be used effectively. This sugar accumulation will damage many organs such as kidney, blood vessels, eyes, and nerves.

In the United States, more than 37 million people have diabetes, which is about 1 in 10. It is estimated that 90-95% of them have type 2 diabetes. Also 1.4 million Americans are diagnosed with diabetes every year. Unfortunately, people are getting diabetes at younger age. About 283,000 Americans under age 20 are estimated to have diagnosed diabetes, or 0.35% of the population. The recommended screening age for Type 2 diabetes has also decreased. American Diabetes Association (ADA) now recommend screening for prediabetes and type 2 diabetes at age 35 instead of age 45.

The good news is diabetes can be improved significantly by losing weight and eating low carbohydrate diet. When patient with Type 2 diabetes loses weight, through diet, exercise or bariatric surgery, insulin sensitivity will improve, which helps reverse the diabetes. Research shows that for patients with early diabetes or pre-diabetes, reversal can be seen with enough weight loss. Consuming less carbohydrate and sugar is also important. For example, in my own practice, I am seeing improvement in hemoglobin A1c (used to measure severity of diabetes) by as much as 2-3 percentage just by cutting out soda or fruit juice from their diet.

Also on a positive note, we are living in an exciting time.  While there is still no cure for type 2 diabetes, physicians have more tools than ever before to manage diabetes effectively. For many years, metformin was the only first-line medication to treat type 2 diabetes but recently the ADA recommended that GLP-1 receptor agonist and SGLT-2 inhibitors can be used as first line medications as well, depending on patient’s comorbidities.

Once weekly GLP-1 receptor agonists injection such as semaglutide(Ozempic), dulaglutide(Trulicity) or Tirzepatide(Mounjaro) not only helps control diabetes better than insulin, they also help patients lose weight effectively. We know that insulin tends to cause weight gain and low blood sugar (or hypoglycemia). GLP-1 receptor agonists also reduce the risk of cardiovascular events in type 2 diabetes patients. SGLT-2 inhibitors such as canaglifozin(Jardiance) or dapaglifozin(Farxiga) are daily pills that works by helping the kidney remove excess sugar from the body. These medications have been shown to provide kidney protection, reducing the risk of kidney failure and the need for dialysis in type 2 diabetes patient. They are also medications that can help improves heart failure. In my practice, I am certainly seeing less reliance on insulin use with the help of these two medications.

Advancement in technology also brings exciting tools such as Continuous Glucose Monitor or CGM. CGM is a tiny sensor inserted under your skin, usually on your belly or arm to measure your sugar under your skin, continuously throughout the day and night. You can see your glucose level at any time and review how glucose changes. This can help you make more informed decisions throughout the day about how to balance your food, physical activity, and medicines

Insurance coverage used to be a big barrier to access these tools. However, over the years we are gradually seeing positive changes. More insurance companies are willing to cover these medications and devices. Medicare has also loosened the requirement for continuous glucose monitors. For, example patients were required to document that they were checking blood glucose four times a day before CGM can be prescribed but now CGM is covered under Medicare/Medicaid for patients using insulin more than one time per day.

In summary, diabetes can be improved and even prevented by adopting a healthier diet and lifestyle. There are also new medications and devices that can help you manage diabetes effectively nowadays. If you are diagnosed with diabetes, please contact Western Wisconsin Health at 715-684-1111 to set up appointment for your care.

Sources:

1. American Diabetes Association guideline
2. American Diabetes Association 2022 update on diabetes standards of care
3. Centers for Disease Control and Prevention
4. Centers for Medicare and Medicaid Services