What to Know About Type 2 Diabetes Including Lifestyle, Ozempic, Mounjaro, and Bariatric Surgery with Dr. Lindsay Ogle
Family practice physician Dr. Lindsay Ogle and I cover the complexities of type 2 diabetes in this episode. We discuss what needs to be known about the condition, prevention strategies, management tips, and take an in-depth look at available medications. We also explore the connection to PCOS and prediabetes.
Additionally, we talk about bariatric surgery, now often referred to as metabolic and bariatric surgery. Although frequently underutilized, this option can be highly effective for managing both diabetes and obesity, and we explore who may qualify for the procedure.
Dr. Lindsay Ogle is based in Missouri, where she focuses on metabolic care, weight loss, and obesity through virtual telehealth services. She is a board-certified family and obesity medicine physician. After spending a few years in primary care, she started the Missouri Metabolic Health Clinic, a telehealth practice that zeroes in on treating and preventing conditions like diabetes, prediabetes, PCOS, fatty liver disease, high cholesterol, metabolic syndrome, and obesity.
Dr. Ogle takes a team-based approach, working closely with dietitians, therapists, coaches, and other doctors to ensure patients receive well-rounded care. She is passionate about helping individuals manage their health and live healthier, longer lives.
What You Need to Know About Type 2 Diabetes
Type 2 diabetes is a major health issue that affects millions of people worldwide, including about one in eight Americans. Despite its prevalence, many individuals with diabetes or prediabetes are unaware of their condition.
There is a common misconception that diabetes always requires insulin, and it’s important to differentiate between type 1 and type 2. Type 1 diabetes typically presents in younger individuals and occurs when the body cannot produce insulin at all, necessitating insulin therapy to survive. In contrast, type 2 diabetes involves insulin resistance, where the body produces insulin but does not use it effectively. Type 2 diabetes is the most common form.
Over time, both types of diabetes can progress, so early detection and management are essential for longevity. The longer the condition persists, the higher the risk of developing complications, including the potential need for insulin as the pancreas becomes less effective and even problems with other vital organs.
The Importance of Early Treatment for Type 2 Diabetes
Treating type 2 diabetes is crucial for preventing a range of serious health complications. One of the primary reasons is its strong link to heart disease, which remains the leading cause of death in the United States. Managing diabetes early can significantly reduce the risk.
The strong connection between type 2 diabetes and heart disease is due to the fact that high blood sugar can damage blood vessels and lead to inflammation, which in turn raises blood pressure and cholesterol levels. This facilitates plaque buildup in arteries and increases the risk of heart attacks and strokes.
In addition to heart disease, diabetes is a major cause of other complications, such as:
Kidney disease: Diabetes is now the leading cause of requiring dialysis. By keeping blood sugar levels under control, many cases can be prevented.
Vision impairment: Diabetes can damage the small blood vessels in the eyes, potentially leading to blindness if left untreated. Therefore, individuals with diabetes need to have annual eye exams with an ophthalmologist to detect and address any early signs of damage.
Nerve health: Diabetes affects nerve health, particularly in the feet. Diabetic foot exams during regular check-ups can identify this early and prevent serious issues, such as infections or amputation.
Immune health: Diabetes impacts immune health, increasing the risk of infections like pneumonia and skin infections.
It is important to remember that most complications related to diabetes can be prevented or greatly reduced with early intervention and consistent treatment.
The Complex Relationship Between Type 2 Diabetes and Weight
The relationship between type 2 diabetes and weight is more intricate than many realize. While 85% to 90% of people with type 2 diabetes struggle with obesity or overweight, about 10% to 15% fall within a normal weight range. This shows that while excess weight is a major risk factor, it’s not the only one. Type 2 diabetes is influenced by a mix of factors, including genetics, lifestyle, and environmental triggers.
A key aspect is insulin resistance. In people with insulin resistance, the body produces more insulin to manage blood sugar. However, insulin also acts as a storage hormone, signaling the body to store fat, which can make weight loss even tougher over time. Despite this connection, not everyone with excess weight will develop diabetes, and those with a normal BMI may still struggle.
It’s also a misconception that sugar alone causes diabetes. While diets high in sugar and processed carbs can contribute to insulin resistance, other factors like physical activity and genetics play a significant role. For example, an active person might consume sugar without developing diabetes, whereas someone with only a slightly higher weight could be at higher risk.
Different populations face varying risks as well. For instance, individuals of Asian descent have a lower BMI threshold for diabetes risk, meaning they may develop the condition even at a lower weight.
Given the complex relationship between weight, insulin resistance, and diabetes, it’s crucial to stay informed about your health. Assessing diabetes risk requires considering a range of factors beyond just weight. To keep your body healthy and manage your risk effectively, regular check-ups are essential for staying aware of your health and catching any potential issues early.
Managing Prediabetes: Key Steps to Prevent Progression to Type 2 Diabetes
Prediabetes is a crucial warning sign on the path to type 2 diabetes, and catching it early can help prevent more serious health problems. Many individuals only discover they have prediabetes after routine blood tests, as sometimes it wasn’t initially flagged by their primary care doctor due to time constraints or oversight.
Prediabetes is indicated by specific blood sugar levels: fasting blood sugar between 100 and 125 mg/dL, or an A1C test result between 5.7% and 6.4%. If these numbers appear in blood work, it’s important to discuss them with a doctor and take proactive steps to address the issue.
Here are key actions to prevent progression from prediabetes to type 2 diabetes:
Reduce Added Sugars: Cutting back on sugar, especially from sweetened beverages like sodas, juices, and sweetened coffees. Even minor reductions in added sugar can be beneficial. Be cautious with seemingly healthy drinks, as they may contain hidden sugars.
Increase Physical Activity: Regular physical activity helps manage blood sugar levels. But remember, you don’t need to run ultra-marathons; even simple activities like walking after meals or increasing daily steps can make a significant difference. Post-meal movement is particularly effective at lowering blood sugar spikes.
Boost Protein and Fiber Intake: Adding more protein and fiber to your meals, such as having a small salad before dinner, can help stabilize blood sugar levels throughout the meal.
Essential Lifestyle Tips for Managing Type 2 Diabetes
For managing type 2 diabetes, key lifestyle recommendations overlap with those for prediabetes plus these additional focus areas:
Reduce Added Sugars: Continue to limit intake of sugary foods and beverages, as this is essential for controlling blood sugar levels. Be mindful of hidden sugars in various products, especially packaged goods.
Increase Physical Activity: Regular exercise helps manage blood sugar and improve overall health. Simple activities like walking after meals can be highly effective.
Boost Protein and Fiber Intake: Incorporate more protein and fiber into your diet to help stabilize blood sugar levels. For example, eating a small salad before meals can be beneficial.
Prioritize Sleep: Aim for seven to eight hours of quality sleep each night. Adequate rest supports better self-care and overall health, plus can improve middle of the night blood sugar spikes.
Manage Stress: Chronic stress can exacerbate diabetes and its complications. Finding ways to manage stress, whether through physical activity, therapy, or other outlets, can be crucial for maintaining well-being.
How New Treatments Improve Blood Sugar Control, Weight Management, and Overall Health
In recent years, advancements in diabetes medications have really changed the game for blood sugar control and weight management.
Older medications, like sulfonylureas (such as glipizide, glimepiride, and glyburide), insulin, and pioglitazone (Actos), were good at managing blood sugar but often led to weight gain and increased the risk of complications like heart disease and kidney problems. They also had a higher chance of causing hypoglycemia, or dangerously low blood sugar levels.
These days, newer medications are taking the spotlight, thanks to their added benefits. Two major classes are:
GLP-1 Receptor Agonists: Medications like Trulicity, Ozempic, Rybelsus (the oral version), and the newest, Mounjaro, not only help control blood sugar but also lower the risk of heart disease and kidney issues. Plus, they’re great for weight management, making them a top choice for many patients.
SGLT2 Inhibitors: Drugs like Jardiance and Farxiga fall into this category. They’re also effective at controlling blood sugar and offer protection against heart and kidney problems. On top of that, they can support weight loss, which is a big plus for managing diabetes.
Overall, while the older meds were important for managing diabetes, these newer options seem to offer even better benefits with fewer side effects, especially when it comes to weight management and reducing complications.
Understanding SGLT2 Inhibitors: Why Newer Diabetes Medications Might Be Right for You
Now, let’s talk about SGLT2 inhibitors, a class of diabetes medications that help the kidneys get rid of excess sugar through urine. These pills are easy to take and have become popular because they manage blood sugar well, and also offer extra benefits like supporting heart health and managing chronic kidney disease.
However, there have been cases where patients hesitate to try these newer medications due to concerns about potential side effects, such as nausea, which they may have heard about in the media. Healthcare providers often face this resistance, even when the medications are a good fit for the patient's condition.
To address these worries, it’s helpful to reassure patients that starting with a low dose and gradually increasing it can minimize side effects. This way, the body has a chance to adjust, and discomfort is less likely.
Switching to these newer meds can lead to better blood sugar control, potential weight loss, and a reduced risk of complications like kidney and heart disease. For many patients, this switch can really boost their quality of life.
The Dual Benefits of GLP-1 Agonists: Managing Diabetes and Obesity
GLP-1 agonists, such as Ozempic, Mounjaro, Trulicity, and Victoza, were initially developed to manage type 2 diabetes. However, an additional and significant benefit has emerged over time: substantial weight loss.
This dual benefit has made GLP-1 agonists a popular choice for those managing both diabetes and weight issues, further highlighting their versatility and effectiveness in diabetes care.
Here's why these medications are effective for both diabetes and weight management:
Hunger Suppression: GLP-1 agonists reduce hunger signals, minimize cravings and help you eat less.
Increased Fullness: They enhance feelings of fullness, making you feel satisfied with smaller amounts of food.
Hormone Regulation: These drugs help regulate insulin and other hormones involved in hunger and metabolism.
GLP-1 agonists, initially developed for diabetes, are now also used for weight management due to their impressive weight loss results. Recent advancements have made these medications even more effective, making them a popular choice for both diabetes and obesity treatment.
Can Patients on Insulin Transition to New Medications?
For patients currently using insulin who might feel discouraged about their treatment options, exploring newer medications could help reduce or even eliminate the need for insulin.
Monitoring progress is crucial during this transition. Working closely with a clinician is essential, and tools like continuous glucose monitors (CGMs) can help monitor blood sugar levels as adjustments are made.
Even if complete discontinuation of insulin isn’t achievable, these newer medications can significantly lower the amount of insulin required. This reduction can be beneficial not only for managing blood sugar but also for improving weight management and overall health.
Some important considerations you’ll want to take if you transition from insulin to a newer medication:
Weight Loss Challenges: Clinical data suggests that people with type 2 diabetes might experience less dramatic weight loss with GLP-1s compared to those without diabetes. It’s crucial to manage expectations and avoid comparisons with others, as individual responses can vary.
Personalized Care: Each patient's situation is unique. While many can benefit from reducing or stopping insulin, it’s important to tailor the approach to each individual’s needs and monitor progress carefully.
Bariatric Surgery for Diabetes and Obesity
Bariatric surgery has proven to be an effective treatment for managing obesity and type 2 diabetes, yet it remains pretty underutilized. For individuals with type 2 diabetes and a BMI of 30 or higher, or a BMI of 27.5 or higher for those of Asian descent, eligibility for this surgery should be considered. The procedure can improve blood sugar control and lead to significant and sustained weight loss.
One of the most common procedures, gastric bypass, has demonstrated notable success. Approximately 40% of patients achieve complete remission of diabetes, eliminating the need for medication to manage blood sugar levels. Additionally, around 90% of patients experience improved blood sugar control.
Bariatric surgery can be especially advantageous for individuals who face challenges with medication access or tolerance, or for those who struggle to manage their blood sugar despite optimal medication use. It also offers a promising alternative for those seeking to manage their diabetes without relying on ongoing medication.
There is a common misconception that bariatric surgery is reserved for those with extremely high weights. In reality, the criteria are more inclusive, and the surgical community increasingly supports its use for managing type 2 diabetes, even among patients who are not severely overweight.
In summary, this episode delves into the multifaceted world of type 2 diabetes, exploring its complexities, management strategies, and the impact of newer treatments and interventions.
Tune in to hear the full discussion and gain a deeper understanding of these topics, as well as discover how the latest developments in diabetes care could impact individual health.
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