Pink Prescriptions - November 2023
Diabetes isn't Sweet! Are You One of the 134 Million Americans at Risk?
November 2023 Issue — Pink Prescriptions
Diabetes isn't Sweet!
Are You One of the 134 Million Americans at Risk?
Sugar has infiltrated the American diet, and it is winning. Pre-diabetes and diagnosis of Type 2 diabetes is at an all-time high—truly epidemic proportions. Diabetes is a brutal disease which affects your entire body. It can be lurking in your bloodstream wreaking havoc on your vital organs and you don’t even know it. However, in the midst of this out-of-control, all-out war with this avoidable dreaded disease, there are new breakthroughs here to save the day and maybe even your life. We needed to know more about diabetes, and what better time than in November—American Diabetes Month? Our power lies within understanding how this disease works, what it does to our bodies, and what we can do to stay healthy. That’s why we asked local experts to help us out climb out of the “sugar bowl” and onto the “dinner plate” of good health.
By James F. Gigante, MD
What is pre-diabetes? What symptoms should I be aware of and what can I do to lessen my chance of being diagnosed with diabetes?
Those who are diagnosed as having pre-diabetes, a higher-than-normal blood sugar level, are at high risk of developing Type 2 diabetes. Pre-diabetes is when your fasting blood sugar is over 100 and less than 126 before you eat breakfast. When you have pre-diabetes, your body doesn’t break down the sugar in the blood as efficiently or as well as it should. So, instead of giving your cells energy, the sugar just builds up in your bloodstream and travels to your organs where it causes damage. The good news is that the progression is not unavoidable. If your doctor tells you that you are pre-diabetic, he or she is probably concerned that the long-term damage to your organs has begun, and you need to make lifestyle changes to bring your blood sugar under control. While pre-diabetes often doesn’t have any symptoms, you could see darkened skin on parts of the body, like the neck, armpits, and groin. Family history and genetics are a big part of the cause of pre-diabetes and diabetes. But the food you eat and the amount of exercise you get is clearly very important. Eating healthy foods, exercising, losing weight, not smoking, and making sure your blood pressure and cholesterol are under control are some of the best things you can do to prevent pre-diabetes. See your doctor regularly and discuss a course of action that works for you.
James F. Gigante, MD is a Board-Certified doctor of Internal Medicine and a fellow with the American College of Physicians. He has been practicing medicine for 25 years, the last 17 here in the Lowcountry. 843-681-2222; 35 Bill Fries Drive, Bldg. H, HHI.
By Kim Edwards, RD, CDE
Beaufort Memorial LifeFit Wellness Services
Managing Type 2 Diabetes can be tough. What are some of the management techniques I should consider?
Testing blood sugars: Using a home glucometer can help with determining glucose level trends. Keeping a logbook of these numbers can let you know how well you are doing and if any changes need to be made. Taking your logbook to your appointment with your provider can help them determine if any new changes are needed to your health care plan.
Healthy food choices: Following a healthy meal plan can assist in better glucose control. Specifically, monitoring the amount of carbohydrates you consume, cutting back on foods with added sugars, and eliminating sugary drinks can aid in not only better glucose control, but weight management as well.
Physical activity: Make a plan to incorporate some form of activity/exercise into your daily life, depending on your current physical ability. This could be taking a daily walk, doing a workout at home, riding a bike, and finding a friend for support. An increase in physical activity can help lower blood sugar and assist in weight loss for better overall health.
Stay hydrated: Drink more water to avoid dehydration. Aim for 6 to 8 cups daily.
Taking medications as prescribed: Skipping medications or missing a dose can have a negative impact on glucose control. Communicate with your physician if you have difficulty keeping a medication regimen, or if side effects are keeping you from adhering to your medication schedule.
Learn all that you can about better diabetes control: Stay informed, communicate with your doctor, and be an active member of your healthcare team.
Kim Edwards, RD, CDE, is a registered dietician and certified diabetes educator with Beaufort Memorial LifeFit Wellness Services.
By Dr. Tracy Blusewicz | Advanced Women's Care of the Lowcountry
Everyone is talking about the new innovative prescriptions to help manage blood sugar and A1c. What are they? Why should I consider taking them?
Right now is the most exciting time in Type 2 diabetes management and weight loss medicine that I have seen as a doctor in the past 25 years! It was sorely needed, as the population of the United States was losing against Type 2 diabetes and obesity. It’s estimated that 37 million people in the US are challenged with Type 2 diabetes, and numbers show 50-percent of all US adults either have pre-diabetes (an elevated hub A 1 c of 5.7 through 6.3) or Type 2 diabetes.
What is Hgb A1c?
It is a lab test that shows a person’s average blood sugar levels over the past three months. So, a higher hgb A1c result means higher blood sugar levels, which in turn, means more sugar circulating throughout the body. If blood sugars are too high, the body can’t keep up and fat gets stored around the abdomen and starts to spill over into the organs, like the liver and the pancreas. This all leads to fatty liver and obesity, and a vicious health circle that can have worsening outcomes. Higher blood sugar also leads to problems with heart disease, kidney disease, and eye problems.
So, what’s all the excitement all about?
There have been colossal scientific advancements in treatment options for both Type 2 diabetes and obesity in the past few years. GLP 1 medicine dosing has been improved, which has led to groundbreaking medical studies showing improvements in hgb A1c management and weight loss. GLP1 agonists were first launched in 2005 as the medicine Byetta, then followed with the releases of Victoza in 2010, Trulicity in 2014, and Ozempic in 2017. Each of these medicines was improved from the previous in decreasing hgb A1c and also seen to result in weight loss. The Sustain 7 trial showed Ozempic lowered hgb A1c better than Trulicity and also resulted in more than double the weight reduction.
What’s GLP 1?
GLP 1 is a hormone the bowels naturally release after eating a meal, which helps the pancreas release insulin and decreases insulin resistance. More GLP 1 leads to more satiety or fullness, less excess free sugar available, and lower Hgb A1c results. Bottom line is less hunger, less excess blood sugars, better use of the body’s insulin, and weight loss. Studies show that losing just 6-percent of a person’s body weight decreases their risk of diabetes by 58 percent! So, a medicine that can efficiently increase the availability of GLP 1 is BIG NEWS!
Doctors were very excited about all these developments. Then 2022 came along, and a new generation of medicines were released that combined agonists for GLP1 with another hormone, GIP. The results are even more impressive. This medicine, Mounjaro, and the SURPASS studies so far seem to present evidence of even better results, with better hgb A1c control and more substantial weight loss. The combination of the two Types of hormone stimulation seems to be synergist in outcome, and the GIP appears to play a role in anti nausea, which can be a side effect.
Life-changing advances:
More new medicines are coming in the very near future and the research is continuing. These medicines are truly life-changing, as I have seen in my practice, many Type 2 diabetes patients having success they have never achieved before in their health care. The reduction of their hgb A1c is impressive, with an example of a patient going from a hgb A1c of 9.8 down to 6.3 in a year with Mounjaro use, weight loss, and lifestyle changes. The domino effect of lowering excessive blood sugars and weight loss is seen throughout the body: better blood pressure; less sleep apnea; less muscle and joint aches; and the list goes on and on.
Now is the time for people to embrace their
best chances for good health:
These scientific discoveries are paving the way for a healthier world. Talk to your doctor or provider about these new medicines if you are affected by Type 2 diabetes or struggling with obesity. Look out for future applications of these medicines for patients with metabolic syndrome and PCOS, as well.
Tracy Blusewicz, MD, FACOG, GYN specialist, who recently underwent fellowship training in the speciality of Obesity medicine with the American Board of Obesity Medicine. Due to the enormous health benefits of these new breakthrough medicines, she realized that would be valuable to her patients. Dr. Blusewicz is a national and international speaker who actively trains fellow doctors and practitioners both nationally and internationally in the field of Women’s Wellness. She has been the principal investigator in a number of journal published research studies pertaining to Urinary Incontinence, Lichen Sclerosis, and Vaginal Atrophy. She can be contacted at Advanced Women’s Care of the Lowcountry, 843-341-9700; www.awclc.com
By Mandy Strickland, AGACNP-BC | Hilton Head Primary Care, an affiliate of Hilton Head Regional Physician Network
What is the difference between
Type 1 and Type 2 diabetes?
Type 1 diabetes can be diagnosed at any age.
What are symptoms I should look for?
In order to understand diabetes and the effects this condition has on the body, let’s briefly discuss the roles of glucose and insulin, as these are the two main affected components of our body when it comes to diabetes. Glucose is the main source of energy for our body’s cells. Insulin is a hormone in the body made by the pancreas. Insulin acts like the “key” that allows glucose into our cells, which in turn allows the cells to use the glucose for energy.
When a person has diabetes, this mechanism no longer works properly. There are two Types of diabetes: Type 1 diabetes is an auto-immune disorder characterized by a lack of insulin in the body. Beta cells are the cells in the pancreas that make insulin, and for people with Type 1 diabetes, most of these cells have been destroyed by the time they are diagnosed. This is the main reason why Type 1 diabetes is diagnosed at a younger age, because the body is not making any insulin. All Type 1 diabetics are insulin dependent.
Type 2 diabetes is characterized by insulin resistance. When our cells become resistant to insulin, glucose is not able to enter the cells of the body, resulting in a buildup of glucose in the bloodstream. While we don’t know exactly what causes a decrease in sensitivity to insulin, we have correlated obesity and family history to an increased risk for developing insulin resistance. Type 2 diabetes is typically not treated with insulin. Along with weight loss, diet, and exercise, there are medications such as metformin and thiazolidinediones that can help the body become more sensitized to insulin.
While Type 1 and Type 2 diabetes are different in the way they affect the body, the symptoms of both are the same—excessive urination, excessive thirst, weight loss, and blurry vision are some of the most common symptoms associated with diabetes.
We have heard there are new innovative options for monitoring blood sugar levels. Tell us about them.
Continuous glucose monitoring is one of the newer technologies available today to help with monitoring blood sugar levels. It consists of wearing a sensor placed either on the stomach or the back of the arm that continually monitors blood glucose levels throughout the day. The data is stored in an app on a smartphone and is accessible at any time. This technology can provide an accurate picture of how food and exercise directly affect blood sugar levels. For Type 1 diabetics, this technology can show how much insulin needs to be administered before a meal. It can also alert you to any sudden drops in blood sugar that may need to be tended to quickly. For Type 2 diabetics, this technology tends to lead to better blood sugar control and awareness, as traditional glucose monitors are not used as often as recommended.
Mandy Strickland is a Family Nurse Practitioner specializing in adult care at Hilton Head Primary Care. Mandy has a passion for patient care and values the strong relationships she creates with her patients. Mandy is accepting new patients—please call Hilton Head Primary Care (843) 682-2004 to schedule an appointment.