December 15, 2022
Dr. Joe DeStefano of Urgent Care 24/7 discusses diabetes.
We currently have a diabetes epidemic in our country. Diabetes is our number one lifestyle disease. Dr. DeStefano speaks here mainly of type two diabetes. There's two broad diabetes, there's type two, your body makes insulin, but doesn't utilize it. Well, you have insulin resistance, and you actually have high levels of insulin and high levels of sugar. With those high insulin levels, it also becomes high blood pressure and obesity.
Type One Diabetes is an autoimmune disease that usually starts in childhood, a cross reaction against certain viruses, and the immune system kills the cells in the pancreas that produce insulin, so it is an insulin deficiency. disease. Absolutely, a totally different disease and type two diabetes. Like so many things we talk about with Urgent Care 247, and our direct Primary Care Plan holistic approach, diabetes starts as a lifestyle disease, you first attack it with lifestyle modifications. This includes exercise 20 minutes of walking a day, which can often make a huge difference.
20 minutes or walking a day, and a 10% weight loss can often get people off insulin who are diabetic. The other items you want to address with diabetics are supplements. B12 deficiency worsens diabetes, our most effective medicine against diabetes is Metformin. It's our most effective against type two diabetes. Unfortunately, it has the side effect of worsening vitamin B12 levels and can cause B12 deficiency long term. If you do not take a B12 supplement with your Metformin. So supplementation is important. Vitamin D levels are important for diabetes, because low vitamin D levels are worse than insulin resistance, and it's worse than diabetes.
So when Dr. DeStefano gets a patient with diabetes, he first talks to them about lifestyle modification, making better dietary choices, more protein, more fats, more complex carbs, less simple sugars, less simple carbs, 20 minutes of walking a day or swimming or some type of exercise, and some type of weight bearing exercise, such as circuit training with weights 20 minutes a day.
All these things massively improve diabetic control. If you can't get there with lifestyle modification circuit training with weights, the 20 minutes of walking the 10% weight loss. Then we move into medicines. One of the first medications we use is Metformin, which is almost considered a vitamin in improves. Insulin levels improve oxidative stress, and have many benefits to using this medication. The main thing you have to be aware of is that long-term it can cause b 12 deficiency, and we recommend that our patients on Metformin take a b 12 supplement.
Then there's the older standard for buying medicines that are inexpensive and can be used as a final urea, such as glipizide and amaryl. Then there are some newer medicines where they have place, and they can be effective medicines, such as ozempic januvia. In many others, they're also expensive. Some of these medications without insurance can be $600 a month. Insulin is expensive. Lance's can be $300 a month, novolog can be upwards of $300 a month. So these are the challenges in the care of diabetes, which is what somebody advances past lifestyle modification. And that form in the sulfonylureas of going on to the next level of medications to control the disease becomes cost prohibitive, and severe cases with a lot of comorbidities, such as sleep apnea hypertension. If somebody is really tried hard and got everything they can, you may have to have a conversation about gastric sleeve surgery that can be cured of type twos.
Type One Diabetes, doing all the things you do for type two is also good. Diet exercise, taking care of yourself. Both types of diabetics must have regular foot exams, preferably by podiatry, regular eye exams, eye ophthalmology, both of these categories. Dental care is important. diabetics get gum disease earlier and much more severe. The non diabetics bad gum disease worsens diabetes by worsening insulin resistance. probably the second most important person in a diabetic's control behind their doctor or healthcare provider is their dentist and their dental hygienist. So, diabetes is again one of these conditions that need a holistic approach.
The provider needs to be concerned about the entire patient and the patient's whole metabolism. The type one diabetics, since the Type One Diabetes is an autoimmune disease. They get a bunch of other autoimmune diseases with it, they can get pernicious anemia where they can't absorb B12. Without shots, they can get adrenal insufficiency, where they can't make adrenaline. They can get Hashimoto thyroiditis, where they don't make enough thyroid hormone. For these reasons. A good relationship with a primary care provider is important, and frequent monitoring. Thank you for this time to chat with me about diabetes. A broad and interesting subject.
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