September 27, 2022
Dr. Joe DeStefano of Urgent Care 24/7 discusses diabetes.
We currently have a diabetes epidemic in our country. Diabetes has been said to be our number one lifestyle disease. Dr. DeStefano is speaking 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 level of sugar. With those high insulin levels also becomes high blood pressure and obesity.
Type One Diabetes is an autoimmune disease usually starts in childhood, a cross reaction against certain viruses and the immune system kills the cells in the pancreas that make insulin so it is an insulin deficiency. disease. Absolutely pretty much 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, can often make a huge difference.
20 minutes or walking a day, and a 10% weight loss can often get people off of insulin who are diabetic. The other items you want to address with diabetics is 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 B12supplement with your Metformin. So supplementation is important. Vitamin D levels are important diabetes because low vitamin D levels 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.
The 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 This is almost considered by some to almost be a vitamin in improves. insulin levels improves oxidative stress has a lot of benefits to using this medication. The main thing you have to be aware of is 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 buy medicines that are very inexpensive and can be used as a final ureas such as glipizide and amaryl. Then there are some newer medicines that are where they do have place and they can be very effective medicines such as ozempic januvia. In many others, they're also very expensive. Some of these medications without insurance can be $600 a month. Insulin is very 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 is what somebody who advances past lifestyle modification. And that form in the sulfonylureas of going on to the next level of medications to control the disease becomes very cost prohibitive and severe cases with a lot of comorbidities such as sleep apnea hypertension is somebody who is really tried hard 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 are good as well. Diet exercise taking care of yourself. Both types of diabetics have to have regular foot exams, preferably by podiatry, regular eye exams eye ophthalmology, both of these categories. Dental Care is very 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 diabetics 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 adrenalin they can get hashimotos 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.