Diabetes treatment

What is Diabetes?

Diabetes Mellitus is a disease characterized by higher than normal blood sugar levels. If untreated diabetes can lead to significant complications in the body, particularly the heart, eyes, kidneys and nervous system. 

How is Diabetes Mellitus diagnosed?

Diabetes is diagnosed by any one of the below: 

• Two fasting blood sugar levels over 125
• Two Ha1c levels 6.5% or above
• Non-fasting blood sugar over 200
• Oral Glucose tolerance testing with blood sugar over 200

What causes Diabetes?

There are several different types of diabetes each with distinct causes. 

Autoimmune or Type 1 Diabetes involves autoimmune destruction of beta cells in the pancreas. Thse are the cells that produce insulin. As this destruction progresses, patients become insulin dependent. While Type 1 diabetes often begins in childhood, there is also a related autoimmune condition called  Latent Autoimmune Diabetes (LADA) which occurs in adults. Sometimes this is initially mistaken for Type 2 diabetes. 

By contrast Type 2 Diabetes, is a disease of metabolism, often related to weight gain and is caused by resistance of body cells to insulin. This is by far the most common cause of diabetes in the U.S. While complex genetic factors play a role, evidence indicates that diets high in animal fats and proteins may drive insulin resistance:

• https://link.springer.com/content/pdf/10.1007%2Fs00125-009-1481-x.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173026/pdf/ajcn94401088.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847817/pdf/nihms530233.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942738/pdf/nutrients-06-00897.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625584/pdf/ajcn101238.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291812/pdf/nihms840125.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690061/pdf/nutrients-07-05509.pdf

Diets high in refined calorie dense foods also lead to weight gain and insulin resistance. While insulin production can be very high for Type 2 Diabetics, the target body cells simply cannot respond appropriately to take up the glucose, leading to increasing blood sugar levels.

There are some potentially transient forms of diabetes such as Gestational Diabetes and Steroid Induced Diabetes. The hormonal and weight changes associated with pregnancy can produce a temporary form of insulin resistance known as Gestational Diabetes. While this does need to be treated to optimize the health of the mother and baby, Gestational Diabetes often resolves after delivery. Another medical driver for insulin resistance can be treatment with steroids. While there can be important medical reasons to treat patients with steroids, they should be used sparingly, because in some cases steroids can produce Steroid induced Diabetes among other side effects.

Finally, there is a third cause for diabetes which is different from Type 1 (autoimmune) or Type 2 (insulin resistance). This third category is called Maturity Onset Diabetes of the Young (MODY) and is caused by an inherited genetic deletion of one of the insulin producing genes. This leads to an inadequate production of insulin. When a parent has MODY, the children carry a 50% risk of inheriting the disease. 

What is the best treatment for Diabetes?

The most effective treatment for diabetes depends on the type of diabetes a patient has.  As a result, accurate diagnosis is vital. In Type 1 Diabetes, when not enough insulin is produced, replacement insulin must be given. But the type of insulin, dosing and frequency can have a significant impact on control as well as quality of life. In contrast, in Type 2 Diabetes, the goal is to use the best combination of medications to improve insulin resistance and assist with weight loss for overall improvement in health and blood sugar control.  Insulin may still be needed for severe cases. With MODY, oral drugs such as sulfonylureas are usually the first treatment step but 30-40% of patients may eventually require insulin.

In general, important considerations in medication management, include patient preference and comorbidities, side effects and cost. We strive to work with each patient to tailor a program that is best for them. 

When should you see an Endocrinologist for diabetes management? 

In general, because of the complexity of Type 1 diabetes management, these patients should be followed by an endocrinologist. Many patients with Type 2 diabetes can be effectively managed through their primary care providers. If blood sugar control is not achieved (HA1c <7%) than a referral to endocrinology should be considered. 

Your comprehensive LiveNew Diabetes treatment

At LiveNew we also recognize that medical treatment is only one component of giving you the most complete and effective diabetic treatment that you deserve. That is why we use comprehensive dietary, lifestyle, and weight loss approaches to treat the underlying driving forces which particularly for Type 2 diabetics can result in complete remission of disease. Using this approach we encourage elimination of processed foods as a first step, ultimately proceeding to a Plant Based Whole Foods dietary approach which can reverse insulin resistant Diabetes and many related metabolic diseases if used consistently.

Additionally, if you are a Type 2 Diabetic who has struggled with your weight, our comprehensive LiveNew diabetes treatments include state of the art bariatric surgery approaches help you lose weight and cure your metabolic disease. Even for Type 1 and MODY patients, while insulin may still be needed, blood sugar can be improved using very careful plant-based approach and working closely with our medical weight loss team.  All of these treatments can be used together, to produce powerful effective metabolic results. Our Endocrinologists and Bariatric specialists at LiveNew will harness the latest technology, medications, and lifestyle modifications to help you optimize your blood sugar control, health, and quality of life.