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With the increase in metabolic issues in the United States and around the world, type-2 diabetes, also known as the silent killer, has become a bona fide pandemic. Type-2 diabetes is the name for insulin disorders, including insulin resistance, and is measured with a blood test – typically when A1C is over 6.5%. While there are few outward symptoms in early type two diabetes, the long-term effects can be dramatic. Diabetes reduces blood flow and damages blood vessels, which can cause significant problems in the extremities and the heart – at the very worst, leading to amputation and a much-heightened risk of heart attack or stroke. Patients with diabetes are also at a significantly higher risk of surgical complications and may not even be able to have surgery because of their blood sugar. Diabetes can cause neuropathy or nerve pain that is often irreversible. The list goes on.
So, let’s discuss how to manage type 2 diabetes with today’s tools.
Diet and Exercise
Of course, the preferred way to manage diabetes is through a comprehensive diet and exercise. Following an appropriate lifestyle plan can improve diabetes dramatically and even put it into remission. Losing 5, 10, or even 15% of one’s body weight can significantly ameliorate many metabolic disorders.
Of course, losing significant weight through diet and exercise alone is hard, which is why so many diets exist. Most don’t work. To that end, there are options:
Traditional Medications
Type 2 diabetics are aware of exceptionally effective medications like Biguanides (metformin), sulfonylureas, SGLT2 inhibitors, and more that help reduce blood sugar levels. Some patients are dependent on insulin injections. Regardless, medications can be very effective in reducing the burden of diabetes. However, they also have side effects and may lose effectiveness over time, requiring ever-higher doses.
GLP-1 Receptor Agonists
We’ve all heard of the weight loss craze associated with GLP-1 receptor agonists. Ozempic® and MounjaroTM are, of course, the “original” GLP-1s that focus on diabetes control. These have been exceptionally effective in managing diabetes, and many patients have also found good weight loss results as an adjunctive benefit. These weight loss results were the impetus for the approval of Wegovy® and ZepboundTM as primary weight loss medications, which, of course, have become blockbuster drugs in their own rights. Recent study data has shown that these drugs and their associated weight loss effectively reduce the risk of major cardiovascular events.
While these drugs are quite successful in controlling diabetes and even helping patients lose weight, their effectiveness may be limited in patients with severe metabolic disease and very high BMI. While data has shown up to 20% weight loss potential, more is often needed for patients higher on the BMI scale (40 or so).
Bariatric Surgery
Most bariatric procedures have shown excellent results in putting diabetes into remission. However, the gastric bypass shows particular promise in this regard. Many patients go into remission after a bypass within just a few weeks, even if they haven’t lost much weight. We theorize that the rebalancing of gut flora may have something to do with improving insulin sensitivity.
Can Diabetes Be Cured?
While the diabetes treatment options above do an excellent job of lowering blood sugar levels, we like to say that diabetes is put into remission or reversed rather than cured. Once insulin resistance kicks in, patients begin a lifetime of sugar control and require follow-up and monitoring. Resurgence of diabetes is possible and more likely once diabetes has been diagnosed.
The Bottom Line
Diabetes is a serious problem in modern society, causing significant metabolic concerns and contributing to heart disease. With proper knowledge and access to appropriate treatment options, like the ones mentioned above, we can get diabetes into remission and help patients live whole and heart-healthy lives.