Rethinking Diabetes Care

This blog post breaks down the essentials of diabetes care, from understanding the types of diabetes to setting realistic health goals, and explains why personalized approaches often lead to the most successful outcomes.

How Personalized Care Transformed JC’s Life

When I first met JC, a 52-year-old man with Type 2 diabetes, he felt like nothing was working. His HbA1c was at 9.5%, and despite taking multiple medications, his blood sugar remained poorly controlled. He was frustrated by the oversimplified advice of “just eat less sugar,” which didn’t help him navigate the complexities of juggling stress, work, and family responsibilities.

What truly changed JC’s diabetes management was a shift toward a more personalized approach. We introduced a continuous glucose monitor (CGM), which provided him with real-time feedback on how his food choices and daily activities impacted his blood sugar levels. For instance, JC could see how a high-carb meal spiked his glucose or how a short walk after dinner helped stabilize it. This gave him actionable insights and helped him regain control over his health.

We also re-evaluated his medication regimen, switching from Januvia to a GLP-1/GIP receptor agonist (Mounjaro). This change, along with personalized lifestyle adjustments like incorporating more plant-based meals and increasing daily movement, helped him reduce his HbA1c to 6.7%, lose 20 pounds, and discontinue insulin therapy. The success lay not just in the tools like the CGM or medication but in the compassionate, individualized care that addressed JC’s specific needs and circumstances.

Types of Diabetes

Understanding the type of diabetes a person has is essential for creating an effective treatment plan. Each type of diabetes requires a different approach:

Type 1 Diabetes (T1D)

An autoimmune condition where the body attacks insulin-producing cells in the pancreas, requiring lifelong insulin therapy, often with the support of technology like CGMs or insulin pumps.

Type 2 Diabetes (T2D)

The most common type, largely influenced by insulin resistance. It can often be managed through lifestyle changes, though many people require medication to keep blood sugar under control.

Latent Autoimmune Diabetes in Adults (LADA)

Sometimes misdiagnosed as Type 2, LADA is a slower-progressing autoimmune condition that eventually requires insulin treatment.

Gestational Diabetes (GDM)

Occurs during pregnancy and usually resolves afterward, though it significantly increases the risk of developing Type 2 diabetes later in life.

The Pathogenesis of Diabetes

Understanding the underlying mechanisms of diabetes is crucial for effective management:

• In T1D, the immune system mistakenly attacks and destroys the pancreatic beta cells, leading to insufficient insulin production.

• T2D begins with insulin resistance—cells don’t respond effectively to insulin. The pancreas initially compensates by producing more insulin, but over time, it may not keep up with demand.

• LADA shares similarities with both T1D and T2D. It involves a gradual autoimmune destruction of beta cells, but the onset is slower than in typical T1D.

• In GDM, pregnancy hormones can lead to insulin resistance, challenging the pancreas to meet increased insulin demands.

Diagnosing Diabetes

Accurate diagnosis is essential for tailoring the right treatment plan. The most common diagnostic tests include:

• Hemoglobin A1c (HbA1c): Measures your average blood sugar over the last 2-3 months. A reading of 6.5% or higher indicates diabetes.

• Oral Glucose Tolerance Test (OGTT): Useful for diagnosing gestational diabetes and insulin resistance, especially in women with PCOS, when HbA1c results might not detect early warning signs.

• Fasting Plasma Glucose (FPG): A fasting blood sugar of 126 mg/dL or higher also indicates diabetes.

Treatment Options: A Rapidly Evolving Field

The management of diabetes has seen significant advancements in recent years:

• For T1D, in addition to traditional insulin therapy, we now have smart insulin pumps and continuous glucose monitors (CGM) like Dexcom, which provide real-time glucose data. Some patients are even using “artificial pancreas” systems, which automatically adjust insulin delivery based on CGM readings.

• For T2D, we start with lifestyle modifications, but we also have an expanding array of medication options. Two newer classes of drugs, SGLT2 inhibitors and GLP-1 receptor agonists, are changing the landscape of T2D treatment. SGLT2 inhibitors work by helping the kidneys remove excess glucose through urine, while GLP-1 receptor agonists enhance insulin release and promote satiety.

The Power of Lifestyle: Your Secret Weapon

While medical management is crucial, the importance of diet and lifestyle cannot be overstated. Here’s a little secret—your fork can be as powerful as any pill! A balanced, nutrient-dense diet is crucial for all types of diabetes. And exercise? It’s like a magic potion that makes your cells more sensitive to insulin.

Managing diabetes is a marathon, not a sprint. It’s about progress, not perfection. Sometimes, it’s as simple as introducing a plant-based meal twice a week or committing to a 15-minute walk after dinner. Every small step counts.

The Foundation of Personalized Care

The American Diabetes Association (ADA) provides general targets for managing diabetes, but personalizing these goals based on individual health needs and lifestyle is crucial for success. Everyone’s journey with diabetes is different, and goals should reflect what works best for the person.

Key targets for diabetes management include:

• HbA1c: For most adults, the goal is below 7%. For older adults or those with complex health conditions, a goal below 8% may be more appropriate.

• Blood Pressure: Maintaining a target below 130/90 mmHg.

• Kidney Health: Annual urine and blood tests to monitor early signs of kidney damage.

• Cholesterol: Keeping LDL levels below 70 mg/dL for high-risk individuals.

These goals are a great starting point, but the real impact comes when we tailor them to each individual’s lifestyle. JC’s focus, for instance, wasn’t just on reducing his HbA1c—it was about improving his energy, feeling more in control of his health, and being able to engage more fully with his family and hobbies.

Preventing Long-Term Complications

Setting and achieving personalized health goals isn’t just about hitting a number; it’s about preventing the long-term complications of poorly controlled diabetes. When blood sugar is not managed well, it can lead to a range of serious health issues that impact quality of life:

• Cardiovascular Disease: People with diabetes are 2-3 times more likely to experience heart disease, heart attacks, or strokes.

• Kidney Disease: Diabetes is the leading cause of chronic kidney disease and kidney failure.

• Retinopathy: Damage to the blood vessels in the retina can lead to vision loss or blindness.

• Neuropathy: Nerve damage, particularly in the feet, which can result in ulcers or, in severe cases, amputation.

While these complications are serious, they are not inevitable. With regular monitoring and proactive treatment these risks can be significantly reduced.

Conclusion

Managing diabetes is a lifelong commitment, but it doesn’t have to be overwhelming. While technology and medications play a key role, the turning point for many people is the moment they feel truly understood and supported. Diabetes care should focus on improving the quality of life of our patients.

As endocrinologists, we’re here to guide you through the complexities of diabetes management. We stay updated on the latest research and treatment options to provide you with comprehensive care tailored to your individual needs. While diabetes is a challenging condition, with the right approach, it’s entirely manageable.

My patients and I work together to make small, manageable changes that add up over time. We use tools like CGMs to gather real-time data, adjust medications as needed, and create personalized lifestyle plans. It’s an empowering approach that turns diabetes management into a collaborative effort.

If you’re feeling overwhelmed by diabetes, know that the right support and guidance can make a huge difference. Stay informed, stay engaged with your healthcare team, and most importantly, stay positive. You have the power to take control of your health, and we’re here to support you every step of the way.