Diabetic Weight Loss and Care: Your Complete Diabetes Guide

Understanding Diabetes

According to the Centers for Disease Control and Prevention (CDC) in the United States, approximately 34.2 million people, or 10.5% of the population, have diabetes as of 2020. This includes both diagnosed and undiagnosed cases. It's worth noting that these figures represent all types of diabetes, including type 1 and Type 2 diabetes. As you can see, these numbers are quite striking. As a primary care doctor, I have managed numerous patients with diabetes. I recognize getting these patients on the right medications is important, but even more so is providing the right education regarding the disease process as well as the lifestyle changes that can be made to address them.

What is diabetes and what causes it?

First we have to make a clear delineation between type 1 and type 2 diabetes as they are very different diseases.

Type 1 Diabetes

Type 1 diabetes is a chronic autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing cells (beta cells) in the pancreas. This results in a deficiency of insulin, a hormone that regulates blood sugar levels.

The exact cause of Type 1 diabetes is not fully understood, but it is believed to involve a combination of genetic predisposition and environmental triggers.

Type 1 diabetes typically develops in childhood or adolescence, but it can occur at any age. The onset of the disease is often abrupt, with symptoms including increased thirst, frequent urination, unexplained weight loss, fatigue, and blurred vision. Individuals with Type 1 diabetes require lifelong insulin therapy to manage their blood sugar levels and prevent complications.

While Type 1 diabetes cannot be prevented or cured, early detection, proper management, and access to medical care are crucial in helping individuals with the condition lead healthy lives.

Type 2 Diabetes

Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar levels resulting from either insulin resistance or inadequate insulin production. It is the most common form of diabetes, accounting for the majority of diabetes cases worldwide.

In Type 2 diabetes, the body becomes resistant to the effects of insulin, a hormone produced by the pancreas that helps regulate blood sugar levels. This insulin resistance means that the body's cells do not respond properly to insulin, preventing glucose from entering the cells efficiently, leading to elevated glucose in your blood stream.

While type 2 diabetes is influenced by genetic factors, it is largely considered a preventable condition. Making healthy lifestyle choices, such as adopting a balanced diet, engaging in regular physical activity, maintaining a healthy weight, and managing stress, can help reduce the risk or delay the onset of type 2 diabetes.

How Do You Know You Have Diabetes?

The signs and symptoms of diabetes can vary depending on the type of diabetes and the individual. Here are some common signs and symptoms associated with diabetes as well as why it happens:

1. Frequent urination: When your blood sugar levels are high, your kidneys try to get rid of the glucose by excreting it in the urine, leading to frequent urination.

2. Excessive thirst: Because of increased urination, the body can become dehydrated, triggering a thirst response.

3. Unexplained weight loss: Rapid or unintentional weight loss can occur in individuals with diabetes, particularly in type 1 diabetes. The body is unable to properly utilize glucose for energy, so it starts breaking down stored fat and muscle for energy instead.

4. Fatigue and weakness: Feeling tired, fatigued, or lacking energy is a common symptom of diabetes. When cells are unable to effectively use glucose, the body may not be getting the energy it needs. In addition, increased urination can lead to dehydration and loss of important electrolytes.

5. Frequent infections: Individuals with diabetes may be more susceptible to infections, particularly urinary tract infections, yeast infections (such as vaginal or oral thrush), and skin infections. Increased blood sugar creates an optimal environment for bacterial or other pathogens to grow.

6. Tingling or numbness: Nerve damage (neuropathy) can occur in diabetes, leading to tingling, numbness, or a loss of sensation, usually starting in the feet or hands.

How to Get Checked for Diabetes

At your primary care doctor’s office, the first test to determine if you have diabetes is a hemoglobin a1c.

Hemoglobin A1c (HbA1c) is a blood test that provides an estimate of a person's average blood sugar levels over the past 2-3 months. So instead of a finger stick to get a snap shot of your blood glucose in that moment, a hemoglobin a1c is a measurement of long term blood sugar control.

HbA1c is commonly used as a diagnostic and monitoring tool for diabetes. It is expressed as a percentage, reflecting how much glucose is attached to your red blood cells. For individuals without diabetes, a normal HbA1c level is typically below 5.7%. Prediabetes is between 5.7% to 6.4%. Above 6.5% results in the formal diagnosis of diabetes.

For individuals with diabetes, the target HbA1c level may vary depending on factors such as age, overall health, and the presence of other medical conditions. However, a general target for most people with diabetes is an HbA1c level below 7%.

What is Prediabetes?

Having prediabetes means your blood sugar levels are higher than normal, yet not high enough to be considered type 2 diabetes. Without any intervention, prediabetes is likely to turn into type 2 diabetes down the road. Patients with prediabetes often will not experience a lot of clear symptoms of diabetes that I mentioned above.

I try to reassure my patients and to more so see prediabetes as a wake up call than seeing type 2 diabetes as inevitable. It is the perfect time to change gears and make those lifestyle choices so you can get back to a normal blood sugar range!

Diabetes Complications

Diabetes is a disease that can effect many organs of the body. As a primary care doctor, I treat this disease systematically to ensure thoroughness and effective health outcomes. So I go with a head to toe approach.

Eyes

Diabetic retinopathy is the most common eye condition associated with diabetes. It occurs when high blood sugar levels damage the blood vessels in the retina, the light-sensitive tissue at the back of the eye. Initially, diabetic retinopathy may not cause noticeable symptoms, but as it progresses, it can lead to vision loss and even blindness.

Doctor’s orders: Yearly referral to optometrist or ophthalmologist for eye screening to allow for early detection and treatment as needed.

Heart

People with diabetes have much higher risk of developing heart disease. Elevated blood sugar levels can damage blood vessels and contribute to the buildup of plaque, narrowing the arteries and restricting blood flow to the heart.

Doctor’s orders: Recommend patient to start statin therapy to decrease cholesterol or maintain low cholesterol levels to help decrease cardiovascular risk.

Kidneys

Similar to the heart and eyes, elevated blood sugar damages the blood supply to the kidneys. In addition, it can damage the tiny filters inside the kidneys called glomeruli, causing the kidneys to then leak and lose protein such as albumin in the urine.

Doctor’s orders: Perform urine test to assess for the amount of proteinuria (protein in the urine) and if substantial, a recommendation may be made to start a medication to protect your kidneys.

Feet

With elevated blood sugar, the blood supply to our feet gets damaged, in addition to its nerves, resulting in something called diabetic neuropathy. As a result, patients lose sensation in their feet and can then damage them without knowing. Once open wounds develop, the compromised blood supply leads to poor healing, resulting in high risk for infections. This is how diabetic patients may develop gangrenous toes, leading to amputation.

Doctor’s orders: Frequent foot checks in the clinic as well as educating patients to do them everyday at home. Make sure not to forget to check between the toes! Wear wider shoes to avoid shoes causing any skin break down that can lead to potential infections. Avoid constricting socks and instead opt for moisture wicking and breathable ones with cushioning to protect your feet!

Diabetic Coma

Not every patient will experience all these complications. However, I want to caution ignoring your diabetes even if you feel well. I have had many patients still have high levels of a1c such as upward of 10%. They decided they felt well and decline all medications and medical screenings, which is extremely dangerous.

The most dangerous part of lack of adherence is the feared complication of diabetic ketoacidosis, or also known as diabetic coma. This is essentially a medical emergency. Your body goes into this state where you have substantially elevated blood sugars leading to severe dehydration due to excess urination. In addition, due to lack of insulin or elevated insulin resistance, your body is unable to use glucose for energy, effectively leaving your body in a state of starvation. Once this happens, your body can begin to shut down, leaving you in a comatose state. The intent is not to scare anyone with this information, but rather I hope to educate. Complications of diabetes don't happen overnight, but once they start developing, they can lead to serious consequences so it becomes imperative to get on top of it.

So as you can see here, diabetes can become a very complex chronic condition, affecting many parts of your body. It is so important to recognize this so you can also make sure your doctors stay on top of your care.

How to Manage Diabetes

With type 2 diabetes, I often don’t jump straight to medications in my patients—especially if their a1c is in the range of 7-8. What we know with type 2 diabetes is that it is largely due to insulin resistance and that lifestyle changes can positively change that.

Weight Loss and Exercise for Diabetes

Weight loss and exercise can have significant benefits in improving diabetes management, particularly for individuals with type 2 diabetes. Here's how weight loss and exercise can positively impact diabetes:

1. Improved Insulin Sensitivity: Excess weight, especially in the abdominal area, can contribute to insulin resistance, where the body's cells become less responsive to insulin. Weight loss helps improve insulin sensitivity, allowing the cells to more effectively utilize insulin and regulate blood sugar levels.

2. Lowered Blood Sugar Levels: Weight loss can lead to decreased blood sugar levels and improved glycemic control. Losing weight can reduce the amount of glucose produced by the liver and enhance the body's ability to use insulin efficiently, resulting in more stable blood sugar levels.

3. Cardiovascular Benefits: Weight loss and exercise is associated with improvements in cardiovascular health, such as reducing blood pressure, improving lipid profiles (lowering LDL cholesterol and triglycerides, increasing HDL cholesterol), and reducing the risk of heart disease and stroke. These benefits are particularly crucial for individuals with diabetes, who are at an increased risk of cardiovascular complications.

It's important to note that weight loss should be pursued in a healthy and sustainable manner. Gradual weight loss, typically 1-2 pounds per week, through a combination of a balanced diet and regular physical activity, is generally recommended. Don’t hesistate to discuss weight loss plans with your primary care doctors! I have these conversations with my patients all the time and even connect them with a dietician for extra support and guidance.

Diet for Diabetes

The diet recommended for individuals with type 2 diabetes focuses on balancing blood sugar levels, achieving and maintaining a healthy weight, and promoting overall health. Here are some key dietary recommendations for managing type 2 diabetes:

1. Carbohydrate Control: It is important to recognize that carbohydrates break down in the body to become glucose. With that said, I don’t ever believe in being restrictive, but rather just consistent and with good quality goods. In addition to cutting down on carbohydrates, it's advisable to choose carbohydrates that are high in fiber and have a low glycemic index, as they have a slower impact on blood sugar levels. Fruits, vegetables, legumes, and dairy products are good carbohydrate choices. Monitoring portion sizes and spreading carbohydrate intake throughout the day can also help regulate blood sugar levels.

2. Balanced Meals: Aim for balanced meals that include a combination of carbohydrates, protein, and healthy fats. This can help slow down the digestion and absorption of carbohydrates, leading to better blood sugar control. Include lean sources of protein (e.g. poultry, fish, tofu), healthy fats (e.g. avocados, nuts, olive oil), and plenty of non-starchy vegetables in your meals.

3. Portion Control: Pay attention to portion sizes to avoid overeating. Controlling portion sizes can help with weight management and blood sugar control. By cutting down carbohydrates and leaning into vegetables, dietary fats, and proteins will not only help keep your portions smaller, but also help you feel full longer!

4. Limit Sugary Foods and Drinks: Minimize the consumption of sugary foods and beverages, including sugary sodas, desserts, candies, and sweetened snacks. These can rapidly increase blood sugar levels and provide empty calories without substantial nutritional value.

5. Healthy Fats: Include sources of healthy fats in your diet, such as avocados, nuts, seeds, and olive oil. These fats can help promote satiety, provide essential nutrients, and support heart health.

6. Regular Meal Timing: Establish regular meal timings and avoid skipping meals. Consistency in meal timing can help regulate blood sugar levels and prevent sharp spikes or drops.

7. Hydration: Stay well-hydrated by drinking water throughout the day. By focusing on water intake daily, you’ll find that you may naturally decrease the sugary drinks naturally!

Remember, dietary management of type 2 diabetes should be personalized, and it's important to consider any other medical conditions or dietary restrictions you may have. Regular monitoring of blood sugar levels and working closely with your healthcare team will help you make informed decisions about your diet and optimize your diabetes management.

Medications for Diabetes

To individuals that are currently taking medications for diabetes, I want to take a moment to explain how some of them work with hopes you can adhere to them as it can make a big difference in getting you back on track.

Metformin

One of the most common diabetes medication and is often first line treatment. As you now know with type 2 diabetes, it is largely due to insulin resistance. Metformin enhances insulin sensitivity, allowing for the insulin your pancreas produces to actually work and decrease the glucose in your blood stream. It also tells the liver to reduce the production of glucose, resulting in lower blood sugar levels. Lastly, it has effects on gut hormones that regulate appetite, breakdown of glucose, and insulin secretion. These all contribute to improved blood sugar control and weight management. Metformin is overall safe, but can cause some initial GI effects such as abdominal pain, nausea, and diarrhea that are normally short lived.

Sulfonylureas

This class of medication is commonly added to metformin if metformin is not enough to control your blood sugar. It works by stimulating the pancreas to release more insulin so your body can then use up the glucose in your blood, effectively lowering your blood sugar. The concerns with this medication is that it can lead to low blood sugars, so make sure you eat consistent meals to avoid episodes of hypoglycemia or low blood sugar.

SGLT2i

This class of medication is now making its way onto more physicians prescription pads to its studied benefits on not just addressing diabetes, but also helping protecting the kidneys. It lowers blood sugar by telling the kidneys to excrete more of it in the urine. It protects the kidneys by mechanisms to improve blood flow to them. Side effects to note of SGLT2i is increased risk for urinary tract infections or yeast infections.

Insulin

For patients with hemoglobin a1c that are extremely high, such as >10%, some physicians may recommend adding insulin to your medication regimen. It is important to note there are many types of insulin. For the sake of convenience, most physicians will start with a long acting insulin, which would be a once a day injection. Although injecting insulin can be cumbersome, it is important to recognize that it is absolutely essential to do if your a1c is too high. However, you don’t have to be on insulin forever. I have had many patients who improved their hemoglobin a1c and we were able to take them off of insulin.

Although there are many more diabetes medications out there, the ones mentioned above are generally the most common. When it comes to information on medication, please don’t rely on simply the internet. Your doctors have so much experience using these medications and will be the best source information to determine what would be the right medications for you.

Is Type 2 Diabetes Reversible?

A patient recently transitioned his care over to me as his now primary care provider. During our initial visit, he made it clear that he wanted to improve his diabetes and eventually get off all medications. I wanted to meet him where he was at and work towards this goal together, so I ordered some blood work to better understand his state of diabetes. It turned out his a1c was 7.5. It wasn’t bad, but we had some work to do.

Firstly, he was 30 pounds overweight, so I discussed how just shedding some weight can substantially improve his A1c. Next, we reviewed his diet. His normal breakfast included milk and cereal. Lunch and dinner were often heavy in carbohydrates, consisting of rice, pasta, tortillas, or bread. To my surprise, his previous doctors never discussed with him the relationship between carbohydrates and blood sugar. When I told him that carbohydrates, once digested, becomes glucose in the blood, he was blown away. In addition, I told him not to fear dietary fats. He was hesitant to eat eggs in the morning for breakfast and instead ate cereal thinking it was more healthy.

When I saw him two weeks later for our follow up, he was excited for my medical staff to take his weight. He had be working diligently. He had already lost 5 pounds by simply reducing carbohydrates in his diet and incorporating a daily 30 minute walk.

When he walked into my clinic three months later, I could barely recognize him. I could tell he had lost substantial weight, but more than that, he looked well. He looked healthy! Because 3 months had passed and he had been so diligent with his lifestyle changes, I was just as excited as he was to recheck his hemoglobin a1c.

His repeat hemoglobin a1c was 6.3. Based off of this, he was no longer considered a diabetic. We had a discussion on discontinuing the medications he was on as long as he continued with the amazing progress he had made with his diet and exercise.

So as you can see here, if you get diagnosed with diabetes, know that is doesn't have to be lifelong condition. You can reverse type 2 diabetes with the right lifestyle changes, the right diet, and the right support!

Mighty Health Takeaways on Diabetes

All right Mighty family, I hope you enjoyed this guide to diabetes. To end, let me summarize a few Mighty take aways:

1. Type 1 and type 2 diabetes are very different disease processes. Type 2 is the more common one and can be very manageable with the right lifestyle changes if caught early.

2. Diabetes is a disease that affects many parts of your body, particularly your eyes, your heart, your kidneys, and your feet. Make sure your doctor stays on top of your care and addresses each of these organs.

3. Changes to diet can make a huge difference to your blood sugar. In particular, cutting down carbohydrate intake and leaning into your proteins, vegetables and dietary fats can substantially improve your diabetes

4. For those that do have more advanced diabetes, sticking to your medication regimen is crucial, as constantly elevated blood sugar levels can cause lifelong damage if not kept under control

5. Type 2 diabetes does not have to be lifelong! If caught early enough, with the right lifestyle changes, you may very well be able to reverse it!

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