Category: Diabetes

CGM
FDA Approves New OTC Continuous Glucose Monitor (CGM) 
Posted on by Leslie Branon

A continuous glucose monitor (CGM) has typically only been available via prescription, until now. 

Recently, the Food and Drug Administration (FDA) approved over-the-counter (OTC) sales of a CGM known as Dexcom’s Stelo Glucose Biosensor System.

This is good news not only for those with diabetes, but also for those who want to support a healthier lifestyle and make smart food choices by monitoring their blood sugar (glucose) levels. 

At Texas Diabetes & Endocrinology, our team of endocrinology experts often include CGMs as part of the treatment plan for our patients with diabetes.

What is a CGM?

A CGM is a small device that adheres directly onto the skin and uses sensors to track real-time glucose readings.  Having this important information at your fingertips can help you better plan food intake goals and medication or insulin doses throughout the day.  The CGM affords patients the opportunity to live more independently without stopping for multiple tests (finger pricks) every few hours. Additionally, the sensor can send an alarm to the patient or their caretaker if their blood sugar is dangerously low or high to alert them to take action.

Under the direction of your endocrinologist, a CGM can be an effective glucose monitoring tool for patients with either Type 1 or Type 2 Diabetes. 

Our endocrinologists can also access these real-time readings so that guidance on adjusting medications can be made swiftly and with as little interruption to your daily routine as possible. 

The introduction of CGMs has changed the way endocrinologist determine how well controlled a person’s diabetes is by looking at the amount of time the blood sugars stay in a target range. “We now understand that keeping blood sugars controlled all day long, instead of just parts of the day, are better for patient outcomes,” explains endocrinologist Dr. Tira Chaicha-Brom. “We still routinely check hemoglobin A1c but this is a three month average of one’s blood sugars.” 

CGMs for Non-Diabetics 

There is a growing number of people who are not diabetic opting to use CGMs in order to monitor their blood sugar levels. Without a confirmed diabetes diagnosis, it has previously been challenging to obtain a CGM.

“As more and more people are wanting to take control of their health and make smart choices, using a CGM can be a proactive way to use data that supports these goals”, says Dr. Tira Chaicha-Brom. 

The benefits of maintaining healthy blood sugar levels include:

  • Boosting energy and circulation
  • Preventing heart and kidney disease
  • Protecting against vision loss and the development of diabetes

The Dexcom Stelo device is a wearable CGM system that provides glucose readings every 15 minutes and delivers them to an app on your phone. It will be available for widespread purchase this summer. 

For questions about CGMs and successful diabetes management, please contact us here. 

Contact Us to Help Manage your Diabetes and Thyroid Conditions 

If you’d like to schedule an appointment with one of our specialists at Texas Diabetes & Endocrinology and discover how our diabetes services  and other endocrinology therapies can help you lead a full and active life, please contact us at (512) 458-8400 or request an appointment online.  

Don’t forget to follow us on Facebook and Instagram and check back with us each month as we provide you helpful wellness and health information.

How ChatGPT helped one patient correct his diabetes misdiagnosis
Posted on by Leslie Branon

Artificial Intelligence (AI) is infiltrating everything these days, even medical diagnoses. One young patient of ours was misdiagnosed with Type 1 diabetes (T1D), but through his own intuition, research using ChatGPT, and the help of Dr. Keta Pandit, discovered that he had an inherited form of diabetes known as Maturity-Onset Diabetes of the Young (MODY).

24-year-old Cooper Myers was first treated for T1D while living in South Carolina after experiencing common diabetes symptoms (high blood sugar despite diet and exercise, fatigue, excessive thirst, and frequent urination). At the time of his diagnosis, he tested negative for GAD antibodies which are typically found in those with T1D. However, even with dedicated efforts at eating well and exercising, his blood sugar was still high, leading the doctor to believe he had T1D. 

Knowing his strong family history of diabetes on his father’s side, dating back to his great grandmother, coupled with the fact that he tested negative for antibodies, Cooper felt like something didn’t seem right about his diagnosis. 

Upon moving to Austin, TX, Cooper established care with Texas Diabetes and Endocrinology under board certified endocrinologist Dr. Keta Pandit and her team. Dr. Pandit managed Cooper’s insulin pump and noticed that he was having frequent low glucose values and had to continue reducing his insulin dosing. 

With a career in technology and extensive knowledge of AI, Cooper relayed his questions regarding his family history and lack of antibodies to ChatGPT, searching for insight on other forms of diabetes. He kept landing on references to Maturity Onset Diabetes of the Young (MODY), a genetic form of diabetes caused by a gene mutation.

Cooper shared his findings with Dr. Pandit, who seemed to agree with Cooper’s concerns at that time.  His insulin requirements were much lower than other TID patients, which raised concerns for Dr. Pandit as well. 

Diagnostic Testing Provides Clarity

Dr. Pandit supported re-evaluating Cooper’s diagnosis and ordered a variety of tests to look at specific antibodies, which included pancreatic antibodies to confirm there are no T1D antibodies and C-peptide which confirms that the pancreas is still producing insulin. After Cooper’s result showed he had no antibodies and low (normal) C-peptide levels, Dr. Pandit ordered a genetic blood test to examine the genes that were associated markers of MODY. 

After this lengthy process, and waiting more than a month for the results, it was confirmed that Cooper had MODY 2 (there are different types of MODY depending on which gene is affected). MODY 2 is caused by a mutation of the GCK gene.

Working with Dr. Pandit, Cooper was able to gradually change his medications and get off his insulin pump.  Now, his blood sugar and insulin production are properly managed, and he is living a normal and healthy life off his insulin. Dr. Pandit says that with his lifestyle, his prognosis is excellent. 

Cooper has now found a great support system online for fellow MODY patients who were misdiagnosed like himself. 

His advice to others who are concerned about a diagnosis is to trust your instincts and do your own research, but also discuss things with your doctor and trust their expertise and guidance.

Maturity Onset Diabetes of the Young

MODY is a genetic form of diabetes that is unlike Type 1 (T1D) or Type 2 (T2D) diabetes as it is not autoimmune (T1D) or triggered by factors like poor diet and obesity (T2D). A gene mutation in those with MODY limits the ability of the pancreas to make enough insulin to support healthy blood sugar levels. There are different subtypes of MODY depending on which gene is affected, each resulting in different symptoms and complications. 

MODY is a very rare diagnosis compared with commonly diagnosed conditions such as T1D and T2D. It is estimated to account for 5% of all diabetes cases in the United States. The genetic mutation that causes MODY has a 50% chance of being passed down to subsequent generations. If a child does inherit the mutation, they will generally develop MODY before they reach 25 years of age regardless of their lifestyle, ethnic group or other risk factors such as obesity or increased weight gain. 

Research shows that up to 80-90% of MODY cases are first diagnosed incorrectly as T1D or T2D. Key features of MODY are the age of diagnosis, under 25 years of age, having a parent with diabetes, and often diabetes in two or more generations. Testing for the presence of antibodies can help rule out the condition. Patients diagnosed with MODY classically do not need insulin. 

It is important to distinguish MODY from T1D and T2D because the treatment and management options are quite different. Insulin injections are primary mode of treatment for T1D, while generally Metformin is the first line of treatment for T2D. On the other hand, MODY is treated through other medications, such as sulfonylureas. 

Contact Us for Help in Managing your Diabetes

If you’d like to schedule an appointment with Texas Diabetes & Endocrinology and discover how our diabetes services  and other endocrinology therapies can help you lead a full and active life, please contact us at (512) 458-8400 or request an appointment online. 

Don’t forget to follow us on Facebook and Instagram and check back with us each month as we provide you helpful wellness and health information.

GLP-1RA gastrointestinal side effects
What are the GI side effects of GLP-1RA Medications, like Ozempic?
Posted on by Leslie Branon

In treating T2D diabetes patients, our Texas Diabetes & Endocrinology board-certified experts may recommend medication to help lower blood sugars in addition to lifestyle changes. Some injectable forms of medical therapy, known as GLP-1RA medications, have been trending in the news lately due to their role in weight-loss management. 

These drugs go by popular brand names such as Ozempic, Mounjaro, and Trulicity. 

While the medicines are very effective for many patients and can be used safely with regular monitoring, recent data reports that there can be serious gastrointestinal (GI) side effects in rare cases. 

GLP-1RA Gastrointestinal Side Effects

GLP-1RAs help to slow the speed at which food passes through the stomach, causing people to feel fuller longer and better regulate blood sugar levels.

This form of drug treatment however can also lead to GI side effects (like severe nausea and vomiting) in some people. 

A new study in the Journal of the American Medical Association recently revealed that those taking GLP-1RAs for weight loss were at an increased risk of GI issues such as:

  • Biliary disease
  • Gastroparesis
  • Pancreatitis
  • Bowel obstructions

These conditions reportedly contributed to many patients electing to discontinue use on their own.

A study published in the American Journal of Managed Care found that approximately 50% of those being evaluated and who were on GLP-1RA meds stopped them within a year. 

What are the consequences of stopping GLP-1RA meds without direction from your doctor?

While initially stopping these medications may not have immediate health repercussions,  it could likely have an effect down the road. 

Failure to properly manage diabetes could lead to complications from continuously elevated blood sugars – like nerve damage, vision loss and worsening kidney function. Stopping these medications could also lead to regaining any lost weight, which typically also worsens insulin resistance and blood sugar control.

With any new therapy, it is important to follow all instructions carefully and as directed by your doctor.   Our endocrinology experts will always discuss treatment options with you and any potential risks or side effects. 

If you ever experience side effects from your diabetic medications, please contact us right away so that we can evaluate the situation and discuss effective alternatives. 

Contact Us Today to Learn More about  Diabetes and Weight Loss Management

If you’d like to schedule an appointment with Texas Diabetes & Endocrinology and discover how our diabetes services  and weight-loss management program can help you lead a full and active life, contact us at (512) 458-8400 or request an appointment online.  

Don’t forget to follow us on Facebook and Instagram and check back with us each month as we provide you helpful wellness and health information.

Texas Diabetes first to offer new treatment to delay stages of T1D
Texas Diabetes First to Offer New Treatment to Delay Stages of T1D
Posted on by Leslie Branon

At Texas Diabetes & Endocrinology, we take pride in offering the most innovative treatments and top clinical trials for conditions affecting the endocrine system, like diabetes.

Recently one of our patients, Liberty, became the first person in Central Texas to try a new drug, TZIELD, to delay the onset of stage 3 type 1 diabetes (T1D). TZIELD is an infusion-based treatment that was approved by the FDA in 2022. 

Liberty works as a scientist at The University of Texas at Austin and was recently diagnosed with T1D at the age of 39 years old. 

T1D is an autoimmune disorder that occurs when the pancreas fails to make insulin because the body’s immune system attacks the cells (known as beta cells) needed to do so. It develops in gradual stages and differs from type 2 diabetes (T2D) which is when the body becomes resistant to insulin. 

It can be challenging to differentiate between the two forms of diabetes as symptoms (frequent urination, fatigue, sudden weight loss and increased thirst) may be similar. 

It is important to visit with an experienced, board-certified endocrinologist to obtain a thorough and accurate diagnosis. A T1D diagnosis can be determined based on clinical presentation, time of onset, and diagnostic blood tests that identify autoimmune markers such as autoantibodies.

What are the stages of T1D ? 

Stage 1: the body’s immune system starts attacking beta cells while blood sugar levels are still typically normal 

Stage 2: beta cells continue to be attacked as blood sugars may begin to rise, however no insulin is needed yet 

Stage 3: blood sugar levels ultimately spike to more than healthy levels and insulin is now needed to manage the condition  

Liberty’s Story and the Link between T1D and Autoimmune Disorders 

Liberty had already been under the care of endocrinologist Dr. Keta Pandit to treat her Hashimoto’s thyroiditis, a chronic autoimmune condition that leads to low thyroid hormone production. 

During a routine blood test, it was discovered that her A1C level was elevated which classified her as ‘prediabetic.’ 

With regular exercise and adopting a low-carb diet, Liberty initially was able to lower her numbers without medication. 

However, she later began to experience fatigue after eating and shakiness at night, prompting her to seek a new evaluation from Dr. Pandit.  

Given that there is a connection between autoimmune diseases and T1D, Liberty and Dr. Pandit discussed the possibility of having it, which was later confirmed through testing.  

How is T1D treated? 

Because T1D cannot be effectively managed with a healthy diet and exercise, administering insulin is the typical course of treatment.

Since Liberty was diagnosed at the earliest stage of T1D, she did not yet require insulin. 

As a scientist herself, she was keen to participate in any clinical trials or innovative therapies that could help slow the progression of the condition. Dr. Pandit suggested infusion therapy with TZIELD. 

TZIELD works by targeting the immune cells that attack the beta cells needed to produce insulin. 

Liberty had her first set of infusions in December 2023 over a 14-day period. She tolerated the infusion well, with minimal side effects. 

Dr. Pandit is monitoring Liberty’s A1C levels to see if they stay low enough and will continue with TZIELD infusions as long as they continue to preserve her pancreatic beta cells to delay insulin dependence. 

To others who may be experiencing symptoms of diabetes, Liberty shares that it’s important to make sure and get a proper and distinct diagnosis for either T1D or T2D so that you can fully understand your options for treatment, or in her case, the ability to even slow progression of the disease. 

“Listen to your body,” she says. “I could have contributed my fatigue to work or stress, but it’s important to take your health seriously if you feel something is wrong.”

Contact Us Today to Learn about Managing Diabetes 

If you’d like to schedule an appointment with Texas Diabetes and Endocrinology and discover how our diabetes services  can help you lead a full and active life, contact us at (512) 458-8400 or request an appointment online.  

Don’t forget to follow us on Facebook and Instagram and check back with us each month as we provide you helpful wellness and health information.

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