Helping people gain better

In 2015, it was estimated that 1 out of 3 adults has Pre-diabetes.  Pre-diabetes can be diagnosed by checking a fasting blood sugar or by measuring the hemoglobin A1c (a 3-month average of blood sugar).  People who are overweight or who have a family history of Diabetes are at high risk for Pre-diabetes (and for Diabetes).  Most people with Pre-diabetes don’t know that they have this condition and it can only be diagnosed with a blood test.  50% of people with Pre-diabetes develop overt Diabetes in 10 years unless they are treated.  The primary treatment of Pre-diabetes is exercise and weight loss.  A 7% weight loss and the equivalent of 30 minutes of walking for 5 days of the week haven been shown to reduce progression of Pre-diabetes to Diabetes by nearly 60%.  A medication, Metformin, is also frequently used to treat Pre-diabetes.

Gestational Diabetes (GDM) is a frequent complication of Diabetes.  Gestational Diabetes is the development of elevated blood sugar in pregnancy.  Certain hormones produced by the placenta can lead to elevated blood sugar later in pregnancy.  This problem can be diagnosed by doing a glucose tolerance test near the end of the second trimester.  If untreated, GDM, can lead to excessive fetal weight gain and prematurity.  GDM can be treated with dietary modifications and many times, insulin.

Thanks to research advances, there are more, and better, options available to treat Diabetes.  Oral medications, which treat the deficiencies in Diabetes have been developed.  The medications are effective and generally safer than older medications such as sulfonylureas.  The newer medications tend to not cause hypoglycemia and they are associated with either weight loss or no weight gain.  Oral medications are currently available, which increase insulin levels and lower glucagon. One oral medication induces the kidneys to lose glucose in the urine, thereby lowering the blood sugar.

One relatively new class of injectible meds is available to be given in daily and weekly injections.  Insulin is also being developed which provides a more predictable background or basal insulin and faster mealtime insulins are being developed.  Inhaled insulin has recently been approved as a rapid-acting mealtime insulin.

One of the most predictable ways to give insulin is with an insulin pump.  Insulin pumps constantly infuse a small amount of insulin to provide a basal insulin.  At mealtimes the user enters data, such as amount of carbohydrate to be eaten and the fingerstick sugar result to help calculate the mealtime insulin dose.  In our practice, it is estimated that over 50-60% of people with Type 1 Diabetes are using insulin pumps.

Insulin pumps are recommended for people with Type 1 Diabetes or Type 2 Diabetes on multiple doses of insulin per day. The insulin pump is used by people trying to improve their Diabetes control and is a must for people with frequent or problematic hypoglycemia.  It offers flexibility in insulin dosing and offers more insulin dose adjustability than injection insulin.  The pump is commonly used in pregnancy.