Ask a Doc: Type 2 Diabetes – Management – Part 2

This is Part 2 of a special two-part Ask a Doc on diabetes. In this article, Bret Kueber, M.D., of the Boca Grande Health Clinic, describes the close link between diabetes and your body’s organs and discusses treatment options for Type 2 diabetes. In the first part of the diabetes series, Dr. Kueber addressed Type 2 diabetes – what it is, who’s most at risk, and ways to prevent it. You can read Part 1 here: https://www.bghc.org/news/healthcare/ask-a-doc-type-2-diabetes-an-epidemic-of-great-proportion-part-1/.

Diabetes Awareness Month happens every November. It’s an opportunity for us to help raise awareness of the disease, talk about ways to manage – and prevent – it, and share the latest advances that could help patients, families and communities live better.

Do you have a question for us? If so, please send questions to the Clinic at https://www.bghc.org/contact or to the Boca Beacon and we will answer them.

What happens to your body when you have diabetes?

Your body breaks down the food you eat into sugar, or glucose. The pancreas secretes a hormone called insulin, which forces glucose into your body’s cells to burn for energy. With Type 2 diabetes, your body either doesn’t make enough insulin, or your body’s cells stop responding properly to insulin. When this happens, blood sugar stays in your bloodstream and some is converted to fat, and this becomes a very serious issue. Over time, abnormally high sugar levels can cause serious damage to your body’s vital organs – the heart, blood vessels, eyes, kidneys and nerves.

Diabetes really can affect just about every organ in your body, from head to toe. Left untreated, diabetes can cause injury to your brain, increasing your risk of dementia and strokes. It leaves you with an increased risk of heart disease and heart attacks. Even your mouth is affected by diabetes, which can cause tooth decay and gum infections. Neuropathy (nerve damage) and loss of feeling in your feet are often caused by diabetes. In fact, your feet are at the highest risk of serious infection due to complications of diabetes. According to the American Diabetes Association, 154,000 people with diabetes undergo amputation each year.

Are pharmaceuticals the only real answer to diabetes?

No! As I mentioned in Part 1 of this series, it is possible to manage most diabetes without resorting to medicine. Sometimes only minor changes in what you eat, minimal weight loss and increased exercise can stave off and help control diabetes. You can learn more about this by reading Part 1 here: https://www.bghc.org/news/healthcare/ask-a-doc-type-2-diabetes-an-epidemic-of-great-proportion-part-1/.

Can dietary supplements like cinnamon, vitamin D and chromium help control diabetes?

For some (but not all) people, dietary supplements may help. Cinnamon has long been promoted as a dietary supplement for diabetes and for other conditions like irritable bowel syndrome. There are several small studies that have linked cinnamon to better blood sugar levels. Unless you have liver damage, it should be okay for you to enjoy cinnamon in your food. It’s certainly easy to incorporate into your diet and it’s a great substitute for sugar in your tea or coffee! If you are considering cinnamon supplements, the usual dosage is 500 mg daily, but be sure to talk this through with your doctor.

The evidence for the use of chromium to control sugar levels is also helpful. The usual dosage is 400 mg daily. Low vitamin D is associated with insulin resistance and Type 2 diabetes and its complications. Low levels of vitamin D are common among older adults. A recent study linked low vitamin D levels to a higher likelihood of foot ulcers in older people with diabetes. Too much vitamin D can be harmful, so it’s a good idea to find out what your vitamin D levels are and talk to your doctor about nutrition and how to make sure you have healthy levels of vitamin D and other essential nutrients. We can run a basic vitamin D test at the clinic.

Why are there so many TV ads for drugs like Ozempic?

For many, many decades, the go-to medication prescribed for Type 2 diabetes has been Metformin. It’s designed to lower your blood-sugar levels and help the insulin you produce work better. It is usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels.

The field of diabetes research and pharmaceuticals has evolved vastly, just over the last 5-10 years. Instead of a drug to try to generically fix blood sugars, today’s medications are far more targeted for specific diabetes issues.

Recent medical guidelines now recommend newer types of diabetes medications, and many people living with type 2 diabetes are eligible. Up to half of all new-onset diabetes cases in this country are linked to obesity. These newer medicines not only help manage blood sugar but can lower your weight too. And the kicker is these drugs can help people lose weight. That’s a Golden Ticket for pharmaceutical companies.

You will have heard of Ozempic, Trulicity and Victoza, these are advertised everywhere. The newest drug to hit the market is Eli Lilly’s Zepbound for chronic weight management. All of these drugs are expensive – yet they are flying off the shelves so quickly and in such demand that supply could be an issue.

Are these new drugs safe?

All of these new medications have been studied and deemed safe by the U.S. Food and Drug Administration (FDA) for use in treating diabetes. Not all of these drugs are approved by the FDA for weight loss. They are very effective in helping with weight loss and have been shown to help patients shed 10 percent to 22 percent of body weight in their first year of use. Like any prescription drug, there are risks that make these drugs not right for everyone. And there are side effects, like hair loss, nausea, vomiting, diarrhea, stomach pain and constipation.

Is weight loss surgery a good option for diabetics?

Weight loss surgery may be an option for some people with Type 2 diabetes. This has been around long enough now that we are able to follow people for quite some time to understand the long-term benefits. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels.

It’s important to understand the risks of weight loss surgery. First, it’s surgery and any surgery carries risks. Risks vary by bariatric procedure and include a long laundry list of side effects from breakage to internal bleeding, spleen or organ injury, blood clots and vitamin deficiency. Weight loss surgery is a life-long decision, and it requires major changes to your lifestyle.

About the Author

Bret Kueber, M.D.

Assistant Medical Director

Dr. Kueber (pronounced KEE-brr) joined the Clinic full time in March 2022. A graduate of Case Western Reserve University’s School of Medicine, he completed his residency in Family Practice at the Cleveland Clinic. He is board certified in Family Medicine. As an avid sportsman, he has a special interest in sports medicine and is a […]