By: Director of Education – Jessica Cook MS, RD, LD, CDE
The reason our physicians and education team began this monthly newsletter was not only to provide information about the latest topics related to diabetes but also to provide support along with encouragement to help you manage your blood sugars. There is no doubt diabetes is a challenging, complicated disease which affects many aspects of your life. Here at Palm Beach Diabetes & Endocrine Specialists, we acknowledge that fact and that is why we provide a whole team to support you on your journey to better health. We have endocrinologists, certified diabetes educators, registered nurses, registered dietitians and licensed clinical social workers to help you manage any difficulties you are facing with your health including weight loss, diabetes control or stress management. We believe that with a support team and education anyone can live a healthy, high-quality life with diabetes. If you ever need a helping hand we are here for you and can be contacted by phone, email, through our patient portal or social media. Do not hesitate to reach out if you are struggling with diabetes because we got your back!
Thank you for taking the time to read our Living Well with Diabetes July Newsletter and we hope you have a great Summer season!
By: William Kaye MD
Type II diabetes (formerly called adult onset diabetes) is not caused by any one defect in the human body. In fact, medical scientists have discovered several issues contributing to high sugar in the body.
When I went to medical school we were taught that the two basic defects that occur in all type 2 individuals with diabetes are:
1) Diminished secretion of insulin for the level of sugar at the moment
2) Resistance to the action of your own insulin (which pushes sugar into your cells)
Now many years later (do not ask how many) we have learned that beyond these 2 major defects contributing to high sugars there are several more. Understanding these defects will help you understand your body better and understand how doctors choose the medications they use. Here are some of the new defects we have discovered.
3) Excess sugar release by the liver especially overnight (this is why you can awaken with a higher sugar than you go to sleep with)
4) High Glucagon levels. Glucagon is another hormone released by the pancreas. Unlike insulin which is diminished, glucagon levels are too high in Type II Diabetes, causing excess sugar release by the liver
5) Low IGF-1: IGF-1 is a hormone that is released from your intestine every time you eat carbohydrates. IGF-1 has two actions. A) it can boost insulin levels and B) it can suppress glucagon levels. (This makes defects #1 and #4 better i.e. better insulin levels and lower glucagon levels, so you push more glucose into cells by way of insulin and less glucose released by your liver).
6) The most recent defect we have discovered that causes diabetes to worsen is the discovery of “increased sugar retention by your kidney.” This last defect requires a long explanation to make it understandable. Let’s first review how the kidney works in general. Below I have outlined functions of the kidney and touched upon a new class of diabetes medications that address this situation.
a) The kidney acts to filter out toxins out of our blood. Common toxins are BUN and Creatinine and at the same time, it selectively prevents the loss of proteins and sugar into the urine.
b) Proteins are not lost into the urine because they are bigger than the holes of the kidney filter, so they are retained
c) Glucose easily passes through the kidney’s filter because it is a small molecule. However, even though it is filtered through the glomerulus, there is another part of the kidney that reclaims glucose and returns it to the bloodstream. Normally, unless our sugar is very high let’s say over 225-250, our urine will not show sugar.
d) For unclear reasons, the diabetic kidney is better at reclaiming sugar than the kidneys of a non-diabetic person. In a non-diabetic sugar appears in urine if blood sugar goes above 180.
e) This finding of excess sugar reclaiming in the kidney led to the discovery of a new class of medication called “SGLT2 inhibitors”
f) SGLT2 inhibitors also known as Sodium Glucose Transport Inhibitors block the reclaiming of sugar by the kidney and allows the sugar to leave the body in the urine.
g) This class of medication (examples: Jardiance, Farxiga, Invokana) not only lowers blood sugars but also reduces blood pressure and weight.
Talk to your doctor about which medication is appropriate for you and learn how that medication works to lower blood glucose levels for a better understanding on the effects in your body.
By: Monika Lambertson MS, RD, LD, CDE
When meeting with clients for nutrition education I often hear statements like “I didn’t take my insulin last night” or “I was in a hurry this morning and I forgot to take my pills.” Missing medication doses is a big problem, especially for people with chronic conditions like diabetes, hypertension, and high cholesterol. Missing a few doses of your medicine every week may seem harmless, but in fact it can be dangerous. In a 2003 report on medication adherence, the World Health Organization found that among patients with chronic illness, approximately 50% do not take medications as prescribed. A more recent study in 2013 by the National Community Pharmacists Association gave the nation a C+ on its Medication Adherence Report Card. In this self-reported survey of over 1000 adults age 40 or older taking medication for a chronic condition, only about half reported adherence to their medication regimen, 35% were somewhat or largely non-adherent, and 15% (1 in 7 adults) reported themselves as non-adherent. Non-adherence may be unintentional, like forgetting doses or taking the medication incorrectly, or intentional, like discontinuing a medication or never filling the prescription, to begin with. Whether intentional or not, not taking your medications as prescribed is likely to cause a decline in health, increase your risk of a hospital admission, or result in more serious complications including premature death.
Here are some tips to help improve medication adherence:
Learn why your medications are important
The more you know about what the medication does to keep you healthy, the more likely you are to take it. You should be able to answer these questions: Why do I need it? How does it work? When do I take it? (what time, with or without food, etc), What do I do if I miss a dose or take too much? What are the possible drug interactions and side effects? If you can’t answer these questions, ask your physician, pharmacist, or certified diabetes educator.
Take your medication with you
If you don’t have them with you, you can’t take them! When heading out for the day, don’t forget to tuck your pill box or insulin pen in your purse or pocket. For longer stays away from home, make sure you have enough to last the entire trip or bring a hard copy of your prescriptions if a refill will be needed.
It’s convenient to combine taking medications with other daily routines, like brushing teeth or eating meals or organize your medications in a weekly pillbox. If you still seem to miss some doses, try setting an alert on your watch or smart phone. Smartphone app medication reminders are available free of charge (use “medication reminder” as your search). Or have a friend or family member call or check-in with you daily to make sure you are taking your meds correctly.
Communicate with your health care team
If you skip, stop taking, or if you never started taking your medication, let your physician know. If your physician is not aware you are missing some or all of your doses, your medication dosage or strength may be increased or a new drug may be added. If you can’t afford your medications, there may be a more affordable drug that can be prescribed. Never skip doses to try to make it “stretch.” Ask if there is a coupon savings card available from the drug manufacturer; these can offer substantial cost savings.
Keep an updated list of all medications
A comprehensive list will help you organize your daily medication routine. Lists should include the name of the drug and dose, prescribing physician, what condition the medication is used for and the dosage, how and when you take it. Bring your list to every doctor appointment.
Make sure to keep all your appointments with your physician and diabetes education team. Open and honest communication with your health care team is a proven method that will improve your medication adherence.
Come learn how to plan healthy meals for diabetes, weight loss and heart health!
Join us at our healthy meal planning refresher class in West Palm Beach. We hold classes every month which include how to plan healthy meals, weight loss, tips on grocery shopping as well as dining out, healthy substitutions and more!
If you have tried losing weight on your own without success why not try our Healthy Meal Planning with Diabetes Refresher Course to help you get back on track with your weight loss goals. If interested attending this program please contact our scheduling department at ((561) 513-5100 today!
At Healthy Living with Diabetes, we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, the information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended. You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!
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