Vicki Williams has had a decades long relationship with type 2 diabetes.
About a year and half ago the relationship took a turn for the worse. Her blood sugar levels spiked to 477, more than double the level of a typical diabetes diagnosis, and she had to be hospitalized.
It was the wake-up call she needed. The Milton resident changed her diet drastically and lost 130 pounds with the help of Dr. Anita P. Raghuwanshi, a physician from Beebe Healthcare specializing in endocrinology, diabetes and metabolism. Now that she has had her knees replaced, she’s able to walk and build muscle.
“Now I am considered borderline,” Williams, 60, said. “When I see pictures of myself then…I did not look like the same person. People who hadn’t seen me in a long time didn’t recognize me actually. I felt 20 years younger.”
Williams hopes that she will be able to stop depending on her diabetes, cholesterol and blood pressure medications some day, too.
“It’s such a complex disease,” said Williams’ physician Raghuwanshi, of diabetes. “You have to attack it from as many different pathways as you can.”
Treatment of type 2 diabetes typically calls for a patient to monitor blood sugar and take medication or insulin, sometimes both.
It’s important to discuss a patient’s goals when first looking into diabetes medication. There are a slew of medications to treat diabetes, including combination pills. Talk to your doctor about what works best for your situation and if you might be at risk of experiencing at drug interactions.
If anything there is one thing they all have in common.
“All the diabetes medications are approved for one thing only and that’s lowering blood sugar,” said Dr. James Lenhard, medical director of Christiana Care Health System’s Diabetes and Metabolic Diseases Center and Christiana Care’s Weight Management Center.
“I take into account not just the money, but also the other disease states the patient has.”
Injecting insulin alone will cause weight gain, Raghuwanshi said, since increasing insulin stimulates hunger. Weight gain causes back pain, knee pain and lack of mobility.
And when you don’t move, you aren’t burning off the food you eat and those carbs get stored as fat.
“So it makes it harder for people to control their diabetes,” she said.
Raghuwanshi said sometimes people will need to be on four or five different medications simultaneously. They impact different parts of the body including the brain, pancreas and liver.
The liver makes and stores glucose or sugar, while the pancreas produces insulin and releases it into the bloodstream to help cells absorb the sugar and convert it to energy.
People should be testing their blood sugar and getting regular tests from their doctors in order to keep track of how their rates fluctuate.
“Low blood sugar will kill you in 5 minutes,” she said. “High blood sugar will kill you in years.”
An A1C test screens a person’s average blood sugar level over the past three months. A normal A1C level is below 5.7 percent. Someone with diabetes may have a level of 6.5 percent or above and a person with prediabetes tests between 5.7 to 6.4 percent.
“Target blood sugar is the non diabetic range,” Lenhard said.
A type 2 diabetes medication class called GLP-1 analogs help the body increase insulin secretion, but delays the time it takes food to empty from the stomach. These medications often cause weight loss too. DPP-4 inhibitors are a class that also increases insulin secretion, but they are two times less effective than the GLP class, Raghuwanshi said. Other medications will help you excrete excess sugar in urine.
Metformin, a medication naturally derived from the French lilac plant, reduces the amount of sugar the liver releases. It is typically the first type 2 diabetes medication people try since it is about $4 a month as opposed to $70 for other types.
Williams started out with Metformin and then moved to a combination pill that contains Metformin and a DPP-4 inhibitor called kombiglyze. She takes the pill twice a day and still abides by a strict diet specially designed by Raghuwanshi.
In the first 10 weeks she lost 42 pounds. Now she’s gone from a 3X to a size 14.
It includes a low-carb shake for breakfast, protein bars and a healthy dinner with about four ounces of meat and half a plate full of vegetables. Williams had to give up grains, pasta and bread.
But, she learned soy pasta with her husband’s “to die for” spaghetti sauce wasn’t half bad.
Williams said she expected the soy pasta to boil down to a pile of white mush, but she was mistaken.
“My husband even eats it. We love it,” Williams said. “It tastes good without sauce.”
You have to make those lifestyle changes Raghuwanshi said, in addition to the medication to see meaningful differences.
“Over time diabetes medications get harder and harder to manage,” Raghuwanshi said. “There’s no medicine that can completely cover a bad diet. There’s no medicine that can completely cover being absolutely sedentary.”
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