Dr. Edelman and Dr. Santos hosted an info-packed Spotlight Series seminar featuring the latest medications and strategies to manage type 2 diabetes. The workshop focused on patient-centered, customizable therapies that can help you find the best treatment plan for your individual lifestyle and healthcare goals.
Additional Q&A with Dr. Jeremy Pettus:
I want to know how often you see GERD/indigestion with Victoza and Trulicity? What is the RX other than change meds? -Anonymous Attendee
If it’s truly GERD, you can try a PPI medication like omeprazole. Otherwise lowering the dose may help, as will time on the medication.
What is the maximum dose of Metformin? – Rochelle
1000mg twice daily
Is the BLOOD Boost Formula effective to replace Metformin?? – Ivan
I’m not aware of any research on that.
What are good resources to read to learn more about lifestyle modification? – Daniel
Does insulin preserve your beta cells? – Chere
Have the doctors ever heard of Pendulum — a medical probiotic that they says helps lower your A1C? The company is based on SF and they are doing a lot of advertising. – Karen
Our general take on these types of things is that they are not harmful but usually expensive and unproven.
What meds are good/safe for pregnancy? – Samantha
We usually use insulin and sometimes an SU like glipizide.
Will a keto diet control diabetes? – Chere
It can definitely help. Low carb in general is a good option if it fits your lifestyle and you can sustain it.
When were blood sugar home test kits invented? – Chere
Really not until the 1980s.
If appropriate, I’d love to know how to evaluate COVID risk and my diabetes. – Francisco
The general thought is that people with diabetes aren’t at a higher risk of getting COVID but are definitely at a higher risk of complications and death unfortunately if infected. So all precautions are especially important if you have diabetes.
Is there a list of the current GLP-1 oral medications on the website? – Adara
There is only one oral GLP-1 and it is called Rybelsus. There are many injectables. Here is an article on Rybelsus: https://tcoyd.org/2019/10/rybelsus-no-needles-no-problem/
And it’s just as effective as the injectables? – Adara
In broad terms, yes. There are always little differences between the compounds. But it is very effective. Have to take on an empty stomach with nothing for 30 minutes.
What do you consider high blood sugar levels?? – Ivan
Complicated answer, but in general we try to keep blood sugars between 70-180 as much as possible. Spikes above that will occur, but this is our goal. Overall, you want to keep your average blood sugar less than 155 which correlates to an a1c of 7.
Is high blood pressure thought of as heart disease? – Maureen
It is a risk factor for heart disease.
Do you continue to take Metformin with the newer meds? – Rochelle
In general, yes.
Is loss of body fat or weight more important? – Kelley
Both are important, but most studies look at overall body weight.
How long does it take for cataract surgery to completely heal if you have type 2 diabetes? – Bill
It depends, but in general would follow the advice of your eye doctor.
If you’re taking 2000 mg should you divide it 2x/day rather than all at once (with a meal)? – Rochelle
If you are talking about metformin, yes, twice per day divided.
Most of the discussion seems to focus on new patients. How does this conversation apply to someone who has been on meds for many years? – Jeffrey
This is still applicable to make sure you are on the “best” medications for you. Once these meds are started, they are continued.
How concerned should I be with tumors as a result of taking Ozempic? Does the benefit outweigh the risk? Is there one GLP1 that is better than another? – KSA
I would not be worried about tumors at all. Not sure what you are referring too exactly but in general, our opinion is that the benefits absolutely outweigh any risks.
Does a decrease in pancreatic function related to advanced age, ie reduced insulin producing capacity, increase the risk of EDKA? If so, how do we mitigate risk? C-peptide level testing? – Kacey
C peptide would give you some information on how much insulin you make. If you still make any at all, it makes you much less likely to develop DKA.
Are the GLP1’s and SGLT2’s replacements for Metformin or in addition to Metformin? – Curt
In general for type 2 diabetes, we add medications and do not stop previous ones…. particularly metformin. We continue that indefinitely.
My issue with metformin was exhaustion. I would do a one hour senior exercise class and then sleep for hours. Is this common? – Denny
No it is not, and there are lots of causes of exhaustion that might not have been metformin.
I have had type 2 Diabetes for 20 years. I am now 70. I take 2,500 ml of Metformin (1,000 in AM and 100 mgs of Januvia; 1,500 Mgs of Metformin in PM). I am able to keep my A1C around 6.9 and 7.0. I reduced my weight by 100 pounds from 335 to 235 20 years ago and maintain it. I walk 2 miles a day. Is this regimine ok. Thanks, Jim
I am 74 and have been on Metformin for 12 years. My A1C is 6.8. My family doctor is happy with that. My cardiologist wants it to be below 6. I have read that below 7 is good for an older patient. Do I need to take more medication? – Ros
In general we are happy with less than 7, but if you can get lower without hypoglycemia, that is an option.
What vitamins or supplements are useful in managing type 2 diabetes? – Michelle
None have been proven as effective but generally are not harmful, though they can be costly. So use your best judgement but none are endorsed by any diabetes society.
Are SGLT2 still safe for older T2? What would you recommend for ongoing lab surveillance to keep safe, given how popular they’ve become, is there more risk of EDKA as people are aging and potentially declining in insulin? – Kacey
In general they are very safe regardless of age. DKA is extremely rare.
A few years ago at a TCOYD conference, the endocrinologist said they never use more than 50 units of basal insulin. If the patient is at 50 units of basal, maximum metformin, a global-1,and prandial insulin 18-20 units with meals and fasting and a1c are not a goal… what next? – Lani
Patients sometimes require hundreds and hundreds of units of insulin, so you can always go up with insulin as needed to control blood sugars while not overdoing it and causing lows.
Why no mention of Time in Range (TIR)? – Anonymous Attendee
TIR is very important and we are HUGE supporters of CGM in patients. It really helps to support the A1c.
Is 7% A1c a sufficient goal or should it be lower? – Aaron
It depends, but in general <7 has been shown to be a good target to reduce risk of complications. The reason we don’t recommend lower is that it may increase your risk of hypoglycemia. However, if you can get your A1c down lower, SAFELY, then you can aim for lower.
When should one consider using a continuous glucose monitor? – Rochelle
For people with type 2, its easier to get through insurance if you are on insulin. However, it can be of benefit at any time.
Dr. Santos suggested losing a certain percent of your body weight – did not catch her suggested percentage and what method would you suggest to accomplish this. – Daniel
In general we target 7%. Specific number but evidence supports that level. But anything over 5% is meaningful.
Question on Jardiance. Any concerns with taking with history of kidney stones (two bouts 10 years ago) but no decrease in kidney function? – Mary
No increased risk of kidney stones.
Why for case #3 was getting her A1c to only 7.5 ok? Why not below 7.0? – Donna
We always push to get below 7 when we can safely, so still work to be done.
How to treat depression with type 2 who has A1c’s out of control? – Brita
The treatment of depression is generally the same with or without diabetes. It is difficult, but can be treated with medication and therapy.
What did PPG stand for? – Daniel
postprandial glucose (after a meal)
What is the best time to not eat before bed? – Jacqueline
Hard to say, but some people set a cut-off time (example 8pm) to stop eating to avoid late night snacking for weight reasons, but there’s not any time you “have” to stop eating.
Is having diabetes all it takes for those Covid complications or is it possible to improve your odds by lowering A1c, losing weight etc? – Francisco
Better blood sugars definitely help. Having “good” blood sugars helps the immune system function better.
Is it better to take Tresiba in the morning? I wasn’t aware of that and have been taking it in the late afternoon/early evening – Adara
You can take it at any time of day.
I have the tandem pump. It alarms when I go through a metal detector. I used to go for the pat down. With problems like COVID 19, I do not want the “pat- down” in future. Does this mean that I have to remove the pump? – Indira
I take mine off and put it though the thing.
Why are SGLT2 not recommended if you are doing a very low carb or keto diet? – George
It can increase your risk of ketoacidocis.
What is the difference between the Dexcom G5 and Dexcom G6? – Anonymous Attendee
Several things, but the G6 doesn’t need calibrations, it lasts longer, and is more accurate.
Does the VA medical center have CGMs & GLP-1? – Bill
Each VA is different, but in general, yes.
Is there a CGM that can allow exercising in a pool for 2 hours or more? – Carol
You can wear any of them in the pool. The reader (usually your phone) of course won’t go in the pool.