Dr. E’s Case Study: What’s the Secret to Managing Type 2 Diabetes for 40 Years?

Meet the Patient: Wayne

Wayne is a 75-year-old man who grew up in a big, close-knit family. They shared a lot throughout their lives…including one bathroom, one TV, and unfortunately a genetic predisposition for type 2 diabetes. Wayne’s mom, grandmother, and two uncles all developed type 2 diabetes before they were 50.

When Wayne was in his late 20’s his career as a pilot took off, and so did his travel schedule. Long hours, airport food, and too little movement eventually caught up to him, and as he approached his 40th birthday, he weighed nearly 270 pounds. 

The Wake-Up Call: Type 2 Diabetes at Age 40

A routine physical revealed that Wayne’s blood sugar levels were through the roof. He had central obesity, a BMI close to 40, and an A1c of 12%. Though he did have some mild symptoms of diabetes at the time (increased thirst and more frequent urination) he hadn’t thought much of it because he still felt fine, and the official diagnosis was a shock.

The “Dark Ages” of Type 2 Medications: Insulin Shots and Sulfonylureas

Back in 1990, sulfonylureas were the only game in town to treat type 2 diabetes other than insulin. However, they were known to cause weight gain and hypoglycemia, and they also lost their effectiveness over time.

Since he wasn’t a fan of needles (who is?), Wayne opted to start on a sulfonylurea called glipizide. After a few months his A1c dropped to 9.5%, but he struggled to make headway with diet and exercise because of the weight gain caused by the medication.

The First Big T2D Advancement: Metformin

When metformin came out in 1995, it was a major advancement because it was more effective than sulfonylureas, it didn’t cause weight gain or low blood sugar, and it didn’t lose its effectiveness over time. Plus it could be added in as a treatment alongside sulfonylureas.

The main side effects of metformin are loose stools and diarrhea, which can happen in up to 25% of people, but thankfully they didn’t happen to Wayne (it’s not easy to have the scoots at 30,000 feet!). Wayne’s doctor put him on the maximum dose of metformin and his A1c dropped to 8.3%. Progress!

The Medication Revolution Begins

Fast forward to 2006 and the introduction of another new class of medication called DPP-4 inhibitors. DPP-4s didn’t lower A1c that much (about .5 to .8%) but they didn’t have any side effects, and they didn’t cause hypoglycemia. Wayne’s doctor added one called Januvia to his regimen, which brought his A1c down even further to 7.9%.

Wayne’s A1c was getting closer to his goal of 7%, but still not quite there. He talked to his doctor about what he could do to reach his goal, and his doctor recommended one basal insulin shot per day to bring his morning blood sugars down and to help the other medications work better throughout the day. 

In 2006, Wayne’s regimen included:

• Glipizide (sulfonylurea)
• Metformin
• Januvia (DPP-4)
• Basal insulin (Lantus at bedtime)

New Hope with GLP-1s

By 2010, GLP-1 medications were making some waves in how they were helping to manage type 2 diabetes. Always curious about the latest therapies, Wayne discussed these new meds with his doctor. His doctor prescribed Victoza to help improve his blood sugars and protect his heart. Combining a DPP-4 inhibitor with a GLP-1 isn’t recommended, so he went off Januvia as well as the Glipizide because it had stopped being effective.

In 2010, his medication lineup included:

• Metformin
• Victoza (GLP-1)
• Basal insulin

Multitasking Meds: SGLT2-Inhibitors

SGLT2 inhibitors came on the scene in 2013. They’re a pretty amazing class of medication for managing type 2 diabetes. They help your body flush out extra sugar from the blood – you literally pee it out – and they also protect your heart and kidneys. Wayne first heard about them at a TCOYD® conference and figured he should ask his doctor about them since he was experiencing some kidney decline. SGLT2s work well with GLP-1s, so Wayne’s doctor added Invokana to his regimen.

He did great on this regimen for years, and his diabetes stayed under good control. The only problem was that he was still having a tough time dropping weight.

The Next Big Thing: Ozempic and Mounjaro

Ozempic and Mounjaro took GLP-1s to the next level, offering improved glucose control and significant weight loss. Wayne switched from Victoza to Mounjaro when it became available, and it started moving the needle for him right away. He dropped 40 pounds in 8 months, and was actually able to come off insulin.

Wayne’s current medication regimen:

• Metformin
• Mounjaro (GLP-1/GIP)
• Invokana (SGLT2)

This is a common and super impactful trio to manage type 2 diabetes, obesity, and heart disease risk. None of these medications cause low blood sugar, and all of them have benefits beyond glucose control including weight loss, heart health, and kidney protection.

Going High-Tech: Seeing Blood Sugars in Real Time with CGM

Even after 40 years with diabetes, Wayne’s still learning and adding new things to his regimen. Recently, he started using the over-the-counter Stelo CGM to track his blood sugar in real time.

Now he can see exactly how his meal choices and exercise affect his numbers. Plus he doesn’t have to fingerstick, and he loves that the app gives him a quick snapshot of how he’s doing. Apparently you can teach an old dog new tricks…at least when it comes to managing type 2 diabetes!

The Secret to His Success

So what’s Wayne’s secret to thriving for nearly half a century with type 2 diabetes?

✅ He embraces change. Every time a new type of medication comes out, Wayne and his doctor discuss whether it could help him.
✅ He never stops learning. He stays up to date on the latest advances in diabetes – now mostly through TCOYD® on Instagram!
✅ He focuses on the big picture of managing type 2 diabetes. Glucose numbers are important, but so are heart, kidney, cholesterol, and weight loss goals.
✅ He doesn’t go it alone. He’s built a good relationship with his healthcare team and he has support from his family and friends.

His success didn’t happen by accident. It was the result of making thoughtful and informed choices, being consistent, having a positive mindset, and taking a proactive approach to his care.

Key Takeaways: How to Manage Type 2 Diabetes

If Wayne’s story proves anything, it’s that living with type 2 diabetes today is not what it was decades ago. With GLP-1s, SGLT2s, and more exciting new therapies on the horizon, you can live a longer, healthier, more active life than ever before.

Many medications today do more for you than just lower your blood sugar. If you can, go for the ones that also help you lose weight (or at least not gain it!) and have other benefits like addressing common metabolic issues that can often run alongside type 2 diabetes.

And of course don’t forget about good nutrition and regular movement (“movement” as in exercise, not bowel movements…although those should be regular too).

Wayne’s focus on education and his willingness to try new therapies have served him well for 40 years. His experience is proof that when you are proactive in your own care, you can turn a diabetes diagnosis into a decades-long success story.

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