Focus on Your Health: Take charge of your diabetes






For the Recorder

Published: 12-15-2023 10:26 PM

Diabetes patients are now seeing better outcomes because of newer drugs, easier glucose monitoring, focusing on a healthy lifestyle, and coordinated approaches working with their health care teams.

According to Dr. Cecilia Lozier, chief of the Division of Endocrine and Diabetes at Baystate Health, managing diabetes takes a team. This often includes a primary care provider or diabetes specialist who helps match the right medications to your needs. A registered dietitian or certified diabetes educator who assists patients in understanding the way diabetes impacts their lives will guide clients to make small but powerful progressive steps toward a healthy lifestyle.

“A diabetes diagnosis most often begins with your primary care provider who will then work with you to manage your diabetes over your lifetime through matching the right medication to your body’s needs to keep you healthy and maintain your blood sugars at a safe level,” Lozier said. “They will also provide you preventative care by monitoring the other parts of the body most impacted by diabetes complications including your eyes, heart, kidneys and feet. Maintaining good blood sugar values while monitoring for and responding to a complication of diabetes should it occur is key to living a long, healthy life with diabetes.”

Diabetes educators, who are nurses or other health care professionals trained in diabetes care and education, are an essential part of the health care team, too.

“There is a lot to learn following a diagnosis of diabetes, and diabetes educators provide patients with comprehensive education,” Lozier said. “They guide diabetes patients on adopting a healthy lifestyle and personalize their diet and exercise plan. They can advise you on monitoring your blood sugar and how to respond to your numbers. And they can look over your blood sugar patterns and help you learn to recognize how food and other things influence your sugars.”

Primary care providers can also refer their patients to a diabetes and endocrinology specialist like Lozier in more complex cases.

“At Baystate Endocrine and Diabetes, we see about 10% of the patients in the area with diabetes,” she said. “Often our patients have complex needs or have difficulty controlling their diabetes. Our role is to work with them to stabilize their diabetes while ensuring they get the comprehensive education needed to better understand their diabetes. Once this is achieved, we transition their care back to their primary care provider to continue monitoring and evaluating their diabetes.”

Diabetes is a chronic disease that happens when your blood glucose, also called blood sugar, is too high. The pancreas makes insulin, which is a hormone that helps glucose get into your cells to be used for energy. But when your body doesn’t make enough — or any — insulin (Type 1 diabetes), or doesn’t use insulin well (Type 2 diabetes), then glucose stays in your blood and can cause health problems.

Symptoms of diabetes include frequent urination and thirst, extreme hunger, unusual weight loss, extreme fatigue and irritability. Those with uncontrolled diabetes may have frequent infections, blurred vision, cuts and bruises that are slow to heal, tingling/numbness in the hands or feet, and recurring skin, gum or bladder infections. Some diabetes-related complications include heart disease, stroke, blindness, kidney damage and limb amputations.

Newer ways to monitor blood sugar, called continuous glucose monitoring, which do not require pricking the finger for a blood sample, a deterrent for many, are helping people with Type 1 and Type 2 diabetes to “take charge.”

Continuous glucose monitors — including the Dexcom G7 and Abbott Freestyle Libre 3 — are sensor-based systems that continuously provide glucose readings day and night. Lozier and her colleagues have a lot of experience helping patients with diabetes by starting them on a continuous glucose monitoring system.

“The benefit of this technology is twofold,” she explained. “First, it is a painless system and the bar to see what your sugar is becomes quite low in doing so. Secondly, and most importantly, you can see how your sugars respond to different foods or conditions. I had a patient tell me recently how the sensor she was wearing helped her attain excellent sugar values by seeing how her body responded to different foods and by using that feedback to drive lifestyle changes.”

There have been new diabetes medications coming to market recently that not only target improvement in your blood sugars, but also protect the heart and kidney from the long-term impact of diabetes. These medications include the GLP-1 agonists and the SGLT-2 inhibitors.

Non-insulin injectable medications such as Ozempic, Trulicity and Victoza belong to the GLP-1 agonists medication class and are designed for people with Type 2 diabetes. Victoza is a daily injection, while Ozempic and Trulicity are weekly injections designed to trigger insulin release, block sugar production in your liver, and slow the metabolism and absorption of sugar from your gut, making you feel full. Commonly, these medications have the additional benefit of aiding in modest weight loss.

SGLT-2 inhibitor medications are pills that you take daily. These pills help the kidneys release sugar into the urine and out of the body. They are used for people with Type 2 diabetes, but because of their powerful benefits on the kidney and heart, they have also been studied for and are helping patients with kidney failure and heart failure stay out of the hospital and slow their disease progression.

Mounjaro, similar to GLP-1 agonists, is a more recent drug in the class GLP-1/GIP agonists. It’s the first medication available in the United States that activates both the GLP-1 receptor and the glucose-dependent insulinotropic peptide (GIP) receptors.

“Mounjaro is a new medication, so we are still learning about it,” Lozier said, “but it appears to be a powerful aid in management of blood sugars and weight loss.”

She noted there are many tools available to help you on your journey with diabetes.

“Get connected with a team of health care professionals,” Lozier said. “Most importantly, actively engage with your primary care provider to be on top of monitoring your diabetes and establishing a smart medication regimen suited for you. Establish a relationship with a diabetes educator to understand how to live a long, happy and healthy life with diabetes. Get set up with a continuous glucose monitor to receive and respond to feedback from your body to make healthy choices. You can do this.”

Anita Fritz is a lifelong resident of Franklin County. She was a reporter for the Greenfield Recorder for 20 years. She is currently the senior specialist for public affairs and community relations for Baystate Franklin Medical Center.