Diabetes control involves a holistic approach with the right balance of diet, exercise, and medication. There is a high chance that most diabetes patients may be on medicines that cause weight gain, exhaust one’s pancreatic beta cells and increase hypoglycemia(low sugars)-risk. Sulfonylureas are a class of medicines very widely used and while they are potent and cheap, they come with the baggage of excess weight gain, draining out pancreatic beta cells-sometimes to the point of failure, and causing hypoglycemia. Insulin, although very important in some cases like high HBA1C(very poor sugar control) with osmotic symptoms(increased urine frequency etc), is an anabolic hormone that causes weight gain. 70% or more of Indian diabetic patients are already obese or overweight and most guidelines recommend a weight loss inducing or at least weight neutral diabetic medicine. In this regard, both sulfonylureas and Insulin increase body weight and are hence preferred as 3rd line agents.
The body mass index (BMI) is strongly recommended to be under 23 and lowering BMI to 23 or less is known to minimize many complications apart from diabetes such as obstructive sleep apnea, osteoarthritis, systemic and pulmonary hypertension, etc. Better classes such as SGLT2 inhibitors(empagliflozin, canagliflozin, dapagliflozin, etc), GLP1RAs (liraglutide, dulaglutide, etc) metformin, alpha-glucosidase inhibitors, etc are known to cause weight loss. The former two classes are further known to improve heart and kidney health. Diabetes affects almost every part of the body and the risk of heart attack, heart failure, kidney disease is very high.
These classes of medicines apart from weight loss properties are known to prevent most types of heart and kidney diseases. The newer regimens of anti-diabetic meds are known to protect the pancreatic beta cells, reduce the risk of hypoglycemia/low sugars, improve vascular(arteries, etc) health, improve fatty liver, reduce uric acid, etc. With weight loss and other such great benefits, insulin sensitivity improves and patients’ daily insulin requirement comes down drastically and in many instances, insulin may even be stopped. Better diabetes control with such protective effects on major organs may even translate to increased lifespan. Most importantly structured diabetic diet and exercise recommendations form the pillar of any diabetes management along with such newer and safer anti-diabetic regimens.
Almost all diabetic patients also suffer from a constellation of other disorders like deranged lipid profile, hypertension, increased waist circumference together known as metabolic syndrome. This syndrome in itself is known to increase cardiovascular risk manifold. It also becomes imperative that diabetic patients get themselves screened periodically for microvascular (damage in the retina, kidney, nerves, etc) and macrovascular (heart disease, brain stroke risk, blood supply defects in legs, etc) complications. In diabetics bringing down LDL cholesterol to the newly recommended goals of less than 100 or 70 depending on risk factors is very important hence necessitating cholesterol-lowering medicines such as statins in almost every diabetic patient. Thus if you are a diabetic, you must discuss these holistic treatment options with your doctor.
Views expressed above are the author’s own.
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