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Diabetes is a chronic and debilitating disease that ranks 6th among the
leading causes of death in the United States. The two main forms of diabetes
are Type I and Type II. In the first type, most commonly seen in the
young, the body does not produce enough insulin to counteract the sugar.
The second, and more common type, is a result of the body being resistant
to the insulin that it produces. Obesity leads to this resistance, so
while the pancreas is working to make insulin, the body can not utilize it.
The failure of insulin leads to several key symptoms because the sugar is
now concentrating in the blood stream and not in the cells of the body.
The sugar will be filtered into the urine and lead to excessive urination in
the day and at night. Excessive thirst will occur as a response to the loss of
water. Since the body cannot metabolize the sugar, weight loss can occur
despite significant hunger and increased food intake. The excess glucose
levels lead to inflammation throughout the body and can cause cardiac
disease, stroke, kidney disease, blindness, failure of wounds to heal and
increased mortality. The symptoms can be warning signs of the disease
which has many lifelong consequences.
Treatment is aimed at fighting insulin resistance and replacing or
increasing insulin levels. The older medications, known as sulfonylureas,
acted to over stimulate the pancreas and force excess insulin production.
While initially useful, these drugs are less in favor now because many
patients would fail to maintain insulin levels after extended use. A different
class, known as biguanides, which include glucophage, is great for
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MEDICINE & HEALTH
THE TRUTH ABOUT DIABETES
By Jason Goldman, MD
diabetes because it will decrease the glucose produced in the liver,
decrease the absorption from the GI tract and decrease insulin resistance.
The thiazolidinediones, such as Avandia and Actos, work to specifically
decrease insulin sensitivity. Of course, insulin itself can be injected to
directly control the sugar levels. These medications all have their role in
reducing glucose levels and controlling the disease.
A new medication has recently been created that works differently
from any other diabetes medicine to date. Januvia is a pill that works to
control glucose levels by modifying a very specific pathway in the body.
Normally, a hormone called “incretin” will help to naturally lower blood
glucose with a complex interaction of chemicals in the body. An enzyme
called “DDP-4” will turn off incretin. Januvia will stop DDP-4 from
working so incretin will work better and thereby allow the body to better
manage glucose.The benefits are less side effects and greater reduction of
glucose levels. The medication will hopefully lead to long term control of
diabetes and therefore less side effects and complications. While this
medication has only been available for the past few months and shows
many great benefits for diabetes control, it is not for every patient.
Patients should consult with their primary care physician, or endocrinologist,
about the use of this medication.
Dr. Jason Goldman is a primary care physician in Coral Springs. E-mail him
at goldman@theparklander.com.
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