#243 Diabetes Triple Distilled | The Curbsiders Internal Medicine

Key Takeaways

  • Anything that would increase red blood cell turnover or increase production can affect A1c, a form of hemoglobin that is chemically linked to a sugar
  • The presence of anemia should guide A1c readings for a more thorough picture
  • The goal is to treat diabetes without insulin
  • Two good alternatives to insulin: SLGT-2 Inhibitors and GLP-1 Agonists
  • SGLT-2 helps patients pee out extra glucose and sodium
  • GLP-1 is a weekly injection

Introduction

The hosts of Curbsiders Internal Medicine podcast (@thecurbsiders) recap four previous diabetes episodes to distill the most up to date information on type 2 diabetes management.

Hosts: Stuart Brigham MD; Matthew Watto MD, FACP (@DoctorWatto); Paul Williams MD, FACP (@PaulNWilliamz), Molly Heublein, MD

Pitfalls of A1c Testing

  • Anything that would increase red blood cell turnover or increase production can affect A1c, a form of hemoglobin that is chemically linked to a sugar
  • If red blood cells are around longer, they will have more sugar stuck to them and can elevate A1c readings
  • Red blood cells with a shorter lifespan will have less sugar attached and could falsely lower A1c readings
  • Anemia should guide A1c readings
  • A1c is an average – could have readings that deviate towards hypoglycemia or hyperglycemia
  • Lowering glucose alone doesn’t necessarily improve cardiovascular function

SLGT-2 Inhibitors

  • Alternative to insulin, helps patients pee out extra glucose and sodium
  • Caution against SLGT-2 inhibitors for patients with glucotoxicity
  • Adverse effects: SGLT-2 inhibitor hides elevated glucose so people can be slower to recognize what’s happening, higher risk of genital infections, risk of hypotension, gangrene
  • Benefits: slightly favor SGLT-2 for reduction of chronic kidney disease, improvements in heart failure outcomes, lower readmission rates for heart failure
  • The goal is to treat diabetes without insulin

GLP-1 Agonist Injections

  • Non-insulin injection used once per week, steady-state achieved around 5 months
  • Most common side effect: slower digestion
The Curbsiders Internal Medicine : , , ,
Notes By Maryann

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