THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
Glycemia refers to the concentration of glucose in the blood. Hyper means high. Therefore, hyperglycemia simply means a high concentration of sugar in the blood. You may recognize this condition by a more familiar name: diabetes. However, diabetes is not the only cause of hyperglycemia, although it is by far the most clinically significant cause.
When we eat, the blood sugar levels go up, which is absolutely normal and cannot be classified as hyperglycemia. However, if the blood sugar levels are still very high after two to four hours of eating, the person may have an underlying condition. Some people may also have elevated blood sugar levels before they even eat anything, which is another sign of hyperglycemia.
The most common cause is diabetes, which is a condition that arises when the body does not produce enough insulin or the body is not using insulin very well, causing high blood sugar. Other causes of hyperglycemia include stress, chronic conditions, hormonal disorders, and certain medications (like corticosteroids and beta blockers).
When the cause of hyperglycemia is non-diabetic in nature, treatment is majorly by identifying and addressing the root cause of hyperglycemia. For instance, if a prescriber suspects that a particular medication is causing a patient’s blood sugar levels to spike, the prescriber may change to alternative treatments. Similarly, if the cause is high-stress levels or a chronic condition, healthcare providers focus primarily on lowering stress levels and treating the underlying conditions.
In addition to addressing the root cause of hyperglycemia in a patient, healthcare providers recommend various lifestyle changes, like dietary modifications, increased physical activity, and weight loss. Usually, when the root cause is addressed, blood sugar levels go down to normal. This is not exactly the case in diabetic patients.
Diabetes (also called diabetes mellitus) is caused by problems in insulin production or problems with insulin usage. Insulin is the hormone that helps body cells absorb glucose from the blood. After eating, the pancreas (the organ responsible for producing insulin) releases insulin into the blood, allowing the body cells to absorb glucose. This leads to a fall in blood sugar levels.
If the body cannot produce enough insulin due to autoimmune pancreatic damage, it is known as type 1 diabetes mellitus (T1DM). Note that autoimmune conditions are those where the body attacks its own cells. On the other hand, if the body’s cells become resistant to insulin and do not utilize insulin as well, it is known as type 2 diabetes.
The management of T1DM revolves around insulin. Since the body is not making nearly enough insulin, the patient takes insulin from external sources. For T2DM, management is not as straightforward and often includes medications and different lifestyle modifications. Of the several different types of diabetes medication, metformin has most gained the trust of health practitioners and is usually the first line of type 2 diabetes treatment. Metformin can even be used in the management of T1DM to improve glucose control.
There are quite a few reasons why metformin is a prescriber-favorite in the management of diabetes, including its glycemic efficacy, promotion of moderate weight loss, low risk of hypoglycemia (low blood sugar levels), low risk of adverse cardiovascular effects, low cost, and overall tolerability in the population. However, metformin is not a perfect drug.
Like all drugs, metformin has side effects, which can be relatively mild (stomach upsets, vomiting, nausea) or severe (a potentially life-threatening condition called lactic acidosis and vitamin B12 deficiency). As science evolves, there is always the quest for more effective and safer therapies, and this also applies to diabetes management. Simply put, metformin is a great drug for managing diabetes, but there are newer, potentially better innovations to effective diabetes management.
One such innovation is actually another medication: GLP-1 agonists. Sounds familiar? Okay, try Ozempic. Now, this should ring a bell. GLP-1 agonists are a class of drugs that mimic the hormone GLP-1, which helps increase insulin production, inhibit glucagon secretion (glucagon triggers the liver to release more sugar into the blood), and regulate appetite. Of course, you will know Ozempic (semaglutide) is frequently used for weight loss, and that’s mainly because of its ability to reduce appetite, make patients eat less, and, by implication, reduce how much sugar a person consumes.
GLP-1 agonists may be the rave now, but they are not exactly new medications, with the first GLP-1 agonist discovered in the 1980s. However, one innovation that has only recently been used for the management of diabetes is nanotechnology. Basically, nanotechnology leverages nanoparticles to deliver insulin to the cells. This technology has the benefits of being less invasive (no need for insulin shots), which significantly increases compliance, and it also causes fewer plasma fluctuations.
Another innovation in diabetes management is gene therapy, especially for T1DM. This therapy can identify the genes associated with autoimmunity and alter them, potentially curing T1DM. Stem cell therapy is also being considered in managing diabetes. It works by replacing malfunctioning or damaged pancreatic cells with healthy stem cells. This therapy can also potentially be used in curing diabetes.
Diabetes affects more than 830 million people in the world today and can cause several health conditions and increase the risk of mortality. Therefore, its treatment is of the utmost importance. There are several treatment options available today; medications are the most typical option for managing type 2 diabetes, while insulin is the most typical for type 1 diabetes. However, both these current medications have their limitations, ranging from side effects to poor convenience.
Fortunately, there is no shortage of innovation in the medical world, and new treatment options are being developed to further improve the way we manage diabetes. However, nothing beats the recommendation of your healthcare provider, and you should follow their instructions about the right treatment for your condition. Stay safe, folks!
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9599361/
- https://www.sciencedirect.com/science/article/pii/S2666970621000056
