Mark Wiesen, MD is a board-certified endocrinologist who specializes in the treatment of diabetes and metabolic illnesses in Teaneck. He brings over 47 years of experience to his practice. Dr. Wiesen is a graduate of Yeshiva University. He then graduated from Columbia University/College of Physicians and Surgeons in 1975. He is affiliated with Holy Name Medical Center in Teaneck. He and his family are longtime residents of Teaneck.
Chapler: What is diabetes, for a layperson?
Wiesen: Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired. This results in abnormal metabolism of carbohydrates and elevated levels of blood glucose. Uncontrolled diabetes leads to many serious health issues.
With diabetes, one’s metabolism is not functioning properly. There is a high level of glucose circulating in the blood that cannot effectively enter the cells where it is needed as a source of energy. This is a result of inadequate insulin or resistance to insulin action. Glucose continues to rise due to dietary intake, as well as the body breaking down stored glucose in the liver (glycolysis), and the production of glucose from stored protein (gluconeogenesis). These processes add to the already high blood glucose.
Is diabetes one disease?
All forms of diabetes manifest themselves in high blood sugar, but there are different types:
Type 1 or juvenile diabetes is a chronic autoimmune condition in which the immune system mistakenly attacks the pancreas and destroys the beta cells responsible for producing insulin. There is a genetic component to Type 1 diabetes and it is often associated with other autoimmune conditions (celiac disease, autoimmune thyroid disease). Type 1 diabetes usually develops in childhood or young adulthood, but can also be seen in older adults (LADA—latent autoimmune diabetes in adults).
Type 2 or adult-onset diabetes is associated with heredity and lifestyle. Habits like unhealthy eating and lack of physical activity are risk factors. Furthermore, obesity contributes to insulin resistance, preventing insulin from working effectively.
Gestational diabetes is a “red flag.” Women who have this condition during a pregnancy are prone to gestational diabetes in future pregnancies and can develop Type 2 diabetes after pregnancy. What can make a woman prone? 1) Being severely overweight during pregnancy (BMI <30/obese). 2) Advanced maternal age. 3) Genetics. If a close family member has diabetes, one may be more prone to gestational diabetes.
What about other types?
There certainly are other less common types of diabetes, such as genetic defects of pancreatic beta cell function (MODY), diseases of the pancreas (e.g., after chronic pancreatitis, post Whipple procedure), the result of medications (e.g., steroid-induced) or caused by other endocrine disorders (e.g., acromegaly, Cushing’s syndrome).
How has treatment for diabetes changed over the last five years?
First of all, there are now new types of blood glucose monitors that are very accurate. Some of these new products can monitor blood glucose without finger sticks. Newer insulins and medications on the market are more effective in controlling diabetes and its side effects in the multiple ways that they target the underlying causes of the disease. In addition, today’s insulin pumps use a closed-loop system whereby the monitoring of blood glucose triggers the necessary insulin dosage in real time.
Many of my diabetic patients have been told by their doctors to lose weight. What do you think?
Probably 85-90% of Type 2 diabetics are overweight. Overweight Diabetics require more medication, or more insulin to maintain control than leaner diabetics. Insulin resistance is more common with heavier people.
Uncontrolled diabetes results in significant weight loss due to the catabolic state (the body breaking itself down). This is undesirable, and possibly even dangerous. Planned weight loss accomplished by exercising, eating healthy and reducing calories enables more effective control of diabetes.
What is your opinion regarding the GLP-1 diabetes medications that facilitate weight loss such as Wegovy, Ozempic, Trulicity, and the newest on the market, Mounjaro?
These medications are very effective in helping people lose excess weight and gain control of diabetes, especially in coordination with healthy diet and exercise. They help slow the passage of food (delay gastric emptying), which allows patients to feel fuller and sends signals to decrease their appetite, as well as increase insulin release and decrease the liver’s production of glucose (gluconeogenesis).
“Basal metabolic rate” (BMR) is the rate
I often see clients with BMIs above 30. What would be your advice to them?
Lose weight. The risk for diabetes and other health problems increases with excess weight. Especially if you are genetically prone or have relatives with diabetes.
What is your opinion regarding exercise for weight loss?
Reducing caloric intake to lose weight causes the basal metabolic rate (BMR) to slow down. Eventually, one will hit a plateau in weight loss. Exercise helps to increase the metabolic rate. It also helps maintain a healthy weight at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm. When reducing caloric intake to lose weight, BMR slows to preserve the body. Exercise boosts the BMR and helps burn calories. And exercise helps reduce stress, lower blood pressure, and helps cholesterol levels.
What is the connection between thyroid function and weight?
The thyroid is a factor in controlling the rate of metabolism. If the thyroid is not functioning properly, metabolism can be affected. In hyperthyroidism the thyroid produces too much thyroid hormone, causing weight loss and other side effects such as hair loss, nervousness, insomnia, excess hunger and sweating. In hypothyroidism the thyroid is not producing adequate thyroid hormone, which can result in weight gain, feeling cold and fatigued, and becoming constipated. Treatment of hyperthyroidism, or thyroid hormone supplementation in hypothyroidism, helps to normalize these conditions.
Is there a relationship between diabetes and thyroid disease?
In certain disease states, such as Graves’ disease, the thyroid produces too much thyroxine, which can cause a rise in glucose. In other autoimmune disorders such as Hashimoto’s thyroiditis, the thyroid is destroyed and cannot produce adequate thyroxine, which slows metabolism.
Who should be screened for thyroid disease?
People who have a family history of thyroid disease and/or other autoimmune diseases should be screened.
For those interested in medical history, diabetes goes back to the first century BCE. It comes from the Greek word “diabainein,” which means “go through.” Later the word became “diabetes” meaning “siphon.” “Mellitus” means “sweet” in Latin. If a person urinated excessively, and the urine was sweet, that individual was diagnosed with diabetes.
Insulin was discovered by Sir Frederick G. Banting, Charles H. Best, and J.J.R. Macleod at the University of Toronto in 1921. It was purified into a usable form by James B. Collip. Banting and Macleod received the 1923 Nobel Prize in Physiology or Medicine for the discovery of insulin. By the end of 1923 insulin was in commercial production. Diabetic patients who received insulin injections recovered from comas, resumed eating carbohydrates (in moderation) and realized they had been given a new lease on life.
Thank you, Dr. Mark Wiesen for sharing with our readers important information regarding diabetes and thyroid disease.
If you have high blood sugar and uncontrollable diabetes, reach out to Nutrition Transformations. We will provide nutrition counseling, diabetic diets and recipe options.
Yours in good health,
Jenn
718-644-1387
www.nu-transform.com see holiday blog
By Jennifer B. Chapler, MS RD CDN
