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June 13, 2020

The Endocrinologist Is In: Special Guest Dr. Ozer Discusses Different Diabetes Medications and Their Uses

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello, and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here as always with my cohost, Donna Lee.

Donna Lee: 

That’s right. That’s me. Hello, everybody. Happy day!

Dr. Mistry: 

Happy day. So I hope everybody out there is having a wonderful day. This is the Armor Men’s Health Hour. This is a men’s health show that is delivered to you on KLBJ news radio, as well as by podcast. You look for A-R-M-O-R Armor Men’s Health Hour. I think I just spelled it wrong, what do you think?

Donna Lee: 

A-R-M-O-R. No. [inaudible]

Dr. Mistry: 

I mean, when I originally made up the name, I think I spelled it wrong.

Donna Lee: 

Oh, yeah. People want the “U” in there.

Dr. Mistry: 

Yeah, I don’t know why…

Donna Lee: 

But that’s the British way of spelling it. We’re American!

Dr. Mistry: 

We’re Americans. This show is brought to you by NAU Urology Specialists. That is the urology practice that I started in 2007. We have four physician partners. We have three nurse practitioner, PA partners. We have a nutritionist, a pelvic floor physical therapist, we have sleep apnea testing, we have sex therapy. You know, I consider us like a full service urology practice.

Donna Lee: 

Mhmm. We do service the people.

Dr. Mistry: 

We do service the people, and servicing people, one part of that is having wonderful physician partners in town. I have one of those here with us today, Dr. Kerem Ozer. Thank you so much for joining us today.

Dr. Ozer: 

Thank you for having me, great to be here.

Dr. Mistry: 

Dr. Ozer is a board certified endocrinologist. Tell me, it’s hard to get in to see an endocrinologist nowadays, isn’t it?

Dr. Ozer: 

You know, ebbs and flows. But when I first moved to Austin, when we first met, this was about 10 years ago and there was really a dearth of endocrinologists in town. Now we’re lucky. We have quite the network. Our clinic has three offices now: South Austin, Central, and Round Rock. And some of the other clinics in town have developed really nice endocrine teams as well.

Donna Lee: 

That’s so nice.

Dr. Ozer: 

And we’re also very lucky in that we have our advanced practice providers who help us not only with diabetes education and lifestyle, but also help us provide that care and provide the availability for both our primary care physicians and our patients and our specialists who we work with.

Dr. Mistry: 

When I was in medical school at Baylor College of Medicine…

Donna Lee: 

What was that?

Dr. Ozer: 

Oh, I did my residency and fellowship there!

Dr. Mistry: 

That’s why you’re here because it is the finest institution known to medicine.

Dr. Ozer: 

It is!

Dr. Mistry: 

And, so we had a class called pharmacology in which you literally learned every drug that existed. I mean, when I graduated medical school in 2001, you really could have some understanding of every drug that existed. That doesn’t exist today. I constantly have to Google the drugs that my patients are on because I’ve never heard of that class of drug or this, and diabetes is a great example. We had insulin back then, and Metformin was brand new and that’s it. It was a very, very short chapter in my pharmacology book.

Dr. Ozer: 

I think what they forgot to tell us in pharmacology class was here’s two medications and there’s a thousand more coming in two years.

Dr. Mistry: 

A thousand more coming in two years. Yeah, yeah, yeah. So I thought what we could do is spend a little bit of time for you to go through and explain to me what are the different classes of diabetes drugs, when are they used, really so that people out there maybe who’ve been on the same regimen for the last 20 years, or maybe hard to treat diabetics, you know, what could they get from seeing an endocrinologist?

: 

So I guess I’ll always start by putting my plug in for lifestyle. Since diabetes is a condition where you’re really looking at kind of an overlap of multiple factors, like we said before, lifestyle, hereditary factors, we always want to keep the leading a lifestyle, being active, eating healthy on the forefront. Beyond that, when we start thinking about medications for diabetes, I think it’s important to think about the two main types of diabetes. There’s type one diabetes, where this is an autoimmune condition where the body’s own immune system attacks the cells, the tissues that produce the main hormone insulin that regulates sugar levels. So our patients who have type one diabetes just don’t make their own insulin. So currently the only medication for them would be insulin. Insulin could be used either in vials or pens, more commonly these days where they take a basal insulin and these will be insulins like Basaglar, Lantus, Toujeo, Tresiba, and this is usually once a day. And then they would take a mealtime insulin, and these would be things like Novolog, Humalog, Fiasp, which they take right before a meal.

Dr. Mistry: 

Because insulin helps the cells take the sugar into them, so it doesn’t stay in the bloodstream and cause damage.

Dr. Ozer: 

Exactly.

Dr. Mistry: 

I’ve even seen a lot of patients now with pumps. Interestingly enough, it’s one of the few prescription medicines that don’t need a prescription. If you have diabetes, you could actually go to the pharmacy right now and go get insulin.

Dr. Ozer: 

Exactly, for certain types of insulin. You’re absolutely right. Great. I’m glad you mentioned pumps because the technology keeps evolving there as well. And we have several different pumps where people have their, both their basal and their mealtime insulin in there. And we have newer pumps now that are called closed loop pumps, where you wear a sensor, which takes your blood sugar level all the time continuously, and you have a pump and these two talk to each other and they regulate your insulin levels as you go about your day.

Dr. Mistry: 

And then you can check your numbers on your phone!

Dr. Ozer: 

Exactly.

Dr. Mistry: 

So most of our patients have type two diabetes and what are some of the medicines we use for that?

Dr. Ozer: 

So for type two diabetes, the first line medication for most people is Metformin. And we talked about Metformin a little bit when we were talking about pre-diabetes. The nice thing about Metformin is it helps your liver process sugars more efficiently, more effectively. So it’s sort of a built in metabolic support type approach. For many of our patients who may not just get enough of a control on Metformin, or they may not be tolerating Metformin, we have a general sort of a wide range of medications now. And we usually think of these medications as different classes. The two things that I’m most excited about in type two diabetes care these days are two classes of medications: One is GLP-1 agonists, and the other class is SGLT-2 inhibitors. GLP-1 agonist are medications these are usually once a week injections. People may have heard of medications like Trulicity, or Ozempic, or Bydureon. And these work by mimicking a hormone that our own intestines make called GLP-1. And this is the hormone that prepares the pancreas for an incoming meal. You start eating and your gut says, pokes your pancreas and says, “Hey, there’s meal coming, slow down the stomach. So we can absorb this food more slowly, increase your insulin levels, drop down your glucagon levels,” which is the main hormone that increases your sugar levels in the body. And it also has an indirect effect on appetite regulation. So, so these medications actually also help with the weight regulation.

Dr. Mistry: 

That’s why the ads on the TV says you may lose weight, but it’s not intended to be a weight loss medication.

Dr. Ozer: 

Exactly. And then the second class that I’m really excited about is SGLT-2 inhibitors. The way these medications came about was through the realization in many of our patients with type two diabetes, this is very counter intuitive, it’s kind of weird. Normally as sugar levels go up, the kidneys help us out by pushing out excess sugar. But in our patients with type two diabetes, that ability of the kidneys is curtailed. So the higher your sugar levels are the more hesitant your kidneys are to push out more sugar. And that’s because of an increase in the level of a protein in their kidneys called SGLT-2. So these SGLT-2 medications, which are usually once a day pills work by…

Dr. Mistry: 

What are some names?

Dr. Ozer: 

So these would be things like Farxiga, Jardiance, Invokana, would be the common names for these medications. They help us out by helping the kidneys get rid of excess sugar, and both for a GLP-1 agonist, the weekly injections and the SGLT-2 inhibitors, one of the really cool things is recently we’re realizing that they actually reduce the risk of heart disease in our patients with diabetes, independent of their effects on your sugar levels.

Dr. Mistry: 

Now, if you’re taking one of these medicines that pushes more sugar out of your urine, a couple of things that we want to remind people: number one is you may pee more often, because you’re, the sugar is actually a diuretic. It pulls water in and you pee more often. So timing of that medicine I think is kind of important, because I got a lot of guys who come in and say, “I have to pee a lot all the time. And it’s just after I started this medicine.” I’m like, “Yeah, no kidding.” And the second thing is a lot of times people worry about finding sugar in their urine on a standard dipstick, but that is what it’s intended to do.

Dr. Ozer: 

Exactly. So we get calls from DOT sometimes saying, “Hey, this person has a lot of sugar in their urine.” And I say, “Yup, their medicine is working. That’s good to hear.”

Dr. Mistry: 

That’s exactly what I wanted to hear. That’s right. That’s right.

Dr. Ozer: 

So we talked about insulin. We talked about GLP-1s and SGLT-2s. There’s an older class of medications called sulfonylureas. People may have heard of things like Glipizide, Glimepiride, Glyburide, and these are usually once or twice daily pills that work by reducing overall sugar levels. And that’s another option that we can use. And then there’s another, I’ll talk about Pioglitazone as the last one. And that again is the once a day pill that helps your muscle and your liver process sugars more efficiently.

Dr. Mistry: 

You know, I think what you’ve really pointed out is that, if you are under the care of a primary care doctor and you have diabetes and your diabetes is under control, then stay there and you’re doing great.

Dr. Ozer: 

Absolutely.

Dr. Mistry: 

But if you’re not tolerating the meds or your sugars are getting out of control, or you don’t think that you’re optimized, then seeking the help of an endocrinologist may be of some benefit.

Dr. Ozer: 

I think that’s a good point.

Dr. Mistry: 

How do people get ahold of you?

Dr. Ozer: 

We are Texas Diabetes Endocrinology at texasdiabetes.com or (512) 458-8400.

Dr. Mistry: 

It’s just texasdiabetes.com, isn’t it?

Dr. Ozer: 

It’s just texasdiabetes.com.

Dr. Mistry: 

That’s right. And how do people get a hold of us?

Donna Lee: 

They can call us at (512) 238-0762. Our website is armormenshealth.com and our email address is armormenshealth@gmail.com. That was awesome guys.

Dr. Mistry: 

That was awesome. Thank you so much, Kerem.

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