Diabetes in Los Angeles, CA
I mostly see type 2 diabetes mellitus, a condition where the pancreas does not produce enough insulin and the body’s insulin receptors resist insulin. Over time, the pancreas will not release any insulin. Since glucose circulates in the vascular system, that is where the damage begins — the circulation. Subsequently, the tissues will later get diseased due to lack of oxygen, a condition known as ischemia.
The big arteries (macrovascular), such as those that perfuse the heart, brain, legs get diseased, which leads to heart attacks, strokes, and pain in the calves (claudication), respectively. Because of poor circulation, if a diabetic suffers a cut in the feet or an ingrown toenail, they may develop gangrene and then require amputations. As for the smaller arteries (microvascular), they supply the retinas and kidneys. If they get diseased then blindness and kidney failure will ensue.
The majority of my referrals are due to chronic kidney disease caused by type 2 diabetes. At the moment it is an exciting time for nephrologists because of the findings of 2 major clinical trials, the Credence and DAPA-CKD trials. They proved that SGLT2 inhibitors ((Invokana and Farxiga) can help patients reduce the risk of requiring dialysis. Prior to this all we could offer our diabetic CKD patients was tight glycemic and blood pressure control with the use of the ARBs/AcEIs. Now we have more to offer.
