In part 8, the conclusion of this Exclusive Interview, Scott Isaacs talks with Diabetes in Control Medical Editor Joy Pape about the big differences with using meal replacements to help people with type 1 versus people with type 2.
Scott Isaacs, MD, FACP, FACE is the medical director for the HMR Program for Weight Management at Atlanta Endocrine Associates and a faculty member at Emory University School of Medicine.
Transcript of this video segment:
Pape: So, we had talked about if someone is on insulin you decrease to maybe half. And getting started, I’m sure you’re looking at their levels and taking other things in consideration. But let’s look at the patient with type 1 diabetes versus a patient with type 2 diabetes,and they’re wanting to start meal replacements, how would you manage that?
Isaacs: So, type 1 diabetes with meal replacements and rapid weight loss is actually not that difficult, because if someone is doing carb counting or if they’re using an insulin pump basically the carbs are just putting in the number of carbs they’re eating and the ratio doesn’t necessarily need to change right away. We do make a small decrease in the long acting insulin or in their basal rate, usually a 10% to 20% decrease in the beginning. And then as they lose more weight that amount may go down and also their carb ration may change. But really it’s still just a standard type 1 diabetes management.
Pape: And type 2?
Isaacs: Type 2 is a different ball game, because many patients with type 2 can discontinue all of their medications at the time that they start the diet. And if not all, most. And so, insulin is usually cut in half or even more substantial reductions, sulfonylureas are discontinued. And other medications, we may stop them as well or we may continue them and stop them later. But there’s a dramatic reduction in the need for medications with type 2 diabetes. There was an article published in the Lancet last year looking at very low calorie diet and diabetes remission. And what was found is at the end of one year, the patients who had lost at least 15% of their body weight, there was an 84% remission in diabetes which was almost identical to the numbers that we see with gastric bypass at the same time. And so, especially with patients who have diabetes relatively recent onset, less than six years, there’s a really high remission rate and this may be one of the best treatments we have for type 2 diabetes.