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A cardiologist who helped set national cholesterol and weight targets for 40 years now says those numbers can mislead. Richard M. Fleming, a physician specializing in cardiovascular and inflammatory disease, argues that weight …
GLP-1s, weight loss, and the inflammation tests your patient needs [PODCAST]
I was a resident physician in New York City when I met a Jamaican woman in her early 40s, newly diagnosed with type 2 diabetes. The hospital was always crowded and the schedules unpredictable, making continuity difficult. But appointment after appointment, she found her way back to me. She trusted me and even brought me gifts on holidays.
Her hemoglobin A1c was 7.2. She had mild obesity, and no major complications. …
How lifestyle interventions reverse type 2 diabetes
An excerpt from Confessions of a Problem Seeker: My Lifetime Journey From Busy Brain To Loving Heart.
In his own intuitive way, with only a second-grade education, my dad knew something was not right. Just hours after peeing in a paper cup at our pediatrician’s office, the doctor called my mom at my father’s butcher shop to inform her I had juvenile diabetes (now referred to as type 1 diabetes). …
Coping with a childhood type 1 diabetes diagnosis
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Is the new oral Wegovy pill a breakthrough or a risk most patients never hear about? Shiv K. Goel, an internal medicine and functional medicine physician, joins the show to unpack his KevinMD …
Oral Wegovy sounds easy, but the reality is more complicated [PODCAST]
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Obesity medicine physician Jessica Duncan discusses the article “GLP-1 weight regain: Why stopping medication leads to weight return.” Jessica explains that expecting to maintain weight loss after abruptly stopping GLP-1 therapy is …
Why weight regain is a predictable biological response after stopping GLP-1s [PODCAST]
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Metabolic health educator Kevin Whitt discusses his article “Insulin resistance is not a disease: a metabolic reframe.” Kevin argues that the skyrocketing rates of Type 2 diabetes are not the result of …
Insulin resistance is a survival mechanism, not a broken system [PODCAST]
Since 2023, while volunteering at an amputee sports competition in Los Angeles, I encountered athletes whose amputations resulted from complications of diabetes. In many cases, limb loss did not begin with a catastrophic injury, but with gaps in preventive care that allowed small, manageable wounds to progress into irreversible outcomes.
Participants traveled long distances to attend the competition, seeking peer support and health information that was often unavailable in their home …
Diabetic foot complications prevention: Stopping amputation before it starts
Stopping a GLP-1 abruptly and expecting maintenance of weight loss is not realistic. Even replacing it with a standard “eat less, move more” plan is not sufficient as it ignores what we know about hunger regulation and metabolic adaptation. A reduced-calorie diet and 30 minutes of daily walking, while helpful, are rarely sufficient to overcome the physiological forces defending prior weight.
Weight maintenance after significant loss requires managing cravings, psychological hunger …
GLP-1 weight regain: Why stopping medication leads to weight return
Type 2 diabetes and metabolic disease are now so common that they are treated as an expected part of modern life rather than as a systemic failure. Roughly 90 percent of American adults are now prediabetic or diabetic, and most are unaware of it. This progression quietly opens the door to heart disease, non-alcoholic fatty liver disease, cancer, neurodegeneration, and other chronic illnesses that are then managed downstream.
We are not …
Insulin resistance is not a disease: a metabolic reframe
Historically, diabetes management focused on blood glucose control and preventing severe complications such as neuropathy and amputation. Over the past two decades, this limited view has proven insufficient for long-term health. Many now emphasize risk factor management, lifestyle changes, and early screening instead of crisis response.
The vascular health risk of a diabetes surge
Diabetes is an epidemic: In the last decade alone, the number of adults living with the disease globally …
From glucose to vascular health: the future of diabetes care
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were introduced to help manage type 2 diabetes. They improve glycemic control and promote weight loss, which we all know are essential for long-term outcomes. In practice, I’ve seen that their impact goes beyond these traditional targets. Patients often benefit from cardiovascular protection and kidney improvements, and emerging data show advantages in areas we did not initially anticipate, such as sleep apnea, joint health, …
Beyond weight loss: the expanding benefits of GLP-1 receptor agonists
According to the CDC, nearly 1 in 3 Americans over age 65 live with diabetes. However, our health care system treats diabetes as if all adults are metabolically and functionally the same. In their attempt to maximize glycemic control, it’s not uncommon for elderly patients to experience hypoglycemic episodes, resulting in falls and confusion among other issues, exacerbating other health conditions while taking a mental and emotional toll on …
Geriatric diabetes management: Why strict A1c targets can harm seniors
A patient stopped me in the hallway recently, not in an exam room, not seated, not “ready” for a clinical conversation. Just a human being catching me between visits and asking a question that felt heavier than any lab result:
“Doc, is this finally the thing that will work? Or is it just another trap?”
That question is the GLP-1 era in one sentence. And with the launch of oral Wegovy, it …
Oral Wegovy: the miracle and the mess of the new GLP-1 pill
In caring for patients with chronic illness, we often assume that if people truly understood the consequences of poor disease management, they would change. We explain complications, cite lab values, outline risks, and sometimes lean into fear in hopes that it will motivate action. When patients do not follow recommendations, we label them as noncompliant or unmotivated. Yet chronic illness is not managed in exam rooms or hospital beds. It …
Why fear-based approaches fail in chronic illness care
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Pediatric endocrinologist Shara Bialo discusses her article, “Why type 1 diabetes screening should be part of back-to-school.” She highlights that back-to-school visits are a critical window to screen for type 1 diabetes …
Catching type 1 diabetes before it becomes life-threatening [PODCAST]
I was diagnosed with type 1 diabetes mellitus in February 2024. Now it all made sense.
It all started in October 2020 when I passed out cold. I was rushed to the emergency room and 3 days later woke up to find I had a thyroid issue and lost 2 pints of blood. Four days later, after a blood transfusion, I was sent home. At that point, I thought I was …
My journey to a type 1 diabetes diagnosis
Paraphimosis is a urological emergency characterized by the inability to reduce a retracted foreskin over the glans penis, leading to vascular congestion, edema, and potential tissue necrosis. While paraphimosis can result from local trauma, poor hygiene, or iatrogenic causes, it is increasingly recognized as a clinical manifestation associated with underlying systemic disease, particularly diabetes mellitus.
Diabetes mellitus, especially when undiagnosed or poorly controlled, exerts profound effects on local tissue immunity, wound …
Paraphimosis and diabetes: the hidden link
In a major advance in medicine, a man with type 1 diabetes is making his own insulin again, this time using genetically engineered donor islet cells. Researchers provided the new cells with an invisibility cloak to allow them to escape immune detection. After three months of follow-up, his body had not only accepted the new tissue but was quietly producing insulin. This single-patient proof-of-concept study gives hope to the millions …
CRISPR therapy offers hope for diabetes
SGLT2 inhibitors have transformed care for people with type 2 diabetes. They not only lower blood sugar but also reduce cardiovascular events and slow the progression of kidney disease. Given these successes, many have asked whether the same benefits extend to people with type 1 diabetes (T1D).
The answer is not straightforward. In T1D, SGLT2 inhibitors remain off-label, and the biggest concern is the increased risk of diabetic ketoacidosis (DKA). Still, …
Are SGLT2 inhibitors safe for type 1 diabetes?
It should come as no surprise that GLP-1 receptor agonists have revolutionized the management of obesity and metabolic syndrome. These drugs have shown extraordinary promise in regulating appetite, promoting weight loss, and improving blood sugar control. Nearly one in eight adults (twelve percent) have taken a GLP-1 agonist, and forty-three percent of adults diagnosed with diabetes have used these therapies, numbers likely to have increased further in the last year …
Life after GLP-1s: How to sustain weight loss
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