An Expert's Answers to Diabetes Treatment FAQs


N. Spencer Welch, MD

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Keeping your diabetes under control can mean making some big lifestyle changes. Piedmont Healthcare Endocrinologist N. Spencer Welch, MD, answers common questions he hears from his patients about treating diabetes.

1. Q: What’s the difference between type 1 and type 2 diabetes?

A: Both type 1 and type 2 diabetes occur when your body’s blood sugar levels aren’t being controlled by insulin. Type 1 diabetes is due to a pure insulin deficiency – your body isn’t making it anymore. In type 2 diabetes, your body makes some insulin, but not enough, and it doesn’t efficiently use the insulin it does make.

2. Q: How is type 1 diabetes typically treated?

A: People with type 1 diabetes need to take insulin everyday. Most of my patients with type 1 diabetes give themselves a dose of fast-acting insulin before each meal, and then another dose of longer-acting or basal insulin at night. 

3. Q: How is type 2 diabetes typically treated?

A: I tell my patients that treating your type 2 diabetes is like trying to balance on a three-legged stool. The legs of the stool are diet, exercise and medication. Without diet and exercise, your medications really can’t be as effective as they could be. My type 2 diabetes patients take an oral medication that decreases their blood sugar levels, and eventually, they may need to take insulin.

4. Q: Am I a failure if I have to go on insulin to treat my type 2 diabetes?

A: I try to make it clear to my patients that type 2 diabetes is a progressive disease, and over time, no matter how hard you’re trying, your body will have fewer and fewer insulin-producing cells that make less and less insulin. Even if you’re doing everything right, your insulin production may continue to decline. When starting treatment, I’ll put you on one medication and tell you to watch your diet and increase your exercise. Then, you may get to a point where we’ll add one or two more medications, and eventually you may need to take insulin to bring your blood sugar back into your goal ranges. No one is a failure for having to take insulin. Diet, exercise, and oral medications can delay it, but for many type 2 diabetics, adding insulin to their treatment regimen is inevitable.

5. Q: What are the most common problems your patients experience with making dietary changes?

A: Healthy eating and good nutrition is the hardest prescription I write for my patients, because it requires a change in the lifestyle that they’ve had for maybe 40 or 50 years. I tell my patients that they need to make a commitment to themselves to learn good nutrition, which means not only learning about the proper foods to eat (and foods to avoid) but also proper portion sizes. Hopefully, after you’ve committed yourself to learning about healthy eating over three or four months, good nutrition will be your new lifestyle. I tell my patients – if you have temptations about certain foods, don’t buy them and don’t bring them into the house. Try to make the distance between the TV and the fridge a little longer. For folks who eat out a lot, I tell them to look for baked or broiled fish or chicken, and to order their vegetables steamed with any sauces or dressings on the side.

6. Q: What are the most common problems your patients experience with exercising?

A: Often, I’m talking to people who have never exercised in their lives. Exercise is sometimes a hard row to hoe, but I tell them the most important thing is to find something they enjoy doing. It doesn’t matter if you’re walking, biking, swimming – choose something you enjoy so that you’ll do it consistently. Some of my patients have problems with arthritis or other conditions that limit their ability to exercise, so I recommend gentler activities to them, like yoga. I also make it clear that we’re not expecting anyone to go out and run a marathon right away. 30 minutes of moderate intensity exercise five days a week is adequate, and you can start small. The first few weeks, just do five or ten minutes of walking, and then keep increasing it every week. We like folks to build up gradually so they can get used to exercising and not think of it negatively

THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.

N. Spencer Welch, M.D.

N. Spencer Welch, MD

Dr. N. Spencer Welch is an endocrinologist with Atlanta Diabetes Associates and Piedmont Atlanta Hospital. Dr. Welch received his medical training at Emory University and is board certified in Internal Medicine as well as Endocrinology and Metabolism.
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