Diabetes & Metabolic Health

Diabetes and Metabolic Disease — Understanding, Managing & Living Well

Comprehensive care for diabetes, diabetes complications, and metabolic disease — including fatty liver disease (MASLD)

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Understanding Diabetes Symptoms & Diagnosis Complications Treatment Technology Delaying Type 1 (TZIELD)

If you have questions about your diabetes care or would like to discuss monitoring technology or treatment, we invite you to contact our office. All care is individualized to your specific history and goals.

Understanding Diabetes

What is diabetes and how does it develop?

Diabetes is a group of metabolic conditions defined by chronically elevated blood glucose. Glucose is the primary fuel for most cells, but it can only enter cells with the help of insulin — a hormone produced by beta cells in the pancreas. When insulin production is insufficient or the body’s cells become resistant to its effects, glucose accumulates in the bloodstream while cells are starved of energy.

Chronically elevated glucose damages blood vessels and nerves throughout the body, leading to the long-term complications that make diabetes one of the leading causes of blindness, kidney failure, lower limb amputation, and cardiovascular disease worldwide.

What is the difference between Type 1 and Type 2 diabetes?

Type 1 diabetes is an autoimmune condition in which the immune system destroys the insulin-producing beta cells, requiring insulin therapy for survival.

Type 2 diabetes develops when cells become resistant to insulin’s effects. Over time, the pancreas exhausts its compensatory capacity and insulin production declines. Type 2 is strongly influenced by genetics, body weight, and lifestyle, and accounts for approximately 90–95% of all diabetes cases.

What is LADA?

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune form of diabetes that resembles Type 2 at diagnosis but is mechanistically similar to Type 1. It is frequently misclassified, leading to years of ineffective treatment.

LADA accounts for an estimated 5–10% of adults diagnosed with “Type 2.” If you were diagnosed with Type 2 but have not responded well to oral medications, or if you are lean and active, LADA should be considered. We routinely test for GAD antibodies and C-peptide when the picture doesn’t fit.

What is prediabetes?

Prediabetes refers to blood glucose levels that are above normal but below the diabetic threshold. Without intervention, approximately 15–30% of people with prediabetes will develop Type 2 diabetes within five years. With structured lifestyle changes, progression can often be prevented or substantially delayed.

What is metabolic syndrome?

Metabolic syndrome is a cluster of conditions that occur together and raise the risk of type 2 diabetes, heart disease, and stroke. It is generally identified when at least three of the following are present: increased waist circumference (abdominal obesity), elevated blood pressure, elevated fasting glucose, high triglycerides, and low HDL (“good”) cholesterol. Because insulin resistance underlies both metabolic syndrome and type 2 diabetes, addressing it early — through weight management, physical activity, and treatment of the individual risk factors — can delay or prevent progression to diabetes and lower cardiovascular risk.

How are obesity and diabetes connected?

Excess body fat, particularly around the abdomen and liver, is one of the strongest drivers of insulin resistance and type 2 diabetes. Weight gain tends to worsen glucose control, while meaningful weight loss can improve it substantially — and in some cases lead to remission of type 2 diabetes. For that reason we treat weight as a central part of diabetes care, using nutrition, activity, and where appropriate medical weight-management options and GLP-1–based therapies that improve both glucose and weight. Patients whose weight is a primary concern are also cared for through our Obesity and Lipedema program.

What is MASLD (fatty liver disease)?

MASLD — metabolic dysfunction–associated steatotic liver disease, formerly called non-alcoholic fatty liver disease (NAFLD) — is a buildup of excess fat in the liver, driven by the same insulin resistance that underlies type 2 diabetes and obesity. It is very common in people with diabetes and metabolic syndrome, and in some cases progresses to inflammation and scarring (MASH). Most people have no symptoms, so we screen at-risk patients and assess liver stiffness in the office with elastography. Management centers on weight loss, glucose and lipid control, and therapies that benefit both the liver and metabolic health. See our Metabolic & Fatty Liver Disease page for more.

Symptoms & Diagnosis

What are the symptoms of diabetes?

Classic symptoms include excessive thirst, frequent urination, unexplained weight loss, fatigue, blurred vision, and slow-healing wounds.

Type 2 diabetes is often silent. Many patients have no symptoms for years while silent organ damage accumulates — which is why screening is important even in the absence of symptoms.

How is diabetes diagnosed?

Test	Normal	Prediabetes	Diabetes
Fasting Glucose	Below 100	100–125	126 or above
HbA1c	Below 5.7%	5.7–6.4%	6.5% or above
2-hr Glucose (OGTT)	Below 140	140–199	200 or above

Why does diabetes affect so many parts of the body?

Over time, elevated blood glucose damages both small blood vessels (the eyes, kidneys, and nerves) and large blood vessels (the heart, brain, and legs). This is why comprehensive diabetes care looks well beyond the glucose number alone — we screen for and manage the complications that drive most of the long-term harm. Good control of glucose, blood pressure, and cholesterol together is far more protective than focusing on any one of them in isolation.

What complications do you screen for?

As part of ongoing care we monitor for several recognized complications:

Eyes (retinopathy) — regular dilated eye exams to catch retinal damage early.
Kidneys (nephropathy) — periodic urine and blood testing to detect early protein loss and assess kidney function.
Nerves (neuropathy) — foot exams and symptom review to identify nerve damage.
Heart and blood vessels — attention to blood pressure, cholesterol, and overall cardiovascular risk.

Catching these early, when they are still silent, is what allows us to slow or prevent their progression.

How is cholesterol (lipid) management part of diabetes care?

Cardiovascular disease — heart attack and stroke — is the leading cause of death in people with diabetes, and abnormal lipids are a major, modifiable contributor. Because diabetes itself raises cardiovascular risk, the cholesterol targets we aim for are typically more aggressive than for the general population. We assess your lipid panel alongside your overall risk and use lifestyle measures and, when appropriate, statins or other lipid-lowering therapy to bring LDL cholesterol to goal. Managing lipids is one of the highest-impact things we do to protect your long-term health.

How does diabetes affect the kidneys?

Diabetic kidney disease (diabetic nephropathy) is one of the most common long-term complications of diabetes and a leading cause of kidney failure. Elevated glucose and blood pressure gradually damage the kidneys’ filtering vessels, often without symptoms until the disease is advanced. We screen for it routinely with a urine test for albumin (the urine albumin-to-creatinine ratio) and a blood test that estimates kidney function (eGFR). Early detection matters: tight glucose and blood-pressure control, together with kidney-protective medications such as ACE inhibitors or ARBs and SGLT2 inhibitors, can slow or prevent progression.

How do you coordinate cardiovascular risk?

Cardiovascular disease is the leading cause of death in people with diabetes, so reducing heart and vascular risk is a core goal of care rather than an afterthought. We take a coordinated approach that manages glucose, blood pressure, and cholesterol together, supports smoking cessation, and favors diabetes medications with proven cardiovascular benefit — such as GLP-1 receptor agonists and SGLT2 inhibitors — when appropriate. We coordinate with primary care and cardiology so the whole cardiovascular picture is managed together, not each number in isolation.

What is diabetic neuropathy, and how is it treated?

Diabetic peripheral neuropathy is nerve damage that most often affects the feet and legs, causing numbness, tingling, burning, or shooting pain. It develops gradually and is closely tied to long-term glucose control, so the foundation of treatment is optimizing blood sugar to prevent further nerve damage, along with careful foot care to avoid ulcers and injury. For painful neuropathy, several treatments can help — including oral medications and, for localized foot pain, the in-office topical treatment Qutenza, which we now offer at both locations. We tailor the approach to your symptoms and what you have already tried.

What about fatty liver disease (MASLD)?

Fatty liver disease is common in people with diabetes and often has no symptoms until it is advanced. We screen for and manage it as part of comprehensive metabolic care. Learn more about our Fatty Liver (MASLD) program →

Treatment

What medications are used to treat Type 2 diabetes?

Metformin

The established first-line agent. Reduces hepatic glucose production, improves insulin sensitivity, and is associated with modest weight loss. Inexpensive and well-tolerated.

GLP-1 Receptor Agonists Semaglutide (Ozempic) · Tirzepatide (Mounjaro)

A transformative class. Stimulate insulin secretion, suppress glucagon, slow gastric emptying, and reduce appetite. Produce meaningful weight loss and have demonstrated cardiovascular and kidney protective effects.

SGLT-2 Inhibitors Empagliflozin (Jardiance) · Dapagliflozin (Farxiga)

Cause the kidneys to excrete excess glucose in the urine. Lower blood pressure, reduce body weight, and have demonstrated robust cardiovascular and renal protective effects. Now recommended early in patients with heart failure or chronic kidney disease.

Insulin

Required for all Type 1 and LADA patients, and for many with Type 2 as the disease progresses.

Technology

What is continuous glucose monitoring (CGM)?

CGM uses a small sensor placed under the skin to measure glucose every 1–5 minutes, providing real-time readings, trend arrows, and alerts — all without fingerstick testing. CGM is standard of care for all Type 1 diabetes patients and is increasingly used in Type 2, particularly for those on insulin.

We initiate and manage CGM in-office — including device selection, training, app setup, and interpretation of your data at every visit.

We also offer the Eversense implantable CGM — a long-term sensor placed just under the skin that lasts up to 12 months, rather than the 10–14 days of standard sensors. We were the first practice in San Diego to place Eversense sensors, and we are an Eversense-authorized implantation center.

What are hybrid closed-loop systems?

Hybrid closed-loop systems pair an insulin pump with a CGM and an algorithm that automatically adjusts insulin delivery in response to real-time glucose levels. Current systems (Tandem Control-IQ, Omnipod 5) have dramatically improved outcomes for Type 1 patients. We initiate, train, and optimize pump therapy in-office.

Delaying Type 1 Diabetes (TZIELD)

What is TZIELD (teplizumab)?

TZIELD is the first FDA-approved therapy shown to delay the onset of clinical (Stage 3) Type 1 diabetes. Given as a once-daily intravenous infusion over 14 days, it calms the immune attack on the insulin-producing beta cells of the pancreas.

Who is a candidate?

TZIELD is for adults and children age 8 and older with Stage 2 Type 1 diabetes — two or more islet autoantibodies plus early blood-sugar abnormalities, but no symptomatic diabetes yet. These individuals are most often found by screening relatives of people who already have Type 1 diabetes.

Why does delaying matter?

In clinical trials, teplizumab delayed the onset of clinical Type 1 diabetes by a median of roughly two to three years — more time without insulin, more time to prepare, and, especially for children, meaningful additional years of normal metabolism and preserved beta-cell function.

How do we use TZIELD here?

We were among the first practices in the US and the first in San Diego to offer teplizumab treatment. We screen at-risk family members for islet autoantibodies, stage the disease accurately, and coordinate the infusion course and follow-up monitoring so eligible patients can benefit as early as possible. Thus far, none of our treated patients progressed to stage 3 type 1 diabetes – the first treatment has been > 2 years ago!

If you have diabetes, prediabetes, or carry extra weight, your liver health is part of your care here. All assessment and treatment is individualized to your history, risk profile, and goals, and we invite you to contact our office to discuss it.

What is your experience with TZIELD?

We were the first practice in Southern California to treat patients with TZIELD. Of the four patients we have treated, none has progressed to Stage 3 (clinical) Type 1 diabetes, with the longest follow-up now beyond two years.