[MUSIC PLAYING]
PAMELA KASENETZ: Hi, Ina.
INA MENDOZA: Hi, Doctor Pam.
PAMELA KASENETZ: Hi, how are
you?
INA MENDOZA: I'm doing great.
Thank you.
How about you?
PAMELA KASENETZ: Oh, not bad,
not bad.
All right, tell me, how have
the past three months been?
INA MENDOZA: The past three
months actually have been great.
I started a new job recently,
so I'm very excited about that.
PAMELA KASENETZ: Wow, that's
exciting.
Congratulations.
INA MENDOZA: Thank you.
PAMELA KASENETZ: So I did get
your labs back, and everything
looks great with hemoglobin A1c,
which, as you know,
is your three-month mark
of your sugar,
is wonderfully controlled
at 5.9.
INA MENDOZA: Thank you.
PAMELA KASENETZ: We checked
your kidney function, which
is looking great.
So I also checked the once
annual urine sample where we
check for the protein
in the urine
to see if your diabetes is
causing loss of protein.
Those numbers look wonderful.
I will say your iron levels
looked a little bit low,
and it was suggestive
of an iron-deficiency anemia.
So I do want to talk to you
a little bit about,
perhaps, where that iron
deficiency is coming from.
Because your last set of labs,
you didn't have that low iron.
We have to make sure,
first of all, that you're not
losing it from your GI tract.
So if you haven't had your colon
cancer screening, I do recommend
following up
with your gastroenterologist.
We can also check a stool sample
just to make sure you're not
losing blood through there.
The other issue, of course,
is you may not be taking
in enough iron from the diet.
But also the diabetes,
in and of itself, as well as
some medications for diabetes
can decrease iron absorption.
In terms of your diet, though,
there are some iron-rich foods
which--
I don't know what your diets
like.
Are you eating meat?
Are you eating
leafy green vegetables?
INA MENDOZA: I am eating meat,
but I only eat poultry
and seafood.
I know like kale
and those other things,
like that spinach
and those other things,
are supposed to be really
good for you.
Seriously, I can't stand them.
So I need some better
suggestions.
PAMELA KASENETZ: I will say
beans are actually
a great source of iron.
Be careful with-- beans
also have a lot of carbs,
but I much prefer you eating
carbohydrates and beans,
than eating breads and pasta.
So I'm OK with you adding
some beans to the diet,
particularly to increase
the iron intake.
How much weight have you ended
up losing?
INA MENDOZA: 75 pounds total,
over about a five-year time
frame.
PAMELA KASENETZ: Wow.
I am so impressed.
And I'll tell you what, when
your body is shrinking,
your body is actually responding
to insulin much better than when
you had more weight on board.
The simple fact of losing weight
can help insulin up regulate
those glucose transport
receptors into the cells, which
then allow lots of sugar
to come out of the blood
into the cells
to use this energy.
Otherwise, when it stays
in the blood, it just deposits
itself on top of all
your organs, and that's where we
see problems.
So all of that that you've done
has improved the insulin
resistance, which of course, is
one of the factors that's
the basis of diabetes.
INA MENDOZA: So Dr. Pam, I have
a question for you.
I've been seeing
these commercials of advertising
a once-a-week GLP-1
versus a once-a-day.
Now, on the once-a-day,
every morning, it distresses me
how I'm thinking about having
to do this job.
PAMELA KASENETZ: I'm on board
with that.
The class of medications,
as a whole, is great.
There are nuanced differences
among the different particular
ones.
Do you have any underlying heart
disease that I need to know
about?
INA MENDOZA: No, I don't.
My blood pressure has been
perfectly fine.
PAMELA KASENETZ: As long
as you're tolerating
the once-daily medication,
the once-weekly injectables
in that class
are going to be fine for you.
So I have no problems
with changing over
to the once-weekly injectable.
INA MENDOZA: Yey.
PAMELA KASENETZ: So I
do think the big takeaway
from today's visit though,
is to get that iron level
repleted.
I do want you taking
the oral iron three times a day
on an empty stomach,
if you can manage that.
Keep an eye out
for constipation, that's
potential side effects of iron.
So, up your fluid intake,
up your fiber intake.
INA MENDOZA: All right,
thank you very much.
Dr. Pam.
I'll see you again in a quarter
and three months?
PAMELA KASENETZ: Perfect.
Blood work in a month,
and I'll see you in three.
INA MENDOZA: OK, no problem.
Thank you.
PAMELA KASENETZ: Thank you.
Bye.
INA MENDOZA: Bye.