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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.