The Truth About Insulin Resistance and Diabetes Medication | What Every Patient Needs to Know

Welcome to the Coastal Pearl Podcast, where we bring you conversations with leaders, innovators, and experts who are making a difference in our community and beyond. I'm your host, Megan Nager, and today we have the pleasure of speaking with Dr. Ahmet Ergin, a board-certified endocrinologist, diabetes specialist, author, and founder of the Diabetes, Thyroid, and Hormone Center of the Treasure Coast. Dr. Ergin has dedicated his career to helping patients better understand and manage complex conditions such as diabetes, thyroid disorders, metabolic health challenges, and hormone imbalances. Through his patient-centered approach and commitment to personalized medicine, he has become a trusted voice in the field of endocrinology and a respected healthcare leader here on the Treasure Coast. Please join me in welcoming Dr. Ergin to the Coastal Pearl Journal Podcast. Thank you for joining us. Thanks for having me. Welcome. We're very excited to have you here. You have a super impressive background. You've done, you basically trained in medicine internationally all over, and then you eventually settled here on the Treasure Coast. So what inspired you, I guess, to settle down here and practice medicine in this area? Primarily really looking for a job when I was younger. So I was initially trained in Cleveland Clinic, Ohio, and then I decided to move down. It was way too snowy for me, way too cold. And I was on a visa because I was an international graduate. So I came in here, I accepted the Cleveland Clinic, did my residency and fellowship, then had to move down to Alabama to serve underserved communities. So that helped me understand medicine because this is not what you normally see in daily life. I have seen patients taking astronomical amounts of insulin. So that helped change my perspective in life, how to approach different types of people. But the bottom line, after Alabama, it was kind of boring. Eventually when I got my green card, I decided to go for a nicer place like Florida. So no offense to Alabama. Then I was in Panhandle, but Panhandle was kind of a semi-Alabama. So I was like, okay, I need a little more action. So let me go down a little more south. And I didn't want to go to Miami because it's pretty crazy down there. So I'm like, okay, I'll settle here in Treasure Coast. I looked at the geography. It's nice. I'm into water sports. I'm like, great. There are like, you know, waterways, ocean, everything is here. And I accepted the job over here. And then I was here for a long time. I obviously recently went into private practice because my vision was way too big to stay in a corporate. And I'm glad I did because in the last year, year and a half, we have made tremendous growth and we have changed our practice to serve our patients to the best possible outcome that's out there. Amazing. I love that. So what got you into endocrinology exactly? Endocrinology is an interesting field because endocrinology looks into endocrine system, which is the hormonal system. When people talk about hormones, the only thing they think about is the female hormones or male hormones, but we have hundreds of hormones in our body. And it's our body's communication system. So endocrine system touches every system. It's not isolated to like kidney or heart. And then there is this complex interplay of hormones. And that actually changes how we feel, how we think, not just, you know, how our body functions, but it affects so many things that it was very inspiring. And I'm a little bit nerdy. So I'd like to know like nerdy stuff. So endocrinology was a great specialty for me for that reason. I love that. And I mean, I've learned a lot about hormones from one being pregnant and two, my mom going through menopause. And I was like, wow, I didn't realize how it really does affect everything. So it's, I think it's a great field. Yeah. Tiny but mighty molecules. Exactly. What continues to motivate you when you're treating patients with diabetes, thyroid disorders, hormone? What really motivates me and keeps me going. And as you know, it's hard to practice medicine nowadays in this environment with the insurance environment. However, it is very satisfying when a patient comes back and says, doctor, you changed my life. You changed my parent's life. I feel so much better. So that happiness in patient's eyes just keeps me going. And we, the reverse disease states, it improves people's like lives, daily, you know, wellbeings. And they notice that. And I'm not the type of doctor who just wants to give a medicine as a Band-Aid and just try to treat the symptoms. And patients understand that. So patients realize that the doctor listens and tries to provide solutions, not only for symptoms, but for the root cause problems. I love that because a lot of doctors sadly do. They just throw you some medicine and then that's it. Goodbye. So yeah, diabetes affects millions of Americans. It's an epidemic. In your experience, what are some misconceptions that people have about diabetes? I think the biggest misconception is that people think diabetes is because of eating too much sugar or eating too much. But in reality, you can be an athlete and you can eat a lot of sugar and a lot of food, but your body will process it. So not only that, but also stress, sleep problems, trauma, even in our past life, as simple as antibiotic use, post-traumatic stress disorder can actually lead to complications like this. Because all of those historical trauma leads to an increased state of cortisol production and adrenaline production. And those hormones don't get along with insulin too well. So when we don't sleep enough, our cortisol levels go up, for example. And all of that gradually leads to diabetes. And that's, I think, the biggest misconception. And the second one is that people think that diabetes just happens like that overnight, but actually it's a process of decades of neglect or not knowingly. People are not neglecting themselves knowingly. But our healthcare system is not designed for healthcare. We are basically practicing sick care. Yeah, absolutely. It's true. I've heard that before and it's very accurate, which is sad, but it's true. So there's type 1 diabetes, type 2 diabetes. Those are the main types, right? Main types. And there's so many other types. And we diagnose people, actually, they come to me after years of misdiagnosis because people, you know, they think that when someone is overweight, it must be type 2. That's not true. There's type 1.5. When I say that patients laugh, but I'm like, it's a real thing. You know, there's type 3. There is, you know, the Morty types, genetic diabetes. There's so many types of diabetes out there. And the correct diagnosis is important because if you don't diagnose it correctly, then you may over or under treat people. Hormones, and I didn't know this until recently, they really do affect your overall health. And I think people just think, again, pregnancy, you know, or testosterone, perimenopause or menopause. What are some common hormone-related issues that you see, or like the most common? The most common issue I see is insulin resistance at different stages. For example, PCOS affects young women, and that's an insulin resistance syndrome. Really? Yes, exactly. I didn't know that. And then it progresses to eventually prediabetes. The same patient will progress to prediabetes and then diabetes. And in between somewhere, they will develop heart disease. So their lifespan is stolen from them on average 20 years. And most of the time when doctors treat PCOS, they will treat, okay, what do you have? Irregular periods. Okay, here's a birth control pill, regulate your periods. What do you have? Excessive hair. Here's some anti-testosterone medication, which is okay to treat the symptoms. But if you do not address the root cause, which is insulin resistance, and most patients have no idea, then you will never come off the medication and you will never really address the future diabetes complication or heart disease complication. So that is a pandemic. 60, 70% of Americans have insulin resistance. One test that most doctors don't do, and I think it's very important to do in primary care setting, which is insulin levels and glucose levels. Yeah, they don't check that unless you ask. They barely check A1C. And the problem with A1C, it is such a late marker. By the time you are diagnosed with diabetes, you actually lost 50% of your pancreas from exhaustion, from overproduction. The poor pancreas has been trying to keep up with the insulin production for years and eventually it starts failing. And then we start telling patients, oh, you have prediabetes, but you know what? You're not diabetic yet. It's like, yeah, you got a step one or you got a bullet in your chest, but you're not dead yet. So it's not a good approach. So now you see the problem, you address it early on, prevent from happening. So prevention, so the wellness longevity is all about prevention. Patients get busy with their lives and they end up just deciding to see the doctor when they have a problem, when they see something red on their blood work. Most of the time that is actually too late. And problem with also blood work, the reference ranges are so broad. It doesn't really tell you what is optimal for that patient. And okay is not always okay. So keeping things optimal will keep you healthy and energetic. Okay. So I have a question. So what are some signs that people would look for that would indicate even just prediabetes that maybe most people would Very simple things. You can look at someone's face and you can actually tell that someone is insulin resistant. And I do that every day. No, you look great. So I can, I can tell you a few signs. For example, um, when people have, like, if you look at from the back, like the, on their neck, you can see dark areas, the darker areas, and then they look like softer velvety kind of tissue. That is just screaming insulin resistance. That's actually like a severe insulin resistance. And most of my PCOS patients have that, or over some of the overweight, overweight patients have that as well. If somebody has skin tags, right. Oh, interesting. Yeah. So people have like skin tags on their neck, on their face. Uh, that is because of too much insulin because insulin is a growth hormone. So it grows things. And then the same people will have an imaging done and they will have polyps and nodules. I have a lot of thyroid patients, for example, they come and they say, you know, why do I have thyroid nodule? And I tell them because you have insulin resistance what I don't get it. Like what's the relationship. And I explained to them, insulin is a growth hormone and a nodule is a growth. So basically grows things in your body. And some of these growths are actually turning to cancer. That's why insulin resistant patients are four times more likely to develop cancer compared to people who do not have insulin resistance. That's crazy. So, okay. So I have a question. So I have a few friends who have PCOS. It's actually very common amongst people I know. And there are, some of them are super healthy. The fitness instructors eat healthy. Is that if you're in that situation, could you still be having an insulin issue or is that something else? Very good question. Actually, I have a lot of skinny PCOS patients. Okay. Yeah. Cause all my friends who have it are skinny. Yeah. Um, so of course it goes a little bit deeper than that for this podcast. It can be a little too much, but I'll summarize. You don't need to has a genetic background. Okay. Um, and, um, without the genetic background, you know, some people will have obesity or overweight and they will not develop PCOS ever. So it is definitely genetic background, but environment definitely pulls the trigger. I always say to patients, the genetics cocks the gun environment, pull the trigger, pulls the trigger. So if you're that a gun will never fire. So that's why people say, you know, I have this in my family. I have, I don't have this in my family. It doesn't mean that it's not going to happen to you because they may not have expressed it because of their personal conditions. Okay. Smart. And also, I wonder if those stress could play a role too, right? In PCOS. Yeah. So obviously stress increases the cortisol cortisol increases insulin. And one thing that most people don't know, um, again, genetically, some people develop visceral fat and they're, they look skinny from the outside and we check their insulin level is high and we call them skinny fats because they're skinny outside, but fat inside. I don't mean to laugh, but yeah. And those are the people who are skinny. But when you, when you ask about their diet, you know, they may be exercising too, but they'll be living on sneakers and fast food all the time. And, um, that's what happens when you're young, when you're in college and you look skinny, but you're probably very unhealthy. That was probably me for sure. Yeah. No, I understand.