Diabetes Prevention & Care
Preventive, specialist-led endocrine care — from early risk assessment and continuous glucose monitoring to long-term glucose control and complication prevention.
Medically reviewed by Dr. Chhaya Makhija, MD, Triple Board-Certified Endocrinologist, in Sept. 2026
Types of Diabetes Mellitus
Diabetes mellitus includes:
Type 2 diabetes
Type 1 diabetes
Gestational diabetes
Secondary diabetes
A Preventive Approach to Diabetes
As a preventive endocrinologist, I encourage people and patients to reach out sooner — no referral needed — before they receive a diagnosis of type 2 diabetes. For those who have type 1 diabetes, I encourage them to optimize their overall glucose and metabolic control in order to prevent complications.
Gestational Diabetes and Preconception Planning
For gestational diabetes, I encourage patients to be evaluated prior to conceiving, and to address and review risk factors such as:
Ethnicity (South Asian, Hispanic, African American)
Family history of diabetes
Pre-diabetes
PMOS (polyendocrine metabolic ovarian syndrome)
Obesity
Weight gain
Insulin resistance
MAFLD (previously known as fatty liver disease)
The goal is to address and mitigate the risk of a gestational diabetes diagnosis sooner — before pregnancy begins.
Why Insulin Resistance Matters
Insulin resistance has become much better known in the last few years, given the growing awareness of metabolic health, prevention, and longevity. As endocrinologists, we learn about insulin resistance in medical school while studying the pathophysiology of prediabetes and type 2 diabetes.
It is well established that insulin resistance plays a role in causing cardiovascular disease, heart disease, inflammation, pre-diabetes, type 2 diabetes, and fatty liver disease, and that it plays a role in obesity. There has also been a relationship shown with an increasing risk of cancer.
What Insulin Resistance Actually Is
In simple terms, insulin resistance is a cellular resistance to insulin. The pancreas — an endocrine organ in our abdomen — has to produce more insulin in order to bring about normalization of glucose. This resistance is commonly seen in muscle cells, adipose tissue cells, and liver cells.
It is also important to know that our muscle cells, when active during exercise, help lower blood glucose levels effectively without the need for insulin.
Evaluation
Clinical Signs
We do have clinical signs of insulin resistance that can be seen in patients, including:
Acanthosis nigricans
Skin tags
Hyperpigmentation of the skin
There are also ethnicities — South Asian, Mediterranean, African American, and Hispanic — that carry a higher risk of developing insulin resistance.
Biochemical Testing
Biochemically, we can test for insulin resistance by calculating HOMA-IR (Homeostatic Model Assessment of Insulin Resistance), which uses fasting insulin and glucose levels.
A person can have insulin resistance despite a normal glucose level and a normal hemoglobin A1C. Insulin resistance occurs much earlier — years earlier — before the A1C becomes abnormal, and before an individual is diagnosed with prediabetes or type 2 diabetes.
This is a very important aspect that I assess in every patient because it helps us identify the root cause of the pathophysiology and approach clinical care, management, and treatment accordingly.
Evaluation: The Essential Tools
Whether the focus is on diabetes prevention, diabetes care, or insulin resistance, essential tools include a detailed first consultation and a personalized treatment plan. Patients are part of a medical membership in which follow-up visits include continuous glucose monitor (CGM) training and review of your meal logs, blood tests, the entire hormonal-metabolic panel, insulin resistance, and assessment of your cardiovascular risks.
At follow-up visits and in between patient portal communication is where real transformation happens step by step, so you are not overwhelmed but feel empowered.
Medications for Type 2 Diabetes range from oral hypoglycemic drugs to GLP-1 injectables or GLP-1 pills to insulin, depending on the severity of diabetes and the patient’s safety and preference.
Medication Options for Insulin Resistance
Medications that could be discussed for patients with insulin resistance, depending on their symptoms and presenting disorders, are:
Metformin
Pioglitazone
GLP-1 receptor agonist
Education, Training, and Ongoing Monitoring
Training and education are also part of our diabetes care — to optimize your glucose control, train on a continuous glucose monitor, and titrate GLP-1 or other medications or insulin to help prevent hyperglycemia and hypoglycemia, reduce the risk of complications, and improve your hemoglobin A1C. This requires time, education, and ongoing monitoring to assess progress and implement each step.
Medical Membership Care
For that reason, after your consultation, patients enroll in our medical membership so they can have direct access to me between visits. This allows us to:
Monitor and improve their glucose control
Provide lifestyle and metabolic assessment and interventions
Help them with diabetes technology, including continuous glucose monitors and insulin pump starts
Coordinate care with a diabetes educator, nutrition support, or specialist referrals
Provide training for medications like SGLT2 inhibitors or GLP-1, and explore the possibility of reducing or weaning off insulin (in DM-2)
Address weight loss measures on a case-by-case basis (lifestyle and medication)
Arrange cardiac screening (case by case)
The medical care at Unified Endocrine is out-of-network, and any necessary orders, such as blood tests, imaging, or referrals, can be covered by your health insurance.
Our Mission
At Unified Endocrine and Diabetes Care, our prevention mission is built on time, trust, and transformation. You have your endocrinologist alongside you to help improve your health, glucose control, and wellbeing, to reduce medication reliance as much as possible, and to help you navigate the healthcare system — so that you can find answers and solutions and prevent chronic disease and its complications.
Frequently Asked Questions
Can I reverse diabetes?
This is a very nuanced answer. It depends on the stage of type 2 diabetes:
If you have pre-diabetes
If you have early-onset type 2 diabetes
If you have had it for 20 years
It also depends on your pancreatic beta-cell reserve and on the lifestyle interventions you have implemented, including non-modifiable factors—that is, the ethnic or familial component. In most of our patients, glycemic control is optimized depending on their health goals and lab evaluation. As they continue to use their continuous glucose monitors to improve health, there is the possibility of reducing reliance on diabetes medications in the early stages. There is also the possibility of diabetes remission, depending on the case-by-case history.
Are there natural ways to treat type 2 diabetes or insulin resistance?
Natural ways are equal to lifestyle interventions. We have sufficient scientific evidence that appropriate lifestyle interventions — that is, personalizing your nutrition, increasing physical activity, and increasing muscle mass to improve insulin sensitivity — all help improve glucose control and the possibility of diabetes remission in patients with type 2 diabetes. This is all natural. These are all natural ways.
The most important element is consistency, along with addressing other factors such as perimenopause, menopause, or a sleep disorder, and treating sleep apnea in conjunction with lifestyle interventions.
What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is generally autoimmune in origin and can be seen at an early onset in childhood or young adulthood, though there is also a latent onset for this condition. The pancreas fails to produce insulin, which is why the patient requires insulin as a life—saving treatment.
Type 2 diabetes, on the other hand, is most commonly tied to insulin resistance and the other risk factors mentioned above. It can be treated with lifestyle interventions as a foundation, along with oral medications (GLP-1 receptor agonists) and, in certain patients, insulin.
Can I reverse insulin resistance?
Yes. You can improve your insulin sensitivity by making the right nutritional changes, exercising, losing weight, and increasing lean body mass. In many cases, individuals might need pharmacotherapy for weight loss, such as a GLP-1 receptor agonist, which can help reduce insulin resistance.
What is the best exercise to reduce insulin resistance?
Any form of physical activity or exercise uses your muscles. Your muscle cells, as explained above, are capable of taking up and using glucose as their fuel without the need for insulin. Exercise also helps increase the number of glucose receptors in muscle cells.
Resistance training and strength training have both been shown to improve insulin sensitivity. Even walking after meals helps to drop blood glucose and improve insulin sensitivity.
Patient Stories and Resources
Patient stories:
How to use a continuous glucose monitor:
A Note on Insurance
Unified Endocrine Care is an out-of-network practice. Practicing outside of insurance networks allows us to give each patient the time and attention their care deserves, and to build treatment plans around clinical need and personal health goals rather than around the limitations insurance coverage places on them.
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Complex Hormones Require Specialist-Level Care
Conditions We Treat:
Where We provide Diabetes & Prevention Care:
In person at our Fresno office (serving Clovis, Visalia, Madera, Hanford, and Tulare) and our Lafayette office (serving Walnut Creek, Orinda, Danville, Berkeley, Oakland, and San Francisco) — plus telehealth for patients anywhere in California.