Primary Care Voice

Kulmeet Kundlas M.D.
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Primary Care Voice With Kundlas M.D. is your dedicated space for delving into the intricate world of Primary Care. Hosted by the experienced and compassionate Primary Care Physician, Dr. Kulmeet Kundlas, this podcast sets out to bridge the gap between medical professionals and patients, unraveling the intricacies of healthcare. In each episode, Dr. Kundlas and his expert guests dive deep into essential topics that encompass everything from preventive measures and chronic and acute disease management to cutting-edge telemedicine innovations, nurturing patient relationships, and staying updated on the latest medical trends

  1. 1d ago

    How Chronic Vitamin B12 Deficiencies Mimic Early Stages of Diabetic Nerve Damage

    Diabetic Neuropathy or B12 Deficiency? Metformin, PPIs, and the Tests You Need The script explains that numbness, tingling, and burning pain in both feet in people with diabetes is often labeled diabetic neuropathy, but up to one-third may have coexisting vitamin B12 deficiency that can mimic neuropathy and may improve with treatment. It describes how metformin can reduce B12 absorption by blocking calcium-dependent uptake in the terminal ileum over years, and how proton pump inhibitors and H2 blockers can also impair B12 absorption by reducing stomach acid needed for intrinsic factor. It highlights distinguishing clues of B12 deficiency such as posterior column symptoms (balance, vibration, clumsiness, falls), mental fog, glossitis, fatigue, and anemia, and recommends not relying only on CBC, checking B12 (aiming 250, preferably 400), using methylmalonic acid (MMA) for borderline cases, and requesting detailed foot exams (monofilament and tuning fork) and doctor-guided B12 replacement.

  2. Oct 11

    The Truth About GLP-1 Titration: What You Need to Know

    Avoid GLP-1 Side Effects: Why Wegovy/Zepbound Titration Matters (Dr. Kulmeet Kundlas) Dr. Kulmeet Kundlas, a primary care physician of 30+ years, explains that many severe GLP-1 agonist side effects from Wegovy, Zepbound/Mounjaro (tirzepatide), and related medications are often due to titration errors, patient impatience, pharmacy/education gaps, or restarting at too high a dose after missed injections. He describes how GLP-1s disrupt GI motility, citing Wegovy trial rates of nausea (40%) and vomiting (26%), and outlines the rigid step-up schedules (Wegovy starting at 0.25 mg weekly for 4 weeks toward a 2.4 mg maintenance dose; tirzepatide starting at 2.5 mg with increases every 4 weeks). He warns against unsafe dose-jumping and using non–FDA-approved compounding sources, notes pancreatitis warning signs, and emphasizes physician/pharmacist training plus lifestyle measures like high-protein diet, exercise, sleep, and stress management. 00:00 GLP-1 Side Effects Explained 01:15 Why the First Dose Hits Hard 02:29 Real Results and Big Picture 03:30 Wegovy Titration and Stacking 05:35 Zepbound Dosing and Missed Shots 06:00 Pen Mistakes and Compounding Risks 07:31 Warning Signs and Safe Wrap-Up

  3. Oct 6

    Hidden Causes and Solutions for Uncontrolled Diabetes 2

    Can’t Control Blood Sugar on Multiple Meds? 24% May Not Be Type 2 Diabetes Hypercortisolism, LADA, Dawn vs Somogyi This episode explains that some people with persistently high blood sugar and A1C despite exercising, eating well, and taking two to three diabetes medications may have conditions that mimic type 2 diabetes, with an estimated 24% chance in difficult-to-control cases. It highlights hypercortisolism autonomous adrenal hormone production as a key cause, linking excess glucocorticoids to higher glucose and insulin resistance and mineralocorticoids to high blood pressure, and describes diagnosis with the overnight 1 mg dexamethasone suppression test checking dexamethasone level, cortisol greater 1.8, and ACTH and possible cure with treatment of adrenal adenoma/hyperplasia. It also reviews LADA diagnosed with C-peptide, dawn phenomenon vs Somogyi effect 2–3 AM glucose check, steroid/medication effects, lifestyle factors, and falsely elevated A1C from iron deficiency anemia or blood disorders.

  4. Sep 29

    Understanding CGRP in Migraine Therapy KundlasMD

    CGRP Migraine Medication Revolution (2026): Prevention, Abortive Options & Avoiding Medication Overuse Dr. Kulmeet Kundlas explains that migraine is a neurological event affecting 1.2 billion people and often leads to pain, disability, and medication overuse headache when treated repeatedly with NSAIDs, triptans, or opioids. He describes migraine biology involving the trigeminal nerve and CGRP release causing blood vessel dilation, brain sensitization, and inflammation, along with four migraine stages and the lack of a definitive diagnostic test. Treatment should include prevention and abortive strategies, emphasizing CGRP-targeted therapies: monoclonal antibodies that neutralize CGRP for prevention (monthly, quarterly, or IV options, including use from age six and up) and oral CGRP receptor antagonists (gepants like Ubrelvy and Nurtec) for acute attacks, which are not shown to cause medication overuse headache. He recommends tracking attacks with a migraine diary, aims for a 50% reduction in frequency/severity/duration, notes evolving guidelines and insurance support for CGRP drugs as first-line therapy, and highlights preventing progression to chronic migraine, especially when attacks exceed four.

  5. Sep 26

    Wegovy and Zepbound Denials

    GLP-1 Medication Denials Explained: Wegovy, Zepbound, Ozempic & Mounjaro | Appeals, Medicare Bridge & Next Steps Dr. Kulmeet Kundlas explains why GLP-1 agonist prescriptions (Wegovy, Zepbound, Ozempic, Mounjaro) are frequently denied and how patients can navigate the process. He distinguishes denials based on whether the drug is prescribed for weight loss versus metabolic health conditions such as diabetes, sleep apnea, and fatty liver/NASH/MASH, noting that coverage rules differ. He discusses high cash prices ($1,000–$1,400), employer benefit exclusions, and how insurers verify approved indications. He outlines Medicare Bridge Program weight-loss eligibility tiers by BMI and comorbidities, advises patients to demand written denial reasons, and notes denials are often reversed with proper evidence and timely appeals. He also covers physician-to-physician appeals, Bridge Program resubmission requirements, and manufacturer direct-purchase programs with escalating costs as doses increase.

  6. Sep 5

    Mounjaro Heart Protection: What You Need to Know

    FDA Expands Mounjaro Approval for Heart Protection (Aug 28, 2026): What the SURPASE Trial Means for Type 2 Diabetes Dr. Kulmeet Kundlas explains the FDA’s August 28, 2026 approval change for Mounjaro (tirzepatide), stating it is now officially approved to reduce the risk of future heart attack and stroke in addition to lowering A1C, supporting weight loss, and improving related metabolic factors. He reviews the SURPASE trial, a large study across 30+ countries with about 13,000 patients, comparing Mounjaro to Trulicity and finding Mounjaro similarly protective and about 1% more effective (13% vs 12%) despite participants already maximizing blood pressure, cholesterol, lifestyle, and standard therapies. He discusses inflammation as a key mechanism via GLP-1 and GIP receptor activity, notes common GI side effects and contraindication with medullary thyroid carcinoma, and emphasizes benefits depend on continued diet, exercise, resistance training, and high-protein intake.

  7. Aug 29

    Men's Health Screening: Essential Numbers and Guidance

    pre-diabetes explained by a primary care physician. Learn about common dietary mistakes that may hinder managing pre-diabetes effectively. 00:00 Important Update 01:27 Common Mistakes to Avoid 03:28 What the Evidence Shows 05:22 Red Flags to Watch For 06:54 Final Takeaway 07:18 What You Should Do Next 08:05 What Changed and Why This video discusses common dietary errors made by individuals with pre-diabetes, emphasizing the importance of balanced carbohydrate intake, the pitfalls of relying on sugar-free labels, and the role of lifestyle changes in managing blood sugar levels. Q: Why shouldn't I eliminate carbohydrates completely? A: Carbohydrates are essential for providing vitamins, minerals, protein, and fiber. Eliminating them entirely can be detrimental. Q: Are sugar-free products always a good choice? A: Not necessarily. Sugar-free labels can be misleading and do not always mean low in carbohydrates or nutritious. Q: Is honey or coconut sugar a healthier option? A: No, honey and coconut sugar can still cause blood sugar spikes and should be consumed in moderation. Q: Can supplements replace lifestyle changes? A: Supplements like cinnamon and vinegar may help, but they are not substitutes for lifestyle changes such as diet and exercise. Q: What is the plate method? A: The plate method involves filling half your plate with non-starchy vegetables, a quarter with protein, and a quarter with complex carbohydrates. Educational content by a board-certified primary care physician. Based on current clinical guidelines and peer-reviewed evidence. This content is for education only and does not replace medical care. Dr. Kulmeet Kundlas – Primary Care, FL Board-Certified Internist in Active Practice 25+ Years Caring for Adult Patients Focus: Diabetes, Heart, Thyroid, Obesity Education Only – Talk to Your Doctor Daily Preventive & Chronic Care Management

  8. Aug 25

    Prediabetes Diet: 7 Steps to Lower Your Blood Sugar Naturally

    Prediabetes Diet: 7-Step Eating Plan to Lower Blood Sugar Without Cutting Carbs Dr. Kulmeet Kundlas explains that prediabetes doesn’t require eliminating carbohydrates or following one specific diet; sustainable, culturally acceptable patterns like Mediterranean, plant-based, or DASH can reduce progression to diabetes. He emphasizes that food quality, portion size, consistency, and overall lifestyle (exercise, sleep, stress, relationships, weight management) address insulin resistance, citing the Diabetes Prevention Program’s 58% risk reduction over about three years. Key targets include losing 5–7% body weight, exercising 150 minutes weekly plus resistance training, and using the plate method (half non-starchy vegetables, one quarter protein, one quarter carbohydrate). He advises avoiding sugary drinks, choosing whole fruit over juice, monitoring broader metabolic markers, and avoiding common mistakes like extreme carb restriction, assuming “natural” sugars are harmless, relying on supplements, or unsafe prolonged fasting. 00:00 Introduction 01:16 Is There a Best Prediabetes Diet? 03:22 Lifestyle Intervention & Weight Loss 06:39 How Food Affects Your Blood Sugar 10:29 The Plate Method 12:15 Monitoring Your Progress 13:34 Common Mistakes with Prediabetes 16:14 Your Prediabetes Action Plan 17:55 Conclusion & Sign-Off

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About

Primary Care Voice With Kundlas M.D. is your dedicated space for delving into the intricate world of Primary Care. Hosted by the experienced and compassionate Primary Care Physician, Dr. Kulmeet Kundlas, this podcast sets out to bridge the gap between medical professionals and patients, unraveling the intricacies of healthcare. In each episode, Dr. Kundlas and his expert guests dive deep into essential topics that encompass everything from preventive measures and chronic and acute disease management to cutting-edge telemedicine innovations, nurturing patient relationships, and staying updated on the latest medical trends

Information

  • Creator
    Kulmeet Kundlas M.D.
  • Years Active
    2023 - 2026
  • Episodes
    100
  • Rating
    Clean
  • Copyright
    © Copyright 2023 All rights reserved.
  • Show Website
    Primary Care Voice

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