Maggie McKay (Host): Welcome to Arbor Health and Life Podcast. I'm your host, Maggie McKay. With me is Dr. Travis Podbilski, family medicine physician at Arbor Health, as we talk about diabetes. Thank you so much for being here.

Travis Podbilski, D.O.: It's my pleasure.

Host: Let's dive right in with what are the most common types of diabetes and how do they differ in terms of causes, symptoms, and general management?

Travis Podbilski, D.O.: Great question. There are two main types. And so, you'll hear most people talk about type 1 or type 2 diabetes. Type 1 diabetes is the one that needs to be treated with insulin. It's the one that's usually diagnosed earlier in life, and it's a disease where the pancreas just does not make the insulin needed to lower the blood sugars. Those folks are treated with insulin. And then, there's type 2 diabetes, which is most often developed later in life, most commonly due to lifestyle, diet. And that's treated with a wide range of different medications, both oral, insulin. But the best thing to do for type 2 diabetes is lifestyle changes, diet, exercise, things like that.

Host: What are some common misconceptions about diabetes that patients and families should be aware of?

Travis Podbilski, D.O.: I think the most common misconception in speaking about type 2 diabetes in specific is that they're stuck with that. That's a diagnosis that they are going to have for the rest of their lives, and they have to deal with whatever consequences that might be, including medications when you can actually cure type 2 diabetes. And you have the power to do that all on your own with just making some lifestyle changes.

Host: I worked with an engineer who had crazy hours for decades, and he got type 2 diabetes and he said, "I'm going to turn it around." And I thought, "Can you do that?" And he did, and a real 360. So, you mentioned lifestyle changes and the impact on the management of type 2 diabetes. What are some practical steps patients can take to do that?

Travis Podbilski, D.O.: The first thing is just to move. A lot of us, we work, you mentioned that gentleman worked long hours. And so, we work long hours and then we go home and maybe we cook dinner, maybe we pick up dinner on the way home. And then, we sit down and we watch TV and that's sort of the lifestyle that we have. We work, we relax. And our relaxing is watching TV and sitting down eating food in front of the TV for the most part.

The very first thing I recommend people do is just move, do something that gets you moving and don't go home and sit down right away. Whether that's something simple as going for a 20-minute walk before dinner or a 20-minute walk after dinner if you have time in the morning doing a little bit of movement. There's specific exercises that we could talk about when we start getting, I suppose, nitpicky, but just doing something active and restorative for your body and moving on a daily basis is the primary thing. That's the first thing I ask people to do.

Host: Some people I know do it before they go home. Like at work, they'll stairs or something. I thought, wow, if you're that disciplined, that's great.

Travis Podbilski, D.O.: Yeah, I think that's fantastic.

Host: Yeah. Can you talk about the importance of diet in managing diabetes, because I know that's a big one and what a balanced meal plan looks like?

Travis Podbilski, D.O.: Yeah, absolutely. Yeah. In type 1 diabetes, balanced meal plans are very important. You know, you're giving yourself insulin and so you want to make sure that you're eating the appropriate amount of food to manage that insulin that you're giving yourself so you don't have any low blood sugars. With type 2 diabetes, the food is extremely important, and that's the way you can really empower yourself to make lifestyle changes and change the course of a disease process that if not intervened upon, can cause lots of really bad health outcomes: heart disease and kidney disease and all sorts of things.

And so, making sure that you're eating an appropriate amount of carbohydrates. You know, our diet in the United States and in a lot of Western countries is we eat a lot of fast food, we eat a lot of processed foods. They're easier, they're cheaper, they're convenient. But those ultraprocessed stuff doesn't work well with our bodies. And so, eating a diet based around lean meats, vegetables, fruits, not adding sugar to things, that's a process that you need to make small changes on. But the diet's very important. Eating a healthy diet that's low in processed carbohydrates and sugars is very important.

Host: So now, we have mobile apps. We have wearable devices. What is the role of technology in supporting diabetes management?

Travis Podbilski, D.O.: I guess the game changer is the wearable stuff. So, the continuous glucometers are very helpful. A lot of times, they're trying to figure out, "Gosh, I've been eating as good as I can. I'm not sure why my blood sugars are still so high. I'm eating fruits and vegetables and then you find out maybe you're really sensitive to grapes. And grapes are pretty high in sugar or you're sensitive to bananas, which are also high in sugar. And so, you think you're doing something good for your body, but it's just learning how to make those different choices of foods that are in the appropriate food groups, but perhaps maybe you are just more sensitive to. So, wearing that continuous glucometer, you can see in real time the changes. And that's been very eye-opening for a lot of the patients that I treat with diabetes, because then they get to see that in real time. "Wow. I didn't think that beans were that bad." I have a patient that told me beans skyrockets her blood sugar, so like the 230s, 250s. And so as she stopped eating beans, that made a huge difference for her.

And so, the wearable technology is amazing because you get every 10 seconds or whatever your device is, you get a blood glucose measurement. And then, you can look at graphs over time and, if you're on medications or insulin, for example, you can find out the impact your medications have. Maybe you can adjust the doses of those medications based on certain times of day. So, they're very helpful in managing diabetes, mostly just because I think it opens people's eyes to the effect that food actually has on them in real time. And they're not looking at that A1c they had last month, or that blood glucose check they did with their fingertip that morning. They can actually watch and see that, which is sometimes very impressive.

Host: Isn't that amazing? Did you ever think when you got into this that there would be wearable technology to help?

Travis Podbilski, D.O.: Yeah. I mean, you go back 30 years and we had insulin and metformin and glucometers. And the changes over the last 30, 40 years have been amazing and pretty fast. The technology is really something these days.

Host: Thank goodness. What are some common complications associated with diabetes and what can be done to prevent them?

Travis Podbilski, D.O.: The main ones that you really think about with diabetes, neuropathy, you talk about people with diabetes, they have neuropathy. They have that stinging pins and needles sensation in their feet and their legs. Kidney disease, which can cause problems processing fluid balances in the body. You have eye disease, there's something called diabetic retinopathy. One of the feared complications of uncontrolled diabetes is unfortunately blindness. There's cardiovascular disease. Diabetes is considered an independent risk factor for coronary artery disease. And by that, I mean heart attacks. And so, it's like smoking or having high cholesterol that can be very negative on your heart and your cardiovascular health.

And really, the main thing to do about that stuff is to decrease the blood sugars. you think about those things. And so, the kidneys, the eyes, the heart, the nerves, all these, their blood supply comes from these very small blood vessels. And so, you can imagine if you've got your blood flowing through your veins, if you think of them as like a rubber tube, and then you put a bunch of sugar in that fluid. And so if you notice when you make sugar water, for example, you can feel those granules in the sugar, and that can start by causing very small damages to the insides of the blood vessels, which leads to further damage. And so if you take away those elevated blood sugars and you don't have that problem. And so, the lowering of blood sugars is the primary thing to do to prevent all of these poor outcomes with diabetes.

Host: Other than a blood test, how would you know you had diabetes?

Travis Podbilski, D.O.: There's different symptoms you can feel. Some folks just don't feel very good. You know, they feel sweaty, maybe their heart rate's going up. They don't feel good on a daily basis. some people start to pee a lot. And so, you'll notice the body's trying to get rid of some blood sugar. Surprisingly, initially, you might even have a little bit of weight loss. But the most notable symptom is someone who's just really peeing quite a bit. They notice, "Now I have to go to the bathroom all the time." There are certainly many reasons for that, but if you're having something like that, you should certainly go talk to your doctor because you could either get a diagnosis of diabetes by doing some screening or perhaps something else.

Host: In closing, is there anything else you'd like people to know?

Travis Podbilski, D.O.: You know, really, I think the most important thing to know, you know, I mentioned earlier is that diabetes is not a thing that you have to live with. You can cure diabetes, if we're talking about type 2 diabetes. It takes some work. But I have dozens of patients that have done it, and those stories are really impressive that they're really just so uplifting and it gives me joy in the daily stuff that I have to do as a primary care doctor.

And so if you talk to your doctor about diabetes and the fact that you can actually cure it, you don't have to be on insulin. You don't have to take a bunch of different medications if you're willing to do the things. And by that, I mean some exercise, some lifestyle changes, some dietary changes, talking about different recipes, expanding your home cooking skills, and just becoming a happier, healthier person, you can really do that.

All of us have the power to be able to change our future by doing those sort of things. And it's not just diabetes that you can prevent or sort of back up from and get rid of that sort of thing. It's all the aspects of your life and the health that helps you be happy and healthy and live a long future without any problems, disease or otherwise.

Host: Well, this has been very encouraging and inspiring. Thank you so much for sharing your expertise.

Travis Podbilski, D.O.: No. Yeah, it's been my pleasure. Thanks for having me, Maggie. I hope people become interested in that and maybe look into seeing their doctor or some other stuff online and make some positive changes in their life.

Host: Absolutely. That's Dr. Travis Podbilski. To make an appointment with Dr. Podbilski, call 360-497-3333. That's 360-497-3333. If you found this podcast helpful, please share it on your socials and check out our entire podcast library for topics of interest to you. Thanks for listening to Arbor Health and Life, a podcast from Arbor Health.