Transcription:
How to Live Better with Diabetes

Melanie Cole (Host): If you’re one of the many who struggle with managing your diabetes, you may have questions about how best to live with and manage it so that you can live a healthier lifestyle. My guest today is Dr. Phuong Nguyen. She’s board certified in family medicine at Baycare Health. Dr. Nguyen what happens when we eat and why do we need to understand insulin and blood sugar and their relationship?

Dr. Phuong Nguyen (Guest): We need to first understand that there are two types of diabetes. Diabetes has type 1 diabetes and type 2 diabetes. Now with type 1 diabetes, the body cannot produce insulin well and insulin is the hormone that breaks down the sugar in our bodies. So what happens in type 1 diabetes is the body’s immune system destroys the beta cells in the pancreas that are responsible for producing insulin. Now type 1 diabetes is going to be seen more in childhood and adolescents. Type 2 diabetes is known as adult onset diabetes where the production of insulin exists but the body can’t use it effectively because the insulin resistance builds up as sugar builds up in the blood, and that has to do a lot with someone’s lifestyle management.

Host: So we’re talking today mainly about type 2 diabetes, which you physicians are seeing more and more in children as well as a result of the obesity epidemic and sedentary lifestyle. You speak about some of the causes that we’re seeing from kids on up to adults and what puts you at risk for diabetes?

Dr. Nguyen: Definitely weight is a huge factor. According to a report in the CDC National Center for Health Statistics recently there’s one in seven adults with diabetes and 10% of them are aware, and so that is not a huge percentage. So there’s a lot of undiagnosed out there. Definitely if you have obesity, it puts you at risk, and we’re finding about 21% of adults with obesity have diabetes. Then there’s the overweight adults, 12% of those have diabetes, and even if you’re under weight or normal weight you might have diabetes. That’s about 6% of adults.

Host: Wow it really is some staggering numbers, and what about the complications of diabetes. If someone has type 2, what other comorbidities can come with a diagnosis or disorder of diabetes and if it’s undiagnosed, what are some of the complications that could happen?

Dr. Nguyen: Right, the worst case scenario if you don’t know you have diabetes, you might develop a heart attack or stroke and never knew that you had diabetes until you’re admitted into the hospital with, if they’re able to save you, they find out. That would be the worst case to find out whether or not you have diabetes. If they know you have diabetes but you’re unable to control it, blood sugar builds up in the body, that can cause blindness, that’s what we call retinopathy and sometimes it can lead to kidney dysfunction and that’s called diabetic nephropathy and all can increase your mortality.

Host: Are there any symptoms? Is there anything we’ve heard with juvenile diabetes and type 1, the thirst and that sort of thing? Are there any symptoms that you would notice if you are at risk for type 2 diabetes or even prediabetes?

Dr. Nguyen: Yeah, sometimes you could feel very weak or very tired, and that is a signal of blood sugar being too high in your body. Some people can present with dizziness, some people can faint, and that would be pretty much very uncontrolled diabetes, but sometimes there’s no symptoms at all, especially if your diabetes is not that advanced yet, then you might not know. So it’s very important that every adult has a primary care physician, goes in annually for their visit to find out if they should get tested for diabetes or not.

Host: Then speak about testing a little bit. We’ve heard this term A1c and fasting glucose. So tell us what the testing for diabetes is and then why is it important to know those numbers?

Dr. Nguyen: The hemoglobin A1c is the lab test that’s most popular for diagnosis of diabetes or prediabetes. Hemoglobin is a protein our red blood cells that carries oxygen. The hemoglobin A1c measures the percentage of how much of that hemoglobin is coated with sugar. So you can imagine the higher the number, the more chances you have prediabetes or diabetes.

Host: Now let’s talk about managing and if you’re told that you’re prediabetic, can you stop the process or is it inevitable, and where does diet fit in to this whole diabetes management and/or prevention?

Dr. Nguyen: Definitely lifestyle management can reverse prediabetes and get you back to normal. That’s going to be maintaining your body fat index. That’s the measure of body fat based on height and weight, and that’s how we’re able to calculate if someone is overweight or obese. In order to get to a healthy body mass index, you have to make the right healthy food choices. To learn how to lose weight, you have know that only 25% of your calories can come from fat. You’ve got to avoid those fatty foods, things like deli meats, hot dogs, snack foods, candies, pastries, things that are easy to grab so you have to motivate yourself to say no to those things and exercise. You can combine exercise with a healthy diet, you can lose weight and you can keep it off and that exercise is for your heart along with it.

Host: So back to food for a second because we’ll touch on exercise because exercise has an insulin like effect and it’s so profound, the effect that exercise can have on diabetes and prediabetes, but people also hear this term low glycemic index. So what does that mean when you’re trying to look, you know obviously you don’t want to eat junk food or processed food, but what types of food, because also doctor, people hear carbohydrates and right away they think bad but not all carbohydrates are created equal, yes?

Dr. Nguyen: Exactly, so there are certain carbohydrates, which we call simple carbohydrates, that are bad. Those are the obvious things like sugar, candy, ice creams, desserts, those are obvious ones, but when you’re choosing between what to eat in terms of bread, wheat bread is going to be better than white bread for instance, brown rice is better than white rice. So more complex carbohydrates is going to give you more energy and you’re going to utilize that sugar rather than let it dissolve into your blood and not be used and besides the quality of the food, you want to look at the quantity. Obviously, you can’t go for a whole plate of brown rice. It should only be a quarter of your plate, the carbohydrates for lunch and dinner so the plate planner method is an easy way that I coach my patients, you know in terms of how much food they should be eating.

Host: How much exercise should we be doing every week to hopefully stave off some of the side effects and comorbidities.

Dr. Nguyen: The American Academy of Family Physicians, we have agreed that we should all aim to get at least 150 minutes of exercise per week, and this should be moderate to high intensity exercise for it to work, and so you can divvy it up. I always tell my patients if there are five days that you can get to exercise, that’s going to be 30 minutes on those five days to add up to 150. If they don’t have five days, just four then that would be 45 minutes on those four days. But I always like to tell them, you know, don’t go more than two days without exercise because once you do that, you’re falling off the band wagon in terms of regular exercise and trying to get yourself into that routine.

Host: So in terms of managing your diabetes, how often or if at all should you be checking your blood sugar?

Dr. Nguyen: The blood sugar should definitely be checked if you’re on insulin, and depending on your regimen, that could go up to as much as three times a day of checking depending if you’re on fast-acting insulin or just basal insulin. For my patients who are not on any medications because some are controlling it through lifestyle or if they’re just on the oral medications by mouth, they don’t necessarily have to check it at all because that has been shown to actually, with evidence based medicine, it hasn’t been shown or proven that it actually leads to better control of diabetes, but a patient with diabetes should have a glucose monitor on hand, especially when they’re on any medications that can lower their blood sugar because of hypoglycemia. If they feel weak or low as we like to call it, their blood sugar might be low. So they need to check, and if it’s low they need to have glucose on hand, like orange juice or glucose tablets in order to get their blood sugar higher. The hemoglobin A1c is going to be the lab test that we run every three months to check how well controlled their diabetes is.

Host: Doctor, you mentioned the comorbidities before of cardiovascular disease, and high blood pressure, and stroke, these are all things that could go along with diabetes, but there are some other sometimes lesser known things if someone is struggling with their diabetes and they’re trying to manage it. What other things like foot health and eye exams, wounds that don’t heal would you like them to pay attention to?

Dr. Nguyen: Every diabetes patient should check their feet regularly because if they do develop neuropathy, they might not be able to feel if they stepped on something, and that could lead to infections and wounds and amputations so it’s very important that not only do they follow up with their primary care physicians where the physician can do a clinical foot exam, they need to be regularly looking at that as well, and we advise our patient to see their ophthalmologist every year at least to make sure there’s no diabetes in their eye.

Host: It’s really important information, if you would wrap it up for us with your best advise about how to live better with diabetes, what you would like the listeners to take away from this to live that healthy lifestyle, to do the exercise and eat healthy so that they can hopefully prevent it in the first place.

Dr. Nguyen: My last advice would be that they’re not in it alone. That if they’re diagnosed with it there are certainly many other people with diabetes and they need to ask their physician about resources around their communities, make it more effective that they will achieve their diabetes A1c goals, not just that but lower their blood pressure. So for instance we have diabetes education classes that we refer our patients to. They can go one on one with a nutritionist or dietitian. If they can afford it, they can also get a personal trainer to help them formulate a way to exercise that they can actually fit into their lifestyle and routine. So I don’t think anyone should go at it alone. They definitely have their primary are physician on board on their team and there’s so many resources out there.

Host: There certainly is and thank you so much for coming on with us today and for explaining and really how to live better with it or even possibly prevent it in the first place. You’re listening to Baycare Health Chat. For more information, please visit baycare.org, that’s baycare.org. This is Melanie Cole, thanks so much for tuning in.