Cheryl Martin (Host): Diabetes is a common disease affecting more than 37 million Americans. That's 11% of the population, and those numbers are on the rise. We learn what it is, how to prevent it, and more with Dr. Dhriti Das, board-certified in Internal Medicine and Endocrinology. This is BayCare HealthChat. I'm Cheryl Martin. Dr. Das, so glad you're on to talk about this disease.

Dr. Dhriti Das: I'm so glad to be here.

Host: So, first, what is diabetes mellitus?

Dr. Dhriti Das: So, the literal, I guess, Latin translation of diabetes mellitus is the siphoning of sugar, which basically is very true to what diabetes mellitus actually is. So, it is your body's inability to hold onto, to process, and to store sugar.

Host: So, what is the main difference between type 1 and type 2 diabetes?

Dr. Dhriti Das: Diabetes mellitus in general is a defect of the hormone insulin, which is produced by our pancreatic beta cells. The main difference between type 1 and type 2 diabetes mellitus is that in type 1 diabetes mellitus, there is an absolute insulin deficiency or a lack of insulin being produced by your beta cells due to an autoimmune process. Whereas in type 2 diabetes, your pancreas and your beta cells are still making insulin, however your body has become resistant to that insulin and you need more and more amounts to do the same functions that you normally would have to do under the same conditions. So, your body becomes resistant to insulin and you need more and more in order to process the same amount of sugar.

Host: So, then, type 1 is more serious?

Dr. Dhriti Das: Type 1 is a disease that can only be treated with the replacement of insulin. So patients who have type 1 diabetes mellitus, because their body is not making insulin, they require multiple daily injections of insulin for treatment. Whereas type 2 diabetes mellitus doesn't necessarily require treatment with insulin. It just depends on how far along you are in the disease process or how resistant to insulin you are.

Host: How would a person know that they have diabetes?

Dr. Dhriti Das: Usually, there are routine tests that your general doctor, your primary care doctor do, especially after a certain age. Type 1 diabetes mellitus, because it is autoimmune, it is typically diagnosed at an earlier age. It used to be known as juvenile diabetes mellitus, because once your body realizes that there's an absolute lack of insulin, is when you usually start having symptoms like increased thirst, increased urination. Usually, you start losing a lot of weight, because none of the nutrients that your body is taking in are being stored. It's kind of just being spilled out in the urine. Whereas usually with type 2 diabetes, patients are not generally symptomatic or they don't really know that anything wrong is happening. It's usually on routine blood work that type 2 diabetes patients realize or are diagnosed with type 2 diabetes.

Host: So, that's really a good reason to make sure that you are getting your blood tests on a regular basis then.

Dr. Dhriti Das: Absolutely. Especially if you have a family history of type 2 diabetes, heart disease.Type 2 diabetes is also more likely to occur if you have a family history. And like I said before, because type 1 diabetes is more autoimmune or an autoimmune process, it's less common and more sporadic.

So, type 2 diabetes is preventable, I would say. And once you know that you're at increased risk, there are steps that you can take to prevent it from progressing or delaying the onset of complications.

Host: I'd like for you to talk about what can be done since you mentioned that type 2, that's good news, diabetes is preventable. What are some of the things that people can do?

Dr. Dhriti Das: Almost every medical study that's been done on prevention of type 2 diabetes and prediabetes has shown that the easiest or, I guess, the simplest thing that people can do to prevent the onset of prediabetes and type 2 diabetes is live a healthy lifestyle. So, eat a healthy balanced diet and incorporate activity into your daily routine. Even light exercise, as simple as walking, you know, taking a stroll after dinner every night is beneficial in helping prevent the onset of type 2 diabetes, because as I said before, it is insulin resistance. And usually, insulin resistance  goes hand in hand with overweight and obesity. So, overweight and obesity are very inflammatory processes, and one of the inflammatory processes that occurs in overweight and obesity is the insulin resistance itself. So, the most important thing you can do to prevent the onset of prediabetes and type 2 diabetes is live a healthy lifestyle.

Host: And what if a person is already in the prediabetes range?Is the A1c the best blood work to determine if one has prediabetes?

Dr. Dhriti Das: I would say that it is. There are a couple of other lab studies that might clue your doctor into you having what we call impaired glucose tolerance. So, fasting glucose after at least an eight hour fast in the morning. If it's somewhere between 100 and 126, we usually kind of have an idea that maybe you're not processing sugar or glucose the way that you should be. But you're also correct in saying that the hemoglobin A1c, usually a value between 5.7% and 6.4% is consistent with prediabetes.

Host: So, should a person in that range even more so attempt to get it down and get it out of that prediabetic range?

Dr. Dhriti Das: Yeah, absolutely.  Once you are above that range, so once you're 6.5% and above, and you have a diagnosis of type 2 diabetes, it is a lot quicker or a lot, for lack of a better term, for you to develop complications once your glucose is already too high. So if you are in the prediabetes range or your A1c is in the prediabetes range,  that is a great time to start making some lifestyle and diet changes and kind of get on a better track.

Host: Now, you talked about type 2 diabetes and if someone has already been diagnosed there. Talk about the risk factors of being in that group.

Dr. Dhriti Das:  The biggest risk factor is heart disease. So as I mentioned before, overweight and obesity are extremely inflammatory processes . And one of the things that insulin resistance contributes to is cardiovascular disease, so more and worse atherosclerosis or the formation of plaques in your blood vessels. So, patients with type 2 diabetes mellitus are absolutely more likely or more at risk for having heart attacks, strokes, and other major adverse cardiovascular events.

Host: I saw the statistic that one in five Americans don't know that they have diabetes. Are you surprised by that?

Dr. Dhriti Das: I'm not at all surprised by that. I mean, I would say, even in terms of type 1 diabetes mellitus, because it is more often associated with a younger age group, I have had patients in their 60s and 70s come into the office with hemoglobin A1cs that are greater than 14, greater than 16, and they tell me they've been healthy their entire lives. They've never been sick. They never felt like they were more thirsty than usual, peeing more than usual. And then, we do some additional lab work and we find out that they have pancreatic autoantibodies, so they have type 1 diabetes.

And the same could be said for patients with type 2 diabetes as well. I mean, one of the things that I see on pretty much a weekly basis is patients who are admitted to the hospital, again, with hemoglobin A1cs that are in the double digits, over 10%, and they come in with chest pain, or they come in with left-sided weakness, or something like that, because they had some adverse cardiovascular event before they actually realized or were diagnosed with type 2 diabetes, and because you're so much more likely to have vascular disease with type 2 diabetes, it's usually, which came first? That's the question that a lot of patients ask. It's like, "Oh, well, I never even knew that I had type 2 diabetes, so did I have a stroke because I had type 2 diabetes? Or did I already have increased cardiovascular risk?" And the answer to both questions is yes. You probably were at increased risk already, but the fact that you also had new-onset or type 2 diabetes without knowing also increased your risk.

Host: I’m glad that you mentioned looking at your diet, because I'm wondering the fact that we have so much sugar in our diets or so many carbs that these are two factors that really impact our levels of a high A1c, what we are eating, especially in those two categories.

Dr. Dhriti Das: Yeah. I mean, you're absolutely right. And one of the things that I also tell my patients probably on a daily basis is we have to be realistic with our expectations and it's impossible for us to tell ourselves or to tell anyone never eat another carbohydrate in your entire life. And I think I would be the biggest hypocrite to tell anyone that, because I myself love carbohydrates. Who doesn't? But what's important is enjoying certain foods in moderation and if you are someone who eats a lot of carbohydrates or it's part of your culture to eat a lot of carbohydrates, I think it's about choosing the right ones. You know, an example I can give is my family is Indian, so we have rice every single day, or I grew up in a house where there was white rice every single day. And then, as I got older and older, I kind of had like a talk with my parents about not only my increased risk, but their own increased risk for diabetes if we have white rice every single day. And that's a very specific example, but there are lots of replacement foods that we can consider like cauliflower rice instead. It's a vegetable. And even though it's rice, it's higher in fiber and it's better for you in general than just plain white rice. So, just little things like that or little changes like that are important and they do make a really big difference.

Host: Well, Dr. Dhriti Das, thanks for educating us on diabetes and how to manage and prevent it. Very informative conversation. Thank you.

Dr. Dhriti Das: Absolutely. Thank you for having me again.

Host: And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media. And be sure to check out all the other interesting podcasts in our library. Thanks for listening.