Melanie Cole (Host): Welcome to Bryan Health podcast. I'm Melanie Cole. Today, we're discussing living with diabetes, what you can do to manage your symptoms and really to experience a better quality of life even if you do have diabetes. Joining me is Samantha Beckler. She's a certified diabetes educator with Bryan Health.

Samantha, I'm so glad you could join us today as we learn about diabetes. Can you tell us about the different types that are out there?

Samantha Beckler: Yes, I can. The different types of diabetes all start with too much sugar in the bloodstream. There's type 1 diabetes, type 2 diabetes. There's a type of diabetes they call 1.5 and there is a type of diabetes called gestational diabetes. They all start with too much sugar in the blood and they all have to do with the fact that there's not enough insulin to help the sugar get into the body's cells.

Diabetes is really about insulin not helping the cells get fed. So when we eat, our body's insulin moves the sugar that we eat into the cells and helps us digest so that we have energy for our day.

Melanie Cole (Host): Well, thank you for that. And it's really such a prevalent disease today and this insulin resistance that we're seeing, you know, people are learning more and more about it. So tell us a little bit about diagnosis. What symptoms might somebody experience, you know, that even would send them to the doctor in the first place?

Samantha Beckler: Generally, the first symptoms, if you feel any at all, would be thirst, to be thirsty or to be hungry, to have some extra tiredness in your day and maybe some more urination than you're used to, in particular at night. But most people who have diabetes don't feel any symptoms at all.

Melanie Cole (Host): That's so interesting. So is there a screening program for this? Is there a protocol? Tell us a little bit about how it is diagnosed. And when we get those well visits and they do that fasting blood glucose and we've heard about that, we've heard about A1c. Can you explain all about diagnosis for us?

Samantha Beckler: So to screen for diabetes would be best done with your primary care doctor or with your well visits. How they will screen you for diabetes is to take blood work and look at your glucose level. Glucose is a measure of sugar in your blood and to see how much glucose or sugar you have at that one time. If they do a further screening with a hemoglobin A1c, that is a measure of sugar in your blood level over three months, giving them a really good idea whether this is a chronic problem or a one-time today problem.

Melanie Cole (Host): Well, then tell us a little bit about if someone's gotten that diagnosis, they've been told maybe even that they have prediabetes, which is really our body's warning system, right? Can you tell us a little bit about what is the first line of defense? What does someone do if they're told that they are prediabetic or that they have full-blown diabetes? As the educator that you are, what do you tell them they need to do pretty quickly?

Samantha Beckler: So prediabetes is a diagnosis that says that you are very likely to develop diabetes in the near future unless some things can be changed. It's about the screening still, it's not about weight or height or lifestyle. It's about the blood sugar number and where it is at that time. A prediabetes screening would be a blood sugar before you eat, somewhere between 100 and 125. Once you hit 126, that indicates a diabetes diagnosis.

No matter which kind of diabetes you have, whether it be pre, type 1 or type 2 or gestational, the best way to treat it is balance, balance with the food you eat, the exercise you do, and the medications you need to take care of it.

Melanie Cole (Host): Who does that? What kind of specialists? Tell us a little bit about your team and the doctors and nurses and diabetes educators that help people once they do get diagnosed.

Samantha Beckler: It is best to have a team for your diabetes care. And I think it starts first with having diabetes educators to help you learn what diabetes is. Educators are nurses like myself or dieticians or exercise specialists that are specifically trained in teaching diabetes self care. Understanding what you need to do to take best care of you and then working with a doctor to help with prescribing medications if that is needed still after being diagnosed.

Melanie Cole (Host): So then let's talk about what that means, Samantha. So how often should people be checking their blood sugar? How do we know how our blood sugar is? If somebody is on medication or they're taking your advice about diet and exercise, how often should they be checking their blood sugar? How do we know whether it's working?

Samantha Beckler: How often you should check your blood sugar is really up to your doctor and you. Some people who are just on the prediabetes scale would need to check their blood sugar maybe once in the office every three months. Those people who have diabetes and are on medication really need to check their blood sugar at least once a day. But depending on the medication, it may be up to six times per day that they need to check, in particular those people who have to take insulin to balance their diabetes best.

Melanie Cole (Host): And now, onto food, I mean, we could really talk all day about this, but I think this is where so much of the confusion lies with people who have been told they have diabetes or prediabetes. You know, carbs, carbohydrates, the big, bad word, but that's not true, right? Not all of them are created equal. Can you give us an example of a healthy diet, ways that people can eat these very low-glycemic foods, foods that are healthy for us, but can also help to regulate our blood sugars, because not all carbs are bad, right?

Samantha Beckler: Absolutely. At my office and at the Bryan Diabetes Center, we follow an approach that there are no good and bad foods or good and bad carbs, and that all foods can get into a healthy meal plan if arranged properly. Of course, dieticians and diabetes educators can absolutely help with that. But if you have a high sugar food that does not have a lot of vegetable or protein attached to it. It does digest quicker and raise the sugars higher than other foods. So oftentimes, we do look at whether you eat a lot of high sugar foods or not when you do talk to diabetes educators and doctors.

Melanie Cole (Host): It certainly helps to control it when you can understand those things. And what about exercise, Samantha? Where does that fit into this team picture and multidisciplinary approach for people with diabetes?

Samantha Beckler: Exercise is almost as good as a medicine for diabetes. It actually assists the insulin into helping the sugar molecule into the cells. And so it's one of the best things you can do for your diabetes, is to be more active.

Melanie Cole (Host): So tell us a little bit about the treatment options for people for whom lifestyle and exercise have not worked, their diabetes is still really not under good control because there's complications, eye issues, foot issues, wounds that won't heal. What medications and things and treatments are out there now that you're most excited about that you've seen really work well for people?

Samantha Beckler: Well, first, I want to let everybody know that if lifestyle and exercise management haven't helped, I want you to first make sure that you find somebody who is resource for that. Talk to your dieticians, talk to the diabetes educators, talk to your exercise specialists and your doctor, and make sure that you really have failed first, because maybe you felt like you were doing it right. I hear a lot from people that "I eat good. I eat really well," but maybe they didn't know what foods had carbohydrates to start or how to exercise and be improved by it and they felt overwhelmed and gave up.

So that is the first thing I wanted everybody to know, and that diabetes is not caused by food and lack of exercise. It's really caused by this high sugar level that is usually genetic and not because of overweight or lack of motivation. And when we do treatment, we really do have to think about that balance. It's not just medicines that we want to put you on. We want to have the medicines match the right foods and exercise that people do. And of course, checking blood sugars is the way that we know if these are all working.

The best help on the market today for managing all of this is to get more information from blood sugars and that's with a continuous glucose monitor. The continuous glucose monitors are small wires put underneath the skin that sends blood sugar information to something that can read it like a cell phone or a controller, and that allows people to see what they're doing that works for their diabetes care. And there are also many new medicines out there for diabetes care that not only help diabetes, but help people's hearts and kidneys too.

Melanie Cole (Host): Well, sure, because there are comorbidities and there's so many tools in this armamentarium of therapies for people with diabetes. Samantha, as we wrap up and you've told us such great information about your team at Bryan Health today, give us your best advice for lifestyle management, even eating out for people that have been told that they have prediabetes or diabetes and why they should look to Bryan Health for their care.

Samantha Beckler: My best advice is to get help, to see a diabetes educator or health coach that can really help you guide and meet your goals for your best health, whether it be diabetes or heart disease or any of the chronic diseases. Let somebody help you is my best advice and to make goals because small goals are easier to reach than I-want-to-lose-30-pounds big goals. And so making a small goal of walking 5,000 steps a day or drinking one less soda a day is absolutely going to help. So I guess to recap my answer, I think small goals and getting help.

Melanie Cole (Host): Really great advice for anybody. Thank you so much, Samantha, for joining us today and telling us about diabetes education at Bryan Health. And thanks to our Bryan Foundation Partner, Union Bank and Trust. You can always head over to our website at bryanhealth.org for more information and to get connected with one of our providers.

That concludes this episode of Bryan Health podcast. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole. Thanks so much for listening.