Transcription:
Lifestyle Strategies to Manage Pre-Diabetes and Diabetes

Maggie McKay (Host): If your doctor tells you you have pre-diabetes, there are probably a lot of questions swirling around in your mind, like "Why me?", "Was it preventable?", "Will I have to change my diet?" and more. Joining me today is Laura Moran, a certified diabetes care and education specialist at Capital Health. We'll discuss lifestyle strategies to manage prediabetes and diabetes, what the symptoms are, how to prevent or manage diabetes and much more.

This is Health Headlines, a podcast from Capital Health. I'm your host, Maggie McKay. Thank you so much for being here, Laura. Let's start from the beginning. What is prediabetes?

Laura Moran: Hi, thanks for having me. So prediabetes is a condition that's characterized by elevated lab values that would potentially be indicative of a risk of developing what we call type 2 diabetes. So specifically, those lab values that we would be looking at in prediabetes would be something called a fasting blood sugar, an A1c, or even a random blood sugar reading. So a fasting blood sugar reading between the values of 100 to 126 would be a sign that that individual has potentially prediabetes. Also, an A1c value of 5.7% to 6.4% again is characteristic of prediabetes. And a random blood sugar, meaning a blood sugar taken five minutes after you eat, five hours after you eat, it doesn't really matter, if that blood sugar value is somewhere between 140 and 199, we would question whether or not that person is developing diabetes. So, regular routine blood work with your physician could potentially lead to a diagnosis of prediabetes.

Maggie McKay (Host): So, is there any other way, you know, symptoms to look for? How would you know you had it other than taking that test?

Laura Moran: So there are some things that people would potentially be at risk for developing prediabetes. And so individuals who are more overweight have a higher risk of developing prediabetes, individuals who are more sedentary in their lifestyle would have that risk of developing prediabetes. But the true diagnosis would come from lab values.

Maggie McKay (Host): Okay. So there are no symptoms to look out for?

Laura Moran: So, as we start talking about the symptoms, usually prediabetes, and the reason why we want to start looking for lab values is because it is asymptomatic. You're not necessarily going to know it until you're really symptomatic. And that's when we start looking at things that would lead you then to diabetes. And so I'm not sure if you're gonna ask me about the diabetes symptoms, but things like being more thirsty, going to the bathroom more, those are more significant of higher blood sugar values. And when patients start to come to see us and they have those symptoms, usually that's more indicative of type 2 diabetes, so we've kind of passed that prediabetes stage.

Maggie McKay (Host): And so what are the different types of diabetes and what are the risk factors? Like if you have diabetes, what could you be facing potentially?

Laura Moran: So, there are two main types of diabetes. Type 1 diabetes is what we used to call juvenile diabetes if you're as old as I am. And that is more of an autoimmune situation where the body has attacked, if you will, the cells that make and release insulin from the body. And so in this particular situation, this particular case, that person has pure insulin deficiency. They don't make insulin anymore, they're deficient in it. And therefore, the only medication that we can give a person with type 1 diabetes is what they lack, which is insulin. So that represents about only 5% of the population of individuals with diabetes.

Maggie McKay (Host): And can babies be born with prediabetes or diabetes?

Laura Moran: So, not usually at birth. But usually in children, we're going to see the diagnosis in young children, adolescents, early adulthood, but not usually at birth. It's not something that the baby would be born in the NICU. And then, we discover it at that time. It's something that develops because we need that time for the body's autoimmune system to start doing that work against the cells.

Maggie McKay (Host): So there's prediabetes and what other types?

Laura Moran: So the other type of diabetes, which is I think what people think of when we talk about diabetes, is type 2 diabetes, and this is the more common type of diabetes. And this situation starts out with a situation called insulin resistance. And it can progress to a point where the body actually doesn't make insulin and, again, that's insulin deficiency. But this is the situation in the body where we want to start working on some lifestyle modification. We want to look at a different array of medications that might be able to help that individual. There's a vast array of oral medications, even injectables that can help a person with type 2 diabetes.

Maggie McKay (Host): And what are some ways that someone can prevent getting diabetes to begin with?

Laura Moran: So diabetes prevention really boils down to a healthy lifestyle. This is what I preach all day, every day. It's not rocket science. It's not anything with dietary omission, it's making your meals more sensible and balancing them and including healthy activity. And that's the best thing that you can do.

Maggie McKay (Host): So if you're diagnosed with prediabetes, is it reversible, like if you change your diet?

Laura Moran: Absolutely. There's enough studies out there that show that we can not only delay, but we can prevent the onset of type 2 diabetes.

Maggie McKay (Host): What are some of the risk factors if you already have diabetes?

Laura Moran: Right. So an uncontrolled or diabetes that is not well-controlled can lead to a multitude of system issues. So if you think about your bloodstream flowing nice and freely, and then we start throwing in a bunch of sugar in there, and that bloodstream starts getting thick and sticky. Think of that syrup, right? So that thick, sticky blood moving through your bloodstream has a multitude of issues that it can cause. So it can cause cellular damage, which can then lead to tissue damage, which can then lead to organ damage. And that organ damage can be vast from your brain to your heart, to your nervous system; to the vessels themselves, so there's cardiovascular problems that can happen; kidney problems that can happen; visual changes that can occur because of this as well, which can include up to blindness; nervous system issues that can occur up to and including amputation of the lower limbs as well. So lots of different issues that can occur with diabetes that is not well-controlled. And, again, it's why I and my colleagues have jobs here because knowledge is power and learning how to control or manage, I should say, your diabetes on a daily basis is hard work and a support system is needed. And that's really why we're here.

Maggie McKay (Host): In addition to eating a healthy diet, what are some other ways to best manage diabetes?

Laura Moran: If you have diabetes, definitely you want to be meeting with your physician on a regular basis. If blood glucose monitoring is part of that plan of care, then you want to be checking your blood sugar on a regular basis and providing those numbers, whether or not they're in range. And I know some patients, they tend to get nervous, like, "Oh, my blood sugars are really high. I'll just leave my meter at home and we won't really talk about it," but that's to somebody's detriment, right? So we're here to support you and certainly not to be punitive in any way. And we want to know when things are not going well. So physician visits, educator visits and those followups are really important. Of course, maintaining your medications on a regular basis, making sure that you're taking them at the right time. And maybe because I'm biased because I work in diabetes education, but I feel like the medications for diabetes are very specific to timing. And sometimes patients don't remember, they forget the right timing of their medications. And so having that conversation, "Okay, exactly what time am I supposed to take this? Is this a before meal medication? Is this an after meal medication?" Those kinds of things are really important. So making sure that you're taking your medication, you're taking it at the right.

And then, finally of course, I feel that beyond meal planning, physical activity is really important. Physical activity is one of those things that, you know, if we could bottle it in a pill, everybody would be prescribed it. I would take it three times a day if I could, right? Physical activity is just really, really important. It's just healthy for the body overall. Every entity would tell you to do that anyway. But the thing about physical activity with diabetes is that the situation of insulin resistance, which is how diabetes starts, it's how type 2 diabetes starts, that can be reduced by being physically active, meaning that your body is not as resistant to your insulin when you're physically active and for a period of time after that activity. So maintaining that physical activity keeps the body using the insulin the right way. The more sedentary we are, the less effective it works.

Maggie McKay (Host): And Laura, can you tell us about the programs that Capital Health offer as part of its free diabetes education series at the Novo Nordisk Family Resource Center?

Laura Moran: Absolutely. We have a series of classes that meet monthly and some of them are more than monthly. They're one hour, I call them hot topics or snippets of diabetes education. They're very informal classes where you can just pop in, get your questions answered, leave when you need to, or stay for the whole hour and learn some different information about diabetes. They're run by myself and by my colleague, Mindy Komosinsky, who is a registered dietician and also a certified diabetes care and education specialist. So again, they're one hour topics. They are currently on Zoom and this is 100% related to the continuation of this pandemic. And they are in a group format on Zoom. So again, the nice part is its convenience from your home. You can pop in when it's convenient for you, get your questions answered, stay and listen to everything that we have to talk about. But we have different topics on meal planning, getting started with diabetes, diabetes prevention, just simply a class where you can ask anything as it relates to diabetes, so that's like a free for all class. And we also have a support group. And that's not just for the patient, but also for the family, because sometimes it is hard on family as well.

Maggie McKay (Host): I can imagine. I wonder if you'll ever go back to in person, do you think?

Laura Moran: I hope so. I like to see people. And we have found that some people really do love Zoom and I appreciate that and I'm willing to continue. But for people who like coming in and just talking to people and seeing faces, it's a different dynamic when you're together with a group of people than it is when everybody's just a face on a screen.

Maggie McKay (Host): I'm sure we'll get back to that eventually. Can you tell us about the referral-based ADA-recognized diabetes education program that you have at Capital Health?

Laura Moran: So this is a program that has been recognized by the American Diabetes Association since 2005. And this basically means that this program meets the national standards of diabetes self-management education. This class is referral-based, meaning that your physician be that your primary care doctor, your endocrinologist would refer you into the program or you could self-refer and then we could obtain that actual referral from your physician. And this program is a 10-hour comprehensive, A to Z, soup to nuts, everything you need to know about diabetes. And it's multidisciplinary, and that means that we have lots of people coming in to talk about the various topics of diabetes, from what is diabetes to how to measure your blood sugars, how to monitor your blood sugars, what do those numbers mean, what do I do when it's high or low, meal planning, lots of discussion about meal planning, medications and, again, the timing and all those specificities regarding your medications. We talk about physical activity. We talk about stress management. Stress is huge, huge in this world, right? And it has a huge component on the body, so we talk about that as well. We talk about those long-term chronic complications for diabetes as well and we talk about how to prevent them. Because even though all of those things I talked about before are really scary, like long-term kidney damage, long-term nerve damage, things like that, it doesn't need to be the scenario when you're diagnosed with diabetes. So we're teaching you, as we're talking about it, how to prevent all of these things.

Maggie McKay (Host): Wow. Well, it really sounds like you've covered every base for a person facing prediabetes or diabetes. So I think someone in your care would feel hopeful that they can manage it, get it under control and possibly reverse it.

Laura Moran: That is the goal when patients come to talk with us, that they do leave with some additional knowledge and they feel like they can put that knowledge into practice and they feel that they can make some positive changes in their life.

Maggie McKay (Host): Laura, thank you so much for educating us on prediabetes and diabetes and how to manage it. You have given us a lot of useful information to think about that will most likely inspire some people to change their lifestyle with all this in mind.

Laura Moran: I certainly hope so.

Maggie McKay (Host): That's Laura Moran, certified diabetes care and education specialist at Capital Health. For more information about the diabetes education program at Capital Health, call 609-537-7081 or visit capitalhealth.org/diabetes. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Health Headlines, a podcast from Capital Health. I'm Maggie McKay. Be well.