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Caitlin Whyte (Host): Welcome to Hally HealthCast the monthly wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every month on our podcast, we address a new topic important to your health and wellbeing, bringing in expert doctors, therapists, and specialists who offer advice and answer your most pressing questions.

November is National Diabetes Awareness Month. So, today we're addressing this important topic, giving you key information about the disease and expert advice on how to manage it. With us today are two guests who work at Health Alliance based in Champagne, Illinois.

Dr. Mariah Pierce is a Managed Care Pharmacist. And Stephanie Orcutt is a Health Coach with the Medical Management and Population Health Departments. Both are experts in diabetes care and management. Welcome and thank you for being with us today. So let's begin. Diabetes, it's one of the most common chronic or long-term conditions.

It's a serious disease that needs to be properly managed. To start, perhaps we should simply explain what diabetes is and how it can be harmful. Ms. Orcutt, can you briefly describe the disease and the three common types?

Stephanie Orcutt, MS in Nutrition Education (Guest): Yeah. So in short, diabetes is when blood sugars are too high. Whether you're diabetic or not though, everyone uses blood sugar for energy, which comes from our carbohydrate sources. But the three different types of diabetes include type 1, type 2 and gestational, but just to distinguish the difference between them; type 1 is considered that insulin dependent type because the pancreas is not making insulin in the body to regulate blood sugars. Typically it's diagnosed earlier on in life in comparison to type 2. Type 2 on the other hand is more likely to develop later on in adulthood and is highly related to lifestyle. So, this type, our cells don't respond to the insulin being produced, which results in higher blood sugars. Lastly, there's gestational diabetes, which is developed during pregnancy or from either the body either not producing enough insulin or the cells become less responsive to it. And it can increase the risk of developing type 2 later on.

Caitlin Whyte (Host): Thank you, Ms. Orcutt and Dr. Pierce turning to you. Can you explain a little about how and why diabetes can be harmful? How does it affect the body and what else can it lead to?

Mariah Pierce, PharmD (Guest): Yes, absolutely. So, there are about three different signs that patients usually present when they have diabetes. So they are more hungry, urinate a little bit more and also are more thirsty and kind of how all that ties in together is that you have this excess glucose hanging around in the body and the cells need this glucose for energy. So, when the glucose is not getting into the cells and just kind of hanging in the bloodstream, the body thinks it's hungry.

Cause the cells are telling them, hey, we need more energy, but there's no glucose here. But the glucose is in the bloodstream. Just not getting into the cells. So, with this high concentration of glucose in the body, the kidneys try to help the body out by getting rid of some. So trying to filter it out through the urine.

And so there's more urinating, but when glucose leaves the body through urination, water follows it. So, this can lead to the patients getting more thirsty and also dehydration. And when we're dehydrated, we don't always reach for water. We reach for those things that taste good. And what's in those drinks that taste good, sugar.

So the cycle kind of continues. As far as like how it can affect the body, when you have glucose hanging around for a long time, it can start to damage the body. So, for example, the heart, they have blood vessels there. And once those blood vessels start to get damaged by the glucose, there can be an increase of cholesterol that can lead to heart attacks. Strokes. Also vessels in the eyes can lead to blurry vision as well as blindness and the kidneys, because they're filtering it out at a constant rate all the time. It can start to break down over time. So, instead of just releasing the glucose, it starts to also release those things that we need in the body such as proteins.

If it's too malfunctioning, then the patient would have to do dialysis, the substitute for those kidneys and also nerves. So, over time there can be numbness and decreased sensation in the fingers and in the toes. And this can be problematic because if an injury occurs, the patient won't be able to feel it and it can get worse.

And because there's poor blood supply in these areas, it can take a long time to heal because blood carries those components that we need to heal these injuries. And if blood is not getting there, it prolongs the healing process.

Host: Thank you so much, Dr. Pierce. All of this brings us to our main point, which is perhaps the best takeaway for our listeners. If you have diabetes, it's incredibly important to manage it and get the healthcare you need. That'll be the focus of the rest of this episode, gathering your expert advice about the best ways to do so. Ms. Orcutt, again, turning back to you, as a Health Coach, you help people with diabetes, find an entire team to help them manage their health. Can you tell us who all should be on this type of team?

Stephanie: Yeah, so definitely primary care physicians and endocrinologists. They're going to be pertinent to a patient's diabetes management as they're essentially going to be the one who facilitates the care, but also your pharmacist, registered dieticians, ophthalmologists, podiatrists, and also just us health coaches or the nurse care coordinators. But as health coaches at Hally Health, we really aim to educate patients on the importance of having these different specialists on their team. We really bring together those other teams to a patient's care by managing up their expertise and highlighting the benefits of having them involved. We also have great access to many resources and other team members who have health specific backgrounds. So we're able to share that information with our members and get them connected to an expert as well.

Host: Wonderful information. And Dr. Pierce as a pharmacist, what role do you play on the team?

Dr. Pierce: Yeah, pharmacists are medication experts and then the majority of people with diabetes take medications to manage it. So we work with the team to make sure that the patients have the medication when it's needed. We also do reviews for interactions, drug interactions, as well as checking the dose, any side effects. And then depending on the pharmacist, they can play additional roles. So for example, retail pharmacists are the most well-known.

So, these are the ones that who fill the medication, making sure it's the right patient, right medication, right dose, and also counsel them on how to take the medication. So, how to take it, when to take it, what to do with a dose if a dose is missed and then managed care pharmacists like myself, we review prior authorization for these medicines.

So making sure they fit the criteria as well as they have access and can afford it. And then hospital pharmacists as well, they prepare medications. So, if a patient has to be hospitalized and is inpatient and making sure that getting them those home medications while in the hospital, and we know that not all hospitals carry the same variety of drugs that aretail pharmacy would have. So a lot of times there has to be substitutions made while they're in the hospital. So, pharmacists will go ahead and make those changes while they're in the hospital, to make sure that their disease is still under control.

Host: Staying with you, Dr. Pierce, can you explain the different types of diabetes medications and what they do to help those with diabetes?

Dr. Pierce: Absolutely. So there are a lot of medications on the market right now, and I'm sure there's even more to come, but the first one and the most obvious is insulin, because that's what we're trying to get to with all these different peas. So, there's different categories to be rapid acting, short acting long acting. And it just depends on the patient and their needs. So our rapid or short acting insulins like NovoLog, Novolin, Humalog, Humulin are usually dosed at meal times when it's usually to help when the, when the body is digesting foods that these insulins kick in and kick that glucose into the cells and then it only lasts a few, a few hours.

So this is why it has to be dosed multiple times a day. But then we also have our longer acting insulins, like Levemir, Lantis, Toujeo. So these last, a little bit longer in the blood stream and kind of linger around and work throughout the day. So, these can be dosed once a day, mostly or sometimes even twice a day.

The first pill is metformin. So, this one is probably the most well-known medication because it's first-line therapy. So, this one works in three different ways. So, it tells the liver to stop making glucagon, which turns into glucose in the bloodstream. It also decreases the absorption of glucose when we're digesting and improves our insulin insensitivity. The next one is our glyburide and glipizide that class of medications. So again, old, but still a goodie. I like to call these the squeezers. So, it helps the pancreas to release insulin. So, if you can think of like a sponge with water in it, when you squeeze that sponge, the water is released. So, this is kind of what this class of medication does.

The next class is the SGLT2 inhibitors. So I'm going to talk about some proteins, but we won't get too deep into them, but these are your Jardiance, Invokana, Farxiga. So SGLT2 is a protein in the kidneys. And once the kidneys have filtered out this glucose to be excreted, this protein brings the glucose back into the bloodstream. So, we don't like this. So we have these medications to block that protein from bringing that glucose back in. We also have two more classes of medications that I'll talk about. So the GLP1 receptor agonists, as well as the DPP4 inhibitors. So just to explain this a little bit, the GLP1s, when we eat, the body releases, this GLP1.

And it kind of mimics glucose so that it can stimulate the insulin to be released, but this DPP4 goes to stop this enzyme. So it gets destroyed. So, it doesn't last very long. So, we liked the GLP1. We don't like the DPP4, so we made medications to kind of mimic both. So we have the GLP1 receptor agonists.

So the Victoza, Ozempic, Trulicity, these are usually injectables, but we also have RYBELSUS, which is the oral form of these medications. So it kind of mimics this GLP1, but it won't be destroyed by the body's DPP4. So it kind of helps it last a little bit longer. And then we also have medications that block the DPP4 from blocking the GLP1s. So this is the Januvia, introdenta . And so also helping to extend the life of the GLP1. And I know that was a lot, but you can see why there's a lot of options when it comes to combining therapies for our patients.

Host: You know, as the saying goes, medicines only work if you take them. So why is medication adherence, that is taking your medications regularly and exactly as prescribed so important for people with diabetes Dr, Pierce?

Dr. Pierce: Yes, like adherence is very crucial. No matter if the disease is chronic or acute, because medications are used to either cure the disease or to maintain the disease and keep it from getting worse. So, for example, with diabetes, we talked about earlier, how it can lead to heart problems, blindness, dialysis, and all these other things.

And all this can lead to hospitalization and hospitalization leads to more costs for both the patient, as well as the insurance companies. And that's what we're trying to prevent because we already know healthcare is already so expensive and you can think of it as like the glucose in the body with diabetes is sticking around for a long time. It's very consistent. So in order for us to fight it, we have to take our medications all the time, on time. Because if not, every day that you miss or every dose that you miss, that's another chance for that glucose to accumulate and cause some of these problems.

Host: Such important information again, thank you. And Ms. Orcutt turning to you. Medicine isn't the only way people should take care of their diabetes. In addition to these drugs, healthy eating is also key. Now you're an expert in nutrition. Can you tell us a little about the importance of maintaining healthy eating habits for those with diabetes and any advice you have?

Stephanie: Yeah. So definitely in combination with medication, it is recommended to also follow a healthy diet. Specifically in diabetes, it is recommended to monitor those carbohydrates in our meals to better control those blood sugars. And those carbs can come from food sources, such as our grains, fruits, starchy and non starchy vegetables, dairy, and of course sweets and a general guideline for women to follow is a total of 45 to 60 grams of carbs per meal and men 60 to 75 grams. And this can be found on the nutrition facts label of those food items. Really just being mindful of the type of carbs and amount of carbs that we are getting can go a long way. For instance, opting for more food items with fiber, like non-starchy vegetables, rather than those with simple sugars like sweets. Those higher fiber food items are going to help regulate those blood sugars by slower digestion versus just immediately getting picked up into our bloodstream. So, that's going to be an important factor when monitoring those blood sugars.

Host: Great. Thank you. As a Health Coach, I understand you're able to partner one on one with people to give them personalized nutrition advice. Is that correct? And what else can you help them with?

Stephanie: Yeah, so there's so much that goes into a diabetic diet that it can be overwhelming. Just all the information that's out there that our members maybe haven't had the opportunity to get educated on. So as a Health Coach, working one-on-one with members, we really aim to break down those dietary components, provide them with the education they need to be successful and help facilitate small changes, one step at a time. That being said, we really focus on guiding members to realistic attainable goals so that they can be successful and remain motivated to continue with taking those steps in the right direction. So, activity is another important key to managing diabetes that we focus on with members. We also provide support and education on general diabetes management, too.

Like the why behind those recommended guidelines. And some of those guidelines would include pertinent exams to monitor diabetes, like getting your hemoglobin A1C tests, two to four times a year or yearly dilated eye exams, yearly kidney function tests, cholesterol checked once a year and also like yearly foot exams to check the sensation in feet. It's important for members to talk to their doctors about these exams and maybe even get individualized goals or like an A1C for instance, but other than using their doctors as a primary resource for exams, we're also available to help members get these appointments by maybe providing a network providers or clinics. While we're not exactly direct care as Health Coaches, we really help guide them in directing their own care and give them that autonomy.

Host: That's such great help you're providing. And Dr. Pierce, I also understand that your role at Health Alliance includes direct support of those with diabetes. Can you tell us a little how Health Alliance supports members with diabetes who are unable to afford their medications?

Dr. Pierce: Yeah. So we have a team of nurses who kind of check in with these members to see if they have everything that they need. And if they have any issues, they can refer to the pharmacist. One of the issues that we see a lot is medication affordability, or just assistance with that. We just go in and make sure that they have all the resources that they need.

So, a couple of ways that we help with this is first, we can reach out to the providers because sometimes they just don't know what's preferred, what's not preferred, what's on the formulary. So we just kind of call and touch base with them and let them know if there's any less costly options that may benefit the patient, whether it's another medication in that class, or if they're taking multiple medications, if there's combination pills, that they can kind of reduce down to one copay and we also help with manufacturer programs.

So these are programs where the manufacturer or the drug makers assist in helping pay for some of the copays so that the medication can be filled. It's a different process for each manufacturer, each medication. And it can also be different timeframes, so it can get really confusing really quick. So, we help them to navigate that process. And a lot of times Medicare members are not a part of these programs or excluded from these programs. So, they have their own assistance. So they can also apply for low income subsidy. If they qualify, if they get approved, they can get their medication co-pays drastically lowered or even free sometimes.

Host: Great, great information to know. And can you tell us a little about the insulin program Health Alliance has for its Medicare Advantage members?

Dr. Pierce: Oh yes. So we know that insulin is life-saving and there have been some controversy about insulin pricing in the news recently, but we do have this program in place to help insulin be more affordable for our Medicare members. So that program has Humulin lens vials for $2 a month, and then Humalin pens, Humalog are all $35 per month. So, for those who are eligible, the discount is automatically applied. So they don't have to do anything to enroll.

Host: Thank you. Well, this has been such great information. I guess one big overarching thing that comes to my mind is just how overwhelming it could be for someone in those first days and weeks after they've been diagnosed with diabetes. There's just so much to do and so much to learn.

So Miss Orcutt, I understand that you and your fellow health coaches are especially good at helping people who have just been diagnosed. Can you tell us a little bit more about this stage?

Stephanie: Yeah. So it really just goes back to that education and support piece that we provide members. It is important for us to keep in mind that they have just diagnosed with a life altering condition and are probably just trying to comprehend the many different components of diabetes. So, at first it's important for individuals to know what resources are available to them, such as what Mariah just mentioned. I think that's all fantastic. While it isn't a condition to take lightly, it is a very complex condition that can be difficult to know every piece. So it's important for members to know that it is normal to maybe feel overwhelmed and that you don't have to try and know it all at once, but there's definitely resources and experts out there to help you break it all down.

Those experts being, for instance, your doctor, it would be important to ask those questions about the exams I mentioned earlier about diabetes management, like what is my specific goal for A1C? How often should I test my blood sugars throughout the day? And if they haven't already, asking to get referred to a registered dietician so that their diet plan could be more individualized. I think that's really, really a key component too. But lastly, just asking about any care coordination programs that may be offered through the hospital to help with disease management.

Host: Great advice, Dr. Pierce, what questions should they or really anyone with diabetes ask their pharmacist?

Dr. Pierce: Yeah, absolutely. So one that I like to point out is that because we're medication experts, they usually come with us with medication questions, which makes sense. But one of the questions that I get very rarely that I wish I got more often, is what can I do outside of my medications to help maintain my disease? Because once you're on the medications, it's really uncommon for someone to be tapered off of them. So even if, you know, they're only taking one therapy at the time, they can still do things outside of their medications to maintain their disease state.

Some of these things that Stephanie mentioned already. Another one is how do I take this medication? Because even, even if they're adherent and they're taking it on time, every day, it can still be optimized depending on how the body affects the medication and how the medication affects the body. So, sometimes it's better to take it on a full stomach rather than an empty stomach.

So just asking us those questions and making sure they understand that. And the last one I think is what side effects should I look out for? Because I know with a lot of medications, sometimes they're the best option for the patient, but they can't tolerate it because the side effects are too much. So pharmacists can help you kind of mitigate those side effects so that the therapy doesn't have to be stopped and that you can take the most optimal medication for you.

Host: Thank you. Okay. I know we're running out of time, so we'll conclude with a couple of important questions, Ms. Orcutt. How can members of our health plan sign up for Health Coaching to take advantage of all these wonderful services you've been discussing?

Stephanie: Yeah, so simply just calling the back of their health Alliance insurance card can get them in touch with a representative, that is knowledgeable about our care coordination programs or at least get them in touch with someone who is knowledgeable on it, but there's also a rotation line. That'll get you in touch with one of our care coordination representatives, which is 1-800-851-3379, extension 28947. Another great way to which we've been really, really putting out there and promoting is just to view the care coordination information by going to hally.com.

Host: Wonderful. And finally, as a way to sum up all that we've learned today, if each one of you had a takeaway message for those with diabetes, that is the most important thing, you'd like them to know what would it be? Dr. Pierce, we'll start with you.

Dr. Pierce: Sure. I think I'll have to go with that you're not alone. You have a team of people who want to see you live your best full life. So take advantage of that team. Don't feel like you're a pest or a burden, more questions. The more informed you are the better. I know it can feel frustrating at times, but getting it under control is key and the more controlled it is, the less cumbersome it will be.

Host: Thank you so much. And Miss Orcutt?

Stephanie: Yeah, really just for our members to give themselves some grace when trying to learn about diabetes, because it really is complex and not easy. And really also just echoing what Mariah was saying. I think it's important to know who's all in your corner. Whenever you do have a chronic condition like diabetes and that's, you know, what we health coaches and care coordinators are here for, your pharmacists. So I encourage members to utilize the resources available in order to make those recommended lifestyle changes for diabetes management. It will really help make it seem less burdensome,

Host: Such important information for our listeners. Thank you so much, Dr. Pierce and Ms. Orcutt for joining us today and for all you do every day at Health Alliance to help so many individuals and families. That concludes today's Hally HealthCast. Tune in next month as we tackle yet another topic important for your health and wellbeing.

And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.com for resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in next month.