Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Scott Webb (Host): Today, we're going to discuss all forms of diabetes from prediabetes to type 1 and type 2 with Dr. Monica Patel. She's an endocrinologist with Duly Health and Care and she's going to explain each type, how they're diagnosed and treated.

Doctor, thanks so much for joining me today. We're going to talk about diabetes, type 1, type 2, and get as much information as we can from you. And I know according to the CDC, over 37 million Americans have diabetes, which is a lot. So, let's start there. Who's most at risk for diabetes and why is it so prevalent?

Dr. Monica Patel: People who are at most risk include adults older than 45, having overweight or obesity, having a family history of type 2 diabetes such as a parent or sibling; being of a high risk race or ethnicity such as African American, Hispanic, Native American, Asian American, or Pacific Islander; having other health issues such as high blood pressure, high cholesterol, and or polycystic ovarian syndrome; having a history of gestational diabetes, or being physically active less than three times a week.

To answer your second question, why is it so prevalent, there are several factors that may be contributing to this, such as the growing rates of obesity, including childhood obesity, the increase in consumption of foods and drinks high in sugar, as well as packaged foods and fatty foods, and lack of physical activity.

Host: Yeah. So, lots of folks at risk, lots of risk factors. Before we get too far ahead of ourselves here, just foundationally, the difference between type 1 and type 2 and why is type 2 more common.

Dr. Monica Patel: In type 1 diabetes, the body completely stops making insulin. This happens because the body's immune system destroys the cells in the pancreas that produce insulin. So, people with type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age. The exact cause of it is unknown, but it may be due to genetics and environmental factors.

In type 2 diabetes, the body produces insulin, but the cells don't respond to it the way they should. So, this is called insulin resistance. So in response to this insulin resistance, the pancreas should make more insulin. But in the case of type 2 diabetes, this does not happen. So, there are two problems going on,, insulin resistance and trouble making extra insulin to overcome this.

So, all of the risk factors I had mentioned before, such as family history, genetics, excess weight, lack of physical activity can lead to insulin resistance and type 2 diabetes, which is why it is much more common.

Scott Webb: Yeah, more common. And, you know, I just wanted to make sure we get everything out here for folks today. So, let's talk about prediabetes. I know that there's maybe some confusion over that. So, maybe you can take us through that. What is prediabetes and how is it diagnosed?

Dr. Monica Patel: Yes. So, prediabetes is where blood sugar levels are higher than normal, but not yet high enough to be diagnosed with diabetes. And most commonly, we use a blood test called the hemoglobin A1c to make this diagnosis. This test gives us an estimated average for how a person's blood sugar has been over an extended period of time. An A1c less than 5.7 is considered to be normal. And a level over 6.5 is in the diabetes range. So, anything in between this 5.7 to 6.4 would be the prediabetes range.

Host: Yeah. When we think about the connection doctor, or the relationship between prediabetes and type 2, you know, folks who have prediabetes, are they able to stop it there? Does it almost always end up being type 2, but then a different severity of type 2? You can see how my head is spinning a little bit here. You know, what are the signs and symptoms, I guess, that would prompt someone to see a provider because they think they might be prediabetic? And can you give us a sense of the relationship or the connection between prediabetes and type 2?

Dr. Monica Patel: Yes. Before people develop type 2 diabetes, they almost always have prediabetes. So without taking any action, many people with prediabetes eventually develop type 2 diabetes. So, making lifestyle changes, which we'll talk about in a minute, can prevent or delay this progression and even possibly reverse it.

As far as signs or symptoms of prediabetes, some individuals can have darkening of the skin on their neck, which is a sign of insulin resistance. However, most people with prediabetes don't have symptoms, so it is important to talk to your doctor about testing for it.

Host: That's interesting. I never heard the darkening of the skin around the neck and it seems, you know, people might just dismiss that as, "Oh, sun damage," you know, "I didn't use enough sunscreen." So, great to have your expertise today. Let's talk about physical activity more. You know, we've talked about genetics and family history. Let's talk about behavior, lifestyle. What can we do to reduce our risk of being diagnosed with type 2?

Dr. Monica Patel: So as far as physical activity, when you are physically active, your cells become more sensitive to insulin, so it works more effectively to lower your blood sugar. Exercise also helps to burn calories and may help with weight loss, which can further reduce the risk for developing diabetes, especially in those with overweight or obesity. As far as the amount of exercise, it is recommended that most adults engage in 150 minutes or more of moderate to vigorous intensity exercise per week, so about 30 minutes, five days per week.

Exercise is also good for health in other ways, such as improving blood flow and blood pressure, increasing energy levels, boosting your mood, and helping with stress management.

It doesn't matter how or where you exercise, just getting started is the most important part, and finding something you enjoy doing. And if you haven't been very active, it's important to start slowly, so with like light walking.

Host: Yeah. Always good to start slow. Maybe speak with a provider if you've had many decades of sedentary lifestyle. You know, we don't want to jump in too fast. Let's talk about dietary recommendations. I've had many experts on and they always reference a Mediterranean diet. I'm not certain that I actually know what that means. You probably do. But when we think about dietary recommendations to, again, reduce the risk of developing type 2, what do you recommend?

Dr. Monica Patel: So, the key is a balanced approach to diet. So, eating a variety of nutritious foods from all food groups. And you had mentioned the Mediterranean diet. And what this basically like is, you know, you incorporate lean proteins, like chicken, eggs, fish, and turkey; non-starchy vegetables, like broccoli, green beans, salad greens, or cucumbers; healthy fats, like avocados, nuts, natural peanut butter, and olive oil; complex carbohydrates, like beans, berries, sweet potatoes, and whole wheat bread. We also recommend avoiding excessive intake of added sugars by limiting sugary drinks; also, limiting portion sizes of refined carbohydrate foods such as white bread, white rice, and white pasta; incorporating more fiber by eating a variety of fruits, vegetables, and whole grains; limiting saturated and trans fats by choosing lean protein and low fat dairy. So, people at risk for developing diabetes, they don't have to eliminate entire food groups or follow any fad diets. All foods can fit in the meal plan. And we encourage making gradual changes, like even small changes can lead to big results.

Host: Sure. It occurred to me, doctor, as you were going through that long list of yummy foods that maybe I should have eaten before we connected. I'm even hungrier now, but fortunately we're getting close to wrapping up here. Let's talk about patients and managing and living with type 2 diabetes, which I think is the accurate way to put that. They're really living with type 2. What can they do and what different types of support systems are out there for them?

Dr. Monica Patel: So, the main aspects of managing type 2 diabetes are lifestyle changes, like the diet and exercise we talked about, blood sugar monitoring and medications in order to keep blood sugar levels in a healthy range. So, it's important to keep up with regular appointments with your doctor to be sure your management plan is working.

Type 2 diabetes is a lifelong disease. It involves constant day to day care and management, and there can be a lot of bumps along the way. And people can get support from their healthcare team, which could include their primary care doctor and or an endocrinologist, dietician, or diabetes educator. Their support team should also include family members and other important people in their lives. Connecting with other people who have diabetes, whether in person or online, can also help people feel less alone.

Host: Yeah, that's perfect. Well, I really appreciate your time today. This was educational and fun, and it's always good to sort of set the record straight. Here we go from, you know, have prediabetes and type one and type 2 and how all of this works. And thank goodness we have experts like yourself. So, thanks so much and you stay well.

Dr. Monica Patel: Alright, thank you. You too.

Host: And for more information, go to dulyhealthandcare.com. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health and Care.