According to the CDC, More than 29 million Americans are living with diabetes, and 86 million are living with prediabetes, a serious health condition that increases a person's risk of type 2 diabetes and other chronic diseases.
Diabetes specialists at Florida Hospital helps tens of thousands of people each year control and manage their diabetes. More astounding is that we've helped to eliminate the disease in many of our patients through nutritional counseling and life-style adjustments. Because of the growing prevalence of diabetes in our communities, we offer treatment hubs throughout the state.
Our highly experienced diabetes specialists offer comprehensive care through medical treatment, education, lifestyle and nutritional modification, group and individual counseling, support groups, and weight management.
Listen in as Dr. Haroldo D. Melo comes on to discuss risk factors for Diabetes and how to make those lifestyle changes you might need to make to manage or possibly prevent Diabetes altogether.
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Are You at Risk for Diabetes?
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Learn more about Haroldo D. Melo, MD
Haroldo D. Melo, MD
Haroldo D. Melo, MD is an expert in the diagnosis and treatment of acute and chronic illnesses.Learn more about Haroldo D. Melo, MD
Transcription:
Are You at Risk for Diabetes?
Melanie Cole (Host): According to the CDC, more than 29 million Americans are living with diabetes and 86 million more are living with pre-diabetes, a serious health condition that increases a person’s risk of Type II diabetes and other chronic diseases. My guest today is Dr. Haroldo Melo. He’s an Internal Medicine physician with Florida Hospital. Welcome to the show, Dr. Melo.
Dr. Haroldo Melo (Guest): Hi.
Melanie: So, first, give a little explanation of what is diabetes.
Dr. Melo: Diabetes is a disease of the carbohydrate—carbohydrate is a fancy name, a five-dollar word for sugar—basically, elevated sugar, uncontrolled. The main organs associated with this problem are the pancreas and it affects the production of insulin.
Melanie: So, how would somebody know if they are at risk for diabetes?
Dr. Melo: The main thing would be look at your weight on a scale. Nowadays, those little scales are really easy to find. They’ll give you your body mass index, which is BMI. And, if you don’t exercise frequently, if you are overweight or obese, you are at risk. If you are eating highly processed foods, highly processed sugars, you are at risk of getting diabetes. Also, if you have family members that have diabetes, especially Type II diabetes (that’s the most hereditary form of diabetes), you are at risk and you may want to speak with your doctor.
Melanie: Are there some symptoms if somebody is overweight or obese or they don’t exercise, have a sedentary lifestyle? Would they notice anything if they were pre-diabetic or actually have Type II diabetes?
Dr. Melo: That’s a good question. Not always. There are the typical symptoms of diabetes. Someone comes into your office and says “You know, doctor, I’ve been eating a lot, I’m hungry all the time. I’m thirsty all the time and I’m drinking too much, and I can’t stop urinating. I have a lot of urine coming out; it’s mostly white.” So those are the typical symptoms of diabetes. That’s the first thing that we think about but it’s definitely not a disease that will reveal itself through symptoms. It’s basically, you know, you are at risk, we check you, and then it turns out that you’re becoming diabetic, your blood sugar is going up slowly. Usually, when someone presents with symptoms to the doctor’s office, it’s usually, I don’t want to say too late, but it’s already a pretty advanced diabetes and your blood sugar’s really, really out of control. But, for most people, they will come to your office. They’re completely asymptomatic and then you give them the news, and it’s a big shock for most of the patients.
Melanie: And, how is it diagnosed?
Dr. Melo: Well, there are very simple things that can be done. The first one and the easiest one is getting a hemoglobin A1C. Hemoglobin, we all know, is the amount of red cells in your body, so the content of the red cells. So we have a certain amount of sugar that attaches to your hemoglobin, to that red part of your blood. If it’s less than 5.8, if it’s 5.7 and below, 5.7% and below, then you should be fine; you don’t have diabetes. If the amount of sugar on your hemoglobin is anywhere between 5.8 and 6.5, then you are what’s known as a pre-diabetic. You’re not able to metabolize the carbohydrates or the sugars adequately. If you’re anywhere over 6.4 or 6.5, then you are a diabetic. That’s the easiest one. The other one is getting a fasting blood sugar. You go to the lab to check your cholesterol. Your doctor checks your blood sugar. You haven’t had anything to eat for 8 hours. You’re blood sugar is over a 126 mg/dL. That’s just a random number; you don’t have to learn it. But if it’s over that number, you’re diabetic. Also, there’s 2-hour glucose where you can drink something that for some people in the past, that used to be a very common way of diagnosing it. You have to drink a liquid that really doesn’t taste that well but it’s very sugary, and they check your blood sugar in 2 hours. If it’s over a certain limit, you are a diabetic. And, I would say, not the most common, but the frequent reason why people show up is that “Hey, I have a friend that has a blood sugar machine because he’s a diabetic. I checked my blood sugar, it’s 240.” We call that a random blood sugar and any random blood sugar over 200, you can consider yourself a diabetic, especially if you’re having symptoms.
Melanie: So, then, what treatments are available for a Type 2 diabetic? People hear the word “insulin”, and with Type I diabetes, Dr. Melo, that’s an insulin-dependent diabetes. The pancreas is damaged or destroyed. But, in Type I, it’s a resistance. Do they have to go on insulin? They hear that and they think right away that’s what they’re going to have to do.
Dr. Melo: No, definitely not. It depends on where you are with your blood sugar when you’re first diagnosed and everything. But I would say, the cornerstone of diabetes treatment is, first of all, weight loss, a healthy diet, and exercise. That is the first thing that we need to get in line, and usually, a lot of people stumble in that area. And the cornerstone, which is these three things: weight loss, diet, and exercise, is very patient-driven and patient-dependent; it doesn’t really depend a lot on the doctor. Now, the next step would be medications and there are a bunch of them, several. The most common ones are Metformin; most diabetics will know the Metformin. Insulin is really, especially on a Type II, on a Type 1, as you said, it’s an insulin-dependent. There’s no way around it. You need the insulin, period. But on a Type 2, insulin, it’s kind of a, you know, “We’ve exhausted all the pills; we’ve exhausted all the other possibilities, your blood sugar is still uncontrolled, then, you know what? We need to use the insulin.” That’s kind of a last step. And, finally, I think, I’d say the most drastic one to treat Type II diabetes is the bariatric surgery--you know, the weight loss surgery. That’ll reshape the form of your intestines; maybe a sleeve. It depends on what kind you’re getting. And, that also, I wouldn’t say cures it, but it definitely puts it under control for a lot of people, especially if you maintain the low weight after bariatric surgery.
Melanie: So, that was going to be my next question, Dr. Melo, is can you reverse it? If you’re told that you’re pre-diabetic or that you are diabetic, and you do all of these lifestyle modifications that you’ve just mentioned; you lose weight, you change your eating habits, you get some exercise, can you then reverse it and be somebody that does no longer have diabetes?
Dr. Melo: Definitely, yes. I advocate a plant-based diet but you can definitely do it just the way you described it. I’ve seen it happen. It’s happened for a few of my patients. I don’t want to say a lot because not a lot of people have the willpower to do it. But it’s definitely something that’s possible. I have seen people go from 3 medications, from insulin-dependence, to becoming completely one pill at the most and some of them actually no pills at all. And followed them for the next one, two, three years and the blood sugar is well controlled. Now that being said, once you develop the problem, you don’t want to be, you know, you have to pay attention all the time because if you gain the weight again, if you start eating the way you used to, it’s just going to revert back. It’s not a “you cured it, then it’s gone.” It’s not like a skin infection where the doctor gave you an antibiotic; you stop taking the antibiotic after the recommended time; and it’s gone, you know? You don’t have the problem anymore. Diabetes is there; if you stop paying attention, it will come back. Your blood sugar will be uncontrolled again and it’s something that you’re going to have to pay attention to for the rest of your life. You need to pay attention but it is definitely possible, people can do it. As I said, the cornerstone is weight loss, a healthy diet, not just extreme diets that will change temporarily and will lower your blood sugar, but healthy changes to the way you feed yourself to the way you consume calories and exercise. There’s no question about that.
Melanie: Thank you so much, Dr. Melo, for being with us today. It’s such great information. You're listening to Health Chats by Florida Hospital. For more information, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.
Are You at Risk for Diabetes?
Melanie Cole (Host): According to the CDC, more than 29 million Americans are living with diabetes and 86 million more are living with pre-diabetes, a serious health condition that increases a person’s risk of Type II diabetes and other chronic diseases. My guest today is Dr. Haroldo Melo. He’s an Internal Medicine physician with Florida Hospital. Welcome to the show, Dr. Melo.
Dr. Haroldo Melo (Guest): Hi.
Melanie: So, first, give a little explanation of what is diabetes.
Dr. Melo: Diabetes is a disease of the carbohydrate—carbohydrate is a fancy name, a five-dollar word for sugar—basically, elevated sugar, uncontrolled. The main organs associated with this problem are the pancreas and it affects the production of insulin.
Melanie: So, how would somebody know if they are at risk for diabetes?
Dr. Melo: The main thing would be look at your weight on a scale. Nowadays, those little scales are really easy to find. They’ll give you your body mass index, which is BMI. And, if you don’t exercise frequently, if you are overweight or obese, you are at risk. If you are eating highly processed foods, highly processed sugars, you are at risk of getting diabetes. Also, if you have family members that have diabetes, especially Type II diabetes (that’s the most hereditary form of diabetes), you are at risk and you may want to speak with your doctor.
Melanie: Are there some symptoms if somebody is overweight or obese or they don’t exercise, have a sedentary lifestyle? Would they notice anything if they were pre-diabetic or actually have Type II diabetes?
Dr. Melo: That’s a good question. Not always. There are the typical symptoms of diabetes. Someone comes into your office and says “You know, doctor, I’ve been eating a lot, I’m hungry all the time. I’m thirsty all the time and I’m drinking too much, and I can’t stop urinating. I have a lot of urine coming out; it’s mostly white.” So those are the typical symptoms of diabetes. That’s the first thing that we think about but it’s definitely not a disease that will reveal itself through symptoms. It’s basically, you know, you are at risk, we check you, and then it turns out that you’re becoming diabetic, your blood sugar is going up slowly. Usually, when someone presents with symptoms to the doctor’s office, it’s usually, I don’t want to say too late, but it’s already a pretty advanced diabetes and your blood sugar’s really, really out of control. But, for most people, they will come to your office. They’re completely asymptomatic and then you give them the news, and it’s a big shock for most of the patients.
Melanie: And, how is it diagnosed?
Dr. Melo: Well, there are very simple things that can be done. The first one and the easiest one is getting a hemoglobin A1C. Hemoglobin, we all know, is the amount of red cells in your body, so the content of the red cells. So we have a certain amount of sugar that attaches to your hemoglobin, to that red part of your blood. If it’s less than 5.8, if it’s 5.7 and below, 5.7% and below, then you should be fine; you don’t have diabetes. If the amount of sugar on your hemoglobin is anywhere between 5.8 and 6.5, then you are what’s known as a pre-diabetic. You’re not able to metabolize the carbohydrates or the sugars adequately. If you’re anywhere over 6.4 or 6.5, then you are a diabetic. That’s the easiest one. The other one is getting a fasting blood sugar. You go to the lab to check your cholesterol. Your doctor checks your blood sugar. You haven’t had anything to eat for 8 hours. You’re blood sugar is over a 126 mg/dL. That’s just a random number; you don’t have to learn it. But if it’s over that number, you’re diabetic. Also, there’s 2-hour glucose where you can drink something that for some people in the past, that used to be a very common way of diagnosing it. You have to drink a liquid that really doesn’t taste that well but it’s very sugary, and they check your blood sugar in 2 hours. If it’s over a certain limit, you are a diabetic. And, I would say, not the most common, but the frequent reason why people show up is that “Hey, I have a friend that has a blood sugar machine because he’s a diabetic. I checked my blood sugar, it’s 240.” We call that a random blood sugar and any random blood sugar over 200, you can consider yourself a diabetic, especially if you’re having symptoms.
Melanie: So, then, what treatments are available for a Type 2 diabetic? People hear the word “insulin”, and with Type I diabetes, Dr. Melo, that’s an insulin-dependent diabetes. The pancreas is damaged or destroyed. But, in Type I, it’s a resistance. Do they have to go on insulin? They hear that and they think right away that’s what they’re going to have to do.
Dr. Melo: No, definitely not. It depends on where you are with your blood sugar when you’re first diagnosed and everything. But I would say, the cornerstone of diabetes treatment is, first of all, weight loss, a healthy diet, and exercise. That is the first thing that we need to get in line, and usually, a lot of people stumble in that area. And the cornerstone, which is these three things: weight loss, diet, and exercise, is very patient-driven and patient-dependent; it doesn’t really depend a lot on the doctor. Now, the next step would be medications and there are a bunch of them, several. The most common ones are Metformin; most diabetics will know the Metformin. Insulin is really, especially on a Type II, on a Type 1, as you said, it’s an insulin-dependent. There’s no way around it. You need the insulin, period. But on a Type 2, insulin, it’s kind of a, you know, “We’ve exhausted all the pills; we’ve exhausted all the other possibilities, your blood sugar is still uncontrolled, then, you know what? We need to use the insulin.” That’s kind of a last step. And, finally, I think, I’d say the most drastic one to treat Type II diabetes is the bariatric surgery--you know, the weight loss surgery. That’ll reshape the form of your intestines; maybe a sleeve. It depends on what kind you’re getting. And, that also, I wouldn’t say cures it, but it definitely puts it under control for a lot of people, especially if you maintain the low weight after bariatric surgery.
Melanie: So, that was going to be my next question, Dr. Melo, is can you reverse it? If you’re told that you’re pre-diabetic or that you are diabetic, and you do all of these lifestyle modifications that you’ve just mentioned; you lose weight, you change your eating habits, you get some exercise, can you then reverse it and be somebody that does no longer have diabetes?
Dr. Melo: Definitely, yes. I advocate a plant-based diet but you can definitely do it just the way you described it. I’ve seen it happen. It’s happened for a few of my patients. I don’t want to say a lot because not a lot of people have the willpower to do it. But it’s definitely something that’s possible. I have seen people go from 3 medications, from insulin-dependence, to becoming completely one pill at the most and some of them actually no pills at all. And followed them for the next one, two, three years and the blood sugar is well controlled. Now that being said, once you develop the problem, you don’t want to be, you know, you have to pay attention all the time because if you gain the weight again, if you start eating the way you used to, it’s just going to revert back. It’s not a “you cured it, then it’s gone.” It’s not like a skin infection where the doctor gave you an antibiotic; you stop taking the antibiotic after the recommended time; and it’s gone, you know? You don’t have the problem anymore. Diabetes is there; if you stop paying attention, it will come back. Your blood sugar will be uncontrolled again and it’s something that you’re going to have to pay attention to for the rest of your life. You need to pay attention but it is definitely possible, people can do it. As I said, the cornerstone is weight loss, a healthy diet, not just extreme diets that will change temporarily and will lower your blood sugar, but healthy changes to the way you feed yourself to the way you consume calories and exercise. There’s no question about that.
Melanie: Thank you so much, Dr. Melo, for being with us today. It’s such great information. You're listening to Health Chats by Florida Hospital. For more information, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.