Transcription:
Managing Your Diabetes

Melanie Cole (Host):  According to the CDC up to 29 million people in the United States have diabetes and as many as 8 million may be undiagnosed or unaware of their condition.  My guest today is Dr. Sina Tebi.  He’s an endocrinologist and a member of the medical staff at Henry Mayo Newhall Hospital.  Welcome to the show, Dr. Tebi.  So, let’s talk about diabetes type 2, used to be called adult onset, but not so much anymore, because we’re even seeing children with it.  So, give us a little physiology lesson, what is type 2 diabetes?

Dr. Sina Tebi (Guest):  Like you said, we have different types of diabetes and in terms of treatment we basically divide them into type 1 and type 2.  And the type 1’s are the ones who cannot take medications, they have to take oral medication, they have to take insulin.  And the type 2, and the other categories, which are the subcategories of type 2, the physiology of that is insulin resistant.  And let me explain that to you.  The pancreas is making insulin to bring the sugar down.  When you eat something and your blood sugar goes up, the pancreas secretes insulin that works as a key to open the door of the cells of the muscle and of the liver to let the sugar go inside.  The problem is not with the insulin, the problem is with the locks that the key has to go and open it.  And the muscle and the liver who have to let the insulin open the door and take the sugar inside, it don’t work very well.  So, what happens is that your pancreas has to secrete more and more insulin to get this process going.  And for the first part, your sugars are still normal, you don’t even know about it.  And more insulin has been secreted, now in this period if you check your sugars are normal, but if you check your insulin, than we will know that you have more insulin compared to normal people, because that is what is going on, because your receptors for insulin are not good and you have to secrete more insulin to compensate for it.  There comes a time as this process is going and going the receptors get worse and worse, and you have need for more and more insulin to the point when your pancreas is making the maximum insulin that it can, that’s just not enough either.  And that’s when we start seeing your sugars going up.  The blood test, you know, the fasting sugar, the after-meal sugar, these sugars are going to start to rising up, so, then we call these things pre-diabetes or diabetes at that time.  And when these things progress and continues, it gets to the point that the poor pancreas that has been making all of this insulin for all of these years is going to give up too.  So now we have receptors that are not responding very well to the insulin and the pancreas that is not able to make that high amount of insulin that it was making before.  So, the sugars keep going higher and higher, and it causes symptoms, and full dominant diabetes shows up.

Melanie:  So, would someone notice something, and you mentioned pre-diabetes.  So, if someone is pre-diabetic or full blown diabetes would they notice some things, are there certain symptoms, red flags that would send them to get tested in the first place?

Dr. Tebi:  Pre-diabetes, as I’ve said, is most of the time is asymptomatic.  If you check your sugars are a little bit higher, if you check that number we call hemoglobin A1c.  If it’s in the pre-diabetic range, but it’s not to the point that it causes symptoms, but it’s a sign that we are going in having you know diabetes.  If the sugars go above a certain number, the symptoms of the diabetes will show itself.  So, the first thing that will happen is that this extra sugar that is in the bloodstream, the kidneys are not able to hold them anymore, they are going to leak into the urine.  And as the sugar goes, the water follows it, so we have something we call polyuria or like frequent urination, that’s one of the symptoms.  The other thing is that when you’re urinating so much, you’re going to be thirsty all of the time and you know, so, we call this polydipsia or increased thirst, a need for drinking water constantly.  The other thing that happens is that, you have all of this sugar in your bloodstream and you’re not able to use it.  It just stays in your bloodstream, as I’ve told you before, the sugar stays but it needs insulin and those receptors for it to be used.  So, your brain doesn’t have enough sugar that it needs, and is always like you’re feeling like you’re hungry, so we call it polyphagia or like you know increased hunger and you’re constantly have the need to eat something.  So, that’s like you know a dilemma, because you have a lot of sugar in your bloodstream and you’re not able to use it and you feel hungry all the time.  If this is very severe then it can cause weight loss, because then your body who’s not able to use sugar, has to burn fat and has to burn the muscle, so very bad diabetes can cause rapid weight loss at that point.  These are the main symptoms of it.  One of the other things that people notice a lot, that when their sugar levels go high, their vision becomes blurry.  That is also something that, you know, because of the high sugar, the fluid which is in the eye gets affected and it gets some kind of dehydrated and causes blurriness.  And usually these patients experience that if they drink more water or do something to bring the sugar lower the blurriness of the eye goes away.  So, this is not the eye damage that eventually happens over the years with diabetes, it is a transient thing that happens when the sugar goes above a certain level and then it goes back to normal when the sugar comes down.  So, these are like, you know some of the main symptoms, more common symptoms of diabetes.

Melanie:  Would we know these things by a routine blood test, you mentioned fasting blood glucose.  But are there certain other tests that would really cement that diagnosis?

Dr. Tebi:  As I mentioned, like you know, these symptoms will show up later.  So many years ago, when you know people were not getting tested very often, or you know the tests were not available, they were not going to the doctors that often.  This was the symptoms and the patient would go to the doctor and explain these things and the doctor would find out that they have diabetes.  You still see this more frequently too.  But most of the patients will find out about these things much earlier.  Because a lot of people do lab tests, annual physical exams.  And we see their like you know their fasting sugars are elevated.  There is another number, it is a lab test, it is a blood draw that we call it Hemoglobin A1c.  That’s a number that show the average of blood sugar in the past three months.  And you want to go and do your blood test and you’re worried about your sugar and you’re going too fast for like, you know, extra-long.  They told you to come in like you know, 8 hours, or 10 hours fasting and you’re going to do it like you know for 16 hours because you’re worried about your numbers.  You go in and you have good blood sugars in the morning, but then if they do the Hemoglobin A1c, which shows the average of your blood sugar for the past three months, then it can show that what your average blood sugar has been and if it’s high it will show itself.

Melanie:  And what about risk factors, who is at risk for type 2 diabetes?

Dr. Tebi:  Type 2 diabetes is a very, very common condition, as I mentioned like in the beginning there are so many people on it.  So, you also see that certain communities, and certain racial like backgrounds and also families are more predisposed to having type 2 diabetes.  Their diabetes type 2 mostly like you know runs in the family, so it’s very genetic.  We don’t know what exactly are the genes.  But there is multi genic, what we call this.  There are so many genes that are involved in this, but it is a genetic thing.  If you have people that diabetes type 2, in your family, you certainly have increased risk of type 2 diabetes as we see most of the people that have type 2 diabetes they have family members on it.  Or like you know certain racial factors.  Native Americans, Philippines, South Americans they are more disposed to have type 2 diabetes.  So, the other part is the non-genetic, the acquired factors.  Weight gain, something that makes the insulin resistant worse.  Which means that your requirement for insulin goes higher as you gain weight.  Lack of exercise also causes these receptors that I was explaining to you, for insulin not to work very well, so this is another risk factor for it.  Diets which is full of carbohydrates and sugars and fat is also a risk factor for developing.  So, it’s a dual thing, you have to have the genes, and you have to have the risk factors and you don’t know which one is the stronger, it’s different in each person.  But it’s a dual thing and these are the risk factors.

Melanie:  So now let’s speak about treatment and possible prevention.  What is your best advice, Dr. Tebi, for people that want to prevent diabetes and what do you tell them about treating if they do have existing?

Dr. Tebi:  So, the first thing is like you know prevention.  If we know that people have high risk factors, for example they’re coming from a genetic group, or they’re coming from a family who have high risk of diabetes, we warn them, that you have the gene, don’t let yourself have the habits or the other risk factors because It’s a very highly likely that you will develop diabetes as well.  And the next thing is that we do the labs and we find out that the sugars are high, the Hemoglobin A1c is high, you were in the pre-diabetic group.  We sometimes decide to treat those patients with medication and sometimes we do lifestyle modifications to prevent these things.  In the earliest stages of diabetes, things are reversible.  When I was telling you that those receptors that respond to insulin are not working very well, exercise, if you start an exercise program, well what have been tested is 30 minute of exercise hard enough that causes sweating, 5 times a week, will be enough to make these receptors better.  The new ones will be made, the new receptors are better responsive to insulin.  So, the disease can revert, the problem that was there is going back towards normal, there is less requirement for insulin, there is less pressure on the pancreas.  So, we can reverse it in the early stages of it.  But then if we do that and we see that, you know we are not able to do that.  There are some medications that can help reverse the problem of receptors not being responsive to insulin to some degree without much of a side effect.  So, we actually the more, and more and the chronologies of starting patients on oral medication treatment in the early stages of the diabetes or pre-diabetes, because we know that it’s beneficial and it postpones the occurrence of the diabetes, rather than waiting until patient become diabetic and then treat them.

Melanie:  In just the last few minutes, Dr. Tebi, it’s such important information too, please give your best advice for preventing diabetes or living with and managing your diabetes with lifestyle behavior modification.

Dr. Tebi:  I just want to add this, you know, diabetes as you mention is a very predominant disease in the community and can cause a lot of problems.  Blindness of the eye, losing the sensation of the lower extremities and the fingers, vascular problems, heart attack, kidney trouble all of these things can happen by diabetes.  But it’s not actually the diabetes, it’s the high sugar over a certain period of time that damages the vessels and the nerves and causes this problem.  So, diabetes or non-diabetes, if you keep the sugars in the normal level either by a lifestyle modification or by taking medication or at some level even taking insulin.  If you keep these sugars in an acceptable range, none of these problems would happen.  But my advice is that get checked if you see that you have risk factors.  Like you have family members that have diabetes, or you see that your bad habits or lifestyle is in a way that increases your risk of diabetes.  Get check and know of where you are.  Are you pre-diabetes, or do you have diabetes, and then the best thing in the early stages for prevention is what I mentioned, trying to make your receptors for insulin revive and that’s by losing weight, exercising and changing your lifestyle.

Melanie:  Thank you so much Dr. Tebi.  It’s great information.  Thank you for being with us today.  You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital.  And for more information you can go to henrymayo.com.  That’s henrymayo.com.  This is Melanie Cole, thanks so much for listening.