Managing Your Diabetes
Michelle Magee, MD, explains why type-2 diabetes is on the rise across all generations, genetic factors surrounding the disease, and lifestyle factors you can shift in order to get control of your blood sugar. Dr. Magee also discusses when you should consider insulin therapy, as well as new medications and advances in insulin delivery methods.
Featured Speaker:
Learn more about Michelle Magee, MD
Michelle Magee, MD
Michelle Magee, MD, MedStar Health Research Institute, is an endocrinologist at MedStar Washington Hospital Center (MWHC) and an associate professor of Medicine at Georgetown University School of Medicine in Washington, DC. She also serves as director of the MedStar Diabetes Institute (MDI). In this capacity she leads and supports diabetes clinical, educational and research programs, including diabetes outpatient and hospital services across MedStar Health and diabetes education programs in the community. Dr. Magee's community work focuses on minority and vulnerable populations.Learn more about Michelle Magee, MD
Transcription:
Managing Your Diabetes
Melanie Cole (Host): According to the CDC, 29 million people are living with diabetes. That's one out of every eleven people in this country. For diabetics, managing diabetes can be challenging every single day. My guest today is Dr. Michelle Magee. She's the Director of MedStar Diabetes Institute at MedStar Washington Hospital Center. Welcome to the show, Dr. Magee. So, tell us about what's going on. What are you seeing with diabetes and the state of this country today?
Dr. Michelle Magee (Guest): We're seeing a really alarming rise in the incidents of diabetes. It tracks along with the rise in obesity and really is largely in consequence of changes in lifestyle over the last 10 or 20 years. People walk less, they're eating out more often. That tends to give you less healthy eating options, so you know, there are two things that I think about when I think about a patient's risk for diabetes. One is whether they have the lifestyle factors and the second is whether it runs in their family because Type II Diabetes, which is the most common form of diabetes, does run strongly in families.
Melanie: So, how would somebody know? Is this something that they get checked on their annual physicals? How would they know?
Dr. Magee: Yes. It's standard now that you'll be checked for diabetes on your annual physical, usually simply by a blood glucose test that should be fasting, nothing to eat after midnight except drink water if you need it, or your doctor may order an A1-C test. That's what I call the diabetes control number. It looks at what the average of your sugars in the past two to three months before the test is done. It’s sugars that attach to your blood cells and there are normal ranges for those numbers, there are ranges that we call pre-diabetes, meaning that you're at particularly high risk for getting diabetes, and then there are numbers that tell us that you have met parameters for a diagnosis of diabetes. So, very important to ask your doctor when you have your once a year physical, "How did my diabetes test numbers look?"
Melanie: Tell us what those number mean. What are the normal ranges people should look for?
Dr. Magee: So, on fasting blood sugar, so first morning sugar, the normal is less than 100, 100-125 is what we call pre-diabetes, and 126 or higher is diabetes. When we're looking at the A1-C control number, we're looking at a range of less than 5.4 to 5.7 is normal, 5.7 to 6.4 is pre-diabetes, and greater than or equal to 6.5 is consistent with a diagnosis of diabetes.
Melanie: What is the first thing you tell your patients if they do come up with some of those numbers that could signal pre-diabetes, or full-on diabetes?
Dr. Magee: So, we have a lot of evidence about how to treat patients in either of those categories. There have been large, national studies that show us that an intensive lifestyle intervention can cut your risk for going from pre-diabetes to diabetes by up to 60% and that's simple things like exercise five days a week for thirty minutes a day, and losing about 7% of your body weight, which, you know, for a 200-pound person would only be 14 pounds, so it's not a lot. That does significantly cut your risk if you have pre-diabetes for it turning into diabetes. And then, once you're in the diabetes range, then, again, lifestyle is important, you can't get away from that and if you want to stay healthy and you don't have diabetes or you have pre-diabetes, or you have diabetes, you have to eat well and you need to exercise. And then, we have multiple medications that we can add to the regimen to help control blood sugars for the patient who actually has diabetes and that is started by your primary care doctor and, if necessary, then you could see an endocrinologist if you don't get to your goals within a three- to six-month period.
Melanie: Dr. Magee, you mentioned that it does run in families and when you're dealing in this age of childhood obesity and you must be seeing children now coming up with this type of diabetes, it used to be called adult onset, but now it's Type II, what do you tell families when you see that this is a possibility for the whole family?
Dr. Magee: I always want to emphasize is what we teach is the patient that has pre-diabetes or diabetes, is a healthy lifestyle for their whole family. It's much easier to do these things if you all jump on the bandwagon together and, yes, one in three children born in the US now is going to develop diabetes in their lifetime. This is a preventable illness by largely, largely by lifestyle factors. So, it's really important for families to embrace being healthy together.
Melanie: That's so important. And as far as treatment goes, and you talked about lifestyle, then you mentioned medication. People think about insulin injections, that's mostly Type I, but could be Type II, so speak about the medicational intervention required if somebody can't control their diabetes with lifestyle.
Dr. Magee: Yes. So, if you can't --and I'm really…Type I always has to take insulin, so I'm not really going to speak to that. Type II diabetes, which is 90% of patients with diabetes, so almost everybody, typically patients will do well with a pill or two for many years, but over time, many patients will need insulin. It's important to start it when you need it, not to wait until you've already developed problems from diabetes. The complications that we think of with eyes and kidneys and nerves, heart disease and stroke. It's very important to treat early on and keep the sugars well-controlled, because we know it decreases the risk of complications over time. The other thing that's really important that I think we need to mention is that you do need some education so that you can learn how to live well with diabetes. We know that over almost half of the people in the US never get any education when they have diabetes and this is really critical. You have to know, not only how to eat and to exercise, but also how to take your medications, what the side effects are, what to do if your sugar is too high or too low. You really need education to be able to get that information.
Melanie: Where do you see diabetes research going in the future? What's on the horizon?
Dr. Magee: Oh, there's always exciting things on the horizon. They're always working on new classes of medications. We had another new class come out this year. We now have 12 classes of pills and insulins that you can take for diabetes and then there are exciting things in the insulin delivery arena. Some, an insulin patch, some implantable depots of insulin, things in the technology arena that help patients track their lifestyle, track their medications, track their sugars. There's a huge amount going on in that arena and you just really need to stay tuned to see what comes through the FDA that are the exciting developments that we can get to the patients.
Melanie: In just the last few minutes, Dr. Magee, wrap it up for us with your best advice for diabetes, for living with and managing the symptoms of diabetes for the listeners.
Dr. Magee: To live well with diabetes, you need to learn enough about it that you can take control of it and so that the diabetes will not take control of you. That's kind of my philosophy and at the root of all the work we do to educate patients and to manage their medication.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Medical Intel with MedStar Washington Hospital Center and for more information, you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.
Managing Your Diabetes
Melanie Cole (Host): According to the CDC, 29 million people are living with diabetes. That's one out of every eleven people in this country. For diabetics, managing diabetes can be challenging every single day. My guest today is Dr. Michelle Magee. She's the Director of MedStar Diabetes Institute at MedStar Washington Hospital Center. Welcome to the show, Dr. Magee. So, tell us about what's going on. What are you seeing with diabetes and the state of this country today?
Dr. Michelle Magee (Guest): We're seeing a really alarming rise in the incidents of diabetes. It tracks along with the rise in obesity and really is largely in consequence of changes in lifestyle over the last 10 or 20 years. People walk less, they're eating out more often. That tends to give you less healthy eating options, so you know, there are two things that I think about when I think about a patient's risk for diabetes. One is whether they have the lifestyle factors and the second is whether it runs in their family because Type II Diabetes, which is the most common form of diabetes, does run strongly in families.
Melanie: So, how would somebody know? Is this something that they get checked on their annual physicals? How would they know?
Dr. Magee: Yes. It's standard now that you'll be checked for diabetes on your annual physical, usually simply by a blood glucose test that should be fasting, nothing to eat after midnight except drink water if you need it, or your doctor may order an A1-C test. That's what I call the diabetes control number. It looks at what the average of your sugars in the past two to three months before the test is done. It’s sugars that attach to your blood cells and there are normal ranges for those numbers, there are ranges that we call pre-diabetes, meaning that you're at particularly high risk for getting diabetes, and then there are numbers that tell us that you have met parameters for a diagnosis of diabetes. So, very important to ask your doctor when you have your once a year physical, "How did my diabetes test numbers look?"
Melanie: Tell us what those number mean. What are the normal ranges people should look for?
Dr. Magee: So, on fasting blood sugar, so first morning sugar, the normal is less than 100, 100-125 is what we call pre-diabetes, and 126 or higher is diabetes. When we're looking at the A1-C control number, we're looking at a range of less than 5.4 to 5.7 is normal, 5.7 to 6.4 is pre-diabetes, and greater than or equal to 6.5 is consistent with a diagnosis of diabetes.
Melanie: What is the first thing you tell your patients if they do come up with some of those numbers that could signal pre-diabetes, or full-on diabetes?
Dr. Magee: So, we have a lot of evidence about how to treat patients in either of those categories. There have been large, national studies that show us that an intensive lifestyle intervention can cut your risk for going from pre-diabetes to diabetes by up to 60% and that's simple things like exercise five days a week for thirty minutes a day, and losing about 7% of your body weight, which, you know, for a 200-pound person would only be 14 pounds, so it's not a lot. That does significantly cut your risk if you have pre-diabetes for it turning into diabetes. And then, once you're in the diabetes range, then, again, lifestyle is important, you can't get away from that and if you want to stay healthy and you don't have diabetes or you have pre-diabetes, or you have diabetes, you have to eat well and you need to exercise. And then, we have multiple medications that we can add to the regimen to help control blood sugars for the patient who actually has diabetes and that is started by your primary care doctor and, if necessary, then you could see an endocrinologist if you don't get to your goals within a three- to six-month period.
Melanie: Dr. Magee, you mentioned that it does run in families and when you're dealing in this age of childhood obesity and you must be seeing children now coming up with this type of diabetes, it used to be called adult onset, but now it's Type II, what do you tell families when you see that this is a possibility for the whole family?
Dr. Magee: I always want to emphasize is what we teach is the patient that has pre-diabetes or diabetes, is a healthy lifestyle for their whole family. It's much easier to do these things if you all jump on the bandwagon together and, yes, one in three children born in the US now is going to develop diabetes in their lifetime. This is a preventable illness by largely, largely by lifestyle factors. So, it's really important for families to embrace being healthy together.
Melanie: That's so important. And as far as treatment goes, and you talked about lifestyle, then you mentioned medication. People think about insulin injections, that's mostly Type I, but could be Type II, so speak about the medicational intervention required if somebody can't control their diabetes with lifestyle.
Dr. Magee: Yes. So, if you can't --and I'm really…Type I always has to take insulin, so I'm not really going to speak to that. Type II diabetes, which is 90% of patients with diabetes, so almost everybody, typically patients will do well with a pill or two for many years, but over time, many patients will need insulin. It's important to start it when you need it, not to wait until you've already developed problems from diabetes. The complications that we think of with eyes and kidneys and nerves, heart disease and stroke. It's very important to treat early on and keep the sugars well-controlled, because we know it decreases the risk of complications over time. The other thing that's really important that I think we need to mention is that you do need some education so that you can learn how to live well with diabetes. We know that over almost half of the people in the US never get any education when they have diabetes and this is really critical. You have to know, not only how to eat and to exercise, but also how to take your medications, what the side effects are, what to do if your sugar is too high or too low. You really need education to be able to get that information.
Melanie: Where do you see diabetes research going in the future? What's on the horizon?
Dr. Magee: Oh, there's always exciting things on the horizon. They're always working on new classes of medications. We had another new class come out this year. We now have 12 classes of pills and insulins that you can take for diabetes and then there are exciting things in the insulin delivery arena. Some, an insulin patch, some implantable depots of insulin, things in the technology arena that help patients track their lifestyle, track their medications, track their sugars. There's a huge amount going on in that arena and you just really need to stay tuned to see what comes through the FDA that are the exciting developments that we can get to the patients.
Melanie: In just the last few minutes, Dr. Magee, wrap it up for us with your best advice for diabetes, for living with and managing the symptoms of diabetes for the listeners.
Dr. Magee: To live well with diabetes, you need to learn enough about it that you can take control of it and so that the diabetes will not take control of you. That's kind of my philosophy and at the root of all the work we do to educate patients and to manage their medication.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Medical Intel with MedStar Washington Hospital Center and for more information, you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.