According to the Centers for Disease Control and Prevention (CDC), as many as 29 million people in the United States have diabetes, but up to 8 million may be undiagnosed and unaware of their condition.
Listen as Dr. Mateo Reyes discusses living with diabetes and what you can do to manage your symptoms and experience a better quality of life, even with diabetes.
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Living with Diabetes
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Learn more about Mateo Reyes, MD
Mateo Reyes, MD
Mateo Reyes, MD works in Laredo, TX and specializes in Family Medicine and General Practice, and is a member of the medical staff at Doctors Hospital of Laredo.Learn more about Mateo Reyes, MD
Transcription:
Living with Diabetes
Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as 29 million people in the United States have diabetes, but up to 8 million may be undiagnosed and unaware of their condition. My guest today is Dr. Mateo Reyes. He’s a family medicine physician and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show. What is diabetes type 2?
Dr. Mateo Reyes (Guest): Type 2 diabetes is a problem with the body having what we called insulin resistance or the body’s inability to use insulin appropriately in order to be able to transfer sugar from the blood into the cells to be used for energy.
Melanie: Are there certain people who are predisposed to type 2 diabetes? We’re distinguishing between type 1 and type 2 because type 1 is something that really can be a lifelong thing, but diabetes type 2, which used to be called adult onset, now we are seeing in children. Just give us a little physiology lesson of the difference between the two.
Dr. Reyes: Type 1 diabetes was always known as insulin dependent diabetes – the pancreas doesn’t produce insulin and therefore they require insulin to manage their sugars. In type 2 diabetes, it’s actually the opposite – there's a lot of insulin but there's insulin resistance and therefore the person builds up high levels of sugar in the blood. One requires insulin and the other one does not require insulin. Sometimes type 2 diabetics however with time people start using insulin doesn’t make them a type 1 diabetic unless they deplete their insulin levels in their body and enter something that’s called diabetic ketoacidosis, at which point a type 2 can become a type 1.
Melanie: I'm glad you made that distinction between insulin resistance and the pancreas being damaged or destroyed for type 1. Who’s at risk for type 2? Are there lifestyle things that can be involved that can help cause it?
Dr. Reyes: One of the biggest risk factors is ethnicity. I think somewhere around 16% of American Indians have type 2 diabetics. Now it is something like 13% of non-Hispanic African American people have type 2 diabetes and also about 13% of Hispanics, 9% of Asian Americans, so that tends to be a big risk factor, and of course the other one would be obesity. Particularly the people that have the centripetal obesity or the pear shaped distribution type of fat. Around the belly, that one produces more insulin resistance than the people that carry it more on their thighs, etc.
Melanie: What would be your first best piece of advice? If someone is told that they have pre-diabetes, that they're on the edge of full blown diabetes, what would you want them to know and what would you want them to do?
Dr. Reyes: The biggest thing that we always start with is lifestyle modifications. Of course, there has been some studies that show that losing up to 10% of a person’s body weight at the diagnosis of prediabetes will keep them from becoming a full blown diabetic, at least in that short period of time. Somebody who’s on the verge of becoming a diabetic, you tell them to lose 10% of your body weight, you encourage a low carb diet, you encourage exercise and of course the weight loss. You can keep them from becoming a diabetic so long as they maintain that lifestyle modification. If they go back to their old ways, then risk comes right back.
Melanie: If they are diagnosed, you’ve mentioned the lifestyle modifications a little bit, and then what about nutrition and then medicational intervention? Nutrition, people hear carbohydrates and right away they say ‘I'm not allowed to eat those anymore, now I'm a diabetic.’ Certain vegetables are carbohydrates and things that are not necessarily so bad for you, so what do you tell people about their nutritional requirements?
Dr. Reyes: The whole key to that is just having a healthy well balanced meal because you being diabetic does not mean you have to eliminate carbohydrates – of course you have to go on a low carb diet. The body still needs some carbohydrates for energy – the body uses glucose for energy and if you totally deplete it, then you're going to start going into glucose starvation mode and then you start breaking down fat, which at some point it can be desirable such as the Atkins diet or something like that, but the brain in particular doesn’t do very well without glucose. The low carbohydrate diet is good. Obviously, you're going to want to go on a low fat diet because most people with diabetics also have issues with fat metabolism or cholesterol. You do want to eat your vegetables. You do want to eat your greens. The huge thing here is moderation and portion size. For example, if you're going to have some rice, it has to be whatever fits in the palm of your hand, but that doesn’t mean you cannot have any rice. Obviously, you want to stick more to the lean proteins, more veggies and a little bit of carbs and the portion size. If you look at the food pyramid that dieticians talk about, that’s a healthy well balanced meal. You want to decrease your fat intake, your carb intake, but you don’t want to totally eliminate them.
Melanie: What about if you do have to look towards medication? Are there some medications that can help reduce your glucose levels? Are there oral medications? What are you doing today for people that are having trouble with those lifestyle modifications and they have to turn toward medicational intervention to help them with this?
Dr. Reyes: There's a lot of medicines available now for diabetes and there's a lot of good medications nowadays that make the body function in a more normal way. Still, the #1 medicine used in type 2 diabetes is probably one of the older ones called Metformin and it allows the body to utilize its own insulin as opposed to having to use insulin. There's some medicines that work by eliminating sugar in the guts, some by eliminating sugar in the kidneys, some that help the pancreas in a more normal fashion. There's a broad spectrum of medications – oral medications, then you have to go to insulin – or if you're diagnosed with a very high level of sugar on presentation, your doctor might even opt to start you on insulin right off the bat with the medication like Metformin to bring your sugar levels down, and then if you do really good, then maybe take you off the insulin and keep you on oral medications.
Melanie: What about exercise? Where does that fit into this picture? It’s really important as exercise can have an insulin like effect. How often would you like people to exercise? What would you like them to do?
Dr. Reyes: In all diabetics, you have to make sure you get an okay from your doctor to exercise at first to begin with. Like I said earlier, the body uses sugar for energy so the more your exercise, the lower your sugar levels go in your blood. If you're a diabetic and you're going to be in an exercise program, it’s going to be important that you check your sugar before you exercise to make sure you're not too low because obviously if you exercise and your sugar is in a low normal range, then you're going to bottom out. The other thing is when you exercise too much and you push your body way too much, then the body starts getting stressed and the adrenaline, the cortisol mechanism of the body starts pushing out more sugar into the bloodstream so your sugar is going to go high. Typically, exercise 30 minutes a day, most days of the week, is recommended – 150 minutes of cardiovascular exercise per week. After your exercise, if you're a diabetic, it’s important to make sure you check your feet, make sure you didn’t get any blisters or ulcers from the exercises and that’s pretty much it as far as exercise goes.
Melanie: What about self-monitoring? Those glucose kits that you can get at the pharmacy – are those what you want them to use to keep track of their blood sugar levels – and how often would you like them to check those?
Dr. Reyes: It depends. If you're a person that has been controlled – your sugars have been very well controlled – then you don’t need to monitor it every day. I tell my patients to monitor it if they don’t feel well or they're getting any signs or symptoms of low blood sugar or high blood sugar. Somebody who’s on insulin three times a day, they require much more frequent monitoring when they wake up, before meals and at bedtime. It depends on where you fall in, but typically somebody on pills shouldn’t be monitoring more than once a day unless they're feeling bad or they're having episodes of their sugars dipping too low or going up too high. Somebody on insulin probably needs to check at least twice a day and sometimes even three or four times a day.
Melanie: In just the last few minutes, what would you like people to know about diabetes and living with and managing their symptoms?
Dr. Reyes: Diabetes doesn’t have to be a dead sentence as people thought before. Diabetes is actually something that’s very manageable and it’s very important that people take care of themselves. A big thing is people always say ‘I don’t feel bad, therefore I skip medication here and there, and I don’t care my sugar’s high because I'm totally okay, you tell me numbers look good,’ and that can happen early on, but with time, diabetes will eventually catch up to you, and 15 or 20 years of uncontrolled diabetes can do a lot of damage. Of course, if you're a 30-year-old with type 2 diabetes or a 20-year-old with type 2 diabetes, then you're looking at problems at a very young age. Diabetes is the #1 cause of blindness in the United States, #1 cause of amputations in the United States, #1 cause of renal failure in the United States, it’s associated with an increase in strokes and an increase in heart attacks. If you take care of yourself, then you minimize your risk of a complication and a better outlook and quality of life later on in life. Don’t wait until you have a problem to start taking care of yourself because a lot of the damage that diabetes does is irreversible – you got to start taking care of yourself the minute you're diagnosed with it.
Melanie: Thank you so much for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, please visit ichoosedoctorshospital.com. That’s ichoosedoctorshospital.com. The physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners, including certain members of the hospital medical staff. This is Melanie Cole. Thanks so much for listening.
Living with Diabetes
Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as 29 million people in the United States have diabetes, but up to 8 million may be undiagnosed and unaware of their condition. My guest today is Dr. Mateo Reyes. He’s a family medicine physician and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show. What is diabetes type 2?
Dr. Mateo Reyes (Guest): Type 2 diabetes is a problem with the body having what we called insulin resistance or the body’s inability to use insulin appropriately in order to be able to transfer sugar from the blood into the cells to be used for energy.
Melanie: Are there certain people who are predisposed to type 2 diabetes? We’re distinguishing between type 1 and type 2 because type 1 is something that really can be a lifelong thing, but diabetes type 2, which used to be called adult onset, now we are seeing in children. Just give us a little physiology lesson of the difference between the two.
Dr. Reyes: Type 1 diabetes was always known as insulin dependent diabetes – the pancreas doesn’t produce insulin and therefore they require insulin to manage their sugars. In type 2 diabetes, it’s actually the opposite – there's a lot of insulin but there's insulin resistance and therefore the person builds up high levels of sugar in the blood. One requires insulin and the other one does not require insulin. Sometimes type 2 diabetics however with time people start using insulin doesn’t make them a type 1 diabetic unless they deplete their insulin levels in their body and enter something that’s called diabetic ketoacidosis, at which point a type 2 can become a type 1.
Melanie: I'm glad you made that distinction between insulin resistance and the pancreas being damaged or destroyed for type 1. Who’s at risk for type 2? Are there lifestyle things that can be involved that can help cause it?
Dr. Reyes: One of the biggest risk factors is ethnicity. I think somewhere around 16% of American Indians have type 2 diabetics. Now it is something like 13% of non-Hispanic African American people have type 2 diabetes and also about 13% of Hispanics, 9% of Asian Americans, so that tends to be a big risk factor, and of course the other one would be obesity. Particularly the people that have the centripetal obesity or the pear shaped distribution type of fat. Around the belly, that one produces more insulin resistance than the people that carry it more on their thighs, etc.
Melanie: What would be your first best piece of advice? If someone is told that they have pre-diabetes, that they're on the edge of full blown diabetes, what would you want them to know and what would you want them to do?
Dr. Reyes: The biggest thing that we always start with is lifestyle modifications. Of course, there has been some studies that show that losing up to 10% of a person’s body weight at the diagnosis of prediabetes will keep them from becoming a full blown diabetic, at least in that short period of time. Somebody who’s on the verge of becoming a diabetic, you tell them to lose 10% of your body weight, you encourage a low carb diet, you encourage exercise and of course the weight loss. You can keep them from becoming a diabetic so long as they maintain that lifestyle modification. If they go back to their old ways, then risk comes right back.
Melanie: If they are diagnosed, you’ve mentioned the lifestyle modifications a little bit, and then what about nutrition and then medicational intervention? Nutrition, people hear carbohydrates and right away they say ‘I'm not allowed to eat those anymore, now I'm a diabetic.’ Certain vegetables are carbohydrates and things that are not necessarily so bad for you, so what do you tell people about their nutritional requirements?
Dr. Reyes: The whole key to that is just having a healthy well balanced meal because you being diabetic does not mean you have to eliminate carbohydrates – of course you have to go on a low carb diet. The body still needs some carbohydrates for energy – the body uses glucose for energy and if you totally deplete it, then you're going to start going into glucose starvation mode and then you start breaking down fat, which at some point it can be desirable such as the Atkins diet or something like that, but the brain in particular doesn’t do very well without glucose. The low carbohydrate diet is good. Obviously, you're going to want to go on a low fat diet because most people with diabetics also have issues with fat metabolism or cholesterol. You do want to eat your vegetables. You do want to eat your greens. The huge thing here is moderation and portion size. For example, if you're going to have some rice, it has to be whatever fits in the palm of your hand, but that doesn’t mean you cannot have any rice. Obviously, you want to stick more to the lean proteins, more veggies and a little bit of carbs and the portion size. If you look at the food pyramid that dieticians talk about, that’s a healthy well balanced meal. You want to decrease your fat intake, your carb intake, but you don’t want to totally eliminate them.
Melanie: What about if you do have to look towards medication? Are there some medications that can help reduce your glucose levels? Are there oral medications? What are you doing today for people that are having trouble with those lifestyle modifications and they have to turn toward medicational intervention to help them with this?
Dr. Reyes: There's a lot of medicines available now for diabetes and there's a lot of good medications nowadays that make the body function in a more normal way. Still, the #1 medicine used in type 2 diabetes is probably one of the older ones called Metformin and it allows the body to utilize its own insulin as opposed to having to use insulin. There's some medicines that work by eliminating sugar in the guts, some by eliminating sugar in the kidneys, some that help the pancreas in a more normal fashion. There's a broad spectrum of medications – oral medications, then you have to go to insulin – or if you're diagnosed with a very high level of sugar on presentation, your doctor might even opt to start you on insulin right off the bat with the medication like Metformin to bring your sugar levels down, and then if you do really good, then maybe take you off the insulin and keep you on oral medications.
Melanie: What about exercise? Where does that fit into this picture? It’s really important as exercise can have an insulin like effect. How often would you like people to exercise? What would you like them to do?
Dr. Reyes: In all diabetics, you have to make sure you get an okay from your doctor to exercise at first to begin with. Like I said earlier, the body uses sugar for energy so the more your exercise, the lower your sugar levels go in your blood. If you're a diabetic and you're going to be in an exercise program, it’s going to be important that you check your sugar before you exercise to make sure you're not too low because obviously if you exercise and your sugar is in a low normal range, then you're going to bottom out. The other thing is when you exercise too much and you push your body way too much, then the body starts getting stressed and the adrenaline, the cortisol mechanism of the body starts pushing out more sugar into the bloodstream so your sugar is going to go high. Typically, exercise 30 minutes a day, most days of the week, is recommended – 150 minutes of cardiovascular exercise per week. After your exercise, if you're a diabetic, it’s important to make sure you check your feet, make sure you didn’t get any blisters or ulcers from the exercises and that’s pretty much it as far as exercise goes.
Melanie: What about self-monitoring? Those glucose kits that you can get at the pharmacy – are those what you want them to use to keep track of their blood sugar levels – and how often would you like them to check those?
Dr. Reyes: It depends. If you're a person that has been controlled – your sugars have been very well controlled – then you don’t need to monitor it every day. I tell my patients to monitor it if they don’t feel well or they're getting any signs or symptoms of low blood sugar or high blood sugar. Somebody who’s on insulin three times a day, they require much more frequent monitoring when they wake up, before meals and at bedtime. It depends on where you fall in, but typically somebody on pills shouldn’t be monitoring more than once a day unless they're feeling bad or they're having episodes of their sugars dipping too low or going up too high. Somebody on insulin probably needs to check at least twice a day and sometimes even three or four times a day.
Melanie: In just the last few minutes, what would you like people to know about diabetes and living with and managing their symptoms?
Dr. Reyes: Diabetes doesn’t have to be a dead sentence as people thought before. Diabetes is actually something that’s very manageable and it’s very important that people take care of themselves. A big thing is people always say ‘I don’t feel bad, therefore I skip medication here and there, and I don’t care my sugar’s high because I'm totally okay, you tell me numbers look good,’ and that can happen early on, but with time, diabetes will eventually catch up to you, and 15 or 20 years of uncontrolled diabetes can do a lot of damage. Of course, if you're a 30-year-old with type 2 diabetes or a 20-year-old with type 2 diabetes, then you're looking at problems at a very young age. Diabetes is the #1 cause of blindness in the United States, #1 cause of amputations in the United States, #1 cause of renal failure in the United States, it’s associated with an increase in strokes and an increase in heart attacks. If you take care of yourself, then you minimize your risk of a complication and a better outlook and quality of life later on in life. Don’t wait until you have a problem to start taking care of yourself because a lot of the damage that diabetes does is irreversible – you got to start taking care of yourself the minute you're diagnosed with it.
Melanie: Thank you so much for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, please visit ichoosedoctorshospital.com. That’s ichoosedoctorshospital.com. The physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners, including certain members of the hospital medical staff. This is Melanie Cole. Thanks so much for listening.