Transcription:
Prediabetes: Don't Sugar Coat It

Amanda Wilde (Host): It may not sound awesome to discover you have pre-diabetes, but it actually is a diagnosis that you can use to your advantage. Amy Huelle is director of diabetes services at Maimonides and she joins me today to explain how pre-diabetes is diagnosed and treated. This is Maimo Med Talk. I'm your host, Amanda Wilde. Amy Huelle, thank you so much for being here. And I think we'd better start by defining pre-diabetes. What is it?

Amy Huelle: Well, thank you. And it's a pleasure to be here. Pre-diabetes is a condition to where your blood sugar is above the normal range, but not quite high enough to be diagnosed as type 2 diabetes. Pre-diabetes is when you're fasting blood sugar is over a hundred, but less than 126, which when you have 126 on two occasions, that's where we hit the type 2 diabetes threshold

Amanda Wilde (Host): Who's at risk for this? Are we all at risk?

Amy Huelle: Well, I'll tell you what, first of all, 96 million Americans have pre-diabetes, which is a lot of people. So one out of three people have it. And the risk factors really, there's quite a few different ones. But generally if you're overweight. That can increase your risk. I don't know if you've heard of the term of apple versus pear shape, but when you have more fat around your abdomen, that can indicate that you may have some insulin resistance going on. Whereas if you have more weight carried in the lower body, that's not as high risk. Poor diet, increased intake of sugary drinks, that certainly can kind of set the tone. If you're physically inactive, if you've got a family history, if you are a woman and had gestational diabetes in pregnancy, if you're over 45, and if you have a history of PCOS, which is polycystic ovarian syndrome, so there's kind of a cluster of different risk factors.

Amanda Wilde (Host): Who are most of your patients? Are they adults? Kids? You mentioned gestational diabetes, so pregnant women?

Amy Huelle: Yeah. So I've been working for almost 30 years in this field. I'm a diabetes care and education specialist and dietician. And I have expertise in diabetes in pregnancy. So I have spent part of my career working with women that have diabetes during pregnancy, make sure they have a healthy outcome. But now here at Maimonides, I'm actually working in the adult endocrinology department. So I see everybody over age 18. Pediatrics is a whole specialty in itself.

Amanda Wilde (Host): And do you see pre-diabetes in children as well as adults?

Amy Huelle: I don't particularly see them, but yes, that is definitely more common. I don't have the exact stats because I don't work with peds, but yes, we are seeing an increase in that. And if you think about what's going on, all of the computers, the cell phones, I mean, when we were kids, we were out there in the streets playing and we didn't have all of the Netflixes and all these things, so that's really interfered with the lifestyle of our kids. Not to mention the processed foods, the sugary drinks and just decreased activity has just set the tone to really put them at risk.

Amanda Wilde (Host): So, no wonder one out of three people have pre-diabetes. Are there symptoms we should watch out for?

Amy Huelle: Pre-diabetes itself, you don't necessarily have symptoms. However, if you have some other underlying condition like insulin resistance, polycystic ovarian syndrome, we may see like in teens or young adults, these brown velvety patches that might be on the skin. And sometimes the dermatologist will pick that up and that prompts them to go get a test, which typically puts them pretty high risk for having abnormal blood sugars. But other than that, there's no real standard risk factor until you start getting closer to that type 2 diagnosis.

Amanda Wilde (Host): So what are the tests we can get to measure where we are with pre-diabetes?

Amy Huelle: Yeah. So there's a couple different ways of doing it. Just that fasting blood sugar, so when you go for your regular annual physical, which we should all be doing, not putting that off, a fasting blood sugar over a hundred, that would be one way. And then, typically, they will watch that and maybe do a second one to confirm it. Another test is the hemoglobin A1c, which that's really a better route to go, because that gives you a 90-day look back or three months to see where your sugars have been running. And we know that when that A1c goes above 5.7 to 6.4%, that's that diagnostic criteria for pre-diabetes. So I think that's really an ideal test to get, if we can over the fasting

Amanda Wilde (Host): Well, if you do find you do have pre-diabetes, what are the risks there?

Amy Huelle: Well, the biggest risks that can really put you at real high risk or like a speedy train on to type 2 diabetes. And that has a whole host of complications that can be very bad, kidney disease, heart disease, there's all sorts of problems. So pre-diabetes itself, it's really, "Are you going to do something about it or is it going to escalate and get into type 2?" And that's where, what you said at the beginning, it's an opportunity. This is a time where you can take that information and make some changes that can totally affect how your health lays out in the future.

Amanda Wilde (Host): Yeah. So let's talk about what changes can you make to avoid diabetes?

Amy Huelle: Well, I think, the first thing is you want to make sure that you're partnered up with somebody to help you understand what's going on. What could potentially be some of the barriers or things that may be going on in your lifestyle that you're not aware of? So there are really great programs out there. The CDC has the Diabetes Prevention Program. That's a 12-week program that you can get in and really learn and educate yourself on all the different things to do differently. And it may start with taking a look at what your eating habits are like. Are you skipping meals, not eating all day and then eating a lot at night? Which is pretty common. Are you drinking sugary drinks? Are you sitting on the couch and not moving your body? So it's kind of like, "Let's find out what's going on here." And I think that's where you could seek out some help or these programs from the CDC to identify what that is, because sometimes it's very obvious and sometimes people are like, "I don't understand what's going on here." So I think it's really reaching out and there's some great resources on the web with the Diabetes Association. And again, talking to your doctor about sending you to someone to help, because there's too much misinformation out there to begin on your own.

Amanda Wilde (Host): So you get to identify in partnership with your doctor what is going on. And then, can you talk a little bit about how to eat and exercise to avoid pre-diabetes?

Amy Huelle: There's a couple things to think about. You know, there's so much misinformation out there. And carbohydrate is the nutrient that we hear about and people say, "It's so bad. You can't eat carbs." I have some patients tell me they can't eat carrots because they're carbs. And I'm just like, "Okay, let's slow down here." Basically, what we want to do is think about a few things. Eat three times a day, if you can. Try not to skip meals because your body needs nourishment and you don't want to set yourself up to overeat. If you think of the real basics, the plate method is where we start. The plate method is basically helping you understand what you should be eating. So when you look at your plate, really trying to fill up about half of it with non-starchy vegetables. They're great for you. They're delicious. And it's a good way to get full and give your body nutrients. A quarter of your plate should be coming from either animal or plant protein. And then, a quarter coming from some kind of carbohydrate that could be sweet potato. It could be brown rice, quinoa. It could be a variety of things. So just understanding what your plate should be looking like. I think a lot of times we're missing some of those things.

Amanda Wilde (Host): Well, I noticed you didn't mention brownie for a carbohydrate.

Amy Huelle: And you know what? It's okay to learn how to work those things in. I think we have to identify some of us just love sweets. And if we keep them in the house, we just keep eating them and we can't stop and that's just being a human being. So it doesn't mean we can't have those, but we need to learn to just understand what amounts, because our portions are so out of control here. It's okay to include small amounts of sweets, but let's try to make sure we get what we need first. Have you had any fruit or vegetables today? And if you want to have a dessert, a small portion and knowing what that is because a pint of Ben and Jerry's is a portion when really that should be feeding four people and we just are so skewed with that. And that's the problem, you know?

And the thing is, if you go back to 1950, what was considered a portion there is so different than what we have today. And we've just gotten accustomed to that. In Europe, they don't do that. They don't eat big, huge things of ice cream. It's like it's just a small little dish, a little ramekin. And so you can teach yourself how to include those things, but we've really got to look at 90% of what we're eating is 90% of the nutrition we're going to have.

Amanda Wilde (Host): When you said we should eat three times a day, should you eat even when you aren't hungry, just to make sure that you have steady nutrition throughout the day?

Amy Huelle: So that's such a great question. And the answer is we really should refuel our body because what happens is sometimes our hunger cues are off. There's some hormones, ghrelin and leptin, which tell us when we're full and when we're hungry. And sometimes those hormones aren't working as efficiently as they should. And we don't even know what our hunger cues are. So when we skip a meal, a lot of times, you're going to make up for it later, and you're going to be eating a lot more. At night after dinner, you're hitting the Netflix and the snacks. And so it's really better to try to get something, you don't need to eat much, but having something small just to break that fast and making sure that you're not playing catch up the rest of the day. I just tell people, think of your body as a car. You need to refuel that gas tank and meet your nutrition needs over the day, not all at one time.

Amanda Wilde (Host): Oh, that's interesting, because intermittent fasting has become so popular lately.

Amy Huelle: Right. And there's a million different things you can do. And it's not that that's a bad thing. I mean, we don't have one diet we tell people to do. But the majority of people that I see just don't do well when they skip meals, it really backfires. And I see a lot of people over the past 30 years. So, if it really works better for a person, I'm going to work with them, whatever they do, because there's no one diet. However, most people we see better blood sugar control, we see better nutrition when people can spread out their food over the day.

Amanda Wilde (Host): And what about the exercise piece? What do you recommend there?

Amy Huelle: If you think about how much time we spend sitting, it's a lot. Even myself, I see patients all day, so really we should be moving a good 30 minutes for just cardiovascular health and just in general health each day. With kids it's really closer to like an hour, is what we recommend. There's been some studies that have shown that just doing 30 minutes by itself may not be as beneficial as if you try to break up your sitting time during the day. So I really try to think of both of those things, try to work on getting that 30 minutes just for cardiovascular health. But during the day, for example, for me, I literally sit all day talking to patients. So in between patients in my office, I have some little exercise bands and things to just try to give your body a break each hour, get up and stretch and move a little bit. So that increases our activity during the day. And then, we can also work and strengthen our heart muscle for 30 minutes outside of that. So it's always about starting where the person is at and some people can't do all of that. So we work with where the person is, but it's very important and the best medicine we could do for not only pre-diabetes, which can really help reduce your moving on to type 2, but it's good for everybody and it's good for everything pretty much. So it's just something we all need to do better at.

Amanda Wilde (Host): I know at Maimonides, you have a special focus on education as part of your diabetes program. Can you give an example of why Maimonides is the place to be treated for pre-diabetes?

Amy Huelle: Yes. And I'm so excited about this. I was recruited, I just moved here from New England to start a diabetes education program. And we have since gotten the American Diabetes Association recognition, as we are a recognized program. And they are so dedicated to make sure that the people of Brooklyn have a place to go. They are dedicated in helping me just build this program from the ground up. And so having the support of my Maimonides to understand how important this is, when diabetes programs are folding across the country because generally they're not always going to generate revenue like a colonoscopy would, but this service is so important for patients and typically there's a shortage of places for people to go. So they're very, very supportive at helping us build this program. And I'm very excited to be here doing this. It's going to be wonderful for the people of Brooklyn.

Amanda Wilde (Host): Yeah, really building something lasting to help people have better health. Are there any other takeaways you want to add?

Amy Huelle: I think the thing is just know that you're not alone. There is help. And you want to talk to your doctor about reaching out to work with a diabetes care and education specialist. It's hard. We're humans. We love to eat sweets. We love to engage in the lifestyles that we have and you need help and support.

One thing that drives me crazy is when they say, "Lose weight and come back in six months." It's like, "What are you going to do to help that person?" They need support. They need someone by their side, and there are some great resources to get started before seeing somebody. But I just think you need someone. I work with people every day and it's my honor to work with them, to support them in this journey. Just so much information, you don't know how to sort through it and it can be overwhelming. So the diabetes prevention programs, diabetes care and education specialist. And then, if you go to the American diabetes association, diabetes.org, there's some great resources. The Food Hub has wonderful resources for nutrition, recipes. They also have some great information and a quiz that you can take to see if you're at risk for pre-diabetes. So I highly recommend going to that site to get started, to educate yourself and then get someone to help you and walk that journey with you.

Amanda Wilde (Host): That part is so encouraging and just reassuring to know there are specialists and resources to help. Thank you, Amy, for these insights. It's so helpful to know we can take steps to beat diabetes before it happens.

Please visit maimo.org for more information. To make a primary care appointment, call 718-283-5700. This has been Maimo Med Talk. I'm Amanda Wilde. Stay well.