Transcription:
Diabetes Mellitus

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician. Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to listen, as we discuss diabetes today with Dr. Douglas Heighton. He's a Family Practice Physician with Memorial Hospital. Dr. Heighton, it's a pleasure to have you join us today.

Melanie Cole (Host): So, let's talk first about the prevalence. How common is diabetes? What have you been seeing? Because we hear this is becoming quite the epidemic.

Dr. Heighton: It's true. Diabetes is on the increase for many reasons. Presently it has an incidence or the percentage of people with diabetes is about 10%, but it is increasing.

Host: I'd like you to tell us the difference. People hear about Type 1 and Type 2, which used to be called adult onset. But you know, now those terms are kind of a little bit different. Can you tell us what Type 1 diabetes is? What Type 2 is? Really how they're different, but we're mostly talking about Type 2 today.

Dr. Heighton: Type 1 diabetes is young age diabetes. It is still of the pediatric population. Type 1 occurs because of auto-immune disease or where the body attacks the pancreas and the pancreas is where everyone makes their insulin. So, it happens at a young age. It can start at three years old, all the way up to 18 years old, but it starts in the younger population.

Type 2 diabetes, which used to be called old age diabetes, historically it started at age 40 or 50, but recently because of obesity or being overweight, I've had people, 15 years old start with Type 2, and that is where you still have your pancreas making insulin, but for multiple reasons, you either have insulin resistance or a slight decrease in production of insulin.

Host: So, people are told that they may have pre-diabetes or diabetes, full blown diabetes. Tell us, first of all, how is it diagnosed and what are some complications if it's left untreated or not managed well?

Dr. Heighton: Well, pre-diabetes means it's before you develop the symptoms of diabetes. And that is of course on the increase too. Quite a few people, more than 50% get pre-diabetes before they get actual diabetes. There are some people who kind of go from no diabetes to full diabetes in a matter of months, but most people have several months to years of pre-diabetes before they get the full onset of Type 2 diabetes.

Pre-diabetes is a diagnosis that's done with a blood test where we look to see, first of all, if either after eating, we call that postprandial, that your sugar's go extremely high or that they stay high or that the blood tests that we do for to see how bad your diabetes is, it's called A1C or hemoglobin A1C and prediabetes is where that is just slightly above normal. Usually normal means it's less than 5.5 and pre-diabetes is from 5.5 to 6.5.

Host: So, if someone is told, and in my opinion, pre-diabetes is a lucky diagnosis in that your body is warning you. They're telling you you're ,having trouble and insulin resistance and trouble with insulin getting into those muscles. So, it's bit of a warning. What is the first piece of advice that you tell someone if they're diagnosed with pre-diabetes and or even full blown, what is the first thing you would try with them?

Dr. Heighton: Usually the first, it's always diet and exercise. So, the first thing is diet. Watch your carbs. Carbs are anything in the bread family. Anything in the potato family and anything in the corn family, the grains. All right. Decrease those. Those are what give you high blood sugars after eating them. Also then the exercise component. Any type of exercise would be fine from simple walking to even running, if you're able to do that.

Of course you want to be careful that you do not have any existing heart problems, which could give you chest pains or heart attacks, but diet and exercise are the things we do for all diabetics pre-diabetes or full diabetes.

Host: Dr Heighton, are there some symptoms? Anything that would let somebody know something's going on because not everybody goes for their annual wellness where you would do blood work and possibly a glucose test. How would somebody know? Are there any signs or symptoms?

Dr. Heighton: Sometimes the symptoms start very mildly or you may not notice them. And because they start years in a row that the onset can be very slow. Usually what we talk about in diabetes is extra hunger, extra thirsty, and extra urine.

Host: Okay. So, if people have these things, that are just not among their regular routine kind of things, hunger, thirst, they're going to the bathroom more often, a visit to the doctor, they've been told this. Now tell us a little bit about what the research says about prevention of diabetes. And if you want to, tell us about the Diabetes Prevention Program at Memorial Hospital.

Dr. Heighton: We do see a correlation or that many people with pre-diabetes and regular diabetes have the onset of weight gain. That weight gain may precede either the pre-diabetes or the normal diabetes, or it may be at the same time. And it may continue after you are diagnosed with either one of those. So again, watching your body weight, trying to maintain a normal BMI, basal metabolic rate or your weight versus your height is what it means. Okay. Not being obese is what it means. All right. Therefore that's where both the diet and exercise are important.

Host: So, tell us a little bit about the prevention program itself. What's involved? What does it focus on and how does it help the community?

Dr. Heighton: As part of our prevention program, first of all, we have opportunities for people to exercise. We have gyms and facilities where people can go or they can pick their own such as a YMCA or a health club, and begin those programs independently or through us. We also, as we see people gain weight, so some people gain weight before they get pre-diabetes or diabetes. So, when we see weight gain in people, we have the ability to send them to a dietician to talk about their weight and to talk about what the appropriate amount of calories, the appropriate food portion size would be and the appropriate times to eat those meals so that you don't get overly hungry and eat too much.

Host: So, how does someone get involved in this type of program or these classes? Is it covered by insurance? Who do they call? Tell us a little bit about how someone gets involved.

Dr. Heighton: Well, some of the programs are covered by insurance, particularly the Medicare age, over the age of 65. But anyone can attend the programs. They can talk to their physician or they can actually call into the hospital and ask for our dietician or our people who deal with watching weights and proper nutrition.

Host: Well, that's great information. And Dr. Heighton, tell us a little bit about as a physician, when you're working with somebody that has been diagnosed with diabetes, what do you want to know if they were to keep track of their data, their sugar numbers. And we're going to talk about that in another episode, but what is it that you're looking for them to keep track of so that you can help them to manage this situation?

Dr. Heighton: We like to see a record of what they are eating at each meal time. Typically, we would like three meals a day. All right. And again, not too much carbohydrates in those meals, cause that can shoot your blood sugars really high. Then in addition to that, we would like them to be monitoring their blood glucose and they do that with a finger stick and a machine and writing those down.

And we would like to see how much exercise they're doing on a daily basis. They can divide it up, you know, three times a day, two times a day, five times a day, sometimes a simple walk. Sometimes other kinds of activities are enough. It all depends on how much they're eating, balances out with their exercise.

Host: So, then how often would you like them to be checking their blood sugar?

Dr. Heighton: Well, early on with either the pre-diabetes or the early diabetes, new onset, they really only need it, to do it once a day. Usually we like it first thing in the morning when you've not eaten anything all night, you know, it's been eight hours or 12 hours while you've been asleep that you have not eaten. That's called a fasting blood sugar. And we would like that number to be from 100 to 130 for those with pre-diabetes or diabetes, that's a fasting blood sugar of 100 to 130.

Host: This is so helpful for people and listeners, I hope you're writing all this down, but if you're not, you can always listen to it again as a podcast. So, if you were to offer your best advice, Dr. Heighton for people to prevent, stave off, if they've been told they have pre-diabetes, what would you like to tell the listeners? Because this is so prevalent and even with our children, as families learn to kind of do this together and be good role models and exercise together, cook healthy together, any of those things. Give us your best advice on how you would like families to work together, to keep everybody healthy and hopefully stave off diabetes.

Dr. Heighton: Well, again, I think having standard mealtimes where the entire family is there at the mealtime, watching what is prepared, not junk food, not snack food, not high calorie foods. Good amounts of vegetables. Vegetables are low glucose or sugar, and they're also high in fiber. So, the fiber helps prevent some of the glucose from getting into the body. So, things like green beans and broccoli and carrots, and instead of fruit juices, would prefer people not have orange juice, but if they ate the oranges, that's much better because orange juice is within your bloodstream within five minutes or less. But if you eat an orange, it may take one hour to two hours for all that digestion to get the sugar into your body.

So, instead of apple juice, eat apples. Okay. Yes, they do have glucose in them, sugar, but eating the apple fiber is safer or slower to get into the body with digestion. So, again, fixed meal times, you know, three meals a day so that you don't become overly hungry by skipping meals and meals that are full of vegetables and fiber things. And keeping the fruit juices as low as possible or zero. And instead of that, fresh fruit.

Host: What great advice we're getting here today. Dr. Heighton, thank you so much for joining us. And to make an appointment with Dr. Douglas Heighton or to learn about the Memorial Hospital Diabetes Health and Wellness Program, please call 216-357-2173, or you can always visit our website at mhtlc.org.

You're listening to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole. And we will continue after this quick message about Memorial Hospital.

Break

Host: Welcome back to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole. Before the break, we were discussing diabetes with Dr. Douglas Heighton. He's a Family Medicine Physician with Memorial Hospital. Dr. Heighton, as we're talking about lifestyle, modifications, behaviors before the break, we were talking about a lot of good advice and things we can do. When it comes to those things, some times they don't work as well as we'd like them to. Tell us what you would do as far as treatments for diabetes Type 2 once we've discovered that some of these lifestyle behaviors are not really working as well as we'd like them to.

Dr. Heighton: Yes, the American Diabetes Association does always recommend lifestyle modification, which means diet and exercise, limiting the amount of calories and trying to burn some of those calories with the exercise. As the sugars or glucose in the blood are elevated or not controlled to an appropriate level, then they recommend medication as the next step. Typically the first medication and the one we have used for decades, okay, is one called metformin or Glucophage was the old name. We start with low doses and we increase the dose every month or so until we're able to maintain a good fasting glucose or throughout the day, what the glucose level is. The way we check that is we do a blood test called a hemoglobin A1C. Usually we just call it A1C and again, for good control, we'd like it less than 7.0, 7. Again, diabetes is diagnosed by when that hemoglobin A1C goes above 6.5.

Host: So, someone might be on medication. And I think one of the things that people are not really clear on is once they're on the medication, it's still important to do all of these lifestyle things. As exercise has an insulin like effect. It helps that insulin to get into the muscles and working out of the bloodstream a little bit. Can you tell us, how often you recommend somebody exercise to make a real difference? Is it just a nice walk? Can they break it up? I'd like you to expand a little bit more on exercise and its role in controlling diabetes.

Dr. Heighton: Well it is important to get some degree of exercise. It does not have to be super strenuous or anything like that. Again, you don't want to put strain on your heart or anything like that, but exercise is recommended. It can be mild and you can break it up into, you know, two times a day, three times a day, four times a day. And we would recommend not within two to three hours of sleep time because exercise warms your body up and increases your heart rate. And sometimes just delays the onset of sleep. But again, you could do a little before or after breakfast, a little before or after lunch, a little before or after an evening meal. And that would be helpful. What the exercise does is it lowers glucose resistance. And as you referred to earlier, glucose resistance and insulin resistance are the same. What it means is that no matter what amount of insulin your body may be making, it is not getting to where it's supposed to get.

And that is into the muscles. Before you have diabetes, your insulin that's released in your body pulls the glucose out of your blood and into all your muscles. As you get diabetes, that becomes one of the two problems. The first problem is high glucose. And the second problem is it's not getting into the muscles where it needs to be and needs to be used. And so by exercising, it makes those muscles pull the glucose into the muscle and it makes the insulin that's already in your body work better at doing that.

Host: What an excellent explanation. You're a very good educator, Dr. Heighton. So, there are a few other things that people need to be aware of if they have diabetes, these comorbid conditions. Diabetes can contribute, and we haven't really discussed this yet, but it can contribute to heart disease and high blood pressure can be a part of that. And as you mentioned, obesity. Now those all things need to be managed as well as the diabetes, but speak specifically right now about how you advise your patients on eye health and foot health if they do have full blown diabetes, because these things can lead to pretty severe complications.

Dr. Heighton: That's true. The first step though is always to keep the glucose levels or the blood test hemoglobin A1C, the better that is, the longer you can prevent those secondary problems of heart disease and eye problems and neuropathy, which means losing the sensation in your feet. So, the first step is always keeping the glucose and therefore the A1C within normal ranges or as normal as possible.

All right. Beyond that, for the longer your glucose level in your blood is up, meaning months and years, or the longer the A1C is up, meaning months or years, the more likely you are to develop those secondary problems of diabetes or glucose levels, such as decreased vision or vision loss, heart disease, high cholesterol, which means that the cholesterol builds up in your arteries and can lead to heart problems, heart failure, or heart attacks, and it can lead to neuropathy, which means the nerves don't work anymore and tend to get worse over the years.

And that would first show up as numbness and loss of sensation in your feet. A lot of people don't realize that they go through their whole life and they walk since they were, you know, one or two years old or they you know, ran when they were in high school or they, you know, hop around in their daily lives. What's important is if you can not feel your big toe, if you cannot feel sensation in the bottom of your foot, you don't know if your foot's on the ground are still up in the air. And so when you get neuropathy, people start to fall a lot. The diabetics with neuropathy can't feel their feet. They don't know if they're standing on the ground or they're walking up the stairs or anything like that. So, we need to prevent these secondary problems of diabetes.

Host: Well and one of the complications, speaking along those feet lines is that because they can't feel those things, they could step on something like a nail or a piece of glass, not know it.

Dr. Heighton: Or have a piece of sand in their shoe.

Host: Or have a piece of sand in their shoe that rubs. Right. So, and now they even have diabetes shoes, they have diabetes socks things, but those wounds that don't heal become a real problem, right?

Dr. Heighton: Right. We would always recommend diabetics always wear socks and always wear shoes and not wear sandals. All right, to help prevent a little teeny grain of sand or even calluses or rubbing, the socks help prevent the buildup of calluses or rubbing and wearing shoes are a little more protective, definitely then sandals or other kinds of open kinds of shoes.

So yes, those are a problem when you can't feel those things. And again, people don't realize that if you can't feel that you just stepped on something, that wound may be small right then, but will get bigger, and get more and more infected. If you can't feel an infection, you don't know you have an infection and it could end up in amputation of your toes or foot.

Host: Or foot. So, that's so, so important that people check their feet. And as you say, wear socks, wear shoes, wear good shoes. So, you don't even get just a little piece of sand or a rock in there. Another thing we've been learning about Dr. Heighton and in the research is the link between sleep and obesity and diabetes. And now a lot of people certainly in these times that we're in right now, people are not sleeping. They're stressed out. Do you have any really good advice about getting a decent night's sleep? Because that does help us to have more energy the next day. So, we can exercise and prepare really healthy meals.

Dr. Heighton: For problems with sleep or what we call insomnia, we would recommend to always try to keep your sleep times the same. Whether it's weeknights or it's the weekend, try to keep your bedtime at about the same hour. Don't go from, you know, weeknights going to bed early, cause you gotta get up for work and then on weekends, oh yeah, I'm going to watch the late, late, late shows or the late, late, late streaming and the movies. Okay. Try to keep your sleep times the same, because sleep is associated with melatonin. Your body makes melatonin. It's actually made in what's called the third eye, the pineal gland. And your body will make that chemical at about the same time that you were trying to sleep the night before.

So, if one day you're going to bed early, it makes it about the same time. If one night you're going to bed late, it then makes it after that time. And so it can be hard to adjust come Monday morning or Tuesday morning when you've been up late on the weekend. So, it is important to keep your sleep times about the same.

And it has been shown that not sleeping well, different people, different ages need different amounts of sleep. Typically, if you're tired the next day, you didn't get enough sleep. But typically we do recommend from six to eight hours of sleep every night for the average adult.

Host: Wow. We've just really loaded the listeners up with so much helpful information today. Dr. Heighton, I'd like you to wrap it up with your best advice for lifestyle and management, prevention. What would you like people to know about diabetes, controlling their blood sugar and the Diabetes Prevention Program at Memorial Hospital?

Dr. Heighton: Yeah. As a review, I would recommend that people start with diet and exercise, maintaining an ideal weight. Occasionally, if you get any symptoms at all, check with your physician, they can do a blood test to see how high your glucose or sugar level is. And beyond that, if you are diagnosed with pre-diabetes or diabetes, maybe getting started on a medicine when the diet and exercise is not working and therefore to keep your hemoglobin A1C, your average sugars, what that means under control, and that will lead less likely to have those secondary complications of heart and nerve and even affect your sleep.

Host: All of those things that can go along with a diagnosis of diabetes. So important. Thank you so much, Dr. Heighton for joining us today. And to make an appointment with Dr. Douglas Heighton or to learn more about the Memorial Hospital Diabetes Health and Wellness Program, please call 217-357-2173, or you can always visit our website at mhtlc.org.

That concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and invite you to download, subscribe, rate, and review on Apple podcasts, Spotify and Google podcast. And if you found this informative, please share on your social channels with your friends and family, because we are learning from the experts at Memorial Hospital together. I'm Melanie Cole.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.