Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm your host, Maggie McKay. Joining us today is Dr. Carrie Alexander, Internist, to talk about why your primary care doctor is your first line of defense against diabetes. Thank you so much for joining us.

Dr. Carrie Alexander: Hi Maggie. Thank you so much for having me. I'm excited to talk with you about this topic.

Host: Me too. So let's just dive in. Why is primary care such a critical part of detecting diabetes early often before symptoms even appear?

Dr. Carrie Alexander: Sure. Primary care is where most patients would come when they're thinking about getting a physical or being checked out. So, standard screening protocols call for diabetic screening, in all people over the age of 35, and in people under the age of 35 who meet certain criteria, like obesity or overweight or high risk with a family history. So primary care is often the first stop for a patient for getting checked out for the routine problems.

Host: There are different types of diabetes. Could you please explain the differences between Type 1 and Type 2 and which is preventable or not, and the role of heredity?

Dr. Carrie Alexander: Sure, I'll start with Type 1 diabetes. Type 1 diabetes is what we used to consider childhood diabetes. We have learned that sometimes adults can be diagnosed with Type 1 diabetes as well, but in Type 1 diabetes, your pancreas, the organ that makes your insulin has quit working. There is a genetic role for Type 1 diabetes.

We think about 5% of people whose parents have Type 1 diabetes will develop Type 1 diabetes, and maybe 10% of people who have a sibling with diabetes will develop Type 1 diabetes. So it's not just genetic. There's a possibility that a virus could attack the pancreas and affect production of insulin.

But it is a different disease than Type 2 diabetes. There is a lack of production of insulin in Type 1 diabetes, therefore patients with Type 1 have to take insulin every day. And they would not be treated with the other medicines for diabetes that you might have heard of, especially the very popular ones now, that would also help with weight loss. Type 1 diabetics would not be treated with those medications.

Type 2 diabetes also can be genetic. It is more what we have thought of as adult onset, but as obesity rates increase and are affecting children, we are seeing Type 2 diabetes in children as well as adults.

That is not a problem with production from the pancreas of insulin. It is more a problem of the body not responding to the amount of insulin that is being made or too much sugar coming in for the amount of insulin that is being made. There is a genetic component to Type 2 diabetes. It is not as directly linked.

We will see some very strong family histories of Type 2 diabetes, but they call it poly genomic. So we can't say you have x percent of chance of having diabetes Type 2 if your family member has it. And of course, diet and exercise also play a much bigger role in Type 2 diabetes, whereas Type 1 diabetes, it's not as related to diet and exercise.

Host: Dr. Alexander, what are the most common signs or risk factors that you watch for during routine visits.

Dr. Carrie Alexander: Sure. Like if I'm asking patients questions about looking for symptoms of diabetes, then I might ask them if they've noticed increased urination, increased thirst, blurry vision, numbness in the toes or the fingers. If the diabetes is advanced, they may actually be having weight loss from the diabetes.

Maybe recurrent infections because diabetes can increase your risk of infection. Those might be some of the symptoms I would inquire about.

Host: Once someone is diagnosed, how does a primary care provider guide day-to-day management and help prevent serious complications?

Dr. Carrie Alexander: Boy, there's a lot of things to talk about with diabetes. Maybe we should focus on Type 2 diabetes because it's such a broad topic when we talk about what I would be recommending for our patients. So to start with, I would need to know probably how severe their diabetes is to help guide medications if they need to be started immediately.

Sometimes it might be mild diabetes or pre-diabetes, and I would really be focusing on talking to the patient about increasing their exercise or some dietary changes. If the diabetes is to the point that I feel like we need to add medication to the diet and exercise, I like to give my patients options, discuss the risk and benefits of each of the medications and give them options.

And I also like to focus on why it's important to treat diabetes. Like what are the long-term complications of diabetes? Because I want my patients to have buy-in. And really want to participate in getting their diabetes under good control.

Host: And it seems like there's a lot of fear and misinformation around diabetes. How do you help patients feel supported and confident managing their health?

Dr. Carrie Alexander: Sure that can be very hard. When I have to give a patient a diagnosis of diabetes, I'm oftentimes watching their facial expressions because I know some people have had family members who had significant complications from their diabetes and they can become quite scared about the diagnosis. And we have to walk people through it in different ways, depending on their concerns and how they want to approach the disease.

So I, think, there are a lot of different ways I approach it based on how my patient is feeling. I think one of the biggest things that I like to do is give patients options about ways they want to address the diabetes. And really try to give them a lot of information about what foods to eat and what exercise to do.

Host: Speaking of that, what role do lifestyle changes like diet, movement, stress, play alongside medications and monitoring?

Dr. Carrie Alexander: Oh, I think I have seen them play a huge role before. It depends on how motivated the patient is and where their starting point is. Some patients eat a very healthy diet and exercise and still develop diabetes, and that may have a stronger genetic component. But I've had some patients who have had significantly high blood sugars that were able to bring them down with exercising 30 minutes every day and really making an overhaul of their diet.

There are different ways that your body responds to those different things. So for instance, if you change the amount of sugar that you're eating, then your body's insulin can be more effective because it doesn't have as much sugar to, to manage with that insulin. So that is one route we can help our body with the diabetes, and if we add exercise to that, that allows the cells in the body to utilize the insulin that you have better. So it's kind of like the one-two punch of treating diabetes. So both things work in different ways, but they add on to each other in how they work.

Host: And what message do you want listeners to hear about preventing diabetes or living well with it once diagnosed?

Dr. Carrie Alexander: I think really learning about diet and exercise, healthy diet and exercise. When I talk to patients about what foods they should be eating, whether it's diabetes or high cholesterol, or gout or any of these conditions, I like to talk about eating whole foods. So I like to use the phrase eat foods that look the way God made them. So not the things in the bags and the boxes, just to make it quick and easy for patients. Like, should I eat this? No, it looks processed. So staying away from the processed foods is one really easy thing I like to talk to my patients about. And then I like to give them goals for exercise.

So American Heart Association recommends 30 minutes, five times a week for exercise, and I think that's a great goal recommendation for our diabetic patients. So I think, or patients who don't want to become diabetic. So I think that either way, whether you're diagnosed or to try to prevent being diagnosed, I think healthy diet and exercise can definitely improve our blood sugar and the way our body handles it.

Host: In closing, is there anything else you'd like to add or you would like patients to know?

Dr. Carrie Alexander: I'm a big believer in diet and exercise for a lot of conditions, and I think in America we have a really hard time knowing what is healthy and unhealthy and there is a lot of misinformation on foods and what we should be eating. But there is a lot of online information to help patients select some healthy foods.

I for one, love the Dash diet, websites, dash D-A-S-H. It's actually the Blood Pressure Diet, but I find it's has a lot more information that's easy to understand online and I think that's a good source for starting to look for ways to eat better.

Host: Great. Thank you so much for sharing your expertise. This has been so informative. We really appreciate it.

Dr. Carrie Alexander: Well, I appreciate your time tonight, Maggie. Thanks so much for having me.

Host: Absolutely. Again, that's Dr. Carrie Alexander. To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, visit healthyheadlines.org.