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Dr. Weis (Host): All right. Well, welcome back to another edition of the Get Wise with Weiss podcast. I have a very special guest today, Amanda Ast. And I'm going to ask Amanda to introduce herself. I think should be the best at it.

Amanda Ast: Hello. I'm so happy to be here. I am a dietician and a diabetes educator, and I work here running the diabetes education program here at Northwest. Happy to be here. I was actually diagnosed with type one diabetes as a patient in this hospital almost 30 years ago. So it's great to see things full circle and to get to help patients with our programs that we have.

Dr. Weis (Host): Fantastic. welcome. So, let's go back to the beginning. So I heard people say, well, I have a touch of sugar, or I have too much sugar, what's the best way to think of diabetes? I mean, what is diabetes mellitusism?

Amanda Ast: Yeah, it's a very confusing disease. Disorder, that's really misunderstood. I think as a culture, there's a lot of negative connotation with the word then makes it challenging for a person to maybe accept the diagnosis. But diabetes, actually, the wording diabetes mellitus comes back from many years ago. Thousands of years ago when, before we even had indoor plumbing, we had those individuals that were finding certain insects were maybe drawn to their. So taking it back that far, that we had individuals that we knew their body wasn't working quite right. And from then we had the society to try to solve the mystery of what was wrong with some of these people.

And just in the last 100 years would have had this huge expansion of understanding with the invention of insulin. Just in the last year, we celebrated the 100 year anniversary of insulin along with technology that has allowed us to understand that diabetes means that our pancreas is not functioning like it's supposed to. That pancreas makes insulin and insulin's job is to turn our food into fuel or energy for our body. So we're able to kind of survive, but we may not be able to thrive. So we definitely see people with different types of diabetes and that's another confusion. We see people with type one type two or gestational.

Dr. Weis (Host): Yeah, that's seriously. Cause you know, I heard the famous story of Dr. Minkowski, who I guess was a doctor years ago that took the pancreas out of dogs and realized that they started to urinate a lot. And for some odd reason, he decided to store their urine in jars. And as the story goes, is that these ants were crawling up this jar one day. And of course in all his wisdom, he decided to taste the urine. Now his daughter swears he did not taste. But apparently he tasted the urine and tasted sugar. And that was the link between the pancreas and sugar control in our body.

So as you mentioned, diabetes comes in different flavors, they're all sweet, of course. But you hear about the diabetes that children get versus adults get versus women who are expecting babies get. Can you tell us a little bit about what separates those?

Amanda Ast: Definitely. So it has to do with what the person is experiencing, first of all. So we see type one is typically that kiddo that diabetes it's diagnosed between nine and 12, but really it can happen at any time. We have an immune system that is supposed to fight off infection within our body, and it can get confused at times and in type one diabetes, it's actually been confused. It breaks down the factory that makes insulin in the pancreas. So that person quickly needs insulin in their body within hours to days, or they will not survive. And then type two diabetes can be diagnosed at any time as well. We typically see it in later in life, but essentially challenging the body for whatever reason can cause t he pancreas to not work like it's supposed to that factory is still open for operations.

It's still making insulin, but maybe not to its best ability. And then similarly we see gestational diabetes where just the stress of having the woman going through developing a baby can cause that pancreas to say, this is too much work. I'm going to text the neck, take the next nine months off. And then I might come back to work for you after nine months. So that's the biggest way to describe those three.

Dr. Weis (Host): Gotcha. So it's not so much that you have too much sugar, as much as the sugar level in your body or particular blood is not controlled properly. So, how would, I know that? If I start to develop diabetes, would I be looking for, to indicate that maybe my sugar control is lost?

Amanda Ast: And that's a common problem that we really, our body is able to function typically with higher glucose or with higher blood sugar readings, we kind of get adapted and acclimated to operating at a higher glucose reading, which is the challenge I think. But the way we can know that something's not right, is really listening to our body. Maybe our vision changes, maybe we're using the restroom more often. Maybe our body's showing that even though I've eaten, I'm still hungry all the time. Could feel lethargic, confused, really just kind of in survival versus thriving and functioning, is typically a red flag that something's not right. The body likes to give us these little ones.

Dr. Weis (Host): Yeah. I've heard that quite often that people say, well, I pee a lot. Lots of people pee a lot. Why does diabetes make you pee a lot? And in particular, is there a problem at night where people say, oh, I'm always getting up all the time to urinate at night, what's causing that?

Amanda Ast: So definitely your body is trying really hard to get rid of that extra glucose. So as you take food in, your body digests that food, then it's broken down in your bloodstream. The glucose is just hanging out in the bloodstream until insulin can remove it and turn it into energy. Right. And so we have a body full of glucose that the body's trying to get rid of it. So you're having increased thirst to maybe thirst, to drink more, to flush it out. And then your kidneys are trying everything they can bring that extra sugar out. So definitely we see it happen even at night when we're not sleeping because our body is still operating.

It's still trying to have operations, which involve glucose. And so, if there's not enough insulin and we have this buildup of glucose, even at night, Into the morning which is a common frustration for people I'm peeing all the time, but really your body's giving you a red flag. That's not normal. Let's look into that. '

Dr. Weis (Host): I've heard people who have devoted diabetes said, God, I lost a bunch of weight with that diabetes. And that sounds like a pretty good deal. Good idea of you losing weight by having your sugars out of control?

Guest: Oh, it's so tricky because they think, oh, it's great. You know, our culture is so focused on maybe the image of our body and we relate health to size. And so it's tricky, but essentially you're taking in food. Your body's not able to use it as energy. So your body's having to break down your stored energy, your stored protein and fat. And so everything you've eaten is not really getting used. So your body's trying to get rid of it. So you're peeing all the time, but then you're also having to use your stored energy just to function. So we see this very rapid weight loss, which is another good red flag. Hey, something may not be right here.

Dr. Weis (Host): Got it. Yeah there when I was a kid, you know, the 10,000 times I spilled Kool-Aid on my mother's counter and left this big sticky mess. And now I'm assuming their sugar is high in your body that it's kinda of sticky too. Does that cause problems, does it cause damage or anything?

Amanda Ast: Yeah, definitely. So just to, I like to use the analogy that your bloodstream is like the superhighway in your body. It's like I 40, or I 27 and as we have. Most important parts of our body are in our bloodstream, our oxygen, our blood cells, and then our nutrients. So they're floating along. And if that glucose cannot get out of the bloodstream, it's stranded. So it's like clogging up I 40. And as that clogs up I 40, really we see damage and to our nervous system, which is, I like to call it our farm to market roads. So you can imagine we've clogged up our highway.

We now have everyone trying to get to the farm to market roads. And so those get clogged really quickly. So imagine that you are, a way to describe it as that, like you have sugar coating of your nerves that we see happen down from our feet up to our eyes. So we can see neuropathy where our feet don't have the sensation or the ability to feel like they're supposed to. So you step on something, you don't feel it. You keep walking around on it. It gets infected, leads to a crisis situation. That's where we hear those really traumatic events where someone has to lose a toe or a limb. we can also see damage to our kidneys. They're trying to filter out all this wasted glucose.

And so that can cause damage to those filtration devices that really get rid of our urine and that waste can back up into our body, which could mean we might need dialysis. And then we also have our. There's a huge optical nerve behind each eyeball. And it's going to get clogged with that extra glucose. It's going to get sticky. It's going to get sugar-coated and it's going to cause vision changes, which can maybe lead to blindness. So we want to prevent those complications. We don't want to let that extra sugar float around to long. For sure.

Dr. Weis (Host): So clearly this bloodstream sugar jam is not a good idea.

Amanda Ast: It's not as good idea.

Okay. Gotcha. All right. So, it kind of goes back to the idea. Now, you mentioned that obviously when children developed diabetes, it's really linked to their immune system, destroying the cells that make insulin. And boy, that doesn't sound like that's, something's really avoidable rather than a treatable afterwards, but how about for us adults that develop diabetes and later in life, Anything we can do to try to maybe prevent that from happening?

Guest: Yeah. I mean, I always tell people, we may not know exactly what happened to cause your pancreas to malfunction, or I like to say act persnickety, but we want to do something to make sure that extra glucose doesn't hang out. It may look like we rid ourselves of diabetes by improving our lifestyle by improving our movement, by finding a way to enjoy being active, by finding a way to understand the role our food has on our body and how we need to maybe look, take a good look at the way we're eating. Maybe not reinvent the wheel, but modify maybe the portion. Portion can really be the poison, there might be some sneaky carbs that we can maybe cut out.

And also just having that awareness that, Hey, this is something that I've been dealt. I may not be able to always prevent something, but I can maybe definitely prevent it from becoming something that takes over my life. And so I always invite family. To come to class to say, let's you have a family member that's already got a pancreas. That's showing us it's not working. What could we do to maybe take on some of these behaviors that are going to help that pancreas, that we could maybe prevent that pancreas from breaking down later on.

Dr. Weis (Host): So that's interesting. So, I'm someone, mom's got diabetes, dad's got diabetes, the dog's got diabetes. Do I have to worry about getting diabetes? I mean, is it contagious?

Amanda Ast: Yeah, it's a good question. It's definitely not contagious, but we definitely see some genetic links where we kind of wonder if it's the chicken or the egg. So do we have a lifestyle that's been created within family dynamics that are causing behaviors with movement and activity? Food choices and our food habits. Or do we also have these predestined genetics that are causing our pancreas to, to want to be persnickety and not work like it's supposed to? So that's a good question.

Dr. Weis (Host): So, okay. I see, I hear you're saying it kind of runs in families now, maybe a genetic component. It also maybe t he family shared lifestyle considerations. Like you said, sometimes it's the foods they eat. Maybe whether or not they exercise as a family or not all have implications. Now let's go back. I know you have a particular interest in the diabetes that affects women who are expecting babies. And we see that we call it, gestational diabetes, a term used for it now. Does it go away when the baby's born?

Amanda Ast: That is almost the first question that's asked, but yes. So we typically see that pregnancy, once that pregnancy is over, the babies are typically fine if we've managed this well, the mother is typically fine, as much as it relates to diabetes effortless pregnancy. But what we do see is that there are definitely. There's a 50% chance that, that person might develop type two later in life. And so we really encourage patients to not just imagine it all away, but take care of themselves too. After that baby is born and you're in that crazy new baby mode, you check in with your doctor and six weeks after delivery, you make sure you're doing okay. And then every year having that A1C routinely just to make sure that, that pancreas is not trying to be trouble again and mimic the behaviors you might've learned while you're a pregnant learning to pre. Movement and being mindful of carbohydrates and our portions throughout the rest of your life.

Dr. Weis (Host): So it sounds like that gestational diabetes is a warning shot across the bow if you will, that maybe diabetes is coming later in life or just down the road if we don't change what we're doing. Now, you used some fancy term there called the hemoglobin A1C. What is that?

Guest: That A1C is a test that your doctor, your provider will do from a lab draw. It's very simple. It's done to see an average of the last three months of what your glucose is running. So imagine you've got that glucose on your highway, right on your bloodstream. And when it's stranded, where it has nowhere to go, it's going to attach itself hitchhike with your blood cells. And so as we pull your blood, we can then do a little test to figure out how much extra glucose is floating around essentially. And remember, that's not a report card, it's not a value of who you are as a human, but that it's letting us know how your pancreas is working.

Because if that pancreas is functioning correctly, then your glucose is going to look good. Your A1C is going to be in a range that we feel good about. But as it creeps up it let's us know, Hey, there's more glucose than should be here. Let's look into this. So it's a great tool. We don't need to test it when women are pregnant though. We do want to test it in type one, type two, and then after a pregnant woman delivers, we want to annually test that.

Dr. Weis (Host): Gotcha. So sticky is sticky. So associate sugar sticks to the red blood cells, Now, if I'm a person who does not have diabetes, What percentage of my red blood cell is have sugar stuck to them?

Amanda Ast: That's a good question. Everyone is going to have a little bit of glucose in their blood, and we want to remember that. So 5.5% is considered normal. So around that area is where we want to be. Once we creep up above 5.5 is when we start to diagnose with prediabetes and type two diabetis.

Dr. Weis (Host): There an official level where they say, oh boy, you hit this level and now you officially have diabetis?

Amanda Ast: 6.5 tends to be when we say, Hey let's go ahead and tackle. That's the recommended amount.

Dr. Weis (Host): And then you mentioned this prediabetes and I think so if I have a 6.4. You know, the diabetes kind of knocking at the door, but I'm not officially diagnosed yet, but that's your pre-diabetes. Huh?

Amanda Ast: Right. And I like to say that's like being sorta pregnant.

Dr. Weis (Host): Got it. All right. That makes all the sense to me now. We're good. Now, can I get the diagnosis made by hemoglobin A1C that I have diabetes?

Amanda Ast: We can, we definitely, we have a standard of care that we provide to all providers. You know, diabetes is very common. From your general practitioner to a specialist might be able to spot this A1C running higher. So we have a standard care within the American Diabetes Association. They create national standards every year that they review that gives a guideline to our practitioners to say, Hey, if you see a patient in this range, Then we need to go ahead and diagnose it as prediabetes. If it's in this range, we need to diagnose it as type two diabetes, etcetera. So, it definitely is an easy way to diagnose diabetes, that A1C.

Dr. Weis (Host): Well, it sounds convenient for the doctor. Good. Okay. Well, so let's talk a little bit, so now suddenly I have a hemoglobin A1C. Is in the diabetes range. I believe it's typically somewhere over about six and a half percent somewhere in there. And now what do I have to go straight to insulin?

Amanda Ast: No, definitely not. I think that the. Resource is to get plugged into some sort of education program. Your doctor, your provider, they're going to do the best they can to maybe just to let you know, you have this complication. And then really we want you to be the best advocate for your. Seek out resources, seek out education that are reputable. This is not a good time to visit your friend, Google or anyone on the www. But I want patients to be encouraged that, you know, here at Northwest, we offer a free education program. We do not want to prevent people from understanding, from learning.

Being plugged into resources, but that's the first step is understanding what's going on inside your body. That, that A1C is a really good indicator that it's not just what you ate that day before or that week before, but it lets us know, Hey, let's really look into this. Let's understand what we could maybe change or not change. Typically the first line of defense when someone has an A1C, that's above 6.5 to 7.5 to 8.5. Even we see the first line of defense is lifestyle modification. So Hey let's dig into what you're eating. Could we modify portions? Could we get our body moving? Is there stress in your life that we need to be aware of?

Is there an infection or an illness you've been fighting prolonged? From there, remember, there are oral medications that are safe and that have been approved and that have been researched for a long time. And then from there we have insulin as an option. So insulin is always the first line of defense for someone with type one diabetes. Remember their factory is shut down. They have no insulin, but an individual with type two just needs possibly some medications to tweak. Functionality of their pancreas.

Dr. Weis (Host): Even more, what I heard you say was, is sometimes if we catch it early diabetes, that there actually may be ways of somewhat reversing it. And you, I heard you kind of mention maybe a diet changes maybe exercise and more activity. Maybe some weight changes, but there's active possibility of going backwards in sense of fixing that diabetes?

Amanda Ast: Definitely. So if we have this higher A1C than we want, it's a great, like you said warning, maybe just to say, Hey, let's prevent this from becoming even worse. So the first step is acknowledging, right? So if that patient is ready to acknowledge that, Hey, this is something I need to check into. Learning about portions, learning about carbohydrates that they're needed. It's about not getting too little or too much, but having that routine refueling throughout the day where you're receiving carbohydrates, that your body can handle. Movement is so beneficial.

As a society, we didn't have to have gyms a hundred years ago. We didn't have to have, you know, CrossFit and different, great organizations, but we, as a culture, we live like royalty now. And so we have a lot of things done for us that day-to-day moving. Where we were able to use, our bodies were not used, and we want to remember that our body benefits from being used. And so we have to be creative. If that means joining a gym or a yoga class, or some other group program, we find a way to utilize our body, let it be used and moved. That is beneficial to our body, similar to like giving it insulin.

It's usually free to move our body and doesn't have to look a certain way, but if they can move their body, at least every hour, it's helpful to help that body utilize its energy, lower that glucose. So those two, those are the first best two things to look at is and a lot of people come to see me. They're like, well, I've told I was, I need to cut all carbs. I need to cut all sugar out of my diet, but we need to remember that carbohydrates are needed. But our is incapable of using them at this point. So we want to find a way to balance them. So not cut them out completely, but find a variety.

Dr. Weis (Host): Great to hear. Yeah, I hear a lot of people say, gosh, now I got to stop eating all sugar and that's not true necessarily. So that's good to hear. And I think if people realize that there are very few interventions that physicians can provide, that have more benefit than exercise. You know, people come looking for the magic pill and things like that. But if you look at overall the medical literature on the benefits of exercise, and we're not talking hours and hours every day. I mean, most of we're talking 30 minutes a day for up to five days a week, about 150 hours of exercise a week has now been recommended to stem off a lot of these problems like diabetes, high blood pressure, things like that. And a lot of times they say, well, it needs to be moderate exercise now, is it? What does moderate exercise mean? An interesting definition.

Moderate exercise is while you're doing it, you can hold a conversation, but you can't sing. but kind of gives the sense of, so you don't have to just, you don't have to kill yourself exercising, but that kind of activity where just bringing a little harder than be able to sing will do that for you. Well, that's great. So, insulin is not upfront now, . When do people have to go to insulin and once they do, does it mean that rest of your life, you're giving yourself injections?

Amanda Ast: Well, I think I always remind every patient, especially when we're in group classes that each person's pancreas is different. We all live different lives. We have different lifestyles, we have different bodies. And so we want to remember that they're on their own journey. And so I encourage each patient that if you get put on insulin, you've got to accept that we need to learn about it. We need to process that information and we need to continue to take care of ourselves. That we can definitely go on a journey where insulin is, what we have for the rest of our lives, with type two diabetes. Or we can see that that person really, maybe it has some things under their control still.

Maybe they're able to still modify their diet. Maybe they're able still to maybe start moving their body more. And then we can see that reduction of insulin. But there's definitely that individual that may think I'm just gonna eat whatever I want. I don't want to move my body. And so then we do see this progression of insulin is the next step. So it's important to identify each person's on their own journey and that we do have our own choices. But something I've found with patients a lot of time is that we're on this stage of grief when it comes with the diagnosis of diabetes. And so I can almost instantly tell what stage a person is at when they come to see me.

If they're at a stage of acceptance, they're willing and ready to learn, and they're ready to learn about what's the next step. But if an individual is maybe in denial. They may be, think there's no way I have diabetes. It's not possible. So that person may not be as willing to make modifications or accept where they're at. There's also that bargaining phase where an individual is like, I'm going to do whatever I can to get rid of this diagnosis of diabetes. I'm going to cut all the foods out. I'm going to work twice a day to prevent. And so there is healthy benefit of being active and being mindful of that. But we want to come from where are we mentally in accepting our diagnosis to maybe have a healthy progression and taking care of ourselves.

Dr. Weis (Host): You made a very important point. I think diabetes is one of the few conditions that a person has to deal with every day. And it has to be mindful of every day. And you think about children who develop type one and for the rest of their lives, that will be something they deal with every day. And it, like I said, there was that grieving process that it is a life changing event and diagnosis. So a great point there. So just finally, if I as a person decide that I'm not going to control my diabetes, and now I'm going to allow that sticky blood to go around my body. Is there a price to pay?

Amanda Ast: There is. And it's unfortunate because I think a person in that state of mind, I don't feel like they're in a great state of mind. Right. And so I feel like they believe that it's going to be. Like, they're just, it's going to just be the end. But instead we see this very slow and painful progression of deconstructing the body. And so I just want to encourage people that if they ever do have the diagnosis of diabetes, that we a hundred percent know that there's so much that's preventable. So if we can find accepted. Get plugged into resources, learn how to take care of it, then we can definitely live a healthy lifestyle that's full of success and comfort. But if we definitely can choose to ignore it, it's going to be painful. And we've seen that for thousands of years because now is the best time to have to be told you have diabetes. We have so many resources available if you do find yourself in that position. So we want to utilize those.

Dr. Weis (Host): Oh, great. I mean, you brought out some very important themes today and I think the biggest thing is diabetes will not go away by itself. It has to be managed. It has to be addressed. But you said there's a lot of resources to help people to manage this condition for themselves. You know, you need, you mentioned everything from education to some of the medications we use, to lifestyle tools that and changes that can be made. And so I think it's important. People realize you're not alone if you have diabetes. What's the best way for people to seek out your attention or your advice or that of the hospital when they want those resources to help them?

Amanda Ast: Yeah, so we offer a free program remember, it's available to all people. It doesn't matter if you have insurance or not. And so you can go to the website, the Northwest Texas website, www.nwths.com. They can call me directly if that's helpful. 806-354-1201 to get plugged into our next class. We have a whole slew of resources available to get patients plugged in with a provider within Northwest if needed. We also have local resources for patients that don't have insurance. So we don't want anyone to, to have the complications developed with diabetes. Because of a lack of resources.

Dr. Weis (Host): Fantastic. I know we've covered a lot of ground on a very complex topic today, but I really appreciate all your insight. Anything else that maybe I forgot to mention or bring up that you wanted to talk about?

Amanda Ast: We also do offer classes for gestational diabetes. It is actually really common to see a person develop gestational diabetes when they're pregnant, particularly if it's their second or third or more pregnancy. It's very common for that pancreas to kind of shut down. So we want to remember that we have free resources for gestational diabetes education classes offered twice as month as well. So we get that information out to their providers as well as on the website it's listed.

Dr. Weis (Host): Fantastic. Well, thank you so much. I think, you know, and as we've talked about, I think for the difference people can make in their own lives. Again, themes of being active, eating healthy balanced diets, maintaining weight control, all these things are hopefully things that could prevent people from ultimately developing a condition like diabetes, which again, is now going to change their life and how they live daily and in a healthy way. Well, thank you again. We really appreciate having you on.