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Amanda Wilde (Host): Welcome to Right Beside You, a Reid Health Podcast, millions of people live with diabetes and cases continue to increase. Today, we'll talk about everything you need to know about diagnosis, treatment and management of diabetes. I'm Amanda Wilde with registered dietician and diabetes educators, Allana Abel, and Jennifer Stachler and registered nurse and certified diabetes educator, Tracey Dingwerth. Welcome everyone. And thanks for being here to talk about this pernicious disease, Tracey, I'm gonna start with you. What causes diabetes?

Tracey Dingwerth: Well, there isn't like a true cause per se. There's a lot of different factors. a lot of it is truly genetics. So the genes that they got from mom and dad, and I think that it is important for people to understand that it isn't their fault. They didn't get diabetes because they didn't eat perfectly their entire life or whatever people want to kind of blame it. It really is a metabolic disorder that is happening within the body where they're making less of a hormone called insulin. And it's a hormone deficiency. And when people have diabetes, they're either not making it or not enough of it or the body isn't using it correctly.

And insulin is necessary for human life. We have to have it. it's secreted by the pancreas and insulin is responsible. Moving sugar out of the bloodstream into the cells of the body to be used as an energy source. So when people have diabetes, the body. It's not moving that sugar into the cells. It accumulates in the bloodstream and that excessive sugar in the blood is really that hallmark or characteristic sign of diabetes. And that can become problematic over time.

Amanda Wilde (Host): There's also different classifications of diabetes. So what are the different types I've heard of type one and type two, Allanna?

Allanna Abel: Yes, there are multiple different types of diabetes, but they all fall into typically type one type two or even gestational. So the difference between type one and type two, historically, we would've called type one as juvenile onset and type two as adult onset. Now we don't really do that anymore. We're starting to see people diagnosed a little bit later on in life with type one diabetes and some individuals diagnosed earlier on in life, for type two diabetes. So that's a historical thing that has changed a little bit. Type one, diabetes does represent a smaller, percentage of the population.

Typically only about 5% of the individuals living with diabetes live with, type one diabetes and as Tracey was mentioning before not having enough insulin type one diabetes, and essentially they do not make any insulin at all. there's a short period where they might still produce a little bit at the very beginning of their diagnosis. We call that the honeymoon period where they're still just plugging along, making small amounts, but just not enough to keep blood sugars well managed.

And ultimately something autoimmune has happened in their body and the cells that would secrete insulin, beta cells are destroyed and thus, that's why they make no insulin whatsoever. So another word for that might be insulin dependent. However, that becomes a little bit difficult because some individuals living with type two diabetes may also use insulin. So that is why we do classify them separately as type one or type two . So for type two diabetes, these are typically individuals who just don't make enough.

They still have some insulin on board, but just not enough to keep blood sugars where we would want them to be. So when we think about where we want blood sugars to be, that's essentially to avoid long term complications that could arise from having those blood sugars staying elevated. Over a long timeframe. The last type that I mentioned earlier was gestational diabetes. That is something that occurs in pregnancy. We typically test for that, between 26 to 28 weeks. Sometimes we can test a little bit earlier and we just simply give them a glucose tolerance test typically.

Sit back and see what happens after they consume that and how their body responds. And that is how we're able to know if in that individual, we should tune in a little bit more closely to what their blood sugars are throughout the rest of the pregnancy does not mean they'll have higher blood sugars, but just knows if those numbers go above where we would like them to that, that person might be at a higher risk for needing to pay a little bit closer attention to their blood sugars during Pregnancy.

Amanda Wilde (Host): And before we talk more about diagnosis and treatment Allanna, what happens if diabetes is left untreated?

Allanna Abel: Absolutely. That's a great question. and even thinking about diabetes, a lot of people walk around not knowing that they have it because the hard part with diabetes is you don't really feel bad. So unless something feels bad, we don't typically. Tune into it or pay attention to it as much as what we would, if we felt something different. So the long term complications of not managing your blood sugars are, ultimately doing different damage within different organs of your body.

So, we could have some kidney disease develop. We could have neuropathy or retinopathy, so nerve damage, or just damage done in other parts of our body.And that's ultimately what we care the most about. What gets your blood sugars under control doesn't matter near as much as achieving and maintaining good blood sugar control so that we can prevent those long term complications from arising.

Amanda Wilde (Host): Jennifer. How do you then test for diabetes? How is it diagnosed?

Jennifer Stachler: So you will typically get tested by a healthcare provider, either a nurse practitioner or your physician, and there's several different ways to test. One of the ways is called a hemoglobin A1C test, and this is where it's a blood glucose average for the last two to three months. And we have some ranges for that hemoglobin A1C and it comes in a percentage. And for prediabetes, we're looking at 5.7 to 6.4%. To be diagnosed with diabetes we're looking at a hemoglobin A1C as 6.5 or greater. Oftentimes with the hemoglobin A1C, your physician or nurse practitioner might also do a fasting plasma glucose, or oral glucose tolerance test.

So for a fasting glucose, this is something that you do typically first thing in the morning, you have an eight or drink anything except for water for at least eight hours. And for the prediabetes range, we're looking at a number of 100 to 125, with diabetes, we're looking at a fasting of 126 or higher. And then we also have this oral glucose tolerance test, which is where we have you drink something that's very sweet and high in glucose. And we test prior to drinking that.

And then we test again two hours later. And for two hours after that result, prediabetes ranges 140 to 199. If we're looking at a diabetes diagnostic range, we're looking at two hours later being 200 or higher. So again, your healthcare provider could do a number of those different tests that I mentioned. And typically they're gonna do two and sometimes even repeat those tests to make sure, that they are getting the proper diagnosis for you.

Amanda Wilde (Host): Now Allanna kind of touched on this, but are there warning signals that you might need to be tested?

Jennifer Stachler: Typically by the time we have warning signals, we're looking at more into that diabetes range for prediabetes. there are no warning signals. Majority of individuals don't even know they have prediabetes because there are no symptoms,

Amanda Wilde (Host): So you do need to get a baseline test. Everyone needs to get a baseline?

Jennifer Stachler: Especially if you have a family history of diabetes, or maybe sometimes over the age of 45 more sedentary lifestyle, those are some more common things that could put you at increased risk of developing type two diabetes or diabetes, prediabetes. Some of the common symptoms we see with, let's say diabetes diagnostic range is you're more fatigued, increased thirst or hunger. Those are some of the other symptoms we see typically associated with higher lab results or elevated blood sugars.

So once diabetes is determined or prediabetes Allanna, how do you determine the best treatment?

Allanna Abel: That becomes a very individualized approach. For each person, we could line up, a few different people living with diabetes and what it takes to manage their blood sugars is kind of unique to them. So obviously diet would be one thing that we could, Talk about, we could talk about physical activity and we could also talk about medications because some individuals, again, just might need a little bit more medication to manage those.

Amanda Wilde (Host): Well, first let's talk food management then. Jennifer, can you take that one?

Jennifer Stachler: Yes, absolutely. So with, Food management. There is no specific diabetes diet, as much as individuals often come to ask us, like, what should I eat and what shouldn't I eat? It's very individualized, but there are some key things that we do want to keep in mind. Carbohydrates. We know they have a direct effect to blood sugars, but one thing we often have to keep in mind is carbs are not a one size fit all. And the amount of carbs someone might need is very individualized and it's key to balance carbs throughout the day.

And also along with carbohydrates, it's important that we also dress those carbs, meaning we wanna include fats and proteins. And making sure we're choosing fats and proteins that are lower and saturated of fats and maybe more foods, rich and unsaturated. And some other key factors is keeping in mind, we wanna get adequate nutrition, why we're looking at these carbs and making sure we're including more non-starchy vegetables. Minimizing, maybe added sugars or refined grains, choosing more whole grains.

Trying to maybe decrease intakes, a processed foods. So again, not a one, size fits all approach, very individualized. That's why as educators and specifically for Atlanta and being dieticians, we work with individuals one on one, so we can get to know what their lifestyle is and what their diabetes is to be able to gear something that's gonna fit for them.

Amanda Wilde (Host): Right because you really have to set people up for success. You can't give people a brand new diet that they're not gonna stick to anyway. So you do have to get to know the person and what they're capable of and what they're already doing. How does that fit in when you're talking about exercise management Allanna?

Allanna Abel: Yes. Just to piggyback on to what Jennifer was mentioning and also what you were mentioning as well. You hit the nail on the head. Each person is their own person. And so what works well for one doesn't work well for another. Another way to say that is oftentimes when we're working with people, we'll acknowledge yes. We're experts in the area of diabetes, but you're an expert in the area of view. So absolutely combining what's going to work well for them in combination with how can we help set this person up for success? Just like what you said.

So same thing goes into exercise. If there's a person that is already really active in their life. That's great. That's awesome. and that's what their body's used to. And so we might encourage them differently than what we might encourage. Someone who has not really been including much exercise or physical activity in their life. That is one thing where a lot of individuals feel like they need to do an all or nothing approach. They might say, well, I'm not doing anything. My doctor said, they want me to, do 30 minutes of activity five days a week.

And that just can feel really overwhelming. So the benefit of exercise is while living with diabetes, is great just on its own. But with that diabetes diagnosis in there as well, there's just added benefits that really helps them. So the key for that we find is trying to one, help them identify things that they like and enjoy just like with foods. If you do not enjoy a particular type of exercise, it does not matter how great or wonderful it might be for you. You're just not gonna do it. So really encouraging them to do anything that gets them moving a little bit more.

Sometimes that might be walking. Sometimes that might be engaging in some sort of social activities, but anything that just gets them moving a little bit more. The benefit for that specifically is when you move more, your body is going to use insulin a little bit more efficiently. So we would call that insulin sensitivity. And that's where there's such a great benefit. I think the alternative is also true. So when we become less active or more sedentary, that has a negative effect on kind of overall health and also blood sugars.

So this past couple years, with everyone being a much more sedentary, not by choice, but just, through life circumstances, through not going out as often, or, using more services where things are delivered to us. Has that kind of double negative effect of not getting out, not socializing one and two, just having less activity. So identifying where someone can be a little bit more active can be really, really helpful. Both from their diabetes, their overall health, throwing in there a little bit of heart health as well. So when we think of living well with diabetes, that is improving our overall heart health and your heart is a muscle.

How do you keep a muscle strong? You gotta use it. So, starting out slow and gradually encouraging them to build up. Some people are gonna build up to that 30 minutes, five days a week. And that's fantastic. Others are gonna get to 10 minutes, three days a week. And while that's not perfect, that's much more than what they were doing before and they're gonna be consistent with it. And that is something where whatever's gonna work is gonna be what we need to do for each person.

Amanda Wilde (Host): I guess just even forming the habit you can build on that over time too.

Allanna Abel: Absolutely. And doing that in a safe space where you feel heard and someone is working well with you to, connect and find what's gonna work best for you can absolutely help with that habit.

Amanda Wilde (Host): So in speaking about management strategies for diabetes, food management and exercise management that we just talked about are the lifestyle changes patients can do. Tracey, can you speak to the medication and technology piece of treatment?

Tracey Dingwerth: Absolutely. And I get excited when I'm talking about these things, because the options that we have to help people manage their blood sugars is so much more even just in the past, I would say five to 10 years. And I think it's really important for people to understand there's so much help available. And we tend to think that if my blood sugars are high, I must not be eating the way I should. And we feel that we can do better. We can do better.

And we hesitate to move forward with medication or even, utilizing insulin. but what we need to understand is that especially if patients have had some education or they've met with a dietician like Jennifer or Allanna, and they're eating reasonably they're following the recommended guidelines, they're doing the best that they can, as far as their eating habits go. And they're exercising to the best of their ability. They're doing what they're able to do. And if blood sugars are still not within the ranges that we know are gonna keep them healthy for a lifetime.

And that's kind of referring back to what Allanna mentioned, high blood sugars over a long period of time takes a toll on a lot of the small vessels in our body that affects some of those organs that were mentioned earlier. Our heart, our kidneys, our eyes, our nerve endings. And so if we're doing the best that we can, we need to move forward with medication. And that's where a really good provider, that you are working with to manage your diabetes becomes very important to you. There are a lot of oral medications that help, people who have type two.

So you have to be making insulin for these oral medications to be able to work, but there's so many oral medications that really help the body either make more insulin or utilize the insulin that's already naturally being produced by the pancreas a little bit more effectively and efficiently. And for many individuals, oral medications can really pull their blood sugars right into the goals that we feel really comfortable with. that we know they're not gonna have any damage happening over the years.

Sometimes if they have tried the oral medications and while they may bring their blood sugars down, they're still not meeting the goal ranges. Then we know individuals will benefit by adding insulin injection therapy to their routine, to their regimen. And a lot of times that I feel like is the scary part of diabetes. People really fear this word insulin. And what we really need to understand is you're really just replacing a hormone that your body is not producing for you. And I think, again, this is where everyone is, absolutely it's individualized therapy.

There's no one right medication. because what's causing that inefficiency and insulin and glucose working together in the body can vary from person to person. So it absolutely is gonna be a different combination of therapies that work for individuals as well. But we keep plugging away until we get our blood sugars into those healthy ranges. The other thing I wanna mention on top of the medications, where we have oral medications, we have some injectable medications and then we also have insulin.

We also have a whole host of technology that has really been booming, as the past 10 or so years have gone by as well. And I think one of the biggest ones that I think is exciting is, testing your blood sugar has always been one of the most hated things from people living with diabetes, because you're sticking your finger all the time to see what that blood sugar is. So if your therapies are working and if you're on the right track and we now have what is called continuous glucose monitoring systems.

And that is where there's a small little sensor that just sits underneath the skin. And there are a couple of different types out there on the market, but basically individuals can see their blood sugar all the time, 24 hours a day. And that's a phenomenal piece of technology to be utilized because when we're aware of what's, causing those changes and what's helping our blood sugars and we can see that. It really motivates us to pursue better control. I think too, there are devices that enhance the ability of patients to successfully deliver insulin.

While we have our typical vials and syringes, we also have pens. We have little devices that people wear and they change it out every 24 hours, they're called Vigo and they deliver insulin. And then we also have insulin pumps that work with the continuous glucose monitoring technology that I referred to earlier. And we really can offer patients what is almost, we kind of coin it as artificial pumps, artificial insulin pump therapy. So we're really replacing that insulin in a way that the body can utilize it the best. So it's really exciting when we look at the technology that we have available today.

Amanda Wilde (Host): Yeah, technology is advancing so quickly. So it'll be interesting to see 10 years from now what diabetes treatment looks like. About the specific programs offered at Reid Health or other community resources, is there anything you wanna say about that Allanna?

Allanna Abel: Yes, we offer a few different, programs through Reid. So we have our diabetes, self management training classes that is a 10 hour educational opportunity where you come in, once a week for four weeks following your one hour pre-assessment. And we sit and have structured format, but the benefit is it's a nice group setting. So you get to have other people engaging in conversations while we're also following that structured format of learning about how to live well with diabetes. Jennifer and Tracey both do diabetes, prevention classes. I can let them touch base on that.

Jennifer Stachler: So, yes, we have a diabetes prevention class that happens twice a month. And this is a free program for the fact that for diabetes prevention, oftentimes it's not covered by insurance. So we have a class that's offered the first Monday of the month from 8:30 to 10:00 AM. And the third Wednesday of the month from five to 6:30, you do not necessarily need a referral for that program. Unlike our diabetes, self management classes, where you do need a referral to the program. This is something that you can call our office and get scheduled for one of the classes and come to the program and learn things, mostly lifestyle interventions and learn more about the prevention of diabetes.

Amanda Wilde (Host): Thanks, Jennifer. Tracey, is there anything you'd like to add about, Reid Health and community resources?

Tracey Dingwerth: Yeah, so, I really just have to add that I encourage anyone who has a new diagnosis of diabetes. even if you've been living with diabetes for 20 years, and it's been a lot of years since you've had some formal education, I really encourage everyone to consider our diabetes, self management training classes. We are all believers that knowledge is power. And the more that people understand about their own diabetes, the more comfortable they're gonna feel. And also they're gonna feel that they can integrate all of these different things into their life in a very usable way, because I do think it can be overwhelming.

And that's part of what we see as our challenge with every person that we meet is to help them integrate the food changes, the adding activity, but also incorporating the right medication and the right pieces of technology. That they can incorporate all these things to help them feel more comfortable about living well with diabetes and along that same vein, we do have diabetes support group, which we've been offering here at Reid for probably almost 20 years now. It's been on hold because of COVID, but we are ramping back up in January of 2023.

And that is just open and absolutely free to the community. Individuals can come in. You don't have to RSVP. We have a special speaker who is talking about. Some topic related to diabetes, health, and wellness. And we will begin offering that the same as we did years past. we will meet the second Wednesday of every month from five to 6:00 PM. We meet in the oncology conference room unless that needs to be changed. So, definitely, they can always call our office and see, how that works, but that's absolutely free and open to the community. Another free program that we offer, is an insulin pump information session.

And this is specifically geared towards individuals who think that insulin pumping might be something for them. This would be someone who's already. Doing insulin injections, maybe they're doing several injections a day and they're interested in moving forward with that therapy. A lot of times people don't even know what that looks like or what that means. Maybe their physician has mentioned it to them, but this is a free class that we offer the first Thursday of every month from five to 6:00 PM. we would ask that they call our office specifically just to do an RSVP for that particular program.

Amanda Wilde (Host): It is so comforting to know there is so much support available. November is National Diabetes Awareness month. Tracey, how can we observe?

Tracey Dingwerth: So National Diabetes Awareness month is, something that really is geared up by the American diabetes association or the ADA. And this is a great time of year for the community to come together so that we can really just talk about this diabetes epidemic and the millions of people who are at risk for it. It's really a time to spotlight education to help people find the resources that they need.

And I think also for the millions of people in our country, living with diabetes, it's also a chance for them to tell their story, for them to speak up and encourage, our communities and our government to push towards a cure. but in the meantime, it's really just a great time to lift each other up, and get everyone involved. The other thing I wanted to mention too is November 14th, you might hear this called, World Diabetes Day.

And this is the 14th of November is every single year because it's the birthday of Mr. Banting, who co-discovered insulin along with Charles Best. And that was clear back in 1922. And that was a monumental day because insulin is absolutely a life giving, medication for especially individuals with type one diabetes. So, it's pretty exciting. we have a lots of opportunities to really spotlight diabetes and to increase awareness and education.

Amanda Wilde (Host): That is perfect. Thank you, Tracey, Allanna and Jennifer for a comprehensive understanding of diabetes. The information is great. And also the support you provide. Thank you so much.

Allanna Abel: You are so welcome.

Jennifer Stachler: Thanks.

Amanda Wilde (Host): You can call 765-983-3000 to schedule an appointment or for more information, visit, reidhealth.org to get connected with one of our providers. And that concludes this episode of Right Beside You, a Reid Health Podcast. Thank you for listening and be well.