Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand, and today I'm going to be joined by Dr. Ramanpreet Grewal, family medicine provider at Riverside's Watsika campus, to talk with us about diabetes basics. And we're back with Dr. Grewal. How are you today?

Ramanpreet Grewal, MD: Hey Helen, I'm doing good. How about you?

Host: Good. Glad to have you. Glad to have you. We know you've been on the podcast a few times. You're a pro. But if you could, for people who haven't listened before on one of yours, could you tell us a little bit about yourself?

Ramanpreet Grewal, MD: All right. Well, first of all, Helen, thank you for having me back. I must be doing a good job at it.

Host: We love having you.

Ramanpreet Grewal, MD: So, hello everyone. I'm Dr. Grewal and I'm thrilled to be here today. I am a family medicine physician and I work in two campuses, actually. My primary location right now is Watsika campus. And my other location is East Court in Kankakee where I work two days a week. So I'm here in Watsika Mondays, Wednesdays, and Fridays, and the T days are in East Court.

My passion mainly is primary care and preventative medicine. I'm also very passionate about women's health. That's why I picked to talk about diabetes today because, prevention is better than cure, always.

Host: Absolutely. Absolutely. So, with that, let's get started on diabetes. Could you explain the different types? I know there are different types and how they impact the body.

Ramanpreet Grewal, MD: Absolutely. So, diabetes indeed is a complex but very crucial topic. To simplify, we primarily have two main types. That's the Type 1 and Type 2. So, Type 1 diabetes is mostly diagnosed in childhood or adolescence. It is an autoimmune condition where the body's immune system attacks and destroys the insulin producing cells in the pancreas.

So consequently the body does not produce insulin, leading to elevated blood sugar levels.

Host: Got it.

Ramanpreet Grewal, MD: Type 2 diabetes, on the other hand, is more in adulthood though it is becoming more prevalent in younger populations because of increased lifestyle changes. In this case, the body either doesn't produce enough insulin or the cells ignore the insulin.

So this, again, results in elevated blood sugar levels. In terms of impact on the body, so both types share the common theme of elevated blood sugar which can cause a range of complications and over time, high blood sugars can damage organs, blood vessels, and nerves. So the complications may include cardiovascular issues, kidney problems, nerve damage, and vision impairment.

Host: Got it. Yeah, that's good. All really good information. I feel like I always have a hard time remembering which one is which so good to like, you know, have it all laid out there as well as kind of the impact of it. It's important to know that, you know, it's something important to take care of and know about for yourself. Moving on from that, could you tell us a little bit about some of the key risk factors in developing diabetes?

Ramanpreet Grewal, MD: So, Helen like I said, it's a complex diagnosis, right? So, we like to divide the risk factors for diabetes into two types. That's our non modifiable risk factors and modifiable risk factors. Non modifiable risk factors are the ones that we do not have a control on. So that would be our genetics, meaning our family history. Especially if you have a parent or a sibling who has diabetes, so you would be at an increased risk. Age, is a risk factor, we can't stop from aging. So, it's coming, right? Increased age will lead to a higher likelihood of developing diabetes. And certain ethnicities, like African American populations, Hispanic population, Native Americans, or Asian Americans, have a higher predisposition.

Modifiable risk factors would be something that we have a control on, so our lifestyle plays a significant role, which would include like poor diet, lack of physical activity, and obesity. High blood pressure and abnormal cholesterol levels are also one of the modifiable risk factors.

How to prevent it would be to try to adopt a healthy lifestyle, try a balanced diet which is rich in fruits, vegetables, and whole grains. Try to minimize processed foods and sugary beverages. Regular physical exercise, even in moderation is crucial which will lead to better weight management which is vital when it comes to Type 2 diabetes.

Also if you already know that you are at a high risk of developing diabetes, so you know just kind of monitoring your blood sugar levels, regular checkups, regular cholesterol checks will also be beneficial.

Host: Absolutely, so, as you know, you've kind of shared, diabetes can manifest in different ways and also, I think with that very varying symptoms. Could you tell us a little bit about the common symptoms that someone might be experiencing and when they should seek medical attention?

Ramanpreet Grewal, MD: Yes. So, the common symptoms would be, in medical terms we say polydipsia, polyphagia, and polyuria. Polydipsia means if you have increased thirst, polyphagia means increased hunger, and polyuria means increased urination. So if you're experiencing one of these three symptoms, can be one, can be both, two together or can be all three together, definitely need to be checked for diabetes. Or if you develop unexplained weight loss. So unexplained weight loss is the key factor here when it comes to Type 1 diabetes. That's how if you see that your child's eating but losing a lot of weight and is always tired, always thirsty, bring them in so that we can check them for Type 1 diabetes.

Other than that, fatigue, weakness, blurry vision, tingling or numbness in your hands or your feet are some of the symptoms. Sometimes we have patients come in and their only symptom is burning sensation in their feet. That sometimes is an indication for high blood sugars.

Host: Interesting. Awesome. We're going to take a quick break to talk about finding a primary care provider.

Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare.org/primarycare.

Okay, so getting back into this, once somebody is diagnosed with diabetes, typically how is it managed? What role does medication play along with the lifestyle changes you mentioned and monitoring?

Ramanpreet Grewal, MD: So, Helen, for diabetes, let's say a patient, now it depends on what type of diabetes you're diagnosed with. Definitely one thing that will be the foundation of treatment would be a lifestyle change. You know, throughout the podcast you'll hear me say lifestyle, lifestyle, and lifestyle, but that is truly important.

So, you know, more of a balanced diet, portion control, regular exercise and weight management is very crucial. Other than that, we have great medications now. Diabetes, a diagnosis for diabetes is not as scary as it used to be 10 years ago. In the last five years, especially since I started training, I have seen so many drugs that have come in.

Even our metformin, you know, metformin is just like the bread and butter that we use for Type 2 diabetes. Other than that, we have medications, GLP-1 mimetics, and you must have heard about them on the TV. Our Ozempic and Mounjaro, they really, they have really changed how we treat diabetes.

They have helped us not introducing insulin into the regimen sooner. So talking about our GLP-1 mimetics, they help with weight loss, they help with controlling blood sugar levels. We've also been able to just kind of decrease the demand for insulin usage just with these medications. Other than that, regular monitoring, so just depending on if you are on insulin, monitor your blood sugars daily. If you're on medications, make sure you go see your primary care physician or your endocrinologist once in three months to get your A1C checked.

So A1C would definitely give you a good value of where you are at in terms of your glycemic control. Other than that just proactive management and regular screening. So, like I talked about the complications of diabetes before. So, you know, cardiovascular health, your nerves, your eyes. So, a yearly foot exam, yearly eye exam, and a yearly urine exam to check for leakage of protein is very crucial just to help detect complications sooner rather than later.

Host: Absolutely. So yeah, those are definitely monitoring it from going to your primary care, getting those tests done perspective, and then kind of moving in. There's also a lot of technology that can be used in the management. Could you tell us a little bit about the technology available now?

Ramanpreet Grewal, MD: Yeah, certainly. So, the use of technology in diabetes management like continuous glucose monitors also known as CGM monitors and insulin pumps is rising.

The CGMs provide real time blood sugar data, enabling timely adjustments, while the insulin pumps offer precise insulin delivery. So these devices enhance control, they empower informed decisions, and significantly improve the lives of individuals with diabetes, promoting a more flexible and a healthier lifestyle.

Host: That's awesome. Yeah, I had some friends in college that would use different devices like that. And I had no idea about them until just talking with them and the things that they can do. And really cool. It's really cool where technology is now. So this management, it kind of often requires ongoing support. How can individuals with diabetes and their families find community resources and educational programs to better understand and cope with the condition?

Ramanpreet Grewal, MD: So, Helen, the individuals with diabetes and their families can access support through their local health departments or hospitals or online platforms. There are some diabetes focused websites or forums that can provide a lot of information. Other advocacy organizations like the American Diabetes Association offers educational resources and they also help connect with people with shared experiences. Other than that just kind of having an open mind, speaking with your primary care provider or other social media platforms is also helpful in finding resources that can provide information and support for coping with diabetes.

Host: Awesome. Well, thank you so much for being on today. We're glad to have you again.

Ramanpreet Grewal, MD: Thank you Helen.

Host: Of course. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare.

For more information, visit riversidehealthcare.org/primarycare.