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Helen Dandurand (Host): Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Helen Dandurand. And joining me today is Dr. Santosh Bhat, primary care provider at Riverside, who is here to talk about prediabetes and what that means and how to prevent it. So welcome, Dr. Bhat.

Dr. Santosh Bhat: Thank you for having me.

Host: Yes. So, you've been on the podcast before, but for anyone who might not have listened to that episode, could you please start by telling us a little about yourself and your background?

Dr. Santosh Bhat: Sure. So, I'm an internal medicine physician. I did my training out in New Jersey, where I did my residency and did my medical school education in New York. I worked previously at IU, Indiana University Health,. And now, I live in Chicago and recently joined here at Riverside to practice internal medicine.

Host: Awesome. Where are you from originally?

Dr. Santosh Bhat: So, I was born and raised in New Jersey In Central New Jersey in Monmouth County.

Host: Are you enjoying the Midwest?

Dr. Santosh Bhat: Yes. It's a change and I like the change, I like the change of pace.

Host: Good. Good. All right. So to start us off, what exactly is prediabetes and how does that differ from type 2 diabetes?

Dr. Santosh Bhat: Yes, that's a great question. Prediabetes and type 2 diabetes, I would say, are just different stages along the same spectrum. And so, I think it's best to understand what actual type 2 diabetes is, which is essentially resistance that your body has to the hormone insulin, as well as eventually also a decrease in the secretion of insulin in your body. And that's important because when your body is not responding appropriately or making enough insulin, your body will not be able to regulate the sugar levels in the blood.

So, prediabetes is just early on on that spectrum. So, you don't have the diagnosis of type 2 diabetes, but you are starting to develop some insulin resistance, and your sugars are probably going to be therefore higher than normal, but you're not yet at a more severe point where we would call it type 2 diabetes.

Host: Okay. And are both of them reversible? Like, once you have type 2, is that something for life? I'm pretty sure prediabetes is reversible. Is that true?

Dr. Santosh Bhat: Yes. Prediabetes is reversible, and it can be reversed without the use of any medications. It does require important changes to your lifestyle, which we'll talk about more in detail. With type 2 diabetes, it is also reversible. But it does get more challenging as you allow the disease to progress to its more severe form.

Host: Okay. So, how common is prediabetes, and are there certain people who might be more at risk than others for it?

Dr. Santosh Bhat: So, prediabetes is very common. You could find reports that potentially up to a third or more of the population might have prediabetes. So, it's one of the most common metabolic issues that you'll come across. And there are many things that make you at a greater risk for it, including your lifestyle, your diet, your activity level, but also genetics will play a big role as well.

Host: Okay. I've heard that it doesn't often have a lot of symptoms that go with it. So, how would that be detected?

Dr. Santosh Bhat: Yes, that's true. prediabetes, because it's in the early phase of the disease, oftentimes will not have any symptoms. And so, you do need to get a blood test to diagnose it. And there's a couple different tests you could do. One is just checking your fasting glucose level. And if that is between 100 and 125, that indicates prediabetes.

And then, another test is known as hemoglobin A1c, which is a great test because it gives us an idea of your sugar levels over an approximately three-month period of time.

Host: Okay. I know we already talked about how it is reversible if you're told you have that. But, like, how serious of a diagnosis is this? Like, how quickly do you need to kind of get on track and change things up?

Dr. Santosh Bhat: What's great about knowing about prediabetes is now you know about this disease in its early stage. So, you could make significant changes and reverse this issue so that you don't develop the long-term health problems associated with it that can sometimes appear in someone who has type 2 diabetes that's not well-controlled.

And so, some of the long-term effects of diabetes would be a whole host of issues, including increased risk of heart attacks, strokes, kidney disease, and damage to your nerves as well.

Host: Okay. We are going to take a quick break now to talk about primary care at Riverside.

At Riverside, our primary care providers are right here in your community offering personalized care for you and your family, close to home and connected to the specialists and services you may need. Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew. And we are back with Dr. Bhat talking about prediabetes. So, what are some of the biggest lifestyle factors that contribute to the development of prediabetes?

Dr. Santosh Bhat: The biggest lifestyle factors would be a poor diet, a sedentary lifestyle and, as we mentioned before, genetic risk factors.

Host: Okay. I feel like those are kind of the big three with everything, you know? You need to be moving, and you need to, you know, make good healthy choices. And that's always important.

So for someone who wants to take action, what are the most impactful changes that they can start making right away?

Dr. Santosh Bhat: In terms of diet, what I typically recommend is commonly referred to as the Mediterranean diet. And this is a diet where you'll be consuming a lot of foods that are high in fiber, healthy fats, and foods that are called low glycemic carbs.

So, typically, people think of carbs as you have to avoid it if you have diabetes. And that's probably true for a lot of the more processed carbs. But when I'm talking about low glycemic carbs, I'm talking about more whole grain, which would be a better option to prevent prediabetes. So whole grains, a healthy amount of veggies, and healthy fats such as nuts, olive oil, and fatty fish.

In terms of your activity level, I tend to recommend a consistent exercise and a combination of both aerobic and resistance training is probably optimal. And for those who need to lose weight, certainly losing weight will also be very beneficial.

Host: Okay. Yeah. That all makes sense and aligns with a healthy lifestyle. One thing that I've seen recently, and I don't know if this is going too far down the nutrition rabbit hole, but people saying in order to, like, balance your blood sugar and stuff, when you're eating a meal, like, trying to eat your protein first, and your veggies, and then eating whatever kind of carb or starch or whatever you have. Is that something that you recommend?

Dr. Santosh Bhat: That might be a good approach because that way you'll be more restrictive in your carb intake, because you'll already be more satiated from the other food groups. That is a good strategy.

Host: Yeah. And then, with the exercise and stuff, I think sometimes people think, "Well, now I have to start doing all this crazy stuff."

And I feel like resistance training and also aerobic exercise can start. You know, it can be a walk. You know, you can be walking. And you can be doing some very light stuff. And if you weren't doing it before, that's going to make a change in you. So, I guess, just letting people know that it doesn't have to be all or nothing.

Dr. Santosh Bhat: Yes. Any improvement from what you were before is going to have a positive impact.

Host: Yeah. So where does a primary care provider kind of fit into helping someone manage this or even prevent this from progressing, that kind of thing?

Dr. Santosh Bhat: So, the primary care provider, especially at the point of prediabetes, will primarily be trying to encourage you to make these lifestyle changes that we talked about. And we can continue to monitor you with routine blood tests every so often to see the progress. And yes, this is something that you wouldn't need to see a specialist for or get, or even necessarily need to take any medications for. It truly can be managed and reversed with making these lifestyle changes.

Host: Okay. And you mentioned a little bit ago about the different tests, the A1c, things like that. With a primary care provider, how do you determine who needs to get those tests?

Dr. Santosh Bhat: It's a good screening test for most adults. But if you have some other risk factors such as high blood pressure or obesity, it just makes it even a more important test to get checked. But it's a good screening test, I think, as a baseline for most adults, at least once every few years.

Host: Just kind of a reminder that, you know, you should be making those annual appointments if you can, and then getting whatever recommended tests there are so you can catch things early and take care of yourself.

Dr. Santosh Bhat: Yes. I would agree with that. Absolutely.

Host: Yeah. So, what's one message that you want listeners to remember if they're worried about the risk of diabetes?

Dr. Santosh Bhat: Keep an eye on any new symptoms that you're developing. With diabetes, you can experience things such as increased urination, especially getting up at night to use the bathroom, increased thirst, as well as hunger. These are common signs of diabetes. For those that don't have those symptoms, as we discussed today, you might still have prediabetes. So, the best thing to do is to make an appointment with a primary care provider and get the tests done and to find out.

Host: Yeah. Well, perfect. Thank you so much for being here today, Dr. Bhat.

Dr. Santosh Bhat: Thank you so much.

Host: Yeah. And thank you listeners for tuning into the Well Within Reach podcast. Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about the services at Riverside Healthcare, go to riversidehealthcare.org.