Scott Webb (Host): Diabetes is common and treatable, especially under the care of medical professionals like my guest today. And I'm joined today by Brian Murphy. He's a nurse practitioner in the Endocrinology Department at St. Joseph Hospital.

Host: Welcome to Wellness First, the St. Joseph Hospital podcast, where we hear and learn directly from the experts in all things health and wellness. I'm Scott Webb. Brian, thanks for joining me.

Brian Murphy, MSN: Hi, Scott. Thanks for having me.

Host: Yeah, it's great to have you here. We're going to talk essentially about diabetes management today. But I thought before we get too far along here, let's just have a little foundational question. You know, what is diabetes? Who gets it? Maybe who's at the highest risk?

Brian Murphy, MSN: So, diabetes is a disease where the glucose levels in the body get uncontrolled because either the body is no longer making the insulin it needs to keep glucose levels controlled or the body has now just become resistant to the insulin it is currently making. In terms of those who are at risk to get this, there's two different types. So, a lot of times you'll hear the distinction being juvenile diabetes and then, type 2 diabetes is the one you see all the funny commercials on TV for with people dancing around fountains and all that fun stuff. Type 1 diabetes or the juvenile diabetes typically occurs, again, in childhood, where oftentimes the immune system starts to attack the pancreas, the gland in the body that produces insulin to the point where glucose levels can no longer be controlled because the body is physically not making enough insulin anymore to account for any food somebody eats, you know, Gatorade if they drink it; coffee, unfortunately, for those of us that have that all day and every day. And then, type 2 diabetes is where your body has now just become resistant to the insulin that your body is still making, but not as efficiently or not using it efficiently enough. And oftentimes, that one is the one that's found much later on because it develops so slowly. Whereas type 1 or juvenile diabetes usually develops very quickly with much more drastic, noticeable symptoms.

Host: Yeah. And it's good to have a little foundation there, right? So, juvenile, type 2. I've seen those commercials, I've seen folks dancing around like, you know, "No problem having diabetes." And maybe it's not with type 2, especially if they listen to experts like yourself. So, let's talk about the effects of exercising on diabetes and blood sugar levels and just our overall health.

Brian Murphy, MSN: So, exercise in general is just healthy for you. That's kind of where I start every conversation I have with diabetic patients, "Well, what do you do for exercise or how's your diet?" A lot of the times, diet wise, they'll pay attention to it. Exercise wise, some people leave a little to be desired in terms of helping themselves. What exercise does for a diabetic? Essentially, it makes your body more sensitive to the insulin that you have, whether you're a type 1 diabetic and need to take synthetic insulin, or you're a type 2 diabetic who is still making insulin in your body. But you're just resistant to it. Exercise effectively makes the insulin work a little better and helps the blood sugar levels kind of be more controlled naturally as opposed to just throwing more and more medication and insulin at somebody to try to get them controlled.

Host: Yeah. As you say, there's many mental and physical benefits from exercising. I should take my own advice and do more of that. Maybe that's a separate podcast. So, when we're looking at labels, right? We go to the store, we look at the labels, what should we be, you know, paying attention to most? Is it the carbohydrates? The sugars? It gets a little confusing. You stand there and I start staring and my eyes get a little blurry. I'm just not sure what I'm looking for.

Brian Murphy, MSN: So, you go to the grocery store and you're like, "Okay, I know I have diabetes. I know my blood sugar is off," so a lot of people hear the blood sugar association and immediately think, "Okay, I need to have low-sugar foods," which, well, yes, that's true. What we ideally want to be looking at is the total number of carbohydrates because the sugar content in foods contributes to the overall number of carbohydrates or grams of carbohydrates that are in one serving of food. So, you look at a food label, you want to want to look at the serving size. Is it reasonable or is it the entire package? Kind of do you eat a whole box of pasta or should you have one cup of pasta? And then, looking at the number of carbohydrates per serving and trying to keep that consistent and usually no more than 30 to 45 depending on the type of food you have in terms of grams of carbohydrates. When again, yes, the sugar content is important because you don't want to be having foods that are super high in sugar because then you're effectively going to undo all of the work you did with all the exercise we just talked about. But ideally, as a diabetic, start by looking at the total number of carbohydrates and then go from there.

Host: Yeah. And it's good we have experts like you because I would be thinking I'm looking at the sugars, right? I'm a diabetic. Stay away from the sugar. But as you say, carbohydrates, need to look at that. We need to be, you know, consistent in our approach in planning meals and, you know, "Do I eat an entire box of pasta or maybe just a cup, right?"

So, let's talk about insulin, Brian. If someone's on insulin lifelong, they're a lifelong insulin taker, does that mean that somehow they've sort of failed as a diabetic?

Brian Murphy, MSN: No. So, it doesn't mean they failed. Oftentimes, it's just their pancreas kind of gives out on them, basically. Not gives out in the terms that it gave up, it's just it couldn't keep up anymore. How I was discussing the distinction between type 1 and type 2 diabetics, type 1 diabetics will be on insulin lifelong. There's no real way around that because your body as a type 1 diabetic just simply does not make the insulin anymore because your pancreas has been attacked by your body, by your immune system, and you need to have it replaced synthetically. There's , no real way around that. Type 2 diabetes, you can be stuck on insulin. And when I say stuck on insulin, it's not that you're stuck on insulin and you're stuck on it for life. What I tell a lot of my type 2 diabetic patients who are on insulin or just starting insulin or potentially to the point where their control was indicating that, we may need to start insulin, that my goal is if you're on insulin or going to start insulin is to get you off of it. With type 2 diabetes, there's so many more medications to choose from that essentially what I do is use insulin to get you back under control, do so safely. We can do a lot of dosing adjustments as we need to. And then once we get you back under control or things are moving in the right direction, then the potential is to come off of insulin. If you are on insulin, again, does not mean that you've failed. It just means that sometimes you are too resistant to the natural insulin your body is making you need more. It's just, as you age too, you put 70, 80, 90, hopefully 100 years of work into that pancreas. It gets tired eventually. You may need to have little extra kick in there to get your control where it needs to go.

Host: Yeah. Let's hope it's 70, 80, 90, 100. I'm in my 50s, so another 40 some years, I'll take that, right? This has been really educational today. As I sort of prefaced today before we got rolling, you know, we need experts like you to help us, whether it's to balance things off with some insulin and work on some other things or really work to get folks off of insulin. Just final thoughts and takeaways on diabetes management and how you can help folks.

Brian Murphy, MSN: Diabetes management wise, definitely, I would say be open to all ideas. I'm very much of the school of thought that I will work with you to see what works mentally, physically. If we can come up with a solution where we can do things strictly diet and exercise wise, fantastic. We don't have to start any medication. If that doesn't work, then we need to reevaluate and adjust from there. If we have to start medications, it's not the end of the world. They're very well studied. And there's only more information coming out as we go. So, diabetes management wise, do what you can to help yourself diet, exercise wise, be as consistent as possible, but also taking it with a grain of salt, but not letting it run your life either. You do need to have a life outside of diabetes. So, I will very much work with my patients in terms of doing things in moderation and within reason to still not let diabetes control every aspect

Host: Right. So that, fortunately, I think, Brian, the goal is for us to be dancing in the commercials, right? For us to be dancing around fountains, like, "No big deal, diabetes." And like I said, you know, when I prefaced things today, we need experts like yourself because it is common, it is treatable. So, thanks so much. You stay well.

Brian Murphy, MSN: Thanks you as well, Scott.

Host: Thank you. And thanks for checking out Welcome to Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts in all things health and wellness. I'm Scott Webb. And if you enjoyed the podcast, please be sure to share on social media and check out our entire podcast library. Until next time, thanks again.