The incidence of diabetes is growing. Meritus Health’s goal is to curb the growth of diabetes in our community and help those diagnosed with diabetes live a happy and healthy life.
Diabetes is often a silent disease and some people have no symptoms of high blood sugar for years. Left untreated or uncontrolled, diabetes can lead to many troublesome health conditions including vision problems, heart trouble, digestive issues, kidney and nerve damage and more.
In this segment, Dr. Anteneh W. Zenebe, board certified endocrinologist at Meritus Health., describes that if you’ve been diagnosed with prediabetes, type 1 diabetes, type 2 diabetes or gestational diabetes, we can give you the support and tools you need to successfully manage your condition.
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Managing Your Diabetes
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Learn more about Anteneh W. Zenebe, MD
Anteneh W. Zenebe, MD
Dr. Zenebe earned his medical degree from Addis Ababa University in Addis Ababa, Ethiopia. He completed a residency in internal medicine and a fellowship in endocrinology, diabetes and metabolism at Howard University in Washington, D.C. Dr. Zenebe is board certified in internal medicine and endocrinology with the American Board of Internal Medicine.Learn more about Anteneh W. Zenebe, MD
Transcription:
Managing Your Diabetes
Melanie Cole (Host): Diabetes is often a silent disease and some people have no symptoms of high blood sugar for years. If left untreated or uncontrolled diabetes can lead to many troublesome conditions. My guest today is Dr. Anteneh Zenebe. He’s a board-certified endocrinologist at Meritus Health. Welcome to the show, Dr. Zenebe. Tell us, what is diabetes?
Dr. Anteneh Zenebe (Guest): Thank you, for having me, Melanie. Diabetes is a metabolic disease when someone has abnormally high glucose in his or her blood. It occurs in children. It occurs in young men and women and also elderly people.
Melanie: So if somebody – we’re going to talk mainly today about type two diabetes, which is getting so prevalent in this country Dr. Zenebe. With type two diabetes, would somebody have symptoms? When would they find out that they may be considered prediabetic or have full-blown diabetes?
Dr. Zenebe: That’s a very important question. Diabetes is actually a rampant disease all over the world. In the United States, the burden is about 8.4% of the total population, and it has about 14% US healthcare expense, so you can image how damaging and how burdensome it is. A patient or a person, we suspect if he has diabetes, most of the time when he has a blood glucose tested at his primary care doctor and if that number is above 125 in fasting blood sugar, or if it is above 200 after he or she eats, or there is another test which is done by any doctor, and it’s called hemoglobin A1c. If that number is 6.5 and above, by definition, that person has diabetes.
Symptom-wise, most of the time, diabetes doesn’t have any symptoms. The only time the patient has symptoms is when the sugar is in excess above 200 and when they feel thirsty, drinking too much water, going to the bathroom more frequently, and sometimes weight loss, unexplained.
Melanie: If someone is told by their doctor that their A1c, or their fasting blood glucose is high enough to tell them that they have pre-diabetes or diabetes, what do you tell them is the first line of defense? What is the first thing you want them to do with that information?
Dr. Zenebe: When a patient is told they have a prediabetes diagnosis or a diabetes diagnosis, the first step is to sit back and think about it and ask questions to the doctor. After that, the first thing to do is to watch what the diet is. Most of the time, people eat without knowing a lot of sugary food like high in starch. Also, people drink a lot of sugary drinks like diet – some people call them pops – bottled juice, and bread, and chips, things like that – will tip off the prediabetes to diabetes or the diabetes to be worse. We have to watch out for those diets.
The second step, which going along with watching your diet is to be more active. The recommended activity is to have 150 minutes of moderate intensity exercise per week. Some people may not exercise that much if they have what we call a sedentary lifestyle. Standing up from sitting position, or lying position every 30 minutes also makes it easier for the body to metabolize sugar. More activity, healthier food, and weight loss – most diabetes, especially type two diabetics have excess weight on them, so a weight loss between 5 to 7% of total body weight will improve the diabetes control. Those are the three things which are most commonly done as a first-line treatment or prevention of diabetes.
Melanie: Dr. Zenebe, if somebody tries exercise, they lose some weight, they’ve changed their diet and yet, they are still having some of these issues, what are some of the medications that might be involved? People hear about insulin, but they think that’s maybe only for type one diabetics, but now, what used to be called adult-onset type two diabetes – which we’re even seeing in children now – sometimes medicational intervention is required. What do you tell them about that?
Dr. Zenebe: That’s a very important question, Melanie. We do what we can do, right? We exercise, we eat right, and we lose weight, but sometimes these actions may not be enough to control the diabetes. The next step has to be starting medications. There are different kinds of medications nowadays for diabetes treatment. There are oral, which are by mouth. There are also injectables, which can be injected once a day, twice a day, or once a week, and also, there are insulin. We start with oral medications and the most common starting oral medication is called Metformin. Based on the A1c level, the doctor can start with one pill a day or two pills a day and increase the dose according to the response to the diabetes treatment.
If that’s not working, there are other pills which can be added. I don’t want to burden you with the names and the doses of the pills, but after additional pills, if still the diabetes were not controlled, we can start injectables, the most common are insulin and GLP analogs. We can start with medications like Byetta twice a day, or Victoza once a day, or once weekly injections. If those are not working properly, or if a doctor chooses, he can start once a day insulin.
We have to think about insulin here. Insulin is a treatment for diabetes, type one or type two. We start only insulin for type one diabetes because they need only insulin because they cannot produce enough insulin. For type two diabetes, adding insulin will make their diabetes well-controlled in collaboration with other injectables or other pills. If a person has questions about why insulin when I have type two diabetes, it’s because insulin is also required to manage diabetes along with other pills or injectables.
Melanie: Do you advocate self-monitoring of blood glucose and if so, how often?
Dr. Zenebe: That’s another excellent question. Patients who have diabetes have to monitor the blood glucose levels. If a patient is only on one pill, he or she can monitor their fasting blood sugar early in the morning or their bedtime blood sugar at around nine or ten O’clock. The targets that we’re looking at for the doctor is the fasting blood sugar has to fall at least less than 130 and above 80, based on the American Diabetes Association guidelines. The bedtime blood glucose has to fall between 110 and 150. If a patient keeps that number, that is a well-controlled diabetes even without checking the A1c.
If the patient has multiple medications, which makes the sugar down, or insulin, we encourage to monitor at least three times or four times a day based on the dosing of the insulin.
Melanie: Dr. Zenebe, to wrap it up, give us your best advice on someone who has recently been told they have pre-diabetes or diabetes and include foot health, exercise, monitoring their blood glucose, and watching their numbers for other comorbidities – maybe like high blood pressure, or obesity. Wrap it up for us and give your best advice on all of these things for the listeners about diabetes.
Dr. Zenebe: Thank you, very much. As I said earlier, diabetes is a big burden for society. If a patient has a habitually inactive behavior physically – we’re told that his numbers are slightly higher than the normal, a family history of diabetes is in high-risk if they grew up like Asian American or African American, Latinos, Native Americans, or Pacific Islanders, or have gestational diabetes, high cholesterol or have polycystic ovary syndrome or any other vascular disease, they need to be screened for diabetes. This could be prediabetes or diabetes, so if they are diagnosed with one or the other, the first step is to change the behavior to be as active as possible and limit high sugary drinks, or avoid them, and decrease the content of starch food in everybody’s meal, and be active and lose weight – at least 5 to 7% of the total body weight.
If that doesn’t work, they can seek help from the doctor to start them on a pill. Metformin, once a day, in a different dosage can also help in preventing diabetes from going pre-diabetes to diabetes. Once someone is diagnosed with diabetes, all of the physical activities, the exercise, and watching the diet, and weight loss have to be continued, and the patient has to be started on a pill or other injectable or insulin according to their hemoglobin a1c. They have to check their glucose as recommended by their doctor. They have to avoid smoking cigarettes, and they have to monitor their cholesterol at least every six months or every year. They have to monitor their kidney function as ordered by their doctor and follow-up with a foot doctor or an ophthalmologist to evaluate and treat a complication of diabetes.
If someone does that and follows up with their doctor regularly, they can be monitored, they can be well-controlled, and they can live a very well and balanced life even with diabetes. Diabetes should not be a problem which cannot be controlled because it can be controlled. If they do everything like that and see their primary doctor all of the time and there’s no response or change, the next step is to ask for their primary care doctor to refer them to a specialist like an endocrinologist or a diabetologist so that they can have a comprehensive management with educators, nutritionists, and endocrinologists.
Melanie: Thank you, so much, Dr. Zenebe, that’s really great information and so important for people ot hear. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much, for listening.
Managing Your Diabetes
Melanie Cole (Host): Diabetes is often a silent disease and some people have no symptoms of high blood sugar for years. If left untreated or uncontrolled diabetes can lead to many troublesome conditions. My guest today is Dr. Anteneh Zenebe. He’s a board-certified endocrinologist at Meritus Health. Welcome to the show, Dr. Zenebe. Tell us, what is diabetes?
Dr. Anteneh Zenebe (Guest): Thank you, for having me, Melanie. Diabetes is a metabolic disease when someone has abnormally high glucose in his or her blood. It occurs in children. It occurs in young men and women and also elderly people.
Melanie: So if somebody – we’re going to talk mainly today about type two diabetes, which is getting so prevalent in this country Dr. Zenebe. With type two diabetes, would somebody have symptoms? When would they find out that they may be considered prediabetic or have full-blown diabetes?
Dr. Zenebe: That’s a very important question. Diabetes is actually a rampant disease all over the world. In the United States, the burden is about 8.4% of the total population, and it has about 14% US healthcare expense, so you can image how damaging and how burdensome it is. A patient or a person, we suspect if he has diabetes, most of the time when he has a blood glucose tested at his primary care doctor and if that number is above 125 in fasting blood sugar, or if it is above 200 after he or she eats, or there is another test which is done by any doctor, and it’s called hemoglobin A1c. If that number is 6.5 and above, by definition, that person has diabetes.
Symptom-wise, most of the time, diabetes doesn’t have any symptoms. The only time the patient has symptoms is when the sugar is in excess above 200 and when they feel thirsty, drinking too much water, going to the bathroom more frequently, and sometimes weight loss, unexplained.
Melanie: If someone is told by their doctor that their A1c, or their fasting blood glucose is high enough to tell them that they have pre-diabetes or diabetes, what do you tell them is the first line of defense? What is the first thing you want them to do with that information?
Dr. Zenebe: When a patient is told they have a prediabetes diagnosis or a diabetes diagnosis, the first step is to sit back and think about it and ask questions to the doctor. After that, the first thing to do is to watch what the diet is. Most of the time, people eat without knowing a lot of sugary food like high in starch. Also, people drink a lot of sugary drinks like diet – some people call them pops – bottled juice, and bread, and chips, things like that – will tip off the prediabetes to diabetes or the diabetes to be worse. We have to watch out for those diets.
The second step, which going along with watching your diet is to be more active. The recommended activity is to have 150 minutes of moderate intensity exercise per week. Some people may not exercise that much if they have what we call a sedentary lifestyle. Standing up from sitting position, or lying position every 30 minutes also makes it easier for the body to metabolize sugar. More activity, healthier food, and weight loss – most diabetes, especially type two diabetics have excess weight on them, so a weight loss between 5 to 7% of total body weight will improve the diabetes control. Those are the three things which are most commonly done as a first-line treatment or prevention of diabetes.
Melanie: Dr. Zenebe, if somebody tries exercise, they lose some weight, they’ve changed their diet and yet, they are still having some of these issues, what are some of the medications that might be involved? People hear about insulin, but they think that’s maybe only for type one diabetics, but now, what used to be called adult-onset type two diabetes – which we’re even seeing in children now – sometimes medicational intervention is required. What do you tell them about that?
Dr. Zenebe: That’s a very important question, Melanie. We do what we can do, right? We exercise, we eat right, and we lose weight, but sometimes these actions may not be enough to control the diabetes. The next step has to be starting medications. There are different kinds of medications nowadays for diabetes treatment. There are oral, which are by mouth. There are also injectables, which can be injected once a day, twice a day, or once a week, and also, there are insulin. We start with oral medications and the most common starting oral medication is called Metformin. Based on the A1c level, the doctor can start with one pill a day or two pills a day and increase the dose according to the response to the diabetes treatment.
If that’s not working, there are other pills which can be added. I don’t want to burden you with the names and the doses of the pills, but after additional pills, if still the diabetes were not controlled, we can start injectables, the most common are insulin and GLP analogs. We can start with medications like Byetta twice a day, or Victoza once a day, or once weekly injections. If those are not working properly, or if a doctor chooses, he can start once a day insulin.
We have to think about insulin here. Insulin is a treatment for diabetes, type one or type two. We start only insulin for type one diabetes because they need only insulin because they cannot produce enough insulin. For type two diabetes, adding insulin will make their diabetes well-controlled in collaboration with other injectables or other pills. If a person has questions about why insulin when I have type two diabetes, it’s because insulin is also required to manage diabetes along with other pills or injectables.
Melanie: Do you advocate self-monitoring of blood glucose and if so, how often?
Dr. Zenebe: That’s another excellent question. Patients who have diabetes have to monitor the blood glucose levels. If a patient is only on one pill, he or she can monitor their fasting blood sugar early in the morning or their bedtime blood sugar at around nine or ten O’clock. The targets that we’re looking at for the doctor is the fasting blood sugar has to fall at least less than 130 and above 80, based on the American Diabetes Association guidelines. The bedtime blood glucose has to fall between 110 and 150. If a patient keeps that number, that is a well-controlled diabetes even without checking the A1c.
If the patient has multiple medications, which makes the sugar down, or insulin, we encourage to monitor at least three times or four times a day based on the dosing of the insulin.
Melanie: Dr. Zenebe, to wrap it up, give us your best advice on someone who has recently been told they have pre-diabetes or diabetes and include foot health, exercise, monitoring their blood glucose, and watching their numbers for other comorbidities – maybe like high blood pressure, or obesity. Wrap it up for us and give your best advice on all of these things for the listeners about diabetes.
Dr. Zenebe: Thank you, very much. As I said earlier, diabetes is a big burden for society. If a patient has a habitually inactive behavior physically – we’re told that his numbers are slightly higher than the normal, a family history of diabetes is in high-risk if they grew up like Asian American or African American, Latinos, Native Americans, or Pacific Islanders, or have gestational diabetes, high cholesterol or have polycystic ovary syndrome or any other vascular disease, they need to be screened for diabetes. This could be prediabetes or diabetes, so if they are diagnosed with one or the other, the first step is to change the behavior to be as active as possible and limit high sugary drinks, or avoid them, and decrease the content of starch food in everybody’s meal, and be active and lose weight – at least 5 to 7% of the total body weight.
If that doesn’t work, they can seek help from the doctor to start them on a pill. Metformin, once a day, in a different dosage can also help in preventing diabetes from going pre-diabetes to diabetes. Once someone is diagnosed with diabetes, all of the physical activities, the exercise, and watching the diet, and weight loss have to be continued, and the patient has to be started on a pill or other injectable or insulin according to their hemoglobin a1c. They have to check their glucose as recommended by their doctor. They have to avoid smoking cigarettes, and they have to monitor their cholesterol at least every six months or every year. They have to monitor their kidney function as ordered by their doctor and follow-up with a foot doctor or an ophthalmologist to evaluate and treat a complication of diabetes.
If someone does that and follows up with their doctor regularly, they can be monitored, they can be well-controlled, and they can live a very well and balanced life even with diabetes. Diabetes should not be a problem which cannot be controlled because it can be controlled. If they do everything like that and see their primary doctor all of the time and there’s no response or change, the next step is to ask for their primary care doctor to refer them to a specialist like an endocrinologist or a diabetologist so that they can have a comprehensive management with educators, nutritionists, and endocrinologists.
Melanie: Thank you, so much, Dr. Zenebe, that’s really great information and so important for people ot hear. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much, for listening.