Bob Underwood, MD (Host): Diabetes is a medical condition that affects millions of people every day, whether they're worried about lifestyle changes or medical management or potential complications from diabetes, or just what does diabetes really mean? These are all the concerns that they've got to struggle with.

Welcome to TriState HealthTalk from TriState Health, your LC Valley Health podcast. I'm your host, Dr. Bob Underwood. If you've got questions about diabetes, either as a patient or a family member, well, this is a discussion that you're going to want to hear. With us today is diabetes educator, Ginger Strobel. We'll be discussing myths, treatments, and how TriState Health is here to support you in your journey. Welcome to Better Health. Ginger, welcome to TriState HealthTalk.

Ginger Strobel, MBA: Thank you, Dr. Underwood.

Host: Yeah, it's great to have you on. So, let's start with the basics, right? What is diabetes?

Ginger Strobel, MBA: Ultimately, I find that people who have been diabetic for years often cannot articulate to me what diabetes is. So, basically we talk about two different kinds of diabetes for what I see. So, type 1 diabetes is what we used to call juvenile diabetes. And that's what we thought of little kids tending to present with diabetes. But anymore type 1 diabetes, we give it that name because type 1 is actually an autoimmune disease. So maybe you have this genetic predisposition, you get exposed to some type of viral illness, and the body is actually attacking itself. It's attacking the cells of the pancreas that produce insulin. And so, the type 1 diabetic makes no insulin at all, and they're depending on injections to have insulin in order to use sugar for the body. Whereas for type 2 diabetes, it's a metabolic disorder.

So in the beginnings, the patient is probably making insulin, maybe not enough. But then, there's also a component of insulin resistance where the body's making the insulin, but the body's not able to utilize it. So, the blood glucose starts to build up.

Host: So, an example is I've got a friend who recently was told they're prediabetic. What does that actually mean?

Ginger Strobel, MBA: Right. So, prediabetes is there is a small elevation in blood sugar, or the lab result we usually refer to is called the hemoglobin A1c, and that's a lab test that reflects what the average blood sugar has been over the past three months. So if there's a small elevation in that A1c, or a small elevation in your day-to-day blood sugar, but it's not to the point that you're type 2 diabetic yet, we term that prediabetes. So, that would mean you're a greater risk for becoming type 2 diabetic. But if you implement some changes now through your diet, exercise, you can very well keep yourself from becoming type 2.

Host: And that kind of gets into my next question, is how does learning that you have one of these conditions of diabetes, type 1, type 2, how would that change your activities, your diet, or even what you might need in terms of medical screenings?

Ginger Strobel, MBA: In a perfect world, everyone would eat like a diabetic is supposed to eat, because really it's all about you're eating up lots of vegetables, you're choosing lean meats, you're having a diet low in saturated fat, you're getting enough protein, you're avoiding processed food. So really, a diabetic diet is not that different from what we consider to be a healthy diet. Everyone should be eating this way. So ultimately, it's about cutting out processed foods, avoiding sugary drinks like soda or juices or sugary coffee drinks. As for activity, increased activity helps with insulin resistance, so it allows your body to use insulin better. Weight loss helps with insulin resistance. So, the ADA, the American Diabetic Association, actually recommends that people with diabetes and pre-diabetics get at least 150 minutes of exercise a week. So basically, it's what we all should be doing anyways. And now that you have this diagnosis, or you have this increased risk, you can start doing these things that will protect yourself from the damage that can happen with high blood sugar over the long term.

Host: Yeah, absolutely. And so, you're saying that the jar of M&Ms on my desk ought to be moved.

Ginger Strobel, MBA: Right. Out of sight out of mind. If you're like me, if it's there, I'm going to eat it, so...

Host: Yeah. Yeah, absolutely. So, are there myths about diabetes that are out there that you'd like to dispel?

Ginger Strobel, MBA: Absolutely. Some people think, "Oh, you're diabetic because you ate too much sugar." You know, you don't become diabetic just because you ate too much sugar. Or people think that type 2 diabetics are always overweight. That is not necessarily the case either. Also, like when, especially people who develop type 1 diabetes, where they're completely dependent on injections, they go, "Well, I can't eat this anymore," "Well, that's the end of me going to restaurants." I mean, you can still do everything you want to do, and you can have the things you like, and in moderation. So, a lot of it, you know, people get bad information or their family member tells them, or they're reading things on the internet from not reliable sources. And, you know, they get these odd beliefs.

Host: I can remember my mother saying that when I was a kid, "Keep eating those sugary things and you're going to be a diabetic." But yeah, I was a kid. I didn't even know what she was talking about. All right. So, what kind of treatment or support plans are out there for diabetes that are offered specifically by TriState Health and Wellness?

Ginger Strobel, MBA: So at the Wellness Clinic, we have myself, as a diabetic educator, and we have our outpatient dietitian, Jennifer Raykovich. Jennifer really tailors a visit with the patient to see what is gonna work for them? What's realistic for them to help with their diet, to feel like they're not getting deprived, to feel like they're not hungry all the time, because the whole diagnosis of diabetes is so overwhelming for people. I mean, it's really depressing. And the idea of I can't do this, I can't have that, there's not much to look forward to. So, she really works with you to see what's going to work best for you. What do you like? What's going to be realistic? And it's really a tailored visit for the person.

And then, my role is a little bit about diet, but also about what medications to take, what their side effects are. If the person has to take insulin, how to do so safely, store it properly. And then, you know, partially too, it's almost like you're a little bit of a counselor because it can be such an overwhelming experience and the changes that you have to make, that it's hard and sometimes people don't have the support that they need from family and friends. And so, sometimes it's just listening to their struggles and helping them through it.

Host: Yeah, I think, this is one of those considerations where every patient is different. And so, the way they're going to manage it, they almost need that customized navigation through this diagnosis.

Ginger Strobel, MBA: And also, when we have our visits, it's not what do I think the patient needs to do. You know, I'm not setting the goals for them. The patient is setting the goals for themselves. So, it's not the visit about me and my plan. It's their plan for themselves. So, they can take real ownership of their disease.

Host: You brought up medications, I think everybody knows about Ozempic, because it's commercials all the time. So, help us understand how do medications like that help diabetes and kind of what category of meds are they in.

Ginger Strobel, MBA: So, Ozempic, it belongs to a class of drugs called the GLPs. GLP is this hormone that the body naturally makes called glucagon-like peptide. So, that exists in the body anyways, but in the type 2 diabetic, there's a deficiency in this hormone. And the reason this hormone is so important is it has a couple jobs. So when a person eats food, this GLP is secreted from cells in the intestine. And they stimulate the pancreas to increase insulin, to release insulin in response to the food that we eat. And it also stops another hormone for being released called glucagon. And glucagon is something that increases your blood sugar if it detects that there's not enough in your bloodstream.

So, GLPs have two of those jobs. The GLPs are great, like Ozempic, because the drug also crosses the blood brain barrier, and it kind of acts to trigger that satiety response, like, you know, "Yep, I have had enough to eat and now I'm done." Because some people don't have that trigger, they never feel satisfied, that cue is not there. So, Ozempic also helps with that. It also slows the emptying of the stomach when you eat food. So, it's a slower release of sugar into the bloodstream. So, your body can deal with it more quickly as it comes through. So, GLPs are pretty great because they work in many different ways to help control blood sugar and they're really good at the weight loss, too. But they can be very expensive depending on what the person's insurance is.

Host: Yeah. Absolutely. And I think that the research is still out, but the benefits, the medical benefits that we're seeing from that particular class of drugs. They're still coming in. And so far, what I've seen almost all positive. So, what would an initial visit with you look like if they came to see you?

Ginger Strobel, MBA: For my role, the first visit, and I want to be clear, ideally, this is not a one-and-done visit. This is a chronic disease. You're not going to learn everything you need to know and remember that at home in one visit, because it's a lot. So that first visit for someone who's newly diagnosed is a little bit of an interview to see what the person already knows about diabetes, dispelling those myths, seeing what medications they're on, making sure they understand how to take them, how they work, whether they're checking their blood sugar or not currently, how they monitor it. Making sure they're using their glucometer correctly, making sure they know about the complications that develop from diabetes and why. Helping them solve problems in their daily life for lows, or when they're sick and don't feel like they can take their medications. So, that first visit is what do they think they need help with? How can I help them? And what knowledge deficits can I fill in for them?

Host: That sounds phenomenal and, you know, some questions they may not even know they need to ask.

Ginger Strobel, MBA: Yep.

Host: How does a patient go about getting an appointment with you?

Ginger Strobel, MBA: There's three different ways. So, they could either call our wellness clinic directly, say, "Hey, I'd really like a visit," and then I can reach out on their behalf to their primary care provider because we are a referral-based clinic. You have to have a referral. They can fill out a form online that they'd like to be seen. They can call the clinic directly, or they can just ask their primary care provider for a referral for our services. And then, once we receive it, we verify through insurance that it is or isn't covered, and then contact them for an appointment.

Host: Oh, that's phenomenal. I've learned a ton. Is there anything else you'd like to kind of close with as we kind of finish up today?

Ginger Strobel, MBA: I just want people to know that there are resources available. That there are people here to help them, who know a lot, and will support them in their journey. You know, we're not judgmental. We're not here to tell you that you're wrong or you've made bad choices. We're here to help you make positive changes and have the least stress as possible and just have good support. So, they feel like they're not doing this alone.

Host: Ginger. Thanks so much for helping us understand more about diabetes and what those resources are and that there's somebody out there who can actually help navigate this new or complicated diagnosis. It's not easy, and you need that education to really be able to manage it well. So, thanks for helping us understand and learn more about it.

Ginger Strobel, MBA: Thank you.

Host: And thank you to our audience for listening to TriState HealthTalk. You can learn more about all of the services that TriState Health has to offer at tsh.org. I'm your host, Dr. Bob Underwood. And if you found this podcast helpful, please share it on your social channels and check out the other podcasts that are available at TriState Health.