Transcription:
Diabetes and Adolescents

Maggie McKay (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.

This podcast is sponsored by UM Upper Chesapeake Health Diabetes and Endocrinology. Today, we're going to talk about diabetes. A diabetes diagnosis can sound a bit intimidating. Is it with me for life? Can it be controlled? How much will my diet have to change? All questions that come to mind when you hear the word diabetes. But the more, you know, and understand what it involves, the better you can manage it. And hopefully the less worrisome it will be. Joining us today is Dr. Meaghan Moxley, Diabetes Expert at UM Upper Chesapeake Health. Welcome Doctor.

Meaghan Moxley, MD (Guest): Thanks so much for having me.

Host: Thank you for being here. According to the CDC, just over 210,000 children and teens in the US have diabetes. Is that number rising? And if so, how does that affect the future of our community?

Dr. Moxley: Unfortunately it is rising and it has a significant impact on the health of our community, as those numbers continue to increase. And so the American Diabetes Association has about one in 10 Americans already diagnosed with diabetes across all of the age ranges. And that doesn't include patients who are not yet diagnosed. In their recent 2022 guidelines, they actually lowered the age of screening for patients who are asymptomatic to 35 years old, so that we aren't missing patients who may have abnormal blood sugars that are without notice. They still continue to recommend screening for patients with risk factors or symptoms such as frequent urination, frequent thirst, or blurry vision, even earlier than that.

And it's important for us to get those abnormal blood sugars early so we can prevent diabetes, ideally. And if we aren't able to prevent it, at least try to prevent the complications. For the patients who are being diagnosed even earlier in life, we're seeing those complications also occur earlier. And so it's important, you know, as we think forward, you know, another 20 or 30 years, we don't want to have a lot of extra complications of diabetes. So, the more aggressive we can be, you know, here in early ages, hopefully the better we can have the community health overall.

Host: And Type 1 was previously thought of as only a form for children when it came to diabetes. But more and more children are getting Type 2. So, what are the differences between Type 1 and Type 2 diabetes?

Dr. Moxley: Sure. That's a great question. So, when we think about Type 1 and Type 2 diabetes or diabetes in general, we're thinking about abnormal blood sugars due to insufficient insulin. And the difference between Type 1 and Type 2 diabetes is why is there insufficient insulin? So, for Type 1 diabetes, it is an auto-immune, attack of the immune system on the pancreas cells that make insulin. And so over a short amount of time, the pancreas isn't able to make any insulin at all. And so those patients require insulin as the cornerstone of their treatment plan.

For patients with Type 2 diabetes, however, it's different. Their bodies are experiencing what we call insulin resistance. And so their pancreas is still making insulin, but due to a variety of factors, such as you know, their genetics or their you know, issues like obesity; their body has become resistant to the insulin that their pancreas is making. And so for those patients, you know, we, we think about how do we try to reverse that process? And so the treatment options are a little bit more varied because we have medicines that can try to increase the sensitivity to insulin, try to increase how much insulin is being produced and secreted. And we have lifestyle components as well to help to counteract that process.

Host: So, how does growth and development affect diabetes and vice versa? Because children, you know, they're still developing and they get diabetes. How does it affect.

Dr. Moxley: Sure. So, you know, I think when we think about development, I think that the development affects diabetes care a lot. And so, you know, if you compare, a child who's diagnosed at 6 versus 12, versus 17, they're going to interact with their disease in a whole different way. You know, how much responsibility they're going to have, how much they're going to be able to even explain their symptoms is going to be really different.

And so, a diabetes care plan is often very intricately affected by a patient's development. When we think about growth, the time that I think the growth and diabetes interacts the most is during puberty. And so with all of the hormonal changes that you see during puberty, those hormones affect the blood sugar. And so blood sugar control can be really challenging in that time and can make diabetes a little bit more difficult during that timeframe and require, lead us to need a lot of close insulin titration.

Host: So, what are some of the best ways to manage a lifelong chronic disease like diabetes?

Dr. Moxley: Yeah. So, diabetes definitely is one of those diseases that affects every facet of someone's life. It's affecting what they're eating, it's affecting their exercise. It's affecting how they feel when they get up in the morning, like many chronic diseases. And so a couple of things that I try to focus on with my patients. First at the time of diagnosis or any time that the blood sugars start to become uncontrolled, putting in the extra effort at the front end to, to get good control of the blood sugars and prevent complications can, even though it's hard work at the front end, can really prevent some heartache later on and thinking about it at a very long-term standpoint.

So, diabetes is a marathon. It's not a sprint. And so when we're thinking about changes, you know, for example, when we're talking to patients with Type 2, you know, either type of diabetes, when we're talking to patients with diabetes, we often are talking about dietary changes that they might want to make.

And so, you know, we recommend, that we make changes that are sustainable. Starting a diet that you can only see yourself continuing for a month, isn't going to be maybe be the best care plan for a chronic disease that is going to be with you lifelong. And so how do we make, how do we make changes that are nice and sustainable?

And I think the third thing, and perhaps most importantly is when you're dealing with a chronic disease that is this pervasive in all aspects of your life; it's really important to have a good support system of people who are going to help you through the day-to-day, who are, you know, helping you to continue to make good choices and support you through the challenging days of a chronic disease.

Host: Can diet reverse either type of diabetes, 1 or 2? Is that possible?

Dr. Moxley: So, for Type 1 diabetes, because the immune system has affected pancreatic insulin production, changes in the diet can make it easier to control the diabetes and to control fluctuations in blood sugar, but it cannot fix the diabetes itself because the pancreas just isn't making the insulin.

For some patients with Type 2 diabetes, your diet can make it easier to treat. And for some patients, if their weight is a large component to their insulin resistance, changes that their diet can help them lose weight, which can help make their body more sensitive to insulin. And so it's very interconnected, you know, diabetes and diet itself and blood sugar control.

Host: Doctor, what are the best ways parents and caregivers can help young people cope with diabetes?

Dr. Moxley: Sure. So, when we talk about that support system, you know, for adolescents, parents and caregivers are the cornerstone of that support system. And so they can, you know, be cheerleaders on days when chronic diseases like diabetes get really hard and they can help them identify barriers to success in their blood glucose management, because they're there day in and day out.

Parents and caregivers have a really unique opportunity to create a healthy environment in the family and kind of help to promote a healthy culture. And so, you know, with regard to nutritious foods being served and, you know, movement as a family, you know, having those healthy lifestyle changes be changes that the entire family is making rather than just the patient with diabetes can really be helpful for diabetes to feel a lot less lonely for patients.

Host: That's a good point. Cause it's like somebody you know, who needs to eat all gluten-free, the rest of the family, isn't eating it. So yeah, I can see how that would be important. So as children, they'll eventually transition from pediatric care to adult care. Right? So, what are the best ways to make that easier on them?

Dr. Moxley: Sure. So, if we think about kind of this time in a young adult's life, it's challenging even without a chronic disease. And so often patients are graduating high school, they're starting a new job or they're going to college. And so there's a lot of changes that are happening in their lives. And then you add diabetes on top of all of that.

And so there's increased risk of poor blood glucose control during this time, as we can imagine. So, it's important to think about it as a process. And so it starts with the pediatric team and the parents and caregivers, as we mentioned previously, helping young adults start to develop those skills and take responsibility for their disease and the different aspects of, you know, for diabetes care, blood sugar management, troubleshooting elevated and low blood sugars. How do they make appointments? How do they feel navigating insurance? You kno, there's a lot of different skills that goes into diabetes management. And so those responsibilities start in the pediatric timeframe and then continue as patients transition over to an adult care team.

And so, you know, we continue as patients start with us, we continue to help them with those skills and help them feel confident to manage their diabetes. And, it's important whenever you're starting at a new office to, to ask a lot of questions and start early, to make sure that you're not going to have too long between you know, moving from one office to another and to make sure that you understand how each new office works. So, who do you get in contact with, if you need a refill and what do you do if your sugars are high, who's on call and how do you get in touch with them?

And so, I think encouraging young adults and anybody moving to a new office to ask questions and feel comfortable with their care team, is really important.

Host: You mentioned kids going off to college. I can imagine that would be so nerve wracking for parents. Is there any kind of app, like there's one for driving where you can track your children and make sure they're not driving too fast or you can see where they are. Is there one for diabetes, like to make sure they take, you know, whatever medicine they need or to remind them? And maybe you can see that they've taken it or not.

Dr. Moxley: Yeah. So, diabetes technology has come a really long way. And so there are for patients who use continuous glucose monitors, which are devices that sit on the skin and record the sugar, you know, update it as often as every five minutes, some of those devices do transmit to the cell phone and patients can share that with their loved ones so that for parents, they can see how the blood sugars, you know, of their children are doing. And so that's one way that, that some parents and families choose to monitor those things.

Host: Dr. Moxley, are there any other takeaways you'd like to share with our audience that might be helpful?

Dr. Moxley: I think overall the, you know, diabetes is becoming more common across all age groups. And so, earlier that we can identify abnormal blood sugar and try to prevent diabetes itself, the better. And then once we have diabetes already diagnosed, the more aggressive we can be to achieve great blood sugar control, the more complications we can prevent. And so that's really important. And then, you know, as we discussed, the chronic diseases are challenging and so it's really important to utilize your support system. And that includes your medical team, you know, we're here to help.

Host: Thank you so much for your time. That was very informative and hopefully it helps some people listening.

Dr. Moxley: Awesome. Thank you for having me.

Host: This episode is sponsored by UM Upper Chesapeake Health. Through an unparalleled combination of high quality care and leading edge technology, Um Upper Chesapeake is improving the health of Northeastern Maryland residents by providing an exceptional patient experience for every person, every encounter, every day.

Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. I'm your host, Maggie McKay.