Scott Webb (Host): Type 2 diabetes is a very common diagnosis. And today, we'll be discussing how we can manage type 2 diabetes in the healthiest ways possible with Jocelyne Loran. She's a clinical dietitian specialist, diabetes educator in the Center for Diabetes Education at the University of Maryland Charles Regional Medical Center.

Welcome to the Live Greater Podcast series, information for a healthier you, from the University of Maryland Medical System. I'm Scott Webb.

Jocelyne, it's so nice to have you here today. We're going to talk about managing type 2 diabetes, you know, the healthy way. So, let's just start with an overview of type 2 diabetes.

Jocelyne Loran: In simple terms, type 2 diabetes is high blood sugar, and it occurs when our bodies are unable to effectively regulate our blood sugar levels. When we eat carbohydrate foods, our bodies break these down into sugar or glucose. Typically, the hormone insulin, which is produced by an organ called the pancreas, it acts like a key, and it opens up our body's cells, allowing sugar to enter from the bloodstream into the cell and be used for energy.

Glucose or sugar is our body's preferred fuel source. So, think of it like gas to a car. However, in type 2 diabetes, there is a phenomenon known as insulin resistance occurring. And this is when our bodies are still making insulin, but it is not working effectively to lower our blood sugar levels. So, it's taking more and more and more insulin to lower blood sugars. And eventually, the body can't keep up and it leads to a form of burnout. The A1c level, which is a lab that's measured as a percentage, that indicates our average blood sugar levels over the past two to three months. When that A1c level reaches 6.5% or higher, this is when an individual is officially diagnosed with type 2 diabetes.

Host: Yeah. So, let's talk about some of the key factors, if you will, that contribute to the development of type 2. Like how does someone end up with type 2? Is it behavior, lifestyle, nutrition, lack of exercise? Is it sort of, you know, all the above?

Jocelyne Loran: That's a great question. It kind of really is all of the above. So, some of the key factors that contribute to the development of type 2 include age. So, the older an individual gets, the more likely they are to develop type 2. Family history, so if any like parents or grandparents had type 2 diabetes, later generations are at increased risk. Certain ethnicities are also at an increased risk of developing type 2 diabetes. So, that includes Asian Americans, African Americans, Hispanic or Latino, American Indian, Pacific Islander. Those are the ethnicities that are increased risk. Also, physical inactivity, like you were saying, being overweight or obese. And even having a history of gestational diabetes mellitus in pregnancy increases your risk of developing type 2 diabetes later on in life.

Host: Yeah. And there's certain things, of course, like family history and genetics that we can't outrun. So knowing our family history, knowing what we're dealing with, and then trying to manage our own behavior, lifestyle, and so on. So, we're going to talk through some of that stuff about managing type 2 diabetes. But let's just kind of foundationally here, once we're diagnosed with type 2, what are the main goals of management?

Jocelyne Loran: So, one of the main goals is honestly just for that individual with diabetes to live as healthy as possible for as long as possible. When sugar levels are too high, that sugar travels throughout the body and it wreaks havoc. So, according to the American Diabetes Association, the A1c goal for most adults living with diabetes is an A1c level less than 7%, and this recommendation is in order to prevent or delay the onset of any complications that may arise with diabetes.

Examples of some complications include something called diabetic retinopathy. That's damage that occurs to the blood vessels in the retina of the eye. Another complication is diabetic nephropathy. So, that's damage that can occur to the filters in your kidney. So in order to minimize the risk of any complications, to minimize the risk of damage, the key really is to truly keep that A1c level at that recommended goal.

Host: Yeah. So, let's talk about, you know, the actual nuts and bolts here of managing type 2. Let's start with diet. What are the dietary recommendations? I hear a lot about the Mediterranean diet and I'm not sure I know exactly what that means. I'm not sure how it applies to type 2, but a lot of dietitians and doctors say, "Yeah, Mediterranean diet." Okay. Well, what does that mean? But anyway, what are some of the recommendations that you commonly provide to patients when it comes to diet?

Jocelyne Loran: So, the Mediterranean diet, that's more kind of like a heart-healthy diet. But I always encourage my patients living with diabetes to follow somewhat of a heart-healthy diet, because having diabetes puts an individual at risk of developing heart disease as well. But diet is a major factor when it comes to diabetes management. It's almost impossible to effectively manage diabetes without making some kind of lifestyle change, either via dietary changes, or by incorporating more physical activity. Even if medications are implemented, that lifestyle change is key.

So, I recommend for my patients to follow the diabetes plate method, which is an eating strategy that's recommended by the American Diabetes Association. And when utilizing that plate method, you want to start by dividing your plate in thirds. On half of the plate, you want to include non-starchy vegetables. So, examples of those are going to be things like your cucumbers, lettuce, spinach, mushrooms, peppers, et cetera. And these have like a minimal impact on blood sugar levels because they have a minimal amount of carbohydrate in them.

Secondly, you want to add lean protein to one quarter of the plate. And lean protein is going to be like your chicken breast, grilled salmon, nuts, tofu, even low-fat cheese. And protein is key because it's going to slow the release of sugar into the bloodstream. And it will, however, cause blood sugar to rise though if it's breaded, like chicken tenders, or if it's sweetened like barbecued chicken.

 Lastly, you want to place your carbohydrate on that final quarter of the plate, and examples are going to be like your fruits, dairy products, or starches like corn, potatoes, peas, and rice. I also encourage my patients to avoid sugary beverages, unless they're having an episode of low blood sugar. And I advise them to focus on fiber-rich foods, like whole grains. And again, the skins of fruits and vegetables, and things like beans or legumes. Because fiber is going to slow down digestion, which helps to minimize blood sugar spikes. And it can help with weight management as well, because it causes individuals to feel full for longer. So, fiber is also going to act like a nice bottle brush to keep that gastrointestinal tract nice and clean. And it's beneficial for that heart health since it lowers cholesterol levels. So, that ties back into your Mediterranean diet.

Host: Sure. Right. Always good when it comes full circle. I love that. I definitely should have eaten before we did this podcast because of all the yummy foods you're talking about making me hungry. Let's talk about physical activity. I know that that's often emphasized in diabetes management. So, what exercises do you recommend and how do they benefit individuals with diabetes?

Jocelyne Loran: Well, exercise works like a pill to lower blood sugar levels. And the Centers for Disease Control and Prevention, or the CDC, it recommends that adults get at least 150 minutes of moderate intensity aerobic activity each week. That's going to equate to about 30 minutes a day, 5 days a week. The good news is that the 30 minutes can be broken down into smaller increments over the course of a day, so 15 minutes in the morning and 15 minutes in the evening, it's all cumulative. It's still going to give you that 30 minute.

However, prior to beginning any kind of exercise regimen, I always advise that my patients get clearance from their doctor. That being said, any kind of exercise will be beneficial, whether it's aerobic or strength training. And some excellent examples include walking, dancing, gardening, yoga, weightlifting, all of them are going to lower your blood sugar levels by taking that sugar out of that bloodstream into the cell to be utilized for energy.

Host: So, let's talk about the common medications prescribed for diabetes, what purpose they have, and how do they really complement lifestyle modifications like nutrition and exercise.

Jocelyne Loran: Scott, there are so many diabetes medications. Honestly, they're broken down into classes, and each class of medications works in a certain way to lower blood sugar levels. So, sometimes I may have an individual that's kind of upset that they're on a couple different diabetes medications, but I always try to explain how it works, because they're all working differently to lower your blood sugars. So, I'm just going to highlight about two to three of the diabetes medications that are out there.

The first one is metformin, and this is a very popular oral medication that's used to treat type 2 diabetes. And it works by lowering your blood sugars in two ways. One, it reduces how much sugar is released from our liver, sugar is stored in our liver. And the second way it works is to allow the body cells to, again, absorb more of that sugar or glucose from the bloodstream. The great thing about metformin is it doesn't usually cause low blood sugar, which is like very dangerous. However, it may cause stomach upset or diarrhea. There is, however, an extended release version that may help to minimize some of that gastrointestinal upset.

Another medication is called Jardiance, and the science term is an SGLT2 inhibitor. And this one works to lower blood sugar levels by filtering extra sugar through our kidneys into our urine. And because extra sugar is released into the urine, this medication can cause urinary tract infections or yeast infection. So, that's always something I encourage my patients to look out for. But it does have, again, a beneficial effect on the heart, which can lower the risk for heart attack or stroke, which is awesome.

Lastly, I have to mention the popular GLP-1 agonist, an example being Ozempic. This once weekly injection works in a couple of different ways. It increases the body's insulin output. It reduces, again, that sugar output by the liver. It slows down digestion and it also promotes fullness, which is how it can potentially lead to weight loss.

And these medications, it's really important to remember that they're not a cheat code. So, they all work in conjunction with lifestyle modifications, like I was discussing earlier, like diet and exercise. And medication is going to complement your efforts to achieve your A1c goal, but you still have to make those lifestyle changes.

Host: Yeah. They are sort of magical in a way, but they're not magic, right? You do have to focus on nutrition and exercise and they sort of complement and everything works together, hopefully, in terms of managing type 2. How does mental health impact diabetes? You know, what strategies do you recommend for managing stress in these individuals with diabetes?

Jocelyne Loran: Mental health, it's a large component of managing diabetes. There's actually something called diabetes distress, which is emotional distress that results from living with diabetes and the daily management of it. If an individual's mental health is neglected, of course, their overall management of their diabetes is going to suffer as well. So, it's really important to address these feelings or these issues as they arise.

For stress in particular, I always encourage my patients to find an outlet. Stress is going to impact your body in a multitude of ways, and all of those ways are usually negative. Specifically in regards to diabetes, stress is going to increase your blood sugar levels. So, keeping those stress levels in check is technically an aspect of diabetes management, and we call that healthy coping. So, I recommend that my patients just, you know, get some exercise in to release those feel good endorphins or engage in a hobby that they enjoy, so like listening to music or reading. Talk with a friend or a loved one, or even seek out a mental health practitioner.

Host: And I know many diabetes centers, like yours, offer classroom and online education to help people to manage their diabetes. What do these programs usually entail and how do they benefit someone with diabetes? And are there resources to help people find these programs if they're not in the Charles Regional Community?

Jocelyne Loran: Our program here at University of Maryland, Charles Regional Medical Center, it gives individuals a step by step guide to managing diabetes. So, we kind of start from the basics. We discuss what diabetes is, how to eat, how to drink, how to take your medications properly, how and when to check your blood sugar levels. We discuss exercise and a number of other topics.

So, our program specifically is very beneficial, because it empowers individuals living with diabetes with the necessary tools to effectively manage their condition, and our patients are really successful at lowering their A1c level considerably after the completion of our program. But there are a multitude of ways to find additional diabetes programs, especially if you're not from the area or you don't live in Maryland. But individuals, they can actually go online and use their ZIP code to find a diabetes education program at the American Diabetes Association's website, which is diabetes.org, or they can go to the Association of Diabetes Care and Education Specialists website, which is diabeteseducator.org. And then lastly, there's the Certification Board for Diabetes Care and Education's website that also has a search engine to find a certified diabetes care and education specialist. And that's going to be cbdce.org.

Host: That's perfect. Sounds really comprehensive and really helpful and good to know that folks have so many people and facilities and resources in their corner. It's been really educational today. I just want to give you a chance as we wrap up here. What are your final thoughts, key takeaways when it comes to managing type 2?

Jocelyne Loran: Consistency is key in diabetes management and it's the behaviors or the habits that you're engaging in most of the time that are truly going to affect your health. even if you have a bad day, stay encouraged, stay the course. Change takes time, but you can do it.

Host: Yeah. That's well said. You know, it does take time, but it's worth the effort, right? The whole point here is to get a handle on things to manage type 2, to live longer, healthier, mentally, physically, all that good stuff. So, thank you so much today and you stay well.

Jocelyne Loran: You too, Scott. Thanks for having me.

Host: And find more shows like this one at umms.org/podcast and on YouTube. Thanks 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 and please share this on your social media.