The Diabetes Education and Management Program at UVA Health System offers a complete approach to diabetes care that addresses your whole body, with special clinics focusing on how diabetes can affect your heart and weight.
Our Certified Diabetes Educators (CDE) are registered nurses and dietitians that provide education and support on how to manage and prevent the complications of diabetes.
Our approach makes it easy for us to evaluate and treat your diabetes and help you understand how to reduce your risk of complications.
Learn more about preventing and managing this condition from Dr. Jennifer Kirby, a UVA Division of Endocrinology and Metabolism physician.
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Diabetes Prevention and Management at UVA Health System
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Jennifer Kirby, MD
Dr. Jennifer Kirby is a physician board-certified in both general internal medicine and endocrinology, diabetes and metabolism at UVA.Learn more about Dr. Jennifer Kirby
Learn more about UVA Health System
Transcription:
Diabetes Prevention and Management at UVA Health System
Melanie Cole (Host): The Diabetes Education and Management program at UVA Health System offers a complete approach to diabetes care that addresses your whole body with special clinics focusing on how diabetes can affect your heart and weight. My guest today is Dr. Jennifer Kirby. She’s a board certified in other general internal medicine and endocrinology. Welcome to the show, Dr. Kirby. So, tell us about the two different types of diabetes.
Dr. Jennifer Kirby (Guest): Primarily, we think about diabetes as Type 1 or Type 2. Type 1 diabetes also known as juvenile diabetes--although I will share with you that more than 30% of the patients diagnosed with type 1 diabetes are adults--are patients who have an autoimmune disorder that causes a loss of insulin production from the pancreas. So, these patients are considered insulin dependent. The more predominant or prevalent diabetes is Type 2 diabetes. This is the one that we think about as being adult onset, and related to weight is Type 2 diabetes which is more insulin resistant. The insulin that we are making isn’t doing a good job at keeping our blood sugars normal.
Melanie: So, just for the listeners, insulin resistant--so the pancreas is making insulin but the cells of our muscles and such are just resistant to the actions of that. They just won't let them in the door, right?
Dr. Kirby: Absolutely, and the way I think about it is a key and a lock. So, if you have Type 2 diabetes, you’ve got the key, but there’s gum stuck in the lock so it’s difficult for that insulin to do its job and get the glucose to go into the cell.
Melanie: So, we used to call Type 2 diabetes “adult onset” but now we’re even seeing children coming up with this type of diabetes as a result of the obesity epidemic. Tell us about some of the risk factors that might affect children and/or adults that would predispose them to diabetes.
Dr. Kirby: That’s a great question. So, right now, we know that there are about 86 million Americans who are in the pre-diabetes category, meaning they are at risk for developing diabetes. That’s a lot of people, about 9 out of the 10 people who have pre-diabetes don’t know about it. So, risks include higher weight. So, those patients who have excess weight, patients who are sedentary, patients who have a family member--a brother, a sister, a mother, a father--who has Type 2 diabetes are at increased risk. So, those are all clues that patients may need to be clued into that they may be at risk for diabetes.
Melanie: And, you mentioned the term pre-diabetes. How would somebody know? Is this something that’s going to show up on their annual physical or would they feel something, would they notice anything that would really send them to the doctor in the first place?
Dr. Kirby: So, with pre-diabetes, they may not actually have any signs or symptoms and so it is something that we probably, as healthcare providers, need to be screening patients for, or for patients who feel that they’re a high risk, to ask about it. It could show up in blood work, so if they have an abnormal fasting blood sugar meaning that if they haven’t eaten anything but their blood sugar is slightly high, that can be a sign. There’s also other tests. Things like a hemoglobin A1C, which is a test of how your average blood sugar is over a three month period. We use that test for our patients with diabetes but it can also help diagnose pre-diabetes.
Melanie: And, because it’s not necessarily insulin dependent, when you’re talking about Type 2, what is the first thing you tell patients that are told that they either have pre-diabetes or full blown diabetes that they have to do that’s so important that they start doing to manage this condition or possibly eliminate it altogether?
Dr. Kirby: So, one of the best pieces of news that I can give patients is that diabetes and pre-diabetes are extraordinarily responsive to weight, meaning that for patients who lose even a small amount of weight, 3% to 5% of their weight, that that can make a big difference on their risk of developing diabetes or on their absolute diabetes control. There was a study called the “Diabetes Prevention Trial” that showed that a 7% weight loss prevented about 50% of patients from going from pre-diabetes to diabetes in five years. And, that’s a doable amount of weight loss for a lot of people.
Melanie: And, what about other lifestyle modifications that they can make, even if they’re small ones, that could make a big difference in this diabetes diagnosis?
Dr. Kirby: Absolutely. Part of the weight loss is being driven by changing how you eat and being more active. So, just increasing your activity level can help and getting help on eating healthy. There’s a lot of confusing information out there about what we’re supposed to be eating. What I usually tell people is, you can never go wrong with lots of vegetables, lean healthy proteins, and making sure that you’re getting up and you’re moving every single day. The American Diabetes Association recommends 150 minutes of cardiovascular exercise every week. That means that you’re doing about five days of 30 minutes where you heart rate is up and you’re feeling like you’re working hard. The good news is that doesn’t have to be all at one time, you can break it up. So, three 10 minute walks during the day can be just as powerful.
Melanie: And, when does it require some kind of medicational intervention?
Dr. Kirby: So, we usually start with our lifestyle intervention first, encouraging patients to change what they’re eating, to be more active, to try to lose weight, but Type 2 diabetes is a progressive disease and if those interventions are not successful, then we would start thinking about medications. Our first line medication for many patients is a drug that’s been around for a long time called Metformin, and it’s a very good drug because it works well, and it prevents the problems of diabetes such as the kidney and eye disease and it’s inexpensive at this point because it’s been around for such a long time.
Melanie: So then, back to foods for just a second, Dr, Kirby, because people say, “Oh well, now I can't eat that, it’s got too much sugar,” and maybe they’re talking about carrots or tomatoes or another type or vegetable or they’re worried about grains, legumes, because they’ve been told they’re pre-diabetic. Clear up that myth for us about those healthy foods that people sometimes get confused for bad carbs.
Dr. Kirby: Absolutely. There’s been a myth out there that carbohydrates are bad and the problem is that not all carbohydrates are alike. There are carbohydrates that are probably ones that people should avoid--all people should avoid--whether you have pre-diabetes or diabetes. These are your simple sugars, so the refined sugars. So, the extra sugars that get put into foods, and I will say that there’s going to be new labeling out there in the world that has--these added sugars that are going to be added to the label so it’s going to make it easier for consumers to get healthier options. But, there are complex carbohydrates, so our whole grains, our whole wheat breads and our very difficult to digest carbohydrates are more healthy and they’re less likely to make blood sugars go high if you have diabetes. And, those are important sources of nutrition that we all need to be eating. So, we talk about these low carb or no carb diets, I think, that has given carbohydrates a bad name when really we should just be getting rid of the extra sugars that are in our diet.
Melanie: Do you advocate or ask your patients to check their blood sugar on a regular basis?
Dr. Kirby: I do. It depends on their situation. So, it depends on the level of treatment they’re getting. If they’re using insulin multiple times per day--because sometimes patients with Type 2 diabetes will need insulin at some point--those patients often need to be checking their blood sugars more often. If there are patients who are on oral medications like Metformin, they may not need to be checking their blood sugars quite as often but I think for patients who check at different times, they can start to see the impact of things like the piece of cake that they had after dinner or the exercise that they did after dinner, and they can start to see the impacts of those choices on their blood sugars. So, there can be real value in that as well.
Melanie: So, wrap it up for us, Dr. Kirby, and your best advice that you tell patients every single day about lifestyle modification, controlling their diabetes or possibly preventing it altogether.
Dr. Kirby: I think every single time a patient walks into my clinic, and my patients will vouch for this, I'm talking to them about how they’re eating, how much they’re eating, what they’re eating, are they getting enough activity. Even for my patients who are not sedentary, meaning they have an active job, I still encourage them to be exercising on top of that. And, the other important piece is sleep. I think it’s the third pillar of our healthy lifestyle that we don’t focus on but patients also need to be getting sleep. So, I think those three components of your life, if you can be working on those, and we all need to be at all times, that’s the best device for all of us.
Melanie: Thank you so much, Dr. Kirby. It’s really great information. For more information on diabetes and the UVA Health System and the programs that they offer, you can go to www.uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole, and thanks so much for listening.
Diabetes Prevention and Management at UVA Health System
Melanie Cole (Host): The Diabetes Education and Management program at UVA Health System offers a complete approach to diabetes care that addresses your whole body with special clinics focusing on how diabetes can affect your heart and weight. My guest today is Dr. Jennifer Kirby. She’s a board certified in other general internal medicine and endocrinology. Welcome to the show, Dr. Kirby. So, tell us about the two different types of diabetes.
Dr. Jennifer Kirby (Guest): Primarily, we think about diabetes as Type 1 or Type 2. Type 1 diabetes also known as juvenile diabetes--although I will share with you that more than 30% of the patients diagnosed with type 1 diabetes are adults--are patients who have an autoimmune disorder that causes a loss of insulin production from the pancreas. So, these patients are considered insulin dependent. The more predominant or prevalent diabetes is Type 2 diabetes. This is the one that we think about as being adult onset, and related to weight is Type 2 diabetes which is more insulin resistant. The insulin that we are making isn’t doing a good job at keeping our blood sugars normal.
Melanie: So, just for the listeners, insulin resistant--so the pancreas is making insulin but the cells of our muscles and such are just resistant to the actions of that. They just won't let them in the door, right?
Dr. Kirby: Absolutely, and the way I think about it is a key and a lock. So, if you have Type 2 diabetes, you’ve got the key, but there’s gum stuck in the lock so it’s difficult for that insulin to do its job and get the glucose to go into the cell.
Melanie: So, we used to call Type 2 diabetes “adult onset” but now we’re even seeing children coming up with this type of diabetes as a result of the obesity epidemic. Tell us about some of the risk factors that might affect children and/or adults that would predispose them to diabetes.
Dr. Kirby: That’s a great question. So, right now, we know that there are about 86 million Americans who are in the pre-diabetes category, meaning they are at risk for developing diabetes. That’s a lot of people, about 9 out of the 10 people who have pre-diabetes don’t know about it. So, risks include higher weight. So, those patients who have excess weight, patients who are sedentary, patients who have a family member--a brother, a sister, a mother, a father--who has Type 2 diabetes are at increased risk. So, those are all clues that patients may need to be clued into that they may be at risk for diabetes.
Melanie: And, you mentioned the term pre-diabetes. How would somebody know? Is this something that’s going to show up on their annual physical or would they feel something, would they notice anything that would really send them to the doctor in the first place?
Dr. Kirby: So, with pre-diabetes, they may not actually have any signs or symptoms and so it is something that we probably, as healthcare providers, need to be screening patients for, or for patients who feel that they’re a high risk, to ask about it. It could show up in blood work, so if they have an abnormal fasting blood sugar meaning that if they haven’t eaten anything but their blood sugar is slightly high, that can be a sign. There’s also other tests. Things like a hemoglobin A1C, which is a test of how your average blood sugar is over a three month period. We use that test for our patients with diabetes but it can also help diagnose pre-diabetes.
Melanie: And, because it’s not necessarily insulin dependent, when you’re talking about Type 2, what is the first thing you tell patients that are told that they either have pre-diabetes or full blown diabetes that they have to do that’s so important that they start doing to manage this condition or possibly eliminate it altogether?
Dr. Kirby: So, one of the best pieces of news that I can give patients is that diabetes and pre-diabetes are extraordinarily responsive to weight, meaning that for patients who lose even a small amount of weight, 3% to 5% of their weight, that that can make a big difference on their risk of developing diabetes or on their absolute diabetes control. There was a study called the “Diabetes Prevention Trial” that showed that a 7% weight loss prevented about 50% of patients from going from pre-diabetes to diabetes in five years. And, that’s a doable amount of weight loss for a lot of people.
Melanie: And, what about other lifestyle modifications that they can make, even if they’re small ones, that could make a big difference in this diabetes diagnosis?
Dr. Kirby: Absolutely. Part of the weight loss is being driven by changing how you eat and being more active. So, just increasing your activity level can help and getting help on eating healthy. There’s a lot of confusing information out there about what we’re supposed to be eating. What I usually tell people is, you can never go wrong with lots of vegetables, lean healthy proteins, and making sure that you’re getting up and you’re moving every single day. The American Diabetes Association recommends 150 minutes of cardiovascular exercise every week. That means that you’re doing about five days of 30 minutes where you heart rate is up and you’re feeling like you’re working hard. The good news is that doesn’t have to be all at one time, you can break it up. So, three 10 minute walks during the day can be just as powerful.
Melanie: And, when does it require some kind of medicational intervention?
Dr. Kirby: So, we usually start with our lifestyle intervention first, encouraging patients to change what they’re eating, to be more active, to try to lose weight, but Type 2 diabetes is a progressive disease and if those interventions are not successful, then we would start thinking about medications. Our first line medication for many patients is a drug that’s been around for a long time called Metformin, and it’s a very good drug because it works well, and it prevents the problems of diabetes such as the kidney and eye disease and it’s inexpensive at this point because it’s been around for such a long time.
Melanie: So then, back to foods for just a second, Dr, Kirby, because people say, “Oh well, now I can't eat that, it’s got too much sugar,” and maybe they’re talking about carrots or tomatoes or another type or vegetable or they’re worried about grains, legumes, because they’ve been told they’re pre-diabetic. Clear up that myth for us about those healthy foods that people sometimes get confused for bad carbs.
Dr. Kirby: Absolutely. There’s been a myth out there that carbohydrates are bad and the problem is that not all carbohydrates are alike. There are carbohydrates that are probably ones that people should avoid--all people should avoid--whether you have pre-diabetes or diabetes. These are your simple sugars, so the refined sugars. So, the extra sugars that get put into foods, and I will say that there’s going to be new labeling out there in the world that has--these added sugars that are going to be added to the label so it’s going to make it easier for consumers to get healthier options. But, there are complex carbohydrates, so our whole grains, our whole wheat breads and our very difficult to digest carbohydrates are more healthy and they’re less likely to make blood sugars go high if you have diabetes. And, those are important sources of nutrition that we all need to be eating. So, we talk about these low carb or no carb diets, I think, that has given carbohydrates a bad name when really we should just be getting rid of the extra sugars that are in our diet.
Melanie: Do you advocate or ask your patients to check their blood sugar on a regular basis?
Dr. Kirby: I do. It depends on their situation. So, it depends on the level of treatment they’re getting. If they’re using insulin multiple times per day--because sometimes patients with Type 2 diabetes will need insulin at some point--those patients often need to be checking their blood sugars more often. If there are patients who are on oral medications like Metformin, they may not need to be checking their blood sugars quite as often but I think for patients who check at different times, they can start to see the impact of things like the piece of cake that they had after dinner or the exercise that they did after dinner, and they can start to see the impacts of those choices on their blood sugars. So, there can be real value in that as well.
Melanie: So, wrap it up for us, Dr. Kirby, and your best advice that you tell patients every single day about lifestyle modification, controlling their diabetes or possibly preventing it altogether.
Dr. Kirby: I think every single time a patient walks into my clinic, and my patients will vouch for this, I'm talking to them about how they’re eating, how much they’re eating, what they’re eating, are they getting enough activity. Even for my patients who are not sedentary, meaning they have an active job, I still encourage them to be exercising on top of that. And, the other important piece is sleep. I think it’s the third pillar of our healthy lifestyle that we don’t focus on but patients also need to be getting sleep. So, I think those three components of your life, if you can be working on those, and we all need to be at all times, that’s the best device for all of us.
Melanie: Thank you so much, Dr. Kirby. It’s really great information. For more information on diabetes and the UVA Health System and the programs that they offer, you can go to www.uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole, and thanks so much for listening.