Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine.

Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Wild Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insight that will help you make the most informed and best healthcare choices for.

 I'm Melanie Cole joining me today to highlight diabetes in women is Dr. Laura Alonso. She's the chief of the division of diabetes, endocrinology and metabolism at Weill Cornell Medicine. The E. Hugh Luckey Distinguished Professor of Medicine at Weill Cornell Medical College, Cornell University, and an attending physician at New York Presbyterian Hospital Weill Cornell Medical Center. Dr. Alonso, thank you so much. This is a great topic. It's so important and timely as we're seeing such an increase in diabetes across all of the spectrums. Can you tell us a little bit about the prevalence that you see? Is it on the rise and especially what you're seeing in women?

Laura Alonso, MD: Well, first of all, thank you very much for inviting me today. I would have to say that diabetes is definitely on the rise in men and in women. Type one, diabetes is increasing. But most of the increase that we see is related to gestational diabetes and type two diabetes.

Melanie Cole, MS (Host): Will you give us a little working definition? So people, they hear the terms type one and type two used to be called adult onset. It's not anymore because we see it in kids. Now can you tell us a little bit about the difference between the two, we're mostly talking about type two today, but can you just give us a little working definition of the two?

Laura Alonso, MD: Type one diabetes, which you're absolutely right, is the kind that used to be called juvenile diabetes and was initially thought to happen in kids. But now we know it can happen at any age is more rare than type two diabetes. Type one diabetes happens when the immune system of the person who's gonna get diabetes runs a little haywire and it attacks the cells in the pancreas that make insulin, the pancreatic beta cells. So after that happens, if enough beta cells are lost due to the autoimmune attack, the body can't make enough insulin. And therefore the person gets diabetes.

That kind of diabetes is not related to being overweight. But it can happen to anyone at any weight. Type two diabetes is different. That is the type of diabetes. That's much, much more common as our population has gotten heavier. The number of people with type two diabetes has increased pretty quickly and to a pretty astonishing amount. I think currently more than 10% of American adults have type two diabetes.

Melanie Cole, MS (Host): Wow. Well, it certainly is. As you say, it's on the rise. And can you tell us a little bit about risk factors? Is there a genetic component to really either type, but to type two? Is it mostly lifestyle? Is there a genetic component and are there certain risks that you know, things about our lives, whether controllable or not that put us at risk?

Laura Alonso, MD: So there absolutely is a genetic component to both type one diabetes and type two diabetes. A family history is actually even more relevant for type two diabetes, which is a little unusual because often. Disorders that happen in children are more often genetic than disorders that are primarily in adults, but for type two diabetes, there really is a strong genetic component. Other factors are things you've already mentioned, common sedentary lifestyle, the types of foods that we encounter at restaurants at the grocery store and often at home as well.

Some of those can increase risk of type two diabetes. Especially when eaten in excess. So the main. Risk factor for type two. Diabetes is excess body weight in particular, excess body fat. And that is because the more adipose tissue or fat tissue that the body has, it reduces the ability of insulin to make the blood sugar go into the tissue so you can use it as a nutrient. That's a condition called insulin resistance and it really is very highly correlated with excess body fat.

Melanie Cole, MS (Host): Okay. So now I'd like you to tell us Dr. Alonso, how do we know? How would someone know we used to hear, if you're thirsty or if your child is thirsty, but for us women, we're so busy caring for everybody else in our lives that we don't always take the best care of ourselves, or even pay attention to some of the things maybe our body is trying to tell us. And as we've learned, we have to be our own best health advocate, put our own masks on before we can take care of those loved ones. Tell us a little bit about some of the things we should pay attention to in our own bodies that would signal a trip to our provider?

Laura Alonso, MD: So some of the things you mentioned at the front of that are exactly right. Urgent, new undiagnosed diabetes may be heralded by increased thirst, increased urination getting up at night to urinate more than your usual. And actually weight loss, unexpected weight loss can mean that you have diabetes and that's because when the blood sugar is uncontrollably high we actually lose calories out in the urine, in the form of sugar. Definitely not a healthy state of being.

And if you have those symptoms, you should go to your doctor and have an examination and some blood work. A lot of people are diagnosed with diabetes through routine blood tests that are performed as part of a physical exam or as preparation for any other health interaction. For example, if you have to have surgery or something like that. So a glucose level is a routine part of blood testing. There's also the blood test that is commonly measured in primary care clinics that will alert to the presence of diabetes is called the hemoglobin A1C.

Melanie Cole, MS (Host): Can you expand just a little bit on that? Tell us a little bit about those testings. You said we're getting screened in our annuals, in our blood work. They look at our fasting blood glucose. Tell us what A1C is? What is it telling us?

Laura Alonso, MD: So the hemoglobin A1C is actually directly measuring sugar molecules, stuck to our red blood cells. The red blood cells live in the body for approximately three months. And so the hemoglobin A1C blood test can give your medical team a window into how high your blood sugar has been during the preceding three months. And we now use the A1C as a diagnostic criteria for the diagnosis of prediabetes or of diabetes.

Melanie Cole, MS (Host): Let's get into that. What if we're told we have prediabetes or full blown diabetes. What's the first thing that you tell patients every day that you want them to do when they get told that they might have diabetes or that they are prediabetic?

Laura Alonso, MD: As you say, this is incredibly common. The first thing that I do when I meet somebody who has an elevated hemoglobin A1C is to assess their diet, what kinds of foods are they eating? Is their body overweight and also what kind of exercise are they getting? It's really common that someone who doesn't know that they have prediabetes or diabetes really may not be paying much attention to what they eat.

And our culture definitely enforces, desserts, sugar, soda, juice. There are really exposures to foods that are not good. If you have prediabetes or diabetes. So many of my patients who come in with an elevated hemoglobin A1C after a little bit of knowledge and paying attention are actually able to fix it quite rapidly.

Melanie Cole, MS (Host): See, I think that's one of the most exciting things. I'm an exercise physiologist, Dr. Alonso, and we learned back in graduate school that exercise has that insulin-like effect. So you can actually really make inroads with diabetes at just what you just said, when you were talking about diet and exercise. But I would like you to touch on complications, because there are comorbid conditions, high blood pressure, heart disease, eye issues, feet issues, wounds that don't heal. There are all these things that can be complications of diabetes. And as a result, those things have to be managed as well, while you're working on your exercise and your diet and working with your provider.

Laura Alonso, MD: You're exactly right about that. The main goal and why we care about diabetes and pay such close attention and help people to try to get their hemoglobin A1C under as good a control as possible, is to reduce the risk of progressing to diabetes complications. Some of the most feared diabetes complications include cardiovascular disease, heart attacks, strokes, high blood pressure often goes along with diabetes and it's really important to treat that. It's concern that people can have damage to their kidneys.

Diabetes is one of the leading causes of kidney failure, especially when combined with high blood pressure. That's a particularly dangerous combination for the kidneys. We're lucky though, when I was initially in training, we really didn't have that many medications that successfully addressed. Kidney dysfunction in people with diabetes. Now we actually have quite good medications that can help prevent damage to kidneys in people that have diabetes. You mentioned the eyes as well. It's really important to have an eye exam every year.

If you have diagnosed diabetes and that's because changes to the retina or the back of the eye from diabetes are totally silent. You don't know that you're having them. Nobody would know unless you have an eye examination. And that's another area in which we have. We are really excellent medications now. So if you have an eye exam once a year and the optometrist or ophthalmologist sees to the back of the eye from diabetes, there are medications they can use that can prevent that from worsening and ever threatening your eyesite.

Melanie Cole, MS (Host): While it's so important for these lifestyle modifications, diet, and exercise, working with your provider. And now you're talking about eyes and all of these comorbid situations that we need to keep an eye on. Tell us a little bit just briefly, because I know there's a lot of medications available now, if these lifestyle changes don't seem to affect diabetes in any measurable way, there are so many interventions now can you tell us just briefly about some of them?

Laura Alonso, MD: Absolutely. And this is another area that I would describe as very exciting. I mentioned how early on people are often able to control their diabetes by changing their diet and changing their exercise habits. It's very well known that people as their diabetes progresses over time, it becomes much harder to control using diet and exercise. And in fact, Many or most people with diabetes, eventually they do need medications. And I'm very happy with the way the field is going with respect to diabetes medications.

When I was in training, most of the medications we had to treat type two diabetes actually caused weight gain, which as you can imagine is really not an ideal place to be. Now we have some excellent medications that lower the blood sugar and help people lose weight. So really resetting their trajectory, I think in a much healthier direction.

Melanie Cole, MS (Host): And nowadays, as you said, this is such an exciting time to be in your field. Dr. Alonso, nowadays we have so much technology as well. How much do you rely on patient provided data when it comes to managing a woman's diabetes? And tell us a little bit about some of the technology that's available to patients, whether there's phone apps or the continuous glucose monitor, activity tracking devices, there's so much now?

Laura Alonso, MD: You're completely right about that. I am entirely dependent on patient derived data in advising and helping my patients because we may have access to a single blood test at the time of the visit, but what's really important are the blood sugars over time. And not so much just that one blood. Unless everything is perfect. So you mentioned continuous glucose monitors. That has been a tremendously exciting and useful tool, not only for management of diabetes, but also specifically for people trying to manage their diabetes through diet.

And definitely for people who need to take insulin injections to manage their diabetes. Honestly, the world is much safer now that people taking insulin injections for their diabetes can have a device that is continuously monitoring their blood sugar and can send them an alarm if it's starting to drop too low. It can alarm if the blood sugar has been too high for a period of time. And it's really useful information. As people try to figure out what can I eat? What are the tolerance of my blood sugar to this particular meal, that particular piece of fruit? It's a minute to minute information that I think has been extremely valuable to my patient.

Melanie Cole, MS (Host): 100%. Now, before we wrap up, can you give us a little advice as an endocrinologist? I know this is a multidisciplinary situation, when someone has diabetes, they work with maybe a dietician or a nutritionist, maybe an exercise physiologist or a trainer. They work with their provider and their endocrinologist. There's a lot of people involved, but certainly. One of the big questions I've heard over the last 30 years is what can I eat? What shouldn't I eat? Can you just give us some of your best advice about things that people with diabetes should really steer clear of or some of the healthier choices that they can make?

Laura Alonso, MD: I think the most important food related decision making for people with diabetes involves avoidance of simple sugars or foods that have a high glycemic index, which means foods that after you eat them, your body rapidly absorbs the sugar from the food. You know, one approach to treating diabetes is low carb, and that is effective. It's a little bit difficult to maintain for a lot of people. Low glycemic index is a little bit easier to maintain.

I think you can readily find online examples of low glycemic index foods, certainly high protein, healthy fats, olive oil and salmon and avocado and things like that are really important addition to the diet for people with any form of diabetes. But I think the number one is avoidance of simple sugar.

Melanie Cole, MS (Host): This is all so important. Such great advice, Dr. Alonso, as we wrap up, I'd like you to summarize it for us, what you would like the key takeaway to be about controlling blood sugar, monitoring that blood sugar and the comorbid conditions like heart disease, blood pressure, eyes, all of those things. Really your best advice on lifestyle management and hopefully preventing diabetes in women?

Laura Alonso, MD: So, I guess my best advice is if you have prediabetes or diabetes and your hemoglobin A1C is not at goal, and that's a number you should discuss with your physician to figure out what your personal goal is for your hemoglobin A1C. It's really important to pay attention to the food you're eating to the exercise. You're getting stress. Also. We didn't mention that before, but physical stress and emotional stress directly raise the blood sugar. So, for some people actually managing their diabetes means trying to rearrange their life in a way that's less stressful.

If they can do. but overall, the message I think I'd like to leave is that we have really great tools now that we didn't have even five, 10 years ago. So, I think it's worth going to talk with your doctor, find out if you have prediabetes or diabetes and get on the right track.

Melanie Cole, MS (Host): What great advice and thank you for bringing up stress. That's so important. So is sleep. I mean, we really, as women, we are just trying to do everything and sometimes we have to tamper down the superwoman mold that we've put ourselves in and take care of ourselves. And thank you for such great advice. Dr. Alonso. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download subscribe, rate, and review Back to Health on apple podcast, Spotify and Google podcast. And for more health tips, please visit weillcornell.org and search podcast. And parents don't forget to check out our Kids' HealthCast I'm Melanie Cole.

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Every parent wants what's best for their children. But in the age of the internet, it can be difficult to navigate what's actually fact-based or pure speculation. Cut through the noise with Kids Health Cast featuring Weill Cornell Medicine's expert physicians and researchers discussing a wide range of health topics, providing information on the latest medical science. Finally, a podcast to help you make informed choices for your family's health and wellness. Subscribe wherever you listen to podcasts. Also, don't forget to rate us five stars.