Joey Wahler (Host): They're important to recognize, so we're discussing the signs of diabetes. Our guest is Liz Marquez, family medicine physician assistant. This is WickCare Talks, the podcast from Wickenburg Community Hospital and Clinics dedicated to helping our community lead healthier, more active lives. In each episode, we connect you with trusted health experts sharing valuable insights on a wide range of topics, from managing chronic conditions to simple tips for everyday wellness. We're here to provide practical information to support you on your health journey. So, be sure to follow us so you never miss an episode. Thanks so much for joining us today. I'm Joey Wahler. Hi there, Liz. Welcome.

Lizbet Marquez, MMS, PA-C: Thank you so much for having me. Hi.

Host: Hi there. Great to have you aboard. So first, can you give us please a quick overview of diabetes and why it's so important to catch it early?

Lizbet Marquez, MMS, PA-C: Sure. I think probably the best way to describe diabetes is to kind of have a little bit of an analogy, because I think it makes people understand it a little bit better. So when I think about diabetes, I kind of think of it like a plumbing system, and I think everybody understands plumbing or your irrigation system or your water in the pipes in your house.

So, you're basically thinking of the source, the well, and what you're thinking of is the glucose is what's in the water, okay? So, that's basically that, it's in the bloodstream. And then, the pipes are basically your arteries and your veins, everything that's trying to get from point A to point B. So when you're a healthy person, you don't have diabetes, your well system, your water system, your irrigation system works just fine. You know, you turn on the faucet, the water comes from wherever it comes from, and it flows, and it gets to where it needs to go, and it does what it needs to do. Everything's great.

But when you have diabetes, there's a breakdown somewhere. And what you need to understand is that there's basically two really big different types of diabetes. There's diabetes 1, and then there's diabetes 2. And in diabetes 1, basically, there is a breakdown of the actual system, the insulin, which is basically what allows the pipes to open and allow the glucose, the water through, isn't working. It's not being made anymore. Maybe the well just isn't going to do that anymore. The municipal system says, "Nope, we're not going to make that anymore. You know, we're not going to put that chlorine in the water," let's just say. So basically, the glucose stays in your pipes, and it doesn't get to where it needs to go, which is what your energy is. So when your glucose doesn't get to your cells, doesn't get to your heart, doesn't get to your brain, doesn't get to your kidneys, you have no energy, okay? Because that's what glucose is, it's energy. So, that's what happens in diabetes type 1.

In diabetes type 2, the system, the pancreas, the well, they're making the insulin. So, they're making the stuff that needs to open up your pipes. But now, those pipes, for whatever reason, they've gotten stiff. Think about the hose that stayed outside for too long, right? Or we have a lot of calcium buildup, especially in our area, and the water just doesn't flow the way it's supposed to. Everything gets stiff, everything gets cracked, nothing works. And so, basically, that insulin, that marker, doesn't basically allow those pipes to open. So again, your glucose is there, it's in the pipes, but it's not getting to where it needs to go.

And so, what happens in this instance is the well is like, "You know what? I'm just going to make more because I'm just going to push it through." And all of a sudden, there's this big increase in pressure, right? And yet they're still not opening, and they're still not getting to where they're going. And that's actually really the big part because in diabetes type 2, because it's not working effectively anymore, that's where you really start having a problem with those vessels, with those pipes.

All of a sudden, you have this increase in pressure. And it starts causing problems long term, not just because of the sugar, but it starts causing problems with the other organ systems. That's why we tell people when you have diabetes, it doesn't affect just your sugar. It affects your kidneys, it affects your brain, it affects your heart. So, that's why it's so important to find out about diabetes and to try and get it to be under control. So, a really big, simple takeaway is in diabetes, the sugar's in the bloodstream, but it's not getting into the cells. And over time, it harms basically the cells, and it harms all the other organ systems.

Host: So that being said, what are the most common signs of diabetes people should be aware of?

Lizbet Marquez, MMS, PA-C: It's really interesting, because diabetes really is a very silent kind of a thing. But if you really wanted to have three things that you're wanting to think about, think about the three Ps. "I'm peeing more often, I'm persistently thirsty, and I'm persistently hungry." If you're also having blurry vision, if you're also really tired, if you notice that you have a cut that you're like, "Wow, that cut's been there for like a month, and it's not getting any better", those are other signs that also make you want to think, "Hmm, I wonder why?"

Host: How about the importance of the symptoms being understood well for diabetes, not just by patients, but by their families as well? Why is that so critical here?

Lizbet Marquez, MMS, PA-C: It's important because, again, you're back to it's not a number. I think everybody always kind of thinks that diabetes is like a number, and it's more than just a number. We should never be chasing a number because a number isn't just, it's, high or low. It's what it's signifying. If your sugar isn't under control, you are more at risk for things like strokes, you're more at risk for things like heart attacks, you're more at risk for having problems with your circulation. You're more at risk for "I had a friend that, lost a few toes because he just wasn't able to get his diabetes under control."

And control really is the big thing that we're aiming for. And if you're looking at a family member and, you know, you're like, it's a lifestyle change. It really is. Diabetes is not taking a little bit of insulin every day or making sure that you take your pills. It is a lifestyle change with regards to your diet, with regards to exercise, and with regards to monitoring.

You need to make sure that you're checking those numbers because, at the end of the day, are they the most important thing? No. But they are definitely something that will help and direct you to whether or not you need to seek help right away, or whether it is a simple change.

Host: And I'm going to ask you more about those lifestyle changes in a moment, Liz. But first, how is diabetes first typically diagnosed by healthcare providers? What testing and such is involved?

Lizbet Marquez, MMS, PA-C: Really, it's a simple blood test. I mean, you need to just come in, and whether you want to sit there and say, "Hey, you know what? I'm feeling a little tired. I have noticed that I have these wounds that aren't healing," or, "I'm noticing that I'm peeing all the time." And it's a simple blood test, a blood glucose.

Ideally, we would love that number to be less than 120 when you're fasting. And then, also there is what we call an A1c, which is kind of like an average of what your numbers have been over the last three months. And for a diabetic, we would love that number to be less than 7. So, you know, if those numbers are higher than that, then we kind of really need to start wondering whether or not you are indeed diabetic.

Host: And once diagnosed, if so, what are some of the common treatments these days or management strategies involved?

Lizbet Marquez, MMS, PA-C: Well, believe it or not, the old management systems are still probably some of the best. So if your number, let's just say your A1c is 7.5 or 8 or 9. So, that is something that we can probably still bring down with just some oral medications. And probably the most common that everybody hears about is metformin. And that is a twice-a-day medication usually. If you use the extended release, sometimes you can do once a day. I am sure that everybody has heard about the GLP-1 medications. You know, the Mounjaro, the Wegovy, and the Ozempic, yes, those are possible medications. If your numbers are very, very out of control, like in the double digits, then we might actually think about actually putting you on some insulin, even though you might be a type 2 diabetic and your body's still making insulin, just because it gets you down faster, it gets you more controlled quicker. And then, we can decide, is that something that is going to be a lifelong therapy, or is that something that we can slowly start to take away and bring you back into the oral medication world?

Host: In terms of those lifestyle changes you mentioned, first, regarding diet, simply put, what's the one change that a diabetic or a pre-diabetic needs to make to their diet overall?

Lizbet Marquez, MMS, PA-C: I know that everybody wants me to sit there and say that it's your sugar, right? Everybody says, "It's got to be my sugar." And you'll hear people go, "But I don't eat a lot of candy," or, "I don't eat a lot of sugar. You know, I drink diet sodas." And sugar is definitely up there. But right up there with the sugar, I believe, is really carbohydrates. Because carbohydrates get turned. When your body breaks them down, guess what they break them down into? They break them down into sugar. Sometimes, I think that's the one that everybody doesn't understand, and it gets masked. So, people are like, but I don't eat cakes. I don't eat this." but then you start asking them, "Do you eat a lot of mashed potatoes? Do you eat a lot of potatoes? Do you eat a lot of pasta? Do you eat a lot of bread?" "I'm Hispanic." So, we eat a lot of rice. We eat a lot of tortillas. Those people, "I hate to tell you this, but they have carbohydrates." A good salsa is made of tomatoes and onions. Guess what? I'm sorry to tell you, it's got carbohydrates.

Host: In terms of exercise, what's the minimum amount of recommended activity that most anyone hopefully is able to do in order to help prevent diabetes on a daily basis?

Lizbet Marquez, MMS, PA-C: Believe it or not, even a 10 or 15-minute walk right after you eat, okay? Right after you eat, go take a walk. Walk outside. And I tell people, "You know what? You don't actually have to sit there and think, 'Well, I have to walk for 15 minutes.'" I tell people, "Walk around the block. Walk away from your house for five minutes," because then guess what? Then, you have to walk back for five minutes, right? Instead of thinking, "Oh my gosh, I have to walk for a mile and a half," just walk away from your house for five minutes. Because just that short amount of time after you eat will make your muscles start to work, and working those muscles will help with that insulin.

Host: Absolutely. Yeah, I love the walking away from the house tip, because you've got to come back at some point, right?

Lizbet Marquez, MMS, PA-C: Exactly. You have to come back.

Host: So, wherever you're going to have to double it. Couple other things for you. How about the biggest new advancement in diabetes treatment that people should know about?

Lizbet Marquez, MMS, PA-C: Obviously, I think the number one advancement is definitely those GLP-1 medications. They not only help with your diabetes, but a lot of them are starting to show signs that they also help to reduce a cardiovascular risk. And again, when you're talking about a diabetic, before I started doing family practice again, I actually worked in the emergency room for quite a long time. And when we would see a diabetic and they would come in with chest pain, I would tell them all the time, we actually put a diabetic in the same category as having someone having had a heart attack in the past. That's actually how serious diabetes can be. So, you know, having some of those medications, like those GLP-1 medications, yes, they're fantastic. They are great for weight loss. I completely understand that. But ideally, those medications were made for diabetics to bring their sugars down. And some of them have some fantastic side effects, like cardiovascular prevention.

Host: A great reminder there. Now if someone does suspect they have diabetes, what's the next step for them?

Lizbet Marquez, MMS, PA-C: Call. Call our clinics. Call the Wickenburg clinic, call the Congress clinic. Get an appointment to see us. We will be more than happy to see you. We will make an appointment. We will get that blood work done. We will review that medication and be able to speak with you about starting a plan of care that is something that you can live with, because at the number one thing is that it has to be something that you'll be able to do the rest of your life. And if you can't do it for the rest of your life, you're not going to be successful. So, we don't want to put you on all these medications or give you this big giant regimen that you're going to sit there and go, "This is too much for me. I can't do this." I never tell people, "Hey, you can never eat another tortilla again. You'll never be able to eat another slice of pizza." Because they're going to look at me and they're going to go, "Yeah, sure. I am not doing that." I understand. I like a good slice of pizza like everybody else.

But when you're diabetic, we need to get you under control. And then, we can kind of start going, "Oh, hey, what can you start bringing back into your life? What can you still live with?" And that really is a journey that you should take with your practitioner.

Host: Then, in summary here, Liz, you've done a great job of breaking down a lot of the details for us. Overall, in terms of a main takeaway for those joining us, what would it be? Perhaps the fact that going for that regular minimum annual blood test is so crucial here, right? Because it's so simple, it's so easy. And if you ignore it, let it go for a couple of years, that's when things can really put you behind the eight ball, right?

Lizbet Marquez, MMS, PA-C: Definitely. If you're a diabetic, you should get seen. Definitely if you think that you're diabetic, you should get seen. Because it's a simple blood test and we can either put your mind at ease and tell you, "Nope, you don't have it," or, "Yes, you do. And these are the things that we can do to help you get it under control."

On top of that, though, there are other doctors that you should be seeing. If you are a diabetic, twice a year, you should get seen also by an eye doctor, and I'm talking about the eyeball doctor, not the one that gives you your glasses. And also, by a podiatrist, by a foot doctor. Those are the two doctors that, on top of your general practitioner, you should be seeing as a diabetic for preventative care.

Host: That's definitely great advice as well. Well, folks, we trust you are now more familiar with the signs of diabetes. Liz, valuable information for everyone. Keep up all your great work, and thanks so much again

Lizbet Marquez, MMS, PA-C: Well, thank you so much for having me.

Host: Absolutely. And for more information, please do visit wickhosp.com, wickhosp.com/wickcaretalks. We hope today's discussion has provided you with valuable insights to support your well-being. Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform. If you found this episode helpful, please do share it on your social media. And thanks so much again for being part of WickCare Talks. Until next time, stay well