Joey Wahler (Host): This is Health Matters Insights from WCH medical experts. Thanks for joining us. I am Joey Wahler. Our guest is Jen DeVries. She's a primary care nurse practitioner for Wood County Hospital. Hi there, Jen. Welcome.

Jennifer DeVries, DNP: Hello. Good morning.

Host: Good morning. Great to have you aboard. We appreciate the time. So first, we're discussing the lesser known aspects of diabetes and also really trying to avoid it if possible.

First, when people hear the term, they usually think about blood sugar and insulin related to diabetes. But how important is early detection and intervention, hopefully before someone is diabetic?

Jennifer DeVries, DNP: Well, early detection and really prevention of progression of disease is the most important component of good diabetes care management. So, one in three adults will have pre-diabetes. And 80% of people don't even know it. So, you can't prevent the progression of disease if you don't first know that you have it.

Host: Wow. One in three people will have it, you say, and 80% don't know it. That's pretty eye-popping, no?

Jennifer DeVries, DNP: Yes. And that is why it is so important to be accessing preventative medicine with a primary care provider, at least on an annual basis, and listening to your body. A lot of my patients come in and they sort of think the symptoms of fatigue and going to the bathroom more frequently and mood swings, that those are just life or stress when really they are warning signs that they are in the pre-diabetic range.

Host: So, let's talk about that. First, what are some of those main early or subtle signs of possible diabetes that people often either brush off or maybe normalize, so to speak, as you said?

Jennifer DeVries, DNP: So, one of the things is sort of sugar cravings. You know, in that afternoon, you sort of want those carbs or sugars to keep yourself going. What that can be is sort of a post-lunch crash where your blood sugars start to decline. And so, your body is used to having that elevated blood sugar. So, It sort of wants to feed that machine. Brain fog is another one. Poor sleep, increased urination specifically at night. Those are all warning signs and symptoms that you are potentially in the diabetic range.

Host: So Jen, what does being diagnosed as borderline or pre-diabetic mean? That's a common term. And how seriously should that be taken by people?

Jennifer DeVries, DNP: Well, it's important to look at diabetes as a spectrum, okay? So, we have not diabetic, pre-diabetic, and then diabetes. And in that not diabetic, we have the potential to be diabetic, which leads into that pre-diabetes. And at pre-diabetes, that is a point where we can make the most impact in a patients life.

So if we make lifestyle modifications there, such as increasing activity just with small changes like parking at the back of the parking lot and taking more steps in or taking a 10 to 15 minute walk after lunch, we can lower our blood sugars. And at this stage, we may actually be able to prevent the progression to the formal diagnosis of diabetes.

So, this is a critical time where patients can have a lot of impact in their future health trajectory by doing the small things consistently. So, it's not complete overhaul of your life. It's swapping out sugary drinks for water. It's taking extra steps. It is making conscientious choices at this phase that will actually potentially prevent you from progressing to diabetes, or at least delay that progression. And that will impact your overall health over time.

Host: So for one thing you said there, don't necessarily grab the spot right in front of the store. Take a little stroll and get some steps in, right?

Jennifer DeVries, DNP: Yes. It is small changes. Our society focuses so much on these massive lifestyle overhauls, and those usually are not sustainable. It is the small, consistent choices that we can make every day to move a little bit more, get a little bit higher quality sleep, to reduce our stress, to choose water over sugary beverages or cut that piece of cake in half at that birthday celebration. That makes really big changes when we're looking at the progression of diabetes.

Host: So, small sustainable steps, both literally and figuratively. Let me ask you one more thing about what you just said there regarding that, and that is, if you are deemed pre-diabetic, it's important to note, isn't it, that you shouldn't take that to mean, "Well, I can just keep on doing what I'm doing if it's not the right thing because I'm not yet diabetic." Your attitude should be the opposite, right? Quit while you're ahead.

Jennifer DeVries, DNP: Absolutely yes. Because if you don't make changes, you most certainly will progress to diabetes. And diabetes links with heart disease, it links with kidney disease. So, intervening at that yellow light or at that pre-diabetic stage gives you the opportunity to prevent even more diseases in the future.

Host: And let me ask you to pick up on what you just mentioned there, namely, diabetes does indeed affect the body beyond what most people expect. It can affect your energy, your healing. You mentioned heart health, even mental health, right?

Jennifer DeVries, DNP: Part of being diabetic or pre-diabetic is not just that your blood sugar's elevated, but it's the swinging of your blood sugar. So as your blood sugar moves from lower levels to high levels, that can affect your mood. I think we've all heard the phrase hangry. You know, "When I'm hungry, I'm angry." And that's really a symptom of low blood sugar. And when our bodies do not manage our blood sugar effectively, like in diabetes, that definitely affects our mood.

Host: Now, as you well know, there's a lot of fear and also stigma around diabetes. So, what common misconceptions do you see in your daily experience that may be causing the most harm or even the most delay in people seeking the proper care here?

Jennifer DeVries, DNP: So, that's a really good question because if you have fear or stigma of a diagnosis, sometimes that prevents people from getting their blood work because they're scared of getting the diagnosis. And we know if we delay the diagnosis, we delay the treatment and we delay the potential improvement of the patient.

So, some of the stigma that I see is a lot of times people know that they don't make the best food choices or that they're not moving their body like they should, right? So, there's this sort of stigma that "I did this to myself and I earned this," and it's sort of a shameful feeling. And the fact of the matter is, is that diabetes is part lifestyle choices, right? But it's also genetics. It's stress. It's availability of fresh, healthy, not processed foods. So, there's a lot of things that impact the potential to have diabetes, and it is not something that is just purely by choice, but we can modify our behaviors to help improve our overall health and reduce the development of diabetes.

Host: And you touched on this, but to elaborate on it a bit, for those with blood sugar issues, how much do these small, realistic lifestyle changes make, especially for people who already may feel overwhelmed or stretched thin in some way? You've talked about what some of those changes could be. How much of a difference can they really make?

Jennifer DeVries, DNP: It makes a huge difference. That's one of the reasons why I really like to treat diabetes or pre-diabetes. Because when you encourage and people make these small changes, there is huge differences in their blood work, there's huge differences in their weight, in their blood pressure, in the progression of disease.

So really, there's so much opportunity in this space when you're in that pre-diabetic phase to improve that. If you embrace that, you can really improve your overall health. I see patients all the time. When I see them with a pre-diabetic diagnosis and we go through moving our bodies more and making food swaps, maybe sometimes adding medication, maybe not. I usually try to identify three goals, like, "I'm going to drink more water." "I like McDonald's three times a week, so I'm only going to have it one time a week." So, just making those small choices really make a huge difference. And, you know, the literature supports that as well, that people who make conscientious small decisions over time are far more likely to impact the progression of the disease than somebody who just overhauls their lifestyle, sustains it for two weeks, and then reverts back to normal. So, those small progressive changes, that progress not perfection, is really where overall health maintenance happens.

Joey Wahler (Host): Now you mentioned this, but what would be one simple doable step other than taking more steps, which we've covered, that people can take to avoid or at least better manage their diabetes, if they were going to do just one thing. You mentioned food swaps. Maybe there's one in particular that's most doable for a lot of people.

Jennifer DeVries, DNP: so that's a really good question because there are so many, I would say probably increasing your water because if you are dehydrated, that increases your hunger and you're really not hungry, but you're more thirsty. So being very conscientious about increasing your water, Number one that's going to, your body will be able to sort out hunger cues from dehydration, cues better.

And then a close second would be like more volume eating instead of eating processed foods, like a bag of chips. That's 300 calories, eating 300 calories of. Vegetables is going to be more volume. It's going to provide you with more fiber, more nutrients, and you're going to have a better feeling of being full because it takes up more volume in your stomach versus a small bag of chips. So, I would say focusing on water and then volume eating, which really hinges on those non-processed whole foods.

And the third thing that I recommend to my patients is to shop the outside of the grocery store, because it's inside the grocery store in the aisles where the processed foods lie. And those are usually less nutrient-dense and more calorie and fat-laden. And so if you're shopping the outside, that's where the fruits and the vegetables and your dairy and your meat products lie. And if you stay out of that middle section, you won't be tempted to pick up those chips or those cookies.

Host: I never realized that. As you're saying that, I'm thinking about the couple of supermarkets that I tend to use, and that's true, right? It's like a ring where the better stuff is on the outside. So, you want to try to stay away from the stuff in those inner aisles as much as possible, because the further in you go, the more you strain away from the best stuff, right?

So in summary, what's one thing you wish people in our community would do sooner rather than later when it comes to either screening or follow-up or asking for help? What's the one thing that you find yourself, Jen, saying to your patients most in terms of "You've got to do this more often"?

Jennifer DeVries, DNP: I would say visiting your primary care provider once a year is probably the most important thing you can do for health maintenance because they know what the standard of care is. They can order the testing that you need to have done. They can help you intervene early, because we need to move from a disease treatment model to a prevention model. And to do that, we have to have eyes on, you know, things like blood pressure, things like our labs like glucose and hemoglobin A1c. And you just can't have that unless you have that relationship with a good primary care provider.

Host: Absolutely. Great advice indeed. Folks, we trust you're now more familiar with diabetes and trying to avoid it. Jen, keep up all your great work and thanks so much again.

Jennifer DeVries, DNP: Thank you.

Host: Absolutely. And to make an appointment with Jen—after all, again, she can help you with those food swaps. Anyone who can come up with a food swap for chips, certainly worth seeing. And you can call her, (419) 352-9071. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Health Matters Insights from WCH medical experts.