Are you at risk or have you been diagnosed with Diabetes?
Patients with Diabetes at BID - Plymouth are cared for using a patient-centered, team-based approach based on national standards.
Dr. Nathaniel Clark, an Endocrinologist with Beth Israel Deaconess Hospital -Plymouth, is here to help you manage your Diabetes so you can live a higher quality of life and keep your Diabetes under control.
Selected Podcast
Managing Your Diabetes
Featured Speaker:
Learn more about Nathaniel Clark, MD.
Nathaniel Clark, MD
Nathaniel Clark, MD, MS, RD specialty is Endocrinology at Beth Israel Deaconess Specialty Group.Learn more about Nathaniel Clark, MD.
Transcription:
Managing Your Diabetes
Dr. Melanie Cole (Host): Are you at risk or have you been diagnosed with diabetes? Patients with diabetes at BID Plymouth are cared for used a patient-centered, team-based approach based on national standards. My guest today is Dr. Nathaniel Clark. He’s an endocrinologist with Beth Israel Deaconess Hospital Plymouth. Welcome to the show, Dr. Clark. Tell us what’s going on in the world of diabetes today. We seem to be hearing more and more about it with the obesity epidemic that we’re seeing in this country. What are you seeing as a diabetes specialist?
Dr. Nathaniel Clark (Guest): I think what I’m seeing mostly is just what you said: that there is clearly an increase over time in terms of the number of patients being diagnosed. We don’t know that that’s really a combination of the number of people that are getting it but also increased recognition of those that already have it. I’m also seeing that it’s very important for patients to be referred appropriately if under the care of their primary care provider, they are not achieving the goals they need to achieve to reduce the risk of complications of diabetes.
Melanie: So then, let’s start with the risks of complications from diabetes, the risk factors for diabetes because I think that’s something that people need to hear as many times as we need to tell them because there are certain things we can control .There are certain things we can’t, but certain things that we can. So let’s talk about those controllable risk factors for type-2 diabetes.
Dr. Clark: I think the most important risk factor that we can control for type-2 diabetes has to do with weight. It’s clear that in those that are overweight and certainly those that are obese, that there is a dramatic increase in the risk of type-2 diabetes. That is really been the only major factor which is controllable. Those that we can’t control that are important to recognize is that as we get older, our risk increases and certainly in those that have a family history of type-2 diabetes or in women who had gestational diabetes during a pregnancy, or those that are in specified risk categories that are shown to have higher risk of type-2 diabetes. All of those together sort of constitute what the risk is.
Melanie: We hear more and more about checking your blood sugar levels. You even see on commercials different products that are advertising being able to keep track of your blood sugar. What do you want people to know about managing your diabetes and keeping track of these things, Dr. Clark?
Dr. Clark: I think for those that have been diagnosed, clearly the greatest advance has been the ability for patients to check their own blood glucose or blood sugar levels and to know what the goals are and to make sure that whatever treatment their on, whether that’s diet and exercise alone or that plus a medication that their goals are being achieved. So, we ask patients to check their blood sugars. It varies the number of times per day depending on what medication they are on or where they are in regards to their diabetes. That, really, is critical for the patient to know whether they’re doing well and then, in turn, for their provider to know whether they are doing well.
Melanie: How often do you want people to have the A1C test?
Dr. Clark: The A1C test should be done according to the guidelines of the American Diabetes Association, and that is every six months in those that are at goal and nothing has changed in regard to their treatment. Generally, every three months in those where they are not at goal and they are trying to get to goal or there may be a change. Functionally, I find with my patients that I want them to be checked every three months because even those that one might not suspect that anything had changed, I do find that patients that are doing quite well. If I didn’t check any more frequently than every six months, I may find that something has changed and I wish that three months before that, I had known that and could have made an intervention.
Melanie: Dr. Clark, how important is blood pressure in the management of diabetes as these things together contribute to the risk of heart disease? How important is it to manage your blood pressure?
Dr. Clark: I think you’ve asked several different questions. I don’t know that there’s any importance to checking blood pressure in regard to managing the diabetes but it is critical to manage the blood pressure in terms of reducing one of the major risk factors of diabetes being heart disease. Studies have shown that the management of blood pressure is perhaps even more important than the measurement of blood sugar in regard to the macrovascular or large vessel complications of diabetes being heart disease and stroke. So, although managing your cholesterol and managing your blood pressure are not technically important in terms of managing the diabetes, they are critical important in terms of the complete treatment of the patient with diabetes.
Melanie: Now, speaking of treatments and learning to live with it, trying to help control those blood sugars, what do you tell people about diet and exercise and the most important information that you give them about their everyday activities that can help them manage it and give them a higher quality of life?
Dr. Clark: I think that your question has given most of the answer to the question. I think diet and exercise is critical in all patients. Unfortunately, I think the medical community jumps too quickly over lifestyle modification and moves into the medications but all of the medications work much better in a patient who is doing their best to maintain their weight and to be as physically active as possible. In terms of what I tell patients, what you’ve said is really the critical factor and that is physical activity is very, very important and that does not only mean going to the gym or engaging in regular exercise. It can also mean walking, so parking further away from a building, walking upstairs instead of taking the elevator or the escalator and being active in your life can be extremely important in terms of weight maintenance.
Melanie: Are there some foods that you like them to stay away from when they are trying to manage diabetes?
Dr. Clark: No. I would say the issue with diabetes management is you want the patient to do as well as they can with managing their blood sugars but, at the same time, to learn to live their life and to have a good life while managing their diabetes well. So, I tell patients there really is no food that if they really want to eat that food, that they need to give that food up. However, the portion of that food or how often that food is what may need to change. I find that if you take an approach of saying to a patient, “You, unfortunately can never have this again because you have diabetes,” then that really detracts from the long-term management in that patient. They begin to think of diabetes as a punishment, a prison sentence, and they resent it. But, if you tell them, “Look, you’re going to celebrate birthdays. You’re going to celebrate holidays. You’re going to go out for a special dinner and as long as those are occasional events, there are all those foods that you enjoy eating now that you can continue to eat but you need to be much more careful of portion size and how often you have them.”
Melanie: What do you tell your patients about the importance of getting a complete foot exam or an eye exam, dental exams and how often they should be doing these every year?
Dr. Clark: All of those are extremely important in terms of the complete care of the patient with diabetes. Foot exams fall in two categories. One, I examine the feet at least twice a year in people who have low risk feet in terms of problems and at every visit in somebody who has a high risk foot. Also important to know is that I would say 90% of the foot exam can be done by the patient by simply looking at the bottoms of their feet and looking for any changes, any sores, any redness, etc. If someone can’t see the bottoms of their feet, they can use a hand mirror or they can find a friend or family member to look at the bottoms of their feet periodically. We could dramatically decrease the risk of foot problems with diabetes if patients would simply look at the bottoms of their feet regularly. Dental exams, generally, are recommended by dentists to be done every six months and I think that’s a very good piece of advice. Eye exams, according to current guidelines, should be done once a year and should be done by an eye care professional who dilates the eye in order to see into the back of the eye to look for any changes in the blood vessels. So, whether that’s an optometrist or whether it’s an ophthalmologist is not as important than it is that it is being done by an eye care professional. It’s important to note that this is looking inside the eye to look for changes. It is not a vision exam. When someone says, “Oh, my primary care checks my eyes and my vision is fine,” that’s a separate category in terms of eye issues.
Melanie: In just the last minute, please, Dr. Clark, and its great information and so important, please give your best advice for those living with diabetes in managing it and why they should come to BID Plymouth for their care.
Dr. Clark: Well, I think that the most important thing, which I’ve already said, is to find a way for the patient to live the life that they want to live, to enjoy their life but, at the same time to incorporate good diabetes care into their life; to not have it be a burden, to not have it be a limitation, a disability, but to learn how to manage their diabetes and yet still enjoy those things they enjoy. The reason to come, in my mind is, that’s the approach that I use. I run a very upbeat, positive practice. In general, I think most patients enjoy coming in. I’m not judgmental. I don’t yell at patients because I feel that it’s their diabetes. I’m just there to help them and to support them. More important than the medical care of diabetes that I offer is really the support, the coaching, the encouragement and we do that by showing patients how much better they can do with the medication or with lifestyle change and to constantly keep them on track and to support them in doing the best they can.
Melanie: Thank you so much for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.
Managing Your Diabetes
Dr. Melanie Cole (Host): Are you at risk or have you been diagnosed with diabetes? Patients with diabetes at BID Plymouth are cared for used a patient-centered, team-based approach based on national standards. My guest today is Dr. Nathaniel Clark. He’s an endocrinologist with Beth Israel Deaconess Hospital Plymouth. Welcome to the show, Dr. Clark. Tell us what’s going on in the world of diabetes today. We seem to be hearing more and more about it with the obesity epidemic that we’re seeing in this country. What are you seeing as a diabetes specialist?
Dr. Nathaniel Clark (Guest): I think what I’m seeing mostly is just what you said: that there is clearly an increase over time in terms of the number of patients being diagnosed. We don’t know that that’s really a combination of the number of people that are getting it but also increased recognition of those that already have it. I’m also seeing that it’s very important for patients to be referred appropriately if under the care of their primary care provider, they are not achieving the goals they need to achieve to reduce the risk of complications of diabetes.
Melanie: So then, let’s start with the risks of complications from diabetes, the risk factors for diabetes because I think that’s something that people need to hear as many times as we need to tell them because there are certain things we can control .There are certain things we can’t, but certain things that we can. So let’s talk about those controllable risk factors for type-2 diabetes.
Dr. Clark: I think the most important risk factor that we can control for type-2 diabetes has to do with weight. It’s clear that in those that are overweight and certainly those that are obese, that there is a dramatic increase in the risk of type-2 diabetes. That is really been the only major factor which is controllable. Those that we can’t control that are important to recognize is that as we get older, our risk increases and certainly in those that have a family history of type-2 diabetes or in women who had gestational diabetes during a pregnancy, or those that are in specified risk categories that are shown to have higher risk of type-2 diabetes. All of those together sort of constitute what the risk is.
Melanie: We hear more and more about checking your blood sugar levels. You even see on commercials different products that are advertising being able to keep track of your blood sugar. What do you want people to know about managing your diabetes and keeping track of these things, Dr. Clark?
Dr. Clark: I think for those that have been diagnosed, clearly the greatest advance has been the ability for patients to check their own blood glucose or blood sugar levels and to know what the goals are and to make sure that whatever treatment their on, whether that’s diet and exercise alone or that plus a medication that their goals are being achieved. So, we ask patients to check their blood sugars. It varies the number of times per day depending on what medication they are on or where they are in regards to their diabetes. That, really, is critical for the patient to know whether they’re doing well and then, in turn, for their provider to know whether they are doing well.
Melanie: How often do you want people to have the A1C test?
Dr. Clark: The A1C test should be done according to the guidelines of the American Diabetes Association, and that is every six months in those that are at goal and nothing has changed in regard to their treatment. Generally, every three months in those where they are not at goal and they are trying to get to goal or there may be a change. Functionally, I find with my patients that I want them to be checked every three months because even those that one might not suspect that anything had changed, I do find that patients that are doing quite well. If I didn’t check any more frequently than every six months, I may find that something has changed and I wish that three months before that, I had known that and could have made an intervention.
Melanie: Dr. Clark, how important is blood pressure in the management of diabetes as these things together contribute to the risk of heart disease? How important is it to manage your blood pressure?
Dr. Clark: I think you’ve asked several different questions. I don’t know that there’s any importance to checking blood pressure in regard to managing the diabetes but it is critical to manage the blood pressure in terms of reducing one of the major risk factors of diabetes being heart disease. Studies have shown that the management of blood pressure is perhaps even more important than the measurement of blood sugar in regard to the macrovascular or large vessel complications of diabetes being heart disease and stroke. So, although managing your cholesterol and managing your blood pressure are not technically important in terms of managing the diabetes, they are critical important in terms of the complete treatment of the patient with diabetes.
Melanie: Now, speaking of treatments and learning to live with it, trying to help control those blood sugars, what do you tell people about diet and exercise and the most important information that you give them about their everyday activities that can help them manage it and give them a higher quality of life?
Dr. Clark: I think that your question has given most of the answer to the question. I think diet and exercise is critical in all patients. Unfortunately, I think the medical community jumps too quickly over lifestyle modification and moves into the medications but all of the medications work much better in a patient who is doing their best to maintain their weight and to be as physically active as possible. In terms of what I tell patients, what you’ve said is really the critical factor and that is physical activity is very, very important and that does not only mean going to the gym or engaging in regular exercise. It can also mean walking, so parking further away from a building, walking upstairs instead of taking the elevator or the escalator and being active in your life can be extremely important in terms of weight maintenance.
Melanie: Are there some foods that you like them to stay away from when they are trying to manage diabetes?
Dr. Clark: No. I would say the issue with diabetes management is you want the patient to do as well as they can with managing their blood sugars but, at the same time, to learn to live their life and to have a good life while managing their diabetes well. So, I tell patients there really is no food that if they really want to eat that food, that they need to give that food up. However, the portion of that food or how often that food is what may need to change. I find that if you take an approach of saying to a patient, “You, unfortunately can never have this again because you have diabetes,” then that really detracts from the long-term management in that patient. They begin to think of diabetes as a punishment, a prison sentence, and they resent it. But, if you tell them, “Look, you’re going to celebrate birthdays. You’re going to celebrate holidays. You’re going to go out for a special dinner and as long as those are occasional events, there are all those foods that you enjoy eating now that you can continue to eat but you need to be much more careful of portion size and how often you have them.”
Melanie: What do you tell your patients about the importance of getting a complete foot exam or an eye exam, dental exams and how often they should be doing these every year?
Dr. Clark: All of those are extremely important in terms of the complete care of the patient with diabetes. Foot exams fall in two categories. One, I examine the feet at least twice a year in people who have low risk feet in terms of problems and at every visit in somebody who has a high risk foot. Also important to know is that I would say 90% of the foot exam can be done by the patient by simply looking at the bottoms of their feet and looking for any changes, any sores, any redness, etc. If someone can’t see the bottoms of their feet, they can use a hand mirror or they can find a friend or family member to look at the bottoms of their feet periodically. We could dramatically decrease the risk of foot problems with diabetes if patients would simply look at the bottoms of their feet regularly. Dental exams, generally, are recommended by dentists to be done every six months and I think that’s a very good piece of advice. Eye exams, according to current guidelines, should be done once a year and should be done by an eye care professional who dilates the eye in order to see into the back of the eye to look for any changes in the blood vessels. So, whether that’s an optometrist or whether it’s an ophthalmologist is not as important than it is that it is being done by an eye care professional. It’s important to note that this is looking inside the eye to look for changes. It is not a vision exam. When someone says, “Oh, my primary care checks my eyes and my vision is fine,” that’s a separate category in terms of eye issues.
Melanie: In just the last minute, please, Dr. Clark, and its great information and so important, please give your best advice for those living with diabetes in managing it and why they should come to BID Plymouth for their care.
Dr. Clark: Well, I think that the most important thing, which I’ve already said, is to find a way for the patient to live the life that they want to live, to enjoy their life but, at the same time to incorporate good diabetes care into their life; to not have it be a burden, to not have it be a limitation, a disability, but to learn how to manage their diabetes and yet still enjoy those things they enjoy. The reason to come, in my mind is, that’s the approach that I use. I run a very upbeat, positive practice. In general, I think most patients enjoy coming in. I’m not judgmental. I don’t yell at patients because I feel that it’s their diabetes. I’m just there to help them and to support them. More important than the medical care of diabetes that I offer is really the support, the coaching, the encouragement and we do that by showing patients how much better they can do with the medication or with lifestyle change and to constantly keep them on track and to support them in doing the best they can.
Melanie: Thank you so much for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.