The Common But Preventable Disease: Prediabetes

What is prediabetes, how is it treated and how can it be prevented? In this episode of the Community Check-In, Lorna Fitzpatrick, vice president of medical affairs for safety net programs and senior medical director at Excellus BlueCross BlueShield answers these important questions about this common but preventable disease. Prediabetes is extremely common, in fact, one third of adults are prediabetic and most don’t even know it. Lorna speaks out about prediabetes in the hopes of helping community members avoid this serious health issue.

Episode Transcript

(00:04):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram

(00:27):
and Facebook. Welcome to the checkin this week, and our guest is
going to be talking about pre diabetes. We're going to explain to you a
little bit about what the condition is, how it's treated, and best of
all, how you can make smallsteps today that can help you prevent it.
Pre Diabetes is extremely common. Infact, a third of adults are

(00:50):
pre diabetic, and most don't evenknow that they are Checking in today on
this topic may help you avoid aserious health issue, which is really the
goal of that we're doing on Communitycheck In. Our guest this week is
doctor Lorna Fitzpatrick. She is thevice president of Medical Affairs for Safety Net
Programs and senior medical director at Excell'sBlue Cross Blue Shield. Just to let

(01:11):
you know a little bit about her, she came to the health plan in
twenty nineteen after practicing academic medicine inBuffalo for some two decades. She's board
certified in pediatrics and pediatric hematology oncology. She did her medical degree at Jacob's
School of Medicine and did residency inpediatrics at Saint Louis Children's Hospital and Washington
University Saint Louis, and then shecompleted a fellowship in Pediatric Heematology oncology at

(01:36):
Johns Hopkins University and spent twenty yearsfocusing on caring for pediatric patients with brain
tumors. So, doctor Fitzpatrick,welcome to the community. Check in.
It is wonderful to meet you.Thank you. Great to meet you too.
I'm glad to be here. Igot to start off by asking,
that's a very specialized bit of medicine. You decided to go into working with
pediatric patients and then a specialty withinpediatrics. What was the draw for that?

(01:59):
What was a pull that brought youinto that specialty? Oh my gosh,
so many draws. But honestly,it comes down to the patients.
I've always been fascinated by taking careof patients and families in a really holistic
fashion, where you can take careof the whole patient, the whole family,
their whole, not just the illness. No one is defined as an
illness, they're defined as a person. So this setting of pediatric brain tumors

(02:23):
who are so complex and of somany needs, Billy was the perfect outlet
to let me do that. SoI loved every minute of it, for
sure. I can certainly see howespecially children could get lumped into their identified
by their condition instead of as theunique personalities they are. And really,
starting with children especially, you canstart to create in a broader sense some

(02:45):
great health patterns and great things withthem that can start young and then they
can carry it through to the restof their lives. Yeah, that's the
absolute beauty of pediatrics too. Weget to intervene early early in life with
families, with parents, with educatorsto make sure that children are able to
live the healthiest life that they can. So we really take that seriously as

(03:07):
pediatricians to be able to do that. So almost every time you go to
the pediatrician, they're going to askyou about healthy lifestyle and changes and choices
and start that dialogue very very early. Healthy lifestyle changes choices that all lumps
in and what we're going to talkabout today, and we're talking about a
condition called pre diabetes. First thingI want to ask, though, how
prevalent is diabetes nationwide. It seemsthat we talk a lot more about it

(03:30):
than I remember as a younger person. Pre Diabetes is so prevalent, and
we don't honestly know everyone who hasit. People who haven't had blood tests
already we may not know. Butso many people have pre diabetes in the
millions of numbers, and we reallywant to make sure that we get to
connect to everybody so that we cantalk to them about doing healthy lifestyle changes.

(03:52):
I'm not talking big, major changes, I'm talking small changes that could
make a huge difference to your lifein preventing a really chronic condition. So
let's talk talk about this condition.Pre Diabetes is defined in the medical community
as what basically pre diabetes means whenyour blood sugar level is higher than normal
but not quite high enough to beconsidered to be diabetes or type two diabetes.

(04:14):
What it is. The problem is, if you have that pre diabetes
and a little bit of an elevatedblood sugar, you are very high risk
of developing type two diabetes within fiveyears. We also want to point out
you're a female and you talk tome about a pediatrician. You know,
fifty percent of women who are diagnosedwith gestational diabetes during pregnancy will also go
on to develop type two diabetes intheir life. So we really want to

(04:39):
focus on people who are at risks, which essentially could be anyone in our
community, as well as looking atwomen and seeing what we can do to
change their lifestyles and make them awareso they can make the changes to avoid
this chronic condition. We typically thinkof a diabetic patient. They have a
certain lifestyle, they look a certainway, perhaps they're a certain weight,

(04:59):
Are there particular risk factors that aremore prevalent, or as you mentioned,
really could it affect anyone at anycondition or point in time in their lives.
Yeah, there's so many things thatgo into it. Sometimes we think,
you know, it goes along withyou know, obesity or other things,
but that is just a very narrowfocus on it. It really could
be any one of us at anytime, and it's so important to take

(05:23):
be mindful of it, to beaware of it, to talk to your
doctor about it, and make surethat you're tested for it. So I
don't like to lump people into onething. There's genetics, there's hereditary there's
environmental factors. There's a whole bunchof lifestyle things that can add to it.
So the most important thing is tohave that conversation with your provider inside
the body as the body is movingpotentially into a diabetic state. If you're

(05:46):
starting in pre diabetic, what ishappening inside of us when that condition starts
to become noticeable. Yeah, sowhen you're pre diabetic, those high sugar
levels aren't really good for anyone atany time, and it can already art
to cause some inflammation and some changesto your circulatory system. So your heart
is a big risk. Even inthe pre diabetes, you want to really

(06:06):
make sure you're modifying their your brain, your immune system. We know people
with diabetes have immune systems and notsuper healthy and even the pre diabetes stage
that can happen to So knowing thatyour pre diabetic and trying to move away
from that and preventing diabetes if youcan, is so critical to your long
term health. And really it doesstart with a conversation and a simple blood

(06:30):
test for your doctor to start doingsome evaluation. It's curious that you mentioned
about the number of people that mighthave this condition and don't even know it.
The numbers are actually pretty staggering.About ninety six million people have the
condition, yet eighty plus percent don'teven know they do. Correct. That's
a huge number. So it couldbe in your family, your friends,

(06:53):
you know, people you're going outto dinner with. So many people that
just will not know that they havethis condition. And it's so important.
So I really talked about the holisticapproach and with your provider and things.
It's really so important do everything thatyou can to reach out and talk to
your provider. Have conversations, breakdown questions if you're not sure if you
have this, if you've been testedfor it, break down the questions when

(07:15):
you go see your provider, havea checklist, and have that conversation with
them. So it's really something youwant to bring up to them to make
sure that they're checking for and notjust checking for, but conveying the information
back to you so you know whatyou need to do to take care of
it exactly. Many doctors, includingmy own general practitioner, is one that
takes that more holistic approach instead ofbeing just diagnostic. Let's say, to

(07:42):
treat something that may be a chroniccondition or looking at just one particular part
of your health picture. She tendsto take a much wider approach to say,
well, how can we bring alot of different resources to bear to
make sure that you're living the healthiestlifestyle possible. Is that a trend that's
really pervasive throughout the medical community.Do you find taking that holistic approach to

(08:03):
say, how many different aspects ofyour life can help you potentially avoid a
condition that could pop up, likepre diabetes? I sure hope. So.
I mean it's the way of medicineto do it. Really look at
the person and to know what theycan be at risk for, have conversations
with it. We certainly encourage thatto do it. I just had my
own checkup and my own blood workdone, and I really chose and picked

(08:26):
my provider because she has that holisticapproach to it too. Thankfully, my
numbers were good. Who knows whatwill happen next year, but she already
had that conversation with me, knowingthat I'm working from home now, more
sedentary, Hey, what are thethings you can do? Let's talk about,
you know, getting up and walkingduring the day and getting out and
walking the dogs. And doing simplethings that you can do to make sure
that this doesn't happen to you.So I really encourage people to look for

(08:50):
that. Really holistic people go intomedicine. We go into medicine because we
love people, we care, andwe really want to make sure that you
know we're talking to people, thatwe have the time and the information to
give you all the things that youcan do to make yourself healthy. In
fact, on Community check In,we did an entire episode on something called
exercise snacking. It's a way thatyou can move some movement into your day

(09:16):
very easily. In case you missedthat episode, you can go back and
check it out on the iHeartRadio appor wherever you get your podcast. It
would be a great resource for youto have and how you can actually make
some small changes for you to startmoving in the right direction. So let's
say you take that test and whatare the doctors looking for in that metabolic
blood panel? What is the testand the number that we're looking at,

(09:39):
and what's sort of the range thatthey want most patients to be in.
Yeah, so mostly for pre diabetesmost of it. There's two tests that
you can do. One is asimple blood test that says what is your
sugar level, it's called glucose level. What is that You really want that
to be in the normal range,which is less than one hundred most of
the time. Anything higher than thatcan get you into the pre diabetes and

(10:01):
then even higher can get you intothe diabetes range. You want to make
sure if you're having that test,do yourself a favor, in a doctor
a favor, and really do thatblood test when you're fasting. So it's
really important if you're like me andalthough I've given up a little bit love
diet coke, even something like thatthat you think is not going to raise
your blood sugar, it actually does. So don't take anything to eat or

(10:24):
to drink for at least eight hoursbefore the test is done, and that
gives you yourself and it gives yourdoctor a really accurate picture of what your
glucose levels are to see that.So that would be the first one you
can start with. There's other teststoo, one called a hemoglobin A one
C that is also a blood testthat can be done, and what that
looks at is the trend of yourblood level blood sugar levels over time.

(10:46):
So that one is also very helpfulfor your doctor to be able to take
a look at and to discuss withyou. Most will start with that fasting
blood sugar. And I can tellyou, like I said, really take
the time to when you're going togo get your blood work done, make
sure it is fasting, and thenhave the conversation with your doctor when you
look at the numbers, what dothey mean and what do they mean for

(11:07):
you? So let's move forward.You've had the test done, you've had
the conversation with your doctor, you'vebeen confirmed you are in the pre diabetic
range. It's trending towards that.What are the steps that you would like
a patient to see do and geton right away so that we can try
to nip this in the butt becauseit isn't a foregone conclusion that you're going

(11:28):
to move from a pre diabetic stageto a diabetic stage. You can make
some course corrections, absolutely, andI think that's the important part. You
can make course corrections and you don'thave to do it with drastic changes,
So you're not going to be drasticallychanging your lifestyle. It doesn't mean you
can't go out and have dinner withfriends. It doesn't mean that you can't
have an occasional drink of alcohol.It's not going to be a drastic change

(11:50):
to your lifestyle, but it's goingto be mindful. I like to think
of people being mindful about what they'redoing, mindful about getting in those extra
steps. When you can get anextra steps, get out and walk.
I'm fortunate enough to have a parkright across the street for me. I
see it, I look at it. I mindfully get up and take my
dogs and go for a walk.So you want to start working in some
kind of exercise. You don't needto run a marathon tomorrow. That's no

(12:13):
one's goal. Get in some steps, increase yourself every day, every week,
whatever your goal is, five tenpercent per week. Small increases will
help you and you're going to feela lot better with it. Doing that,
and then watching what you eat,eating healthy you know. Again,
I really advocate for people to eathealthy foods when they can. We all

(12:33):
eat junk at times, but reallyfocus on the most of your time eating
healthy foods. There's no room forfad diets here and for dramatic diets.
You want small, mindful changes again, eating more towards a Mediterranean diet,
green leafy vegetables, whole healthy grains, and limiting things like re read meats

(12:54):
and things like that. You don'thave to give everything up, but you
want to limit it somewhat. Soreally be mindful of what you eat,
I mean, be mindful of howmuch you move. And I think you're
going to feel better with it too. And is your sugars come down a
little bit, you start to feelhealthier. You probably will lose some weight
from doing these small, minor activitieswe really want to see. I think

(13:16):
it's slow, steady progress towards thegoal and no dramatic changes would be my
recommendation. This is doctor Lorna Fitzpatrick. She's vice president of Medical Affairs for
Safety Net Programs and a senior medicaldirector with Excell's Blue Cross Blue Shield.
This is their community check in.We are talking about a condition known as
pre diabetes, something that many Americanshave and don't even realize that they have.

(13:39):
And it is not something that isa foregone conclusion that it's going to
be just a precursor to a diabeticcondition which you will have to monitor and
take care of much differently than thisone. These little steps that you make,
these lifestyle changes. They really arefor many people. They're a necessary
change, and it's very easy forus to get into habits that are not
good for us, that becoming grained. But we can make changes. It's

(14:03):
not like we're just while I'm toosaid in my ways, I can't do
anything different. Yeah, it absolutelymake it fun. I mean for us,
the pandemic has certainly meant for mepersonally, meant from a very active
running around seeing a lot of patientsto sitting in a chair and working from
home. I think that happened fora lot of us over time. It's
really that mindfulness, you know,grab a neighbor, a friend, espouse,

(14:26):
a dog, of anything that youwant, and just start to move
a little bit, really get somewalking in and doing. If you don't
walk at all, you know,start with just a few steps. Stop,
start going down the block, startgoing out to your mailbox. Increase
yourself and push yourself just a littlebit every day. It's hard to stop,
it's hard to start, but Ican guarantee you once you do start,

(14:48):
you're never going to want to stop. You just feel better, and
all of your body, all theinflammation and the high sugars and all of
those things. Your body will startto notice differences that you're going to make
huge changes to your outcomes. Iwill really courage it's fun. Yeah,
it I will look myself through it. It's fun. Totally agreement, total
in agreement. I got off ofan exercise routine during the pandemic, kind

(15:13):
of fell away from it. Justrecently got back onto it, and I
miss it when I don't do it, And now I feel different. And
it's only been a couple of weekssince I've really kind of got back into
that, and I've noticed that Ijust feel more energetic. I just want
to do more things. And ithelps you, I think when you're more

(15:35):
active, would you agree that ithelps you to I don't even subconsciously.
Your body just helps you make betterchoices. I mean to reach for the
water instead of the soda, toreach for the vegetables instead of the process
foods. Yeah. And I thinkit's it's very important to be mindful of
recognizing your body signaling you that yourbody's happy with the changes that you've made,
because that in itself is a positivereward for you to continue to continue

(15:58):
that healthy habit. I gave updiet soda at the beginning of January.
It was hard. You know,it was not a good thing for me
to do. I've been drinking itfor many years. But switching to water,
which I used to think as anegative, now has become a very
positive thing for me to do.And I agree with you completely. That's
all because my body keeps saying,breach for that water. It makes you

(16:21):
feel good. So I really encouragepeople to listen to their bodies and listen
to what we're being told when wemake these small changes. And when you
talk about those small changes, Ithink I want to go deeper into that
a little bit because many people mightthink, and this could be a mental
block that keeps people from making especiallyphysical activity changes to their lifestyle, that
I have to go to the gym, I have to sweat it out for

(16:45):
an hour or more a day,I have to push myself very hard.
I don't know whether I can.Maybe I have other physical limitations that would
prevent me from doing that. Iguess I'll just give up on that idea
completely. Let's talk just about whatthat level of physical activity could really look
like, and as far as minutesper day, let's sort of parse it
down that far. Yeah, Ithink everyone. So it depends what people

(17:07):
are going to start from. Soyou really want to start from where you
are now and just do more tomorrowthan you did today. I think that
will make a big difference. Andit doesn't take a gym membership or going
to the gym or doing anything likethat. So it is going to be
different for every single person. Butyou really want to try to get to
the point where you can do somebrisk exercise every day, and by that
I mean a brisk walk, youknow, walking with your spouse, with

(17:30):
your dog, with whoever you wantto getting outside, just moving a little
bit. So really move to theeffort where you really want to get to.
From where you are today to whereyou are tomorrow. You're going to
see a difference in it for someonewho's already a marathon runner. And yes,
people who are marathon runners can bepre diabetic. A walk isn't going

(17:51):
to do them any good. They'regoing to have to look through for different
lifestyle changes or whatever may may happenwith it. So it is unique and
different to everybody. You really wantto try to get up to thirty minutes
a day if you can of goodexercise most days of the week to be
really considered to be helpful. Butdon't give up if you're not there right
now, because you're going to getthere. It's a matter of taking slow,

(18:14):
steady steps towards progress. That's theonly thing you have to do.
And that's an interesting point that youmake. You know, it doesn't matter
potentially your level of current activity oryour level of fitness. Pre diabetes can
be something that you have to paymore attention to regardless of your because you
may have other factors that are involvedin there. So just because you say,

(18:34):
okay, well I do five k'sand I do that very you know,
and I'm very active, or Iwork outside and I work physically all
the time, I don't have toworry about that. I don't even have
to get the blood test to seewhat my benchmark number is right now,
let alone even consider it. Yeah, I would encourage everyone to get it
done. There's so many other factors. You know, being in good physical

(18:55):
help does not automatically say you're notgoing to get pre diabetes or more.
But do you know that people thatwork more and exercise more and have less
of a chance. But it's notzero. So I think everyone should be
screened. Everyone should talk to theirprovider about getting screened and see where you
are to start and continue healthy modificationsto your lifestyle. We can all do
what we can all do a littlebit more tomorrow than we do today.

(19:17):
You really want to strive towards thatwhen you can. When it comes to
how often one should get tested,typically we do physical examinations and hopefully people
are doing physical examinations checking in withtheir doctors at least once a year.
But let's say your doctor and youhave a conversation and they're noticing, okay,
these levels in the glucose. Sothe A one C is starting to

(19:40):
move you in a range which wewould not like to see. How about
when do you come back and testagain? Is there a place that could
be too soon for good results andone that might be right on the money
for good results. Yeah, Ithink again, you want to give yourself
enough time to make and implement theselifestyle chains. Is when you can and
then get another check three six monthslater. Whatever you and your provider decide

(20:04):
upon to go back and get thatcheck up to see if what you're doing
is helping and if it's working.It also, I think is great when
it is working, to get thatpositive feedback again to continue to motivate you
to continue with the lifestyle changes.So that's a really good conversation to have
with your provider. All of thesecheck ins are so important, not just

(20:26):
for pre diabetes but for everything.So I really want you know when you
go and have those conversations with theprovider that provider patient relationship is so critical
for all of us, and toknow that it can be you can affect
change, You can make some changesthat can really make some and the improvements
that you might have seen in somepatients in some of the studies that you've

(20:48):
looked at can be relatively dramatic withjust that little change in lifestyle, diet,
exercise, and then you look attheir numbers three to six months later
and go, wow, that canbe a dramatic swing in how the things
look. Yeah, I think whenwe talk about if you do develop into
diabetes, you have a really chronicdisease that it can affect your eyes,

(21:10):
you can become blind from it,your heart, your kidney's, chronic kidney
disease, your feet, infection,your immune system. Diabetes affects every part
of our body and every system andour body. So it really is worth
the investment in yourself to take thoseextra steps to eat that a little bit
healthier, to really avoid that fromhappening. So once you're in the diabetes

(21:30):
range, you can't really pull back. You will be a diabetic. You
want to do everything you can toprevent that from happening. Diabetes is not
simply high blood sugar. So manymore things come with it that affect your
body, literally every organ system inyour body. And according to recent studies,
I mean, diabetes is currently theeighth leading cause of death in the

(21:51):
United States. So it is severeand I suspect it has come up that
list of mortality causing diseases over timeas our lifestyles and health styles have shifted
over the years. I want tojust go really quick in than the last
couple of minutes we have. Iwant to go back to that test and
about the conversations they have with yourdoctor, and I think more importantly too,

(22:12):
what we need to know about isthis going to cost me a whole
lot? And is this going tobe covered under my plan? To make
sure that I can keep an eyeon this, because this really is kind
of a critical thing. Yes,under the Affordable Care Act, nearly all
health plans have to provide certain preventativecare to their members at no cost.
You likely won't have to pay acopay, co insurance or even a DEDUCTI

(22:33):
both to get these exams when they'reused to help find conditions or diseases early
before you have symptoms. Here atexcel As Blue Cross Blue Shield tests are
covered on most plans. It's alwaysgood to call it confirm your benefits.
You can call your doctor, youcan call your local pharmacy for more information
about getting tested if needed. It'sa critical test that we know is going
to help prevent long term illness andchronic disease. So we really all of

(22:57):
us want to encourage you to goget it. Don't fear that doctor's appointment,
and don't fear the cost for it. It is accessible with high quality,
affordable healthcare. And also have theconversation pertemps with a member of Exceller's
Blue Cross Blue Shield about what otherresources can be brought to bear. We've
had a dietician, a registered dietitianon our program recently that talked about ways

(23:18):
that you can use bcbs to helpmenu planning. Learn about things and good
foods for you to eat. Perhapswe don't know because nutrition definitely plays a
part in it, and most ofus don't know how to properly fuel our
bodies sometimes, so the resources fromExceller's are there to be taken advantage of.
Yeah, absolutely give us a callif you've questions about it. We

(23:40):
have a whole host of people availableto help, like you said, nutritionists
and ways to healthy lifestyles, informationpamphlets, just so many resources at our
fingertips. Resources we can point youto in the community. So where is
invested in your health too? Wereally want people to take advantage of it
and get all the information they canfrom. And we want to thank doctor

(24:00):
Lorna Fitzpatrick, who's the vice presidentof Medical Affairs for Safety Net Programs and
senior medical director with Excell's Blue CrossBlue Shield. Thank you for explaining to
us about what pre diabetes is,how important it is for us to be
watching it, and more important thanthat, what we can be doing every
single day by making small steps topotentially have some giant leaps in our overall

(24:23):
health, to make sure that weare being mindful about something that can affect
anybody at any time of life.Thank you for this critical information. It's
been a pleasure to talk with you. Thank you, great to meet you.
Thanks for joining us on Community checkIn, a presentation of excel Us
Blue Cross Blue Shield at iHeartRadio.Podcasts of Community check In are available on

(24:45):
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