April 16, 2023 • 29 mins
04/16/23
The Healthy Matters Podcast
S02_E10 - Diabetes. It's on the Rise, so it's Time to Get Wise.
In 2019, the CDC estimated that 8.7% of all adult Americans had diabetes, and it's been projected that by 2040, that number could rise to around 20% (1 in 5 people!). That's a staggering statistic, but where does it come from? What does it do to the body? What's the difference between Type 1 and Type 2? And why is it dubbed "sweet urine" (eew...)? We've all heard of it, but it's time we broke it down to the basics.
On Episode 10 of the podcast we'll be joined by Dr. Laura LaFave, Director of the Division of Endocrinology at Hennepin Healthcare, to discuss the origins of this condition, how it's diagnosed and treated, complications that can arise from it and what can be done to prevent it. We'll also look at how it can be controlled through insulin, effective lifestyle changes and emerging drug treatments. There are plenty of challenges one faces with this condition and this episode is loaded with important information for all of us. Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:21):
Hey everybody, it's Dr.
David Hilden, and this isepisode 10 of the podcast.
And today we are talking aboutdiabetes.
What is it?
What causes it?
What are the symptoms?
What can be done about it?
Tell me out.
I've invited Dr.
Laurel LaFave.
Dr.
LaFave is the director of thedivision of Endocrinology here
at Hennepin Healthcare with mein downtown Minneapolis.
We trained together a couplethree years ago, or maybe a few
(00:44):
more than that, and now she isleading that division.
Laura, thanks for being on theshow.
Speaker 3 (00:48):
Thanks for having me, Dave.
Speaker 2 (00:49):
So let's talk about diabetes.
If we could.
First of all, some definitions.
What, what is diabetes?
Speaker 3 (00:56):
Diabetes is a state of having too much sugar in your
bloodstream.
And the reason that that happensis because something is often
the balance of the physiology inyour body.
So carbohydrates or sugar thatgo into your body through food
or from stored places like inyour liver, will exit the liver
or, or come in through the thegut and the, and get into the
(01:16):
bloodstream.
And diabetes is the state of nothaving adequate mobilization of
that sugar into the muscles andcells where it belongs to power
your body.
Speaker 2 (01:27):
Yep.
Before I even get into morediabetes mellitus, I think means
something along the lines ofsweet urine or something like
that.
Is that true?
Speaker 3 (01:33):
Correct.
So when you have too much sugarin your bloodstream, one of the
ways it tries to get out isthrough your urine.
And so back in the days before,we had adequate ways to test
blood sugar.
Doctors would actually diagnoseit by tasting a patient's urine.
Speaker 2 (01:47):
Do you still teach that?
We do.
Is that
Speaker 3 (01:48):
What you do?
We do not.
Speaker 2 (01:49):
, that has a
huge oo factor.
They really did that.
They l and it was if it wassweet, yeah.
Diabetes.
Correct.
Oh my goodness.
Okay.
Back to some definitions.
Type one versus type two.
Are they the same thing or arethey different?
Speaker 3 (02:03):
They're not the same thing, although there tends to
be a little bit of overlap.
Okay.
Type one diabetes is what weused to call juvenile onset
diabetes because it's, you getit when you're a kid mostly.
And the problem that leads totype one diabetes is really a
destruction of the pancreas,which is the organ, the gland
kind of right in the middle ofyour belly that produces
(02:25):
insulin.
And insulin is the hormone thatis essential for getting that
sugar into the places it needsto be.
So when people have type onediabetes, what happens is that
they have a destruction of partof that gland, the pancreas that
produces insulin.
And so they no longer produceany insulin at all.
Speaker 2 (02:42):
And we need insulin for life.
Speaker 3 (02:44):
Absolutely.
Speaker 2 (02:45):
Even that sounds kind of weird to me.
So what you got a little extrasugar in your body?
Is it just that you can't storeit or something?
Speaker 3 (02:50):
Right.
So if you have too much sugar inyour body, not only do you then
your muscles and organs andcells actually get depleted
because sugar is basically thefuel for it.
So if it's not in the rightplace, your body, all your body
processes get weaker.
But also just having too muchsugar in the bloodstream and
kind of hitting up against bloodvessels, kidneys, eyes, nerves,
(03:14):
all these parts actually does alot of damage to those organs
and blood vessels.
And that causes further healthproblems that we see when people
have diabetes long term or notin a state of control that is
helpful for
Speaker 2 (03:28):
Them.
What about type two?
Speaker 3 (03:30):
So type two diabetes is by and large the most common
kind of diabetes.
So we mentioned type one, andthat is something that we see a
lot in our endocrine practice,but it's actually the very, very
rare kind of diabetes comparedto type two.
So type two is by and large,when you hear people talk about
diabetes, they're usuallytalking about type two diabetes.
Type two diabetes starts withmore of a problem where a body
(03:53):
becomes less receptive toinsulin.
So a person with type twodiabetes makes insulin, but
their body does not recognize orreceive it well.
And so they typically, not allthe time, but typically have a
state of what we call insulinresistance.
So their pancreas is churningout insulin to try to keep the
sugar in the right place, but itjust can't keep up with it.
(04:15):
So as a person who has an, anunderlying insulin resistance as
they get maybe older orsometimes heavier or just are on
different medicines or thingslike that, or maybe they're less
active, their body in trying tokeep up with producing enough
insulin to overcome this issue,eventually the pancreas may kind
of poop out and not make enoughinsulin.
(04:37):
And that's when the balance tipsand the blood sugar goes up
despite the fact that the body'sstill producing a fair amount of
insulin.
Speaker 2 (04:44):
So a few more definitions.
You've used the terms, uh, sofar, carbohydrates, glucose,
sugar, and, and I use sugars allthe time.
I talk about patients abouttheir blood sugars.
Many people I've been told when,when you say sugar, I think of,
you know, the teaspoon of sugaror sugar cube that you put in
your coffee.
That's sugar.
I don't need any sugar.
What is, what is sugar versusglucose versus a carbohydrate?
Speaker 3 (05:06):
I think it's a confusing point because again,
the same thing, sugar is not,does not only come the form of
sugar or coke or you know, sodasand things like that.
Carbohydrates are amacronutrient.
So it's one of the big threethings that you get in your
food.
Carbohydrates, fats, proteins,carbohydrates are basically
turned into sugar in your body,different kinds of sugars.
(05:26):
And so when we think about sugarintake, it really extends to not
just sweet things, but starchyfoods.
So foods that are high in starchare high in carbohydrate.
So that includes for mostpeople, pastas, breads, rice,
crackers, chips, potatoes, corn.
So lots of foods that are veryhigh and carbohydrates are,
(05:48):
they're turned into sugar inyour body.
I should say.
Fruit also has a fair amount ofsugar in it, but that form of
sugar fructose that it, itbecomes, is less harmful to your
body
Speaker 2 (05:59):
Than the glucose that the others are turned into.
Correct.
Could you talk about riskfactors for developing diabetes
Now?
It sounds like there might besome genetic predisposition to
it, if you could comment on thatand also what puts people at
risk for developing type two
Speaker 3 (06:14):
Diabetes?
Yeah, so type two diabetes isjust so incredibly common in the
US now in I think 2019, the CDCc statistic was at 8.7% of all
adult Americans have diabetes.
A very, very small percentage ofthat is type one diabetes.
We know that there are somepretty clear risk factors for
developing diabetes, and one ofthem is a family history.
(06:36):
So, uh, you know, first degreerelatives with, uh, parent or
sibling with type two diabetesbeing from a high risk ethnic
group.
And so we do know that the, uh,rates of diabetes in Native
Americans, black Americans,Latinos, and non-Latino Asians
are all higher than innon-Latino white Americans
history of having hypertension,having heart disease, having
(06:58):
underlying hyperlipidemia, um,
Speaker 2 (07:00):
Cholesterol
Speaker 3 (07:01):
Problems, cholesterol, exactly.
For women having a history ofpolycystic ovarian syndrome,
which is a very, again, a commonkind of metabolic syndrome that
shows up in women ofreproductive age, um, and then
physical inactivity and thenbeing overweight or obese has,
uh, a higher risk as well.
Speaker 2 (07:18):
And these rates are all on the rise, aren't they?
That's you, you said about 8%,9%, that's one in 10 or 11
people have diabetes and thereis a connection with obesity and
being overweight.
Correct.
So that, and since those ratesare going up, I imagine diabetes
is, uh, also becoming a littlebit more prevalent.
I
Speaker 3 (07:34):
Think it's predicted that by 2040 we're gonna be at
about 20%
Speaker 2 (07:39):
Of American, of the population one in five.
Wow.
And in my primary care practice,you said it's roughly one in 10
people have diabetes, it'seasily one in three of my clinic
visits involve a patient who isliving with diabetes, even if
it's not the main reason they'rethere.
I would say a third of my clinicvisits have involve a patient
(07:59):
with diabetes.
Is this problem mostly in theUnited States or is this a
global phenomenon?
Speaker 3 (08:04):
It's a global phenomenon.
It's worse than the us but it'sa global phenomenon.
Speaker 2 (08:08):
Is it worse than the US because of our diet, of our,
of our prevalence of beingoverweight?
Or do we know?
I
Speaker 3 (08:14):
I think it's multifactorial.
Mm-hmm.
, our, our diet isa big part of it.
And I think when you look atpeople moving from other
countries with low rates ofdiabetes into the us, the rates
in those groups skyrockets.
So there's definitely somethingin the diet slash environment
slash culture slash somethinghere.
Speaker 2 (08:32):
Let's shift gears.
Let's talk a little bit aboutsymptoms.
When would somebody, um, knowthey have diabetes or, or maybe
another way to say that is, iswhat are some of the presenting
symptoms for someone who has notyet been diagnosed?
How do you know if you havediabetes?
Speaker 3 (08:45):
So the classic symptoms that diabetes presents
with are increased thirst.
So feeling thirsty all the time,increased urination, peeing more
often, blurry vision, weightloss and fatigue.
Other less typical things thatwe see is just craving sugar
craving.
People will say they just feltlike they couldn't get enough
soda or candy because they justhad this intense sugar craving.
(09:08):
Headaches, again, fatigue orlethargy or just not being able
to kind of participate in whatyou're doing.
It affects other hormones inyour body.
So you know, people won't sleepas well.
They will have things like lowlibido, low interest in things,
um, even association withdepression.
So
Speaker 2 (09:24):
That's a, a myriad of symptoms I've seen, uh, more
people that I can count over mycareer that did show up with,
I'm urinating more and I'mthirsty and maybe have blurry
vision.
So those are the folks that havesome symptoms that are pretty
attributable to diabetes andwe'll obviously we'll go test
you right away.
Uh, I wanna kind of shift intowhat is the diagnostic plan?
Do we screen people and if sowhen?
(09:44):
And talk about that if you
Speaker 3 (09:46):
Could.
I'm glad you asked that becausewhen people are diagnosed with
diabetes, they usually onaverage have had diabetes for
about five years.
Mm.
As many people as we'rediagnosing with diabetes, we're
missing a lot
Speaker 2 (09:56):
And we're catching'em five years too
Speaker 3 (09:58):
Late.
Right.
And part of the reason is thatpeople probably don't have
symptoms for years when they'reobviously when they're
developing it.
And, and that might have a lotto do as well with things like
access to care and thelikelihood of seeing healthcare
providers at that point.
As far as screening fordiabetes, the general
recommendation is to screenadults who have risk.
(10:19):
So the risk factors that Imentioned before, if you have
one of those risk factors, youshould let your healthcare
provider know.
If you don't have any of those,you should start being screened
at age 35.
Speaker 2 (10:30):
So how is it diagnosed?
Speaker 3 (10:31):
It can be diagnosed three different ways.
One way is with a screening testcalled a hemoglobin a1c.
This is a blood test that doesnot require fasting.
It measures a person's averageblood sugar over the previous
three months.
So it's a lab test that we usewhen we are monitoring a
person's diabetes control and wehave targets for that, but it
(10:52):
can be used for diagnosis.
The second way is to get afasting blood glucose or sugar
level that requires an eight to10 hour fast, which is a good
reason to maybe go in fastingwhen you see your doctor.
It's a
Speaker 2 (11:04):
Good idea.
Get a morning appointment.
Speaker 3 (11:06):
Get a morning appointment.
That's right.
And the third way is veryinconvenient.
We used to do these a lot, whichwas an oral glucose tolerance
test and that's where you comein and you drink 75 grams of
glucose, which is basically kindof like slamming two cans of
Coca-Cola and then you measurethe blood sugar two hours after
that.
Speaker 2 (11:22):
So those are the diagnosis.
We're gonna take a quick break.
We've covered a lot of groundhere, but when we come back from
the break, we're gonna talk moreabout diabetes including
treatments, outcomes,complications, and Dr.
LaFave, three tips for all ofyou.
Stay with us.
We'll be right back.
Speaker 1 (11:37):
You are listening to the Healthy Matters podcast with
Dr.
David Hedon.
You got a question or commentfor the doc?
Email us at healthy matters hc me d.org or give us a call at six
one two eight seven three talk.
That's 6 1 2 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (12:00):
And we're back talking about diabetes with Dr.
Laura Lafe.
So Laura, people living withdiabetes are so used to sticking
their finger and havingglucometers and keeping checking
their blood sugars.
Could you comment a little bitabout, first of all, why do
people need to check their bloodsugars and what are some of the
techniques they can do that,including some of the more
advanced techniques?
Speaker 3 (12:21):
This is the thing that people with diabetes
probably like the least aboutliving with diabetes, right, is
having to monitor and know andwatch and react to what their
blood sugar is all the time.
And it's important to do itbecause how much insulin you
take might depend on what yourblood sugar is or perhaps you're
trying to restrict or reduceyour carbohydrates and you need
(12:44):
to know whether that's workingor not.
Uh, perhaps your provider putyou on a new medication and you
need to see if it's effective.
It's working and hopefully thediabetes educator has given you
some good goal blood sugars tobe looking for.
But again, this is an area wherewe have, it has just changed
tremendously in the last fiveyears.
There are now pretty broadlyavailable glucose sensors,
(13:04):
little devices that you insertin your upper arm and that can
be used to scan or directly goto a little meter or a phone.
So it has basically aviated theneed to stick the finger four or
five or six times a day to getblood to do that.
It's really becoming a standardof care to use these and to
(13:25):
prescribe these.
And insurances have kind of comealong and have started to cover
them much more broadly.
And the advantage is removinganother one of the barriers to
being able to be engaged withdiabetes and what your blood
sugar is.
It just, it just takes away onemore barrier.
Speaker 2 (13:40):
It's a game changer.
I wish all my patients were onthese continuous glucose
monitoring systems.
Wonderful, wonderful developmentin patients living with
diabetes.
Dr.
Lafe, tell us a little bit abouttreatments.
What is available?
Speaker 3 (13:52):
Well, there are certainly a lot more treatments
available than when I wastraining to do this 25 years
Speaker 2 (13:56):
Ago.
Oh my gosh.
You and I trained togetherroughly 25 years ago,.
And there was metformin.
There were some drugs we barelyuse anymore called
Sulphonylureas and there wasinsulin and they were not even
as good as the insulins we havenow.
Talk us through
Speaker 3 (14:09):
It.
That's correct.
The story of diabetes treatmentis both wonderful and also
awful.
Um, and the reason I say that isbecause the ways that we now
have to treat diabetes are somuch more specifically
addressing the underlyingproblems with diabetes.
And they are so much more, themeds are so much more likely to
(14:30):
help other body systems, butthey are incredibly expensive.
Yeah,
Speaker 2 (14:34):
I just, I was, I think that's what you were gonna
say.
I am so frustrated by howexpensive these effective drugs
Speaker 3 (14:39):
Are.
The story locally, state andnationally has been insulin
prices, which I think werepossibly turned a corner on on
that area.
But you know, again, 25 yearsago there was just a, a very new
insulin called glargine insulin,which was just sort of a
revolutionary advance in the waythat people could administer
insulin once a day.
(14:59):
Very steady background insulin.
It was sort of really was
Speaker 2 (15:03):
Revolutionary, I remember when it came out.
Yep.
Speaker 3 (15:05):
And with time, the prices of that insulin as well
as other very good, excellentphysiologic insulins, insulins
that basically mimic the way ahuman body makes insulin, those
all became so much better.
But they also becameprohibitively expensive such
that people were rationinginsulin, they were going without
it and being at very high riskof being very severely ill and
(15:26):
dying.
So now there is a cap onMedicare Part D and now going to
be part B that a monthprescription of insulin should
not, will not exceed$35.
And the, the drug companies havesort of followed suit with that.
So the three main producers ofinsulin have gone ahead and
limited their prescription costsfor some of their kinds of
(15:46):
insulin now for privatelyinsured people as well.
So returning a big corner onaccessibility to very excellent
types of insulin
Speaker 2 (15:55):
Before you move on from insulin.
So type one diabetics, peoplewith type one diabetes require
insulin.
So that is nothing but good newsfor people living with type one
diabetes.
There are a number of otherdrugs now medications that are
highly effective for type twodiabetes that are still really
cost prohibitive.
Do you think the lower cost ofinsulin will lead us to
(16:18):
prescribing more insulin insteadof these other new medicines
that are so good?
Speaker 3 (16:23):
I think that's the reality
Speaker 2 (16:25):
Is that reality
Speaker 3 (16:25):
Insulin is the absolute essential medication
for people with type onediabetes, but it turns out that
about 30% of people who havetype two diabetes also take
insulin.
And yeah, I think the bigadvances that I'm concerned
about with the newer medicationsfor diabetes being so, so
expensive is that one of thekind of holy grails of, of
(16:45):
diabetes treatment is to try totreat the disease but also
prevent and treat thecomplications of the disease
because it's really, diabetes isterrible, but it's also the
complications of the diseasethat really tend to make people
sick and not feel good and notbe able to work and not be able
to enjoy their families andthings like that.
(17:06):
So the development ofmedications that have been shown
to not only treat the diabetesbut also protect the kidneys for
example, or protect the heartare very potent.
And so the idea that we couldtreat people in a way that gets
at all of these things is verypromising, but again, at a very
high cost.
(17:27):
So, and those medications are ingeneral many years away from
being generically produced,
Speaker 2 (17:32):
Et cetera.
Most of, if, if you happen to bea TV watcher, most of the
medications that are beingadvertised on TV and it says ask
your doctor if this is right foryou.
In general, those are all theexpensive medications that are
so wonderful but are socost-prohibitive.
So, um, that is, is a problemfor our policy makers and our
healthcare systems.
But I think it's the reality fora lot of people living with
(17:55):
diabetes.
Before I get off treatments,could you just say like the, the
basics of what people should beon now?
Like for instance, the firstthing people should be on
metformin,
Speaker 3 (18:03):
Correct?
It's still metformin.
Metformin is our old oldmedication.
It's been around for decades.
It's safe, it's very effective.
There's an association withactually lower risks of heart
disease, of cancer, of all kindsof things.
So metformin is still a mainstayof treatment for type two
diabetes and that might be theonly medicine that many people
(18:25):
need to control their diabetesalong with lifestyle changes if
they have some things to adjustin that area as well.
The second realm of treatmentused to be, as you mentioned,
sulfonylureas, which are alsopills.
And those are pills that helpthe body release more insulin on
its own.
We try to not use those as oftenbecause they do tend to cause a
(18:45):
lot of weight gain, whichdoesn't help diabetes and also
hypoglycemia or low bloodsugars, which is not safe.
They're also a little bitlimited when people have other
issues such as kidney problemsor when they're older patients,
there are class of medicinesthat are still, they still work
to lower blood sugar.
Beyond that, they don't havemuch benefit.
They really don't benefit otherorgan systems and they put
(19:07):
people at a little higher risk.
That being said, do we still usesulfonylureas?
We do.
We do.
And this gets into, you know,the idea that with other drugs
being very cost-prohibitive, ifthis is something that somebody
can afford, then it's going towork probably to control their
blood sugar.
Speaker 2 (19:23):
Right.
So listeners, if you're on glideor glimepiride or glipizide,
they're still okay.
They're still okay.
What about the new kids on the
Speaker 3 (19:30):
Block?
Yeah, the new kids on the blockone an an oral pill that has
become very widely prescribedand is quite good is a, a
category of medications calledSG l T two inhibitors.
Those are pills that get thebody to get rid of sugar by
through the urine.
So again, making the sweet urineeven sweeter.
Mm-hmm pushingsugar out through the urine.
These medicines are welltolerated.
(19:52):
They are very effective forprotecting the kidneys, which is
an issue with a lot of peoplewho have diabetes and also they
have now an indication toactually treat people who have
heart failure.
So this is one of those examplesof a medication that has
wide-reaching benefits to peopleis a fairly low risk medicine in
(20:14):
terms of its side effects andits serious consequences, not
without side effects, right?
Because no medication is without
Speaker 2 (20:20):
Those, it's easy to take.
It's just a pill.
Speaker 3 (20:21):
Just a pill.
Again, pretty expensive.
So still in the realm of, youknow, when it's covered with
good coverage, it's affordableand when it's not good coverage,
it's not, how
Speaker 2 (20:30):
About the one everyone's trying to get
nowadays cuz it causes weightloss?
Speaker 3 (20:34):
So I think you're talking about ozempic.
Speaker 2 (20:35):
I am
Speaker 3 (20:36):
.
Um, Ozempic is in a larger classof medications called the GLP
one agonist.
So this is where we're kind ofjumping from oral medicines to
injectable medicines.
So ozempic and its friends areinjected medicines that you
inject either once a day or oncea week.
It's a class of diabetesmedicines.
That's very interesting becauseit is also like insulin, it is
(20:57):
also a hormone, but it's adifferent hormone than insulin.
So it's, it's mimicking ahormone that comes from your,
your gut, your small intestine.
And it has some pretty favorableeffects on things like causing
you to feel full sooner, causingyour carbohydrates to be
absorbed more slowly and alsostimulating your own pancreas to
(21:18):
secrete or produce more insulin.
So it's got kind of athree-pronged way that it really
benefits people's blood sugarsbut they lose weight with it.
So with this class of medicines,it is now crossed over into
having some labeling for weightloss as well.
So not only for diabetes but for
Speaker 2 (21:34):
Weight loss.
Same drug, new name,
Speaker 3 (21:36):
Same drug, different doses, new name.
Yep.
Speaker 2 (21:38):
Yeah.
Mm-hmm.
and I havepatients all the time tell me
they have to almost pharmacyshop to find it because it, it's
really effective.
But as you said, expensive.
So you talked about all of thosecarbohydrates and the starches
and the sugars in our diet, manypeople are trying a variety of
diets including some low carb,high protein diets, the
Mediterranean diet.
What is the effect if we see oneof the diet you eat on the risk
(22:01):
of developing diabetes,
Speaker 3 (22:02):
There is very good evidence that if you are able to
modify your diet, that you canprevent diabetes.
Those studies go back away acouple of decades where showing
that pretty significantlifestyle interventions prevent
people from developing diabetesor from progressing from what we
call pre-diabetes to diabetes.
This isn't funny, but I kind ofdo think we're, we all have
(22:24):
pre-diabetes because basicallywe all have capacity to have
diabetes someday.
So I think the category ofpre-diabetes is sort of a funny
one cuz I think, I think it sortof extends to
Speaker 2 (22:33):
Everybody.
Yeah, I think it, I think you'reabsolutely right on that.
Do also, does that extend topeople who are living with type
two bi diabetes and are carryinga little extra weight?
Does losing weight have aneffect on the diabetes you
already have?
Speaker 3 (22:46):
Absolutely.
So we know that control ofdiabetes improves and sometimes
resolves meaning maybe goes intoremission or you don't
Speaker 2 (22:55):
Use the word cure, but you're get, you're, you're
adjacent to the word cure.
Yeah.
Right,
Speaker 3 (22:58):
Right.
I'll avoid the, I'll avoid that.
The use of the word cure.
Uh, but certainly losing five to10% of body weight in a person
who has a higher body weight isdefinitely shown to improve
control and possibly pushdiabetes into remission.
Just to hop back to the low carbapproach, there have been many
different trendy diets that havecome up over the years, kind of
(23:20):
going back to like the Atkinsdiet or the South Beach diet.
I think maybe back in theeighties where people really
restricted carbohydrates andbrought the level or the percent
of carbohydrate in their dietvery, very low or even to zero.
There is not terrific evidenceto show that that will keep
diabetes at bay forever.
(23:41):
My counsel to patients is tomake smaller changes that you,
you can live with for the restof your life.
And so going to a diet that iscompletely restrictive of all
carbohydrates, I think can leadto certainly some other health
issues.
And also it's simply in someways just not a sustainable diet
for most people.
The diet that has been the mostconsistently studied and
(24:04):
confirmed to be beneficial to arealm of different, uh, issues
including diabetes, is theMediterranean diet, which again
includes carbohydrates, it doesmm-hmm.
.
So it just includes healthycarbohydrates.
Speaker 2 (24:15):
I wanna shift gears.
I wanna talk a little bit aboutthe complications of diabetes.
What are the potential problemsdown the road for people living
with it?
Speaker 3 (24:23):
Really the big three main complications are those
that affect tiny blood vessels.
So the tiniest blood vessels inyour body are the most
susceptible to the harm fromexcess amounts of sugar.
Thinking about that, the tiniestblood vessels are in your eyes,
in your retina, the back of youreye in your kidneys where
there's just tons and tons oflittle tiny blood vessels and
then in your nerves.
(24:44):
So the little blood vessels thataffect that serve nerves are
also small and susceptible.
So, so those are the threemicrovascular complications or
small blood vessels.
And for that reason, not onlybeing aggressive about
controlling diabetes, because weknow from very long time worn
studies that keeping diabetescontrolled really lowers the
(25:05):
risk of those developing thosethree complications.
Speaker 2 (25:07):
And that's blindness and kidney failure and
neuropathy.
Speaker 3 (25:11):
And with that, having your provider check your kidney
function and urine for anyproblems with your kidneys,
seeing an eye doctor once a yearand then having a regular once a
year foot exam, reviewing signsand symptoms of neuropathy or
numbness, tingling pain, thingslike that is important.
Speaker 2 (25:27):
And all of this is controllable.
You aren't destined to have allthese things, but it takes a
team.
And so I, I always encourage mypatients who are living with
diabetes to not only see me, butif need be, go see you and your
team in endocrine, but it's notjust the doctors tell us.
Talk to us about the team-basedcare in diabetes.
I'm specifically thinking aboutthe education team, but I know
(25:50):
you have a broad swath ofexpertise.
Speaker 3 (25:52):
Yeah, so for sure here in other places I've
worked, I think the, theteam-based approach is always
the best for sure.
And another part of that wouldbe that we have advanced
practice providers such as nursepractitioners and physician
assistants who also dospecialize in diabetes care.
So in addition to physicians orMDs, those are also people who
will be at the head of yourdiabetes team.
(26:14):
As far as certified diabeteseducators, these are usually
nurses, sometimes dieticians.
And they are really essentialbecause particularly at the time
of diagnosis, when somebody isfirst diagnosed with diabetes,
learning about all of thesecomponents, all of the things
that are involved, I meandiabetes is, it's a 24 hour a
day thing.
So it's kind of like youwouldn't not wanna get all of
(26:37):
the education that you can getto be able to live with and
thrive in the, with this thingthat that is gonna be with you
for 24 hours a day.
And the diabetes educators areessential for that.
The other thing I would say isthat all the ones that I work
with in clinic, what do they doat lunch?
They go out and walk.
So that group is,
Speaker 2 (26:55):
They're the ones walking around the campus or
around the block.
Speaker 3 (26:58):
They're always, they're always walking.
I mean they, first, first whatthey do is they all have lunch
together.
They all bring salads, so theyall mix up salad.
Speaker 2 (27:05):
Okay.
Do these guys ever like have apizza?
Speaker 3 (27:07):
Yeah, yeah, yeah, yeah.
For sure they do.
But I guess my my point aboutthis is that they are living,
they are like walking the walk,talking the talk.
And, and, and I say that becauseI think that their insight and
their commitment is really, isreally there.
Um, and, and they support eachother.
And that's the other part that Iwas gonna say is that none of
this happens in isolation.
You just have to be really incommunity to be doing this kind
(27:29):
of thing.
So they bring their salad, theymake a big salad together, and
then they go and walk for like40
Speaker 2 (27:33):
Minutes.
.
That is just amazing.
Speaker 3 (27:34):
It is amazing.
Yeah.
Speaker 2 (27:36):
That role modeling and support.
I love what you just said aboutsupporting each other because
people living with diabetes needus, need to have people
supported them just like you andyour team have that.
Um, in your clinic, before I letyou go, what one or two things
would you like to leave ourlisteners that they should
remember about diabetes?
Speaker 3 (27:53):
I think that if there are three things that you can do
to try to prevent gettingdiabetes or improve control of
your diabetes, if you have it,the three things I would say is
get 150 minutes of physicalactivity every week.
The second thing I would say isdo not drink your sugar.
And the third thing I would sayis be in community.
Because we know that when wefind a physical activity that we
(28:14):
like to do, if it's walking withyour friend or if it's playing
pickleball,
Speaker 2 (28:18):
We're of a certain age, we're at the pickleball.
So playing age, but
Speaker 3 (28:20):
Young people are playing it now too.
Oh gosh.
There's lots of evidence thateven if you are a solitary
exerciser, that just doingthings in community with other
people is better for our healthand that includes diabetes.
And I think a lot of that comeswith just the support, the
acknowledgement that, you know,we're just not in this alone.
And plus it's all just more fun,you know, to do things together
with people.
And so I think those are mythree main takeaways.
(28:43):
Those
Speaker 2 (28:43):
Are great takeaway tips, lots of great information
on a complicated and importanttopic.
Thank you for being here, Laura.
You're welcome.
We've been talking with Dr.
Laura Lafa, the director ofendocrinology here at Hennepin
Healthcare in downtownMinneapolis.
And we've been talking about theworld of diabetes listeners, I
hope you've picked up a thing ortwo that you didn't know before.
On our next episode, we're gonnaspecifically talk about weight
(29:05):
management with Dr.
Aisha Galloway Gilliam.
It's gonna be a great episodeand I hope you'll join us.
In the meantime, be healthy andbe well.
Speaker 1 (29:13):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
If you enjoy the show, pleaseleave us a review and share the
show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
(29:36):
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:21):
Hey everybody, it's Dr.
David Hilden, and this isepisode 10 of the podcast.
And today we are talking aboutdiabetes.
What is it?
What causes it?
What are the symptoms?
What can be done about it?
Tell me out.
I've invited Dr.
Laurel LaFave.
Dr.
LaFave is the director of thedivision of Endocrinology here
at Hennepin Healthcare with mein downtown Minneapolis.
We trained together a couplethree years ago, or maybe a few
(00:44):
more than that, and now she isleading that division.
Laura, thanks for being on theshow.
Speaker 3 (00:48):
Thanks for having me, Dave.
Speaker 2 (00:49):
So let's talk about diabetes.
If we could.
First of all, some definitions.
What, what is diabetes?
Speaker 3 (00:56):
Diabetes is a state of having too much sugar in your
bloodstream.
And the reason that that happensis because something is often
the balance of the physiology inyour body.
So carbohydrates or sugar thatgo into your body through food
or from stored places like inyour liver, will exit the liver
or, or come in through the thegut and the, and get into the
(01:16):
bloodstream.
And diabetes is the state of nothaving adequate mobilization of
that sugar into the muscles andcells where it belongs to power
your body.
Speaker 2 (01:27):
Yep.
Before I even get into morediabetes mellitus, I think means
something along the lines ofsweet urine or something like
that.
Is that true?
Speaker 3 (01:33):
Correct.
So when you have too much sugarin your bloodstream, one of the
ways it tries to get out isthrough your urine.
And so back in the days before,we had adequate ways to test
blood sugar.
Doctors would actually diagnoseit by tasting a patient's urine.
Speaker 2 (01:47):
Do you still teach that?
We do.
Is that
Speaker 3 (01:48):
What you do?
We do not.
Speaker 2 (01:49):
They really did that.
They l and it was if it wassweet, yeah.
Diabetes.
Correct.
Oh my goodness.
Okay.
Back to some definitions.
Type one versus type two.
Are they the same thing or arethey different?
Speaker 3 (02:03):
They're not the same thing, although there tends to
be a little bit of overlap.
Okay.
Type one diabetes is what weused to call juvenile onset
diabetes because it's, you getit when you're a kid mostly.
And the problem that leads totype one diabetes is really a
destruction of the pancreas,which is the organ, the gland
kind of right in the middle ofyour belly that produces
(02:25):
insulin.
And insulin is the hormone thatis essential for getting that
sugar into the places it needsto be.
So when people have type onediabetes, what happens is that
they have a destruction of partof that gland, the pancreas that
produces insulin.
And so they no longer produceany insulin at all.
Speaker 2 (02:42):
And we need insulin for life.
Speaker 3 (02:44):
Absolutely.
Speaker 2 (02:45):
Even that sounds kind of weird to me.
So what you got a little extrasugar in your body?
Is it just that you can't storeit or something?
Speaker 3 (02:50):
Right.
So if you have too much sugar inyour body, not only do you then
your muscles and organs andcells actually get depleted
because sugar is basically thefuel for it.
So if it's not in the rightplace, your body, all your body
processes get weaker.
But also just having too muchsugar in the bloodstream and
kind of hitting up against bloodvessels, kidneys, eyes, nerves,
(03:14):
all these parts actually does alot of damage to those organs
and blood vessels.
And that causes further healthproblems that we see when people
have diabetes long term or notin a state of control that is
helpful for
Speaker 2 (03:28):
Them.
What about type two?
Speaker 3 (03:30):
So type two diabetes is by and large the most common
kind of diabetes.
So we mentioned type one, andthat is something that we see a
lot in our endocrine practice,but it's actually the very, very
rare kind of diabetes comparedto type two.
So type two is by and large,when you hear people talk about
diabetes, they're usuallytalking about type two diabetes.
Type two diabetes starts withmore of a problem where a body
(03:53):
becomes less receptive toinsulin.
So a person with type twodiabetes makes insulin, but
their body does not recognize orreceive it well.
And so they typically, not allthe time, but typically have a
state of what we call insulinresistance.
So their pancreas is churningout insulin to try to keep the
sugar in the right place, but itjust can't keep up with it.
(04:15):
So as a person who has an, anunderlying insulin resistance as
they get maybe older orsometimes heavier or just are on
different medicines or thingslike that, or maybe they're less
active, their body in trying tokeep up with producing enough
insulin to overcome this issue,eventually the pancreas may kind
of poop out and not make enoughinsulin.
(04:37):
And that's when the balance tipsand the blood sugar goes up
despite the fact that the body'sstill producing a fair amount of
insulin.
Speaker 2 (04:44):
So a few more definitions.
You've used the terms, uh, sofar, carbohydrates, glucose,
sugar, and, and I use sugars allthe time.
I talk about patients abouttheir blood sugars.
Many people I've been told when,when you say sugar, I think of,
you know, the teaspoon of sugaror sugar cube that you put in
your coffee.
That's sugar.
I don't need any sugar.
What is, what is sugar versusglucose versus a carbohydrate?
Speaker 3 (05:06):
I think it's a confusing point because again,
the same thing, sugar is not,does not only come the form of
sugar or coke or you know, sodasand things like that.
Carbohydrates are amacronutrient.
So it's one of the big threethings that you get in your
food.
Carbohydrates, fats, proteins,carbohydrates are basically
turned into sugar in your body,different kinds of sugars.
(05:26):
And so when we think about sugarintake, it really extends to not
just sweet things, but starchyfoods.
So foods that are high in starchare high in carbohydrate.
So that includes for mostpeople, pastas, breads, rice,
crackers, chips, potatoes, corn.
So lots of foods that are veryhigh and carbohydrates are,
(05:48):
they're turned into sugar inyour body.
I should say.
Fruit also has a fair amount ofsugar in it, but that form of
sugar fructose that it, itbecomes, is less harmful to your
body
Speaker 2 (05:59):
Than the glucose that the others are turned into.
Correct.
Could you talk about riskfactors for developing diabetes
Now?
It sounds like there might besome genetic predisposition to
it, if you could comment on thatand also what puts people at
risk for developing type two
Speaker 3 (06:14):
Diabetes?
Yeah, so type two diabetes isjust so incredibly common in the
US now in I think 2019, the CDCc statistic was at 8.7% of all
adult Americans have diabetes.
A very, very small percentage ofthat is type one diabetes.
We know that there are somepretty clear risk factors for
developing diabetes, and one ofthem is a family history.
(06:36):
So, uh, you know, first degreerelatives with, uh, parent or
sibling with type two diabetesbeing from a high risk ethnic
group.
And so we do know that the, uh,rates of diabetes in Native
Americans, black Americans,Latinos, and non-Latino Asians
are all higher than innon-Latino white Americans
history of having hypertension,having heart disease, having
(06:58):
underlying hyperlipidemia, um,
Speaker 2 (07:00):
Cholesterol
Speaker 3 (07:01):
Problems, cholesterol, exactly.
For women having a history ofpolycystic ovarian syndrome,
which is a very, again, a commonkind of metabolic syndrome that
shows up in women ofreproductive age, um, and then
physical inactivity and thenbeing overweight or obese has,
uh, a higher risk as well.
Speaker 2 (07:18):
And these rates are all on the rise, aren't they?
That's you, you said about 8%,9%, that's one in 10 or 11
people have diabetes and thereis a connection with obesity and
being overweight.
Correct.
So that, and since those ratesare going up, I imagine diabetes
is, uh, also becoming a littlebit more prevalent.
I
Speaker 3 (07:34):
Think it's predicted that by 2040 we're gonna be at
about 20%
Speaker 2 (07:39):
Of American, of the population one in five.
Wow.
And in my primary care practice,you said it's roughly one in 10
people have diabetes, it'seasily one in three of my clinic
visits involve a patient who isliving with diabetes, even if
it's not the main reason they'rethere.
I would say a third of my clinicvisits have involve a patient
(07:59):
with diabetes.
Is this problem mostly in theUnited States or is this a
global phenomenon?
Speaker 3 (08:04):
It's a global phenomenon.
It's worse than the us but it'sa global phenomenon.
Speaker 2 (08:08):
Is it worse than the US because of our diet, of our,
of our prevalence of beingoverweight?
Or do we know?
I
Speaker 3 (08:14):
I think it's multifactorial.
Mm-hmm.
And I think when you look atpeople moving from other
countries with low rates ofdiabetes into the us, the rates
in those groups skyrockets.
So there's definitely somethingin the diet slash environment
slash culture slash somethinghere.
Speaker 2 (08:32):
Let's shift gears.
Let's talk a little bit aboutsymptoms.
When would somebody, um, knowthey have diabetes or, or maybe
another way to say that is, iswhat are some of the presenting
symptoms for someone who has notyet been diagnosed?
How do you know if you havediabetes?
Speaker 3 (08:45):
So the classic symptoms that diabetes presents
with are increased thirst.
So feeling thirsty all the time,increased urination, peeing more
often, blurry vision, weightloss and fatigue.
Other less typical things thatwe see is just craving sugar
craving.
People will say they just feltlike they couldn't get enough
soda or candy because they justhad this intense sugar craving.
(09:08):
Headaches, again, fatigue orlethargy or just not being able
to kind of participate in whatyou're doing.
It affects other hormones inyour body.
So you know, people won't sleepas well.
They will have things like lowlibido, low interest in things,
um, even association withdepression.
So
Speaker 2 (09:24):
That's a, a myriad of symptoms I've seen, uh, more
people that I can count over mycareer that did show up with,
I'm urinating more and I'mthirsty and maybe have blurry
vision.
So those are the folks that havesome symptoms that are pretty
attributable to diabetes andwe'll obviously we'll go test
you right away.
Uh, I wanna kind of shift intowhat is the diagnostic plan?
Do we screen people and if sowhen?
(09:44):
And talk about that if you
Speaker 3 (09:46):
Could.
I'm glad you asked that becausewhen people are diagnosed with
diabetes, they usually onaverage have had diabetes for
about five years.
Mm.
As many people as we'rediagnosing with diabetes, we're
missing a lot
Speaker 2 (09:56):
And we're catching'em five years too
Speaker 3 (09:58):
Late.
Right.
And part of the reason is thatpeople probably don't have
symptoms for years when they'reobviously when they're
developing it.
And, and that might have a lotto do as well with things like
access to care and thelikelihood of seeing healthcare
providers at that point.
As far as screening fordiabetes, the general
recommendation is to screenadults who have risk.
(10:19):
So the risk factors that Imentioned before, if you have
one of those risk factors, youshould let your healthcare
provider know.
If you don't have any of those,you should start being screened
at age 35.
Speaker 2 (10:30):
So how is it diagnosed?
Speaker 3 (10:31):
It can be diagnosed three different ways.
One way is with a screening testcalled a hemoglobin a1c.
This is a blood test that doesnot require fasting.
It measures a person's averageblood sugar over the previous
three months.
So it's a lab test that we usewhen we are monitoring a
person's diabetes control and wehave targets for that, but it
(10:52):
can be used for diagnosis.
The second way is to get afasting blood glucose or sugar
level that requires an eight to10 hour fast, which is a good
reason to maybe go in fastingwhen you see your doctor.
It's a
Speaker 2 (11:04):
Good idea.
Get a morning appointment.
Speaker 3 (11:06):
Get a morning appointment.
That's right
And the third way is veryinconvenient.
We used to do these a lot, whichwas an oral glucose tolerance
test and that's where you comein and you drink 75 grams of
glucose, which is basically kindof like slamming two cans of
Coca-Cola and then you measurethe blood sugar two hours after
that.
Speaker 2 (11:22):
So those are the diagnosis.
We're gonna take a quick break.
We've covered a lot of groundhere, but when we come back from
the break, we're gonna talk moreabout diabetes including
treatments, outcomes,complications, and Dr.
LaFave, three tips for all ofyou.
Stay with us.
We'll be right back.
Speaker 1 (11:37):
You are listening to the Healthy Matters podcast with
Dr.
David Hedon.
You got a question or commentfor the doc?
Email us at healthy matters hc me d.org or give us a call at six
one two eight seven three talk.
That's 6 1 2 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (12:00):
And we're back talking about diabetes with Dr.
Laura Lafe.
So Laura, people living withdiabetes are so used to sticking
their finger and havingglucometers and keeping checking
their blood sugars.
Could you comment a little bitabout, first of all, why do
people need to check their bloodsugars and what are some of the
techniques they can do that,including some of the more
advanced techniques?
Speaker 3 (12:21):
This is the thing that people with diabetes
probably like the least aboutliving with diabetes, right, is
having to monitor and know andwatch and react to what their
blood sugar is all the time.
And it's important to do itbecause how much insulin you
take might depend on what yourblood sugar is or perhaps you're
trying to restrict or reduceyour carbohydrates and you need
(12:44):
to know whether that's workingor not.
Uh, perhaps your provider putyou on a new medication and you
need to see if it's effective.
It's working and hopefully thediabetes educator has given you
some good goal blood sugars tobe looking for.
But again, this is an area wherewe have, it has just changed
tremendously in the last fiveyears.
There are now pretty broadlyavailable glucose sensors,
(13:04):
little devices that you insertin your upper arm and that can
be used to scan or directly goto a little meter or a phone.
So it has basically aviated theneed to stick the finger four or
five or six times a day to getblood to do that.
It's really becoming a standardof care to use these and to
(13:25):
prescribe these.
And insurances have kind of comealong and have started to cover
them much more broadly.
And the advantage is removinganother one of the barriers to
being able to be engaged withdiabetes and what your blood
sugar is.
It just, it just takes away onemore barrier.
Speaker 2 (13:40):
It's a game changer.
I wish all my patients were onthese continuous glucose
monitoring systems.
Wonderful, wonderful developmentin patients living with
diabetes.
Dr.
Lafe, tell us a little bit abouttreatments.
What is available?
Speaker 3 (13:52):
Well, there are certainly a lot more treatments
available than when I wastraining to do this 25 years
Speaker 2 (13:56):
Ago.
Oh my gosh.
You and I trained togetherroughly 25 years ago,
And there was metformin.
There were some drugs we barelyuse anymore called
Sulphonylureas and there wasinsulin and they were not even
as good as the insulins we havenow.
Talk us through
Speaker 3 (14:09):
It.
That's correct.
The story of diabetes treatmentis both wonderful and also
awful.
Um, and the reason I say that isbecause the ways that we now
have to treat diabetes are somuch more specifically
addressing the underlyingproblems with diabetes.
And they are so much more, themeds are so much more likely to
(14:30):
help other body systems, butthey are incredibly expensive.
Yeah,
Speaker 2 (14:34):
I just, I was, I think that's what you were gonna
say.
I am so frustrated by howexpensive these effective drugs
Speaker 3 (14:39):
Are.
The story locally, state andnationally has been insulin
prices, which I think werepossibly turned a corner on on
that area.
But you know, again, 25 yearsago there was just a, a very new
insulin called glargine insulin,which was just sort of a
revolutionary advance in the waythat people could administer
insulin once a day.
(14:59):
Very steady background insulin.
It was sort of really was
Speaker 2 (15:03):
Revolutionary, I remember when it came out.
Yep.
Speaker 3 (15:05):
And with time, the prices of that insulin as well
as other very good, excellentphysiologic insulins, insulins
that basically mimic the way ahuman body makes insulin, those
all became so much better.
But they also becameprohibitively expensive such
that people were rationinginsulin, they were going without
it and being at very high riskof being very severely ill and
(15:26):
dying.
So now there is a cap onMedicare Part D and now going to
be part B that a monthprescription of insulin should
not, will not exceed$35.
And the, the drug companies havesort of followed suit with that.
So the three main producers ofinsulin have gone ahead and
limited their prescription costsfor some of their kinds of
(15:46):
insulin now for privatelyinsured people as well.
So returning a big corner onaccessibility to very excellent
types of insulin
Speaker 2 (15:55):
Before you move on from insulin.
So type one diabetics, peoplewith type one diabetes require
insulin.
So that is nothing but good newsfor people living with type one
diabetes.
There are a number of otherdrugs now medications that are
highly effective for type twodiabetes that are still really
cost prohibitive.
Do you think the lower cost ofinsulin will lead us to
(16:18):
prescribing more insulin insteadof these other new medicines
that are so good?
Speaker 3 (16:23):
I think that's the reality
Speaker 2 (16:25):
Is that reality
Speaker 3 (16:25):
Insulin is the absolute essential medication
for people with type onediabetes, but it turns out that
about 30% of people who havetype two diabetes also take
insulin.
And yeah, I think the bigadvances that I'm concerned
about with the newer medicationsfor diabetes being so, so
expensive is that one of thekind of holy grails of, of
(16:45):
diabetes treatment is to try totreat the disease but also
prevent and treat thecomplications of the disease
because it's really, diabetes isterrible, but it's also the
complications of the diseasethat really tend to make people
sick and not feel good and notbe able to work and not be able
to enjoy their families andthings like that.
(17:06):
So the development ofmedications that have been shown
to not only treat the diabetesbut also protect the kidneys for
example, or protect the heartare very potent.
And so the idea that we couldtreat people in a way that gets
at all of these things is verypromising, but again, at a very
high cost.
(17:27):
So, and those medications are ingeneral many years away from
being generically produced,
Speaker 2 (17:32):
Et cetera.
Most of, if, if you happen to bea TV watcher, most of the
medications that are beingadvertised on TV and it says ask
your doctor if this is right foryou.
In general, those are all theexpensive medications that are
so wonderful but are socost-prohibitive.
So, um, that is, is a problemfor our policy makers and our
healthcare systems.
But I think it's the reality fora lot of people living with
(17:55):
diabetes.
Before I get off treatments,could you just say like the, the
basics of what people should beon now?
Like for instance, the firstthing people should be on
metformin,
Speaker 3 (18:03):
Correct?
It's still metformin.
Metformin is our old oldmedication.
It's been around for decades.
It's safe, it's very effective.
There's an association withactually lower risks of heart
disease, of cancer, of all kindsof things.
So metformin is still a mainstayof treatment for type two
diabetes and that might be theonly medicine that many people
(18:25):
need to control their diabetesalong with lifestyle changes if
they have some things to adjustin that area as well.
The second realm of treatmentused to be, as you mentioned,
sulfonylureas, which are alsopills.
And those are pills that helpthe body release more insulin on
its own.
We try to not use those as oftenbecause they do tend to cause a
(18:45):
lot of weight gain, whichdoesn't help diabetes and also
hypoglycemia or low bloodsugars, which is not safe.
They're also a little bitlimited when people have other
issues such as kidney problemsor when they're older patients,
there are class of medicinesthat are still, they still work
to lower blood sugar.
Beyond that, they don't havemuch benefit.
They really don't benefit otherorgan systems and they put
(19:07):
people at a little higher risk.
That being said, do we still usesulfonylureas?
We do.
We do.
And this gets into, you know,the idea that with other drugs
being very cost-prohibitive, ifthis is something that somebody
can afford, then it's going towork probably to control their
blood sugar.
Speaker 2 (19:23):
Right.
So listeners, if you're on glideor glimepiride or glipizide,
they're still okay.
They're still okay.
What about the new kids on the
Speaker 3 (19:30):
Block?
Yeah, the new kids on the blockone an an oral pill that has
become very widely prescribedand is quite good is a, a
category of medications calledSG l T two inhibitors.
Those are pills that get thebody to get rid of sugar by
through the urine.
So again, making the sweet urineeven sweeter.
Mm-hmm
These medicines are welltolerated.
(19:52):
They are very effective forprotecting the kidneys, which is
an issue with a lot of peoplewho have diabetes and also they
have now an indication toactually treat people who have
heart failure.
So this is one of those examplesof a medication that has
wide-reaching benefits to peopleis a fairly low risk medicine in
(20:14):
terms of its side effects andits serious consequences, not
without side effects, right?
Because no medication is without
Speaker 2 (20:20):
Those, it's easy to take.
It's just a pill.
Speaker 3 (20:21):
Just a pill.
Again, pretty expensive.
So still in the realm of, youknow, when it's covered with
good coverage, it's affordableand when it's not good coverage,
it's not, how
Speaker 2 (20:30):
About the one everyone's trying to get
nowadays cuz it causes weightloss?
Speaker 3 (20:34):
So I think you're talking about ozempic.
Speaker 2 (20:35):
I am
Speaker 3 (20:36):
Um, Ozempic is in a larger classof medications called the GLP
one agonist.
So this is where we're kind ofjumping from oral medicines to
injectable medicines.
So ozempic and its friends areinjected medicines that you
inject either once a day or oncea week.
It's a class of diabetesmedicines.
That's very interesting becauseit is also like insulin, it is
(20:57):
also a hormone, but it's adifferent hormone than insulin.
So it's, it's mimicking ahormone that comes from your,
your gut, your small intestine.
And it has some pretty favorableeffects on things like causing
you to feel full sooner, causingyour carbohydrates to be
absorbed more slowly and alsostimulating your own pancreas to
(21:18):
secrete or produce more insulin.
So it's got kind of athree-pronged way that it really
benefits people's blood sugarsbut they lose weight with it.
So with this class of medicines,it is now crossed over into
having some labeling for weightloss as well.
So not only for diabetes but for
Speaker 2 (21:34):
Weight loss.
Same drug, new name,
Speaker 3 (21:36):
Same drug, different doses, new name.
Yep.
Speaker 2 (21:38):
Yeah.
Mm-hmm.
they have to almost pharmacyshop to find it because it, it's
really effective.
But as you said, expensive.
So you talked about all of thosecarbohydrates and the starches
and the sugars in our diet, manypeople are trying a variety of
diets including some low carb,high protein diets, the
Mediterranean diet.
What is the effect if we see oneof the diet you eat on the risk
(22:01):
of developing diabetes,
Speaker 3 (22:02):
There is very good evidence that if you are able to
modify your diet, that you canprevent diabetes.
Those studies go back away acouple of decades where showing
that pretty significantlifestyle interventions prevent
people from developing diabetesor from progressing from what we
call pre-diabetes to diabetes.
This isn't funny, but I kind ofdo think we're, we all have
(22:24):
pre-diabetes because basicallywe all have capacity to have
diabetes someday.
So I think the category ofpre-diabetes is sort of a funny
one cuz I think, I think it sortof extends to
Speaker 2 (22:33):
Everybody.
Yeah, I think it, I think you'reabsolutely right on that.
Do also, does that extend topeople who are living with type
two bi diabetes and are carryinga little extra weight?
Does losing weight have aneffect on the diabetes you
already have?
Speaker 3 (22:46):
Absolutely.
So we know that control ofdiabetes improves and sometimes
resolves meaning maybe goes intoremission or you don't
Speaker 2 (22:55):
Use the word cure, but you're get, you're, you're
adjacent to the word cure.
Yeah.
Right,
Speaker 3 (22:58):
Right.
I'll avoid the, I'll avoid that.
The use of the word cure.
Uh, but certainly losing five to10% of body weight in a person
who has a higher body weight isdefinitely shown to improve
control and possibly pushdiabetes into remission.
Just to hop back to the low carbapproach, there have been many
different trendy diets that havecome up over the years, kind of
(23:20):
going back to like the Atkinsdiet or the South Beach diet.
I think maybe back in theeighties where people really
restricted carbohydrates andbrought the level or the percent
of carbohydrate in their dietvery, very low or even to zero.
There is not terrific evidenceto show that that will keep
diabetes at bay forever.
(23:41):
My counsel to patients is tomake smaller changes that you,
you can live with for the restof your life.
And so going to a diet that iscompletely restrictive of all
carbohydrates, I think can leadto certainly some other health
issues.
And also it's simply in someways just not a sustainable diet
for most people.
The diet that has been the mostconsistently studied and
(24:04):
confirmed to be beneficial to arealm of different, uh, issues
including diabetes, is theMediterranean diet, which again
includes carbohydrates, it doesmm-hmm.
So it just includes healthycarbohydrates.
Speaker 2 (24:15):
I wanna shift gears.
I wanna talk a little bit aboutthe complications of diabetes.
What are the potential problemsdown the road for people living
with it?
Speaker 3 (24:23):
Really the big three main complications are those
that affect tiny blood vessels.
So the tiniest blood vessels inyour body are the most
susceptible to the harm fromexcess amounts of sugar.
Thinking about that, the tiniestblood vessels are in your eyes,
in your retina, the back of youreye in your kidneys where
there's just tons and tons oflittle tiny blood vessels and
then in your nerves.
(24:44):
So the little blood vessels thataffect that serve nerves are
also small and susceptible.
So, so those are the threemicrovascular complications or
small blood vessels.
And for that reason, not onlybeing aggressive about
controlling diabetes, because weknow from very long time worn
studies that keeping diabetescontrolled really lowers the
(25:05):
risk of those developing thosethree complications.
Speaker 2 (25:07):
And that's blindness and kidney failure and
neuropathy.
Speaker 3 (25:11):
And with that, having your provider check your kidney
function and urine for anyproblems with your kidneys,
seeing an eye doctor once a yearand then having a regular once a
year foot exam, reviewing signsand symptoms of neuropathy or
numbness, tingling pain, thingslike that is important.
Speaker 2 (25:27):
And all of this is controllable.
You aren't destined to have allthese things, but it takes a
team.
And so I, I always encourage mypatients who are living with
diabetes to not only see me, butif need be, go see you and your
team in endocrine, but it's notjust the doctors tell us.
Talk to us about the team-basedcare in diabetes.
I'm specifically thinking aboutthe education team, but I know
(25:50):
you have a broad swath ofexpertise.
Speaker 3 (25:52):
Yeah, so for sure here in other places I've
worked, I think the, theteam-based approach is always
the best for sure.
And another part of that wouldbe that we have advanced
practice providers such as nursepractitioners and physician
assistants who also dospecialize in diabetes care.
So in addition to physicians orMDs, those are also people who
will be at the head of yourdiabetes team.
(26:14):
As far as certified diabeteseducators, these are usually
nurses, sometimes dieticians.
And they are really essentialbecause particularly at the time
of diagnosis, when somebody isfirst diagnosed with diabetes,
learning about all of thesecomponents, all of the things
that are involved, I meandiabetes is, it's a 24 hour a
day thing.
So it's kind of like youwouldn't not wanna get all of
(26:37):
the education that you can getto be able to live with and
thrive in the, with this thingthat that is gonna be with you
for 24 hours a day.
And the diabetes educators areessential for that.
The other thing I would say isthat all the ones that I work
with in clinic, what do they doat lunch?
They go out and walk.
So that group is,
Speaker 2 (26:55):
They're the ones walking around the campus or
around the block.
Speaker 3 (26:58):
They're always, they're always walking.
I mean they, first, first whatthey do is they all have lunch
together.
They all bring salads, so theyall mix up salad.
Speaker 2 (27:05):
Okay.
Do these guys ever like have apizza?
Speaker 3 (27:07):
Yeah, yeah, yeah, yeah.
For sure they do
But I guess my my point aboutthis is that they are living,
they are like walking the walk,talking the talk.
And, and, and I say that becauseI think that their insight and
their commitment is really, isreally there.
Um, and, and they support eachother.
And that's the other part that Iwas gonna say is that none of
this happens in isolation.
You just have to be really incommunity to be doing this kind
(27:29):
of thing.
So they bring their salad, theymake a big salad together, and
then they go and walk for like40
Speaker 2 (27:33):
Minutes.
That is just amazing.
Speaker 3 (27:34):
It is amazing.
Yeah.
Speaker 2 (27:36):
That role modeling and support.
I love what you just said aboutsupporting each other because
people living with diabetes needus, need to have people
supported them just like you andyour team have that.
Um, in your clinic, before I letyou go, what one or two things
would you like to leave ourlisteners that they should
remember about diabetes?
Speaker 3 (27:53):
I think that if there are three things that you can do
to try to prevent gettingdiabetes or improve control of
your diabetes, if you have it,the three things I would say is
get 150 minutes of physicalactivity every week.
The second thing I would say isdo not drink your sugar.
And the third thing I would sayis be in community.
Because we know that when wefind a physical activity that we
(28:14):
like to do, if it's walking withyour friend or if it's playing
pickleball,
Speaker 2 (28:18):
We're of a certain age, we're at the pickleball.
So playing age, but
Speaker 3 (28:20):
Young people are playing it now too.
Oh gosh.
There's lots of evidence thateven if you are a solitary
exerciser, that just doingthings in community with other
people is better for our healthand that includes diabetes.
And I think a lot of that comeswith just the support, the
acknowledgement that, you know,we're just not in this alone.
And plus it's all just more fun,you know, to do things together
with people.
And so I think those are mythree main takeaways.
(28:43):
Those
Speaker 2 (28:43):
Are great takeaway tips, lots of great information
on a complicated and importanttopic.
Thank you for being here, Laura.
You're welcome.
We've been talking with Dr.
Laura Lafa, the director ofendocrinology here at Hennepin
Healthcare in downtownMinneapolis.
And we've been talking about theworld of diabetes listeners, I
hope you've picked up a thing ortwo that you didn't know before.
On our next episode, we're gonnaspecifically talk about weight
(29:05):
management with Dr.
Aisha Galloway Gilliam.
It's gonna be a great episodeand I hope you'll join us.
In the meantime, be healthy andbe well.
Speaker 1 (29:13):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
If you enjoy the show, pleaseleave us a review and share the
show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
(29:36):
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
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