July 20, 2025 • 32 mins
07/20/25
The Healthy Matters Podcast
S04_E20 - Sweet Talk: Decoding Diabetes
With Special Guest: Dr. Allison Estrada, MD
Think about this: 1 in every 10 Americans is living with Diabetes in one form or another. It's one of the most common chronic conditions today, and it's a condition that's often misunderstood and easily oversimplified. Diabetes isn’t just about sugar—it’s about science, lifestyle, and the small decisions that shape our health every day. But who's most at risk? Is it at all reversible? Can GLP1 drugs actually help? And is cream always a bad idea?
The truth is, it's a complicated subject since there are many types and origins of the condition, and on Episode 20, we'll untangle it with one of our top docs at Hennepin Healthcare - endocrinologist Dr. Allison Estrada. We'll dig in to how diabetes develops, what happens in the body, and why early detection and consistent management are essential. From diagnosis to treatment options and the latest help from the pharmacy - this is a great chance to get wise on a condition that's simply all too common in our society. We hope you'll join us!
Here's a great resource for more information:
https://www.cdc.gov/diabetes-prevention/index.html
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
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_03 (00:18):
Hey everybody, welcome to episode 20 of the
podcast here in season four.
I am David Hilden, your host,and today we're going to tackle
a topic that affects literallymillions of people, that being
diabetes.
So today we're going to unpackwhat diabetes actually is, how
it affects your body, who's atrisk, and what you can do to
(00:38):
manage it.
To help us do that, I'm joinedby an expert in diabetes, Dr.
Allison Estrada.
She is an endocrinologist, andI'm maybe going to ask her to
tell us what the heck that is.
I I kind of know, but it's maybehelpful to find out what that
is.
And being an endocrinologist,she's an expert on diabetes and
other conditions of the body.
Allie, welcome to the show.
SPEAKER_02 (00:58):
Thank you so much for having me.
I'm excited to be here.
SPEAKER_03 (01:00):
Can you explain briefly what is an
endocrinologist?
SPEAKER_02 (01:03):
Sure.
We are hormone doctors, and Ithink a lot of people think
hormones and maybe think kind ofthe sex hormones like estrogen,
testosterone.
We do deal with that too, butthere are a lot of hormones in
our body.
So we'll talk today a lot aboutinsulin, which is a hormone
involved in diabetes.
There are hormones that comefrom the pituitary gland,
adrenal gland, all sorts ofstuff.
Did you know
SPEAKER_03 (01:23):
you wanted to be a hormone doctor when you went to
med school?
I think most people said, Idon't even know what that
SPEAKER_02 (01:28):
is.
No, I did not.
But I found it and I loved it.
And here I am many years later,practicing as an
endocrinologist, a hormonedoctor.
SPEAKER_03 (01:35):
And I see tons of diabetes in my clinic as a
primary care doctor.
So it is a huge issue in ourpopulation.
You do it as a specialist.
So could you dig back into themost basics of diabetes and
explain to us what that is?
Yes.
SPEAKER_02 (01:49):
Diabetes is a condition in which your sugar
level in your blood is elevated.
And there are different reasonswhy this occurs, but it usually
has to do with your body notmaking enough insulin or not
being able to use that insulineffectively.
SPEAKER_03 (02:04):
So you said sugar.
Well, I don't eat sugar.
What do you mean by sugar?
SPEAKER_02 (02:08):
Another really good question.
So to give a little context, Ilike to talk about carbohydrates
and sugars and how our bodybreaks them down.
So anytime we eat somethingstarchy or something sweet, our
body breaks it down to the kindof most basic building blocks.
The biggest one I'd say isglucose.
And that's kind of what we callsugar.
Blood sugar is glucose in theblood.
(02:29):
And that flows through all ourbody and it's used as fuel.
But in order to get that fuel sowe can use it, we need insulin.
SPEAKER_03 (02:39):
So that's where insulin comes in.
And insulin's the hormone that Ithink a lot of people have heard
about.
But insulin isn't sugar.
Insulin is your body's responseto blood sugars.
SPEAKER_02 (02:48):
Exactly.
How does it work?
Exactly.
So I have a nice little analogythat I like to think of.
Insulin is a key to a door andreally to like a storage unit, I
say.
So if you think about you're inthe hallway, your blood sugar,
your sugar that's in the blood,you're in the hallway and you
want to get inside the cell.
That's where we can use thatfuel again.
So insulin is like the key thatopens up this door and allows
(03:11):
the glucose to go inside thecell.
And the glucose can then be usedas fuel right away.
It can burn that glucose and wecan get energy out of it.
So you've
SPEAKER_03 (03:22):
mentioned sugar, glucose, carbohydrates, starch.
So you and I might think of allthose things as basically
sugars.
But when people think of acarbohydrate, their spaghetti
noodle or their potato, they'renot thinking that's sugar.
SPEAKER_02 (03:36):
That's right.
Are those the same?
They essentially break down tothe same thing.
So when we're thinking abouttable sugar, for example, that
you might sprinkle on something,that is a combination of glucose
and sugar.
and another version of a sugarcalled fructose, which in the
body, we often just change it toglucose.
And things like potatoes orbreads or noodles are mostly
(03:57):
made up of glucose moleculesthat just all break down.
So all these things look verydifferent on your plate, but our
body breaks them down to thesame kind of basic thing.
SPEAKER_03 (04:06):
So we have to eat these things and your body deals
with it by insulin.
So let's talk about when thatdoesn't work.
So the normal human body makesinsulin so that you can unlock
the key to the storage.
And I love that.
That analogy, by the way.
What is diabetes, the diseasethen?
SPEAKER_02 (04:22):
Yeah, so diabetes, again, is that either you don't
have the key to unlock the door,you don't produce it, or Or you
kind of think of it as likeresistance to that insulin.
So you need like four keysinstead of just one key to open
that door.
And if you can't open that door,the blood sugar just rises.
(04:44):
Those sugar levels go up and upand up in the bloodstream.
And that's when we can diagnosediabetes when the blood sugars
start to get high.
SPEAKER_03 (04:51):
So what?
So you got high blood sugars.
Is that a problem?
SPEAKER_02 (04:54):
It definitely can be a problem in the long run, yes.
So high blood sugars anduncontrolled diabetes are
associated with a lot ofdifferent health problems or bad
health outcomes, I would say.
The biggest things we thinkabout are our eye health, our
kidney health, and our nervehealth.
So you might have heard aboutpeople who develop blindness
(05:14):
from diabetes or kidney failureand have to be on dialysis or
people who have amputations.
Those can all be complicationsfrom these high levels of sugar
in the blood, really kind ofinjuring our blood vessels and
our different tissues in ourbody.
SPEAKER_03 (05:30):
There's all these types of diabetes, type 1, type
2, type 1 1⁄2, juvenile, adult.
There's all insulin dependence.
Could you break that down for
SPEAKER_02 (05:40):
us?
Yes, absolutely.
So kind of the simplest way tothink about type 1 diabetes is
that it is an autoimmunedisorder.
So your own body is attackingthe cells that make insulin.
And so people with type 1diabetes just really can't
produce insulin.
So they need to use insulin as amedication.
People with type 2 diabetesoften make quite a bit of
(06:02):
insulin.
But due to those other factorsthat I talked about, they have
more resistance.
They need more of that insulin,more of those keys.
And And so their body tries tocompensate and compensate by
making more and more and more,and they get to a kind of a
critical threshold where it justcan't keep up anymore, and your
blood sugars start rising.
And so that has more to do withresistance to the insulin.
SPEAKER_03 (06:21):
Insulin resistance.
So how common are these, the twoof them?
SPEAKER_02 (06:25):
Yeah.
In the United States, type 2diabetes is much more common.
Actually, about 10% of thepopulation, about 35 million
Americans roughly, have type 2diabetes as of the last kind of
big statistical count.
When it comes to type 1diabetes, it's about 1.8 million
or 0.5% of the population.
SPEAKER_03 (06:44):
So it's 10 times more common or 20 times more
common, type 2.
Exactly.
Why might that be?
SPEAKER_02 (06:50):
That's a really good question.
So there are a lot of riskfactors for type 2 diabetes.
Obesity is probably the biggestone.
As we as Americans are gainingmore weight, it becomes harder
for our body to, again, makeenough insulin.
We become more insulinresistant.
Genetics can play a part.
It actually, we see that type 2diabetes is a stronger genetic
(07:11):
disease than type 1 diabetes.
Age, as we age, we get a higherrisk of type 2 diabetes.
And then family history.
So we talked a but familyhistory, just thinking about if
you have a first-degreerelative, so that's a mom, dad,
brother, sister that hasdiabetes, you're two to three
times more likely than thegeneral population to develop
(07:32):
type 2 diabetes.
SPEAKER_03 (07:33):
I want to get more into risk factors and what
people can do to some of those.
You can't actually change, canyou?
But others, there are things youcan do.
Before I do that, we talkedabout type 1, small percentage
of people, but you don't makeinsulin.
We talked about type 2, insulinresistance.
Two other terms.
What is gestational diabetes andwhat is prediabetes?
SPEAKER_02 (07:52):
Yes.
So gestational diabetes is atype of diabetes that you can
develop during pregnancy.
So it really just affects womenand it typically occurs in the
second or third trimester.
And what's happening is that theplacenta is making a lot of
hormones that make our body moreinsulin resistant.
So it kind of is mimicking thistype 2 diabetes, but as soon as
(08:14):
the placenta is delivered, thenthat diabetes typically goes
away.
SPEAKER_03 (08:18):
Are they at higher risk for getting Type 2 diabetes
later?
SPEAKER_02 (08:21):
Yes, they are.
And it has to do with, again,placentas are going to make a
lot of extra hormones in everywoman, but not every woman
develops gestational diabetes.
So it is kind of this markerthat down the road there is a
higher risk because during thepregnancy they couldn't keep up
with that insulin production.
So down the road, even outsideof pregnancy, they might have
that risk as well.
SPEAKER_03 (08:40):
So here's a term that we didn't invent, but came
into practice pre-diabetes whileI've been practicing.
When I started out, we called itimpaired glucose tolerance.
That was 20-some years ago.
Somewhere along the lines, weused the word pre-diabetes.
And I think it was literallyjust to maybe raise more
awareness that, hey, you're atrisk for diabetes.
(09:02):
So what is pre-diabetes?
SPEAKER_02 (09:04):
I like to think of it all on a spectrum,
essentially.
And you're right, pre-diabetesis this condition where...
It's the same kind of underlyingdriving causes that bring us to
type 2 diabetes, but it's allbased on the numbers at which we
diagnose diabetes.
And people of prediabetes haveelevated blood sugars, but just
to a milder extent.
(09:26):
And it's important because itcan help us recognize who's at
risk for going on to developtype 2 diabetes.
And it can be a better time tointervene with lifestyle
measures and really be able toreverse that so you don't go
into type 2 diabetes.
SPEAKER_03 (09:42):
What do you recommend for people who don't
have diabetes to be tested thento see if they might have
prediabetes?
SPEAKER_02 (09:50):
Yeah, there's a lot of things that can increase your
risk of diabetes.
And so screening for diabetes isimportant.
We want to test and make sure ifthey have it, we can start
treating early.
And so people who are 35 yearsor older, people who have a
family history of diabetes,people who struggle with
overweight or obesity, people incertain ethnic backgrounds
(10:12):
should be screened earlierbecause, again, if we can
diagnose early, we can hopefullytry to reverse it.
SPEAKER_03 (10:17):
Just because it's more common in certain groups?
Exactly.
Who might it be more common in?
Yeah,
SPEAKER_02 (10:22):
so again, people who struggle with overweight or
obesity, when we think aboutethnicities, there is a high
risk of diabetes, type 2diabetes in people of Black,
Native American, PacificIslander, and Latino
populations.
You know, when we're thinkingabout percentages, you know,
white people have about an 8.5%risk of developing diabetes over
(10:48):
their lifetime.
But when we look at NativeAmericans, it's more like 16%.
So that's nearing double therisk over a lifetime.
So it's important to kind ofknow that and be able to Check
into it early.
SPEAKER_03 (10:59):
I'm glad you mentioned it.
We have to name healthdisparities so that we can do a
better job about that.
So I'm glad you named that.
Maybe you could talk to us aboutwhat are some of the short-term
bad things that can happen andthen what are some of the
long-term complications?
SPEAKER_02 (11:15):
So short-term, you can just feel crummy.
So when your blood sugars arehigh, you can have symptoms like
tiredness, feeling reallythirsty, having to pee a lot.
So those are kind of big signsthat if you're struggling with
that definitely see your doctor.
And in the short term, highblood sugars can also cause
things like increased risk ofinfection, increased risk for
(11:38):
hospital stays.
So we don't want that.
And like we talked aboutearlier, in the long run, when
you have blood sugar levels thatare high for many years.
Again, we get these risks ofdamaging the small nerves and
small arteries in the body thatleads to these symptoms like eye
problems, kidney problems, andnerve
SPEAKER_03 (11:58):
problems.
Do we know why that is?
I mean, at the nitty grittylevel, why does your little
nerves in your feet or in youreye, why do they get infected by
high blood sugars?
SPEAKER_02 (12:07):
It's a good question, but I kind of think of
it as like, you know, the mostvulnerable things in the body
sometimes are the smallestthings, right?
And in comparison to those smallnerves and small arteries, those
blood sugar molecules have aneasier time kind of affecting
the walls of those things, thecells of those things.
(12:28):
And the hard part is sometimesonce you get the damage, it
can't really be reversed.
So it's really important tocontrol the blood sugars to
prevent those complications fromhappening.
SPEAKER_03 (12:38):
So I want to ask you, how inevitable are those
complications for someone livingwith diabetes?
We'll talk about treatmentslater, but just Give us a
teaser.
Are those inevitable if you havediabetes?
SPEAKER_02 (12:48):
No, they're not.
We can definitely avoid those,again, with good blood sugar
control.
I will say I think there's somepeople who are more susceptible
for reasons that we don't alwaysunderstand.
But again, the more we cancontrol the blood sugars in the
long run...
the lower your risk of thesecomplications.
And that's why we have goals forour blood sugar management.
(13:11):
Many of you may have heard of atest called the hemoglobin A1c,
often just referred to as an A1ctest.
And, you know, in manypopulations, we try to get that
under 6.5 if, you know, they'renot really complicated or on a
lot of medicines because we knowthe risk of those complications
are going to be the very lowestif we can keep that number under
6.5.
SPEAKER_03 (13:31):
When we come back from a break, we're going to
talk more about that.
Who should be getting that testdone and then what you can do
about it to manage diabetes.
We're talking withendocrinologist Dr.
Ali Estrada all about diabetes.
And when we come back from thisshort break, we're going to talk
about some symptoms, how thedisease is diagnosed and
treated, as well as how you canpotentially avoid type 2
(13:52):
diabetes altogether.
So stay with us.
We'll be right back.
SPEAKER_01 (13:57):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(14:19):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou, and here for life.
Thank you so much.
SPEAKER_03 (14:35):
Ellie, we're going to talk now about symptoms,
diagnosis, and that kind ofstuff about diabetes.
So what symptoms might someonehave that would cause them to
think, oh, geez, this might bediabetes?
SPEAKER_02 (14:46):
So the symptoms that are the most common for diabetes
are actually feeling reallythirsty and peeing a lot.
And interestingly, it's becausewhen our sugars get high enough,
our kidneys have to kind of getrid of the sugar so that we pee
it out.
And when we pee out sugar, waterfollows it.
So we get diabetes.
And then we get thirsty, so wekeep drinking.
(15:07):
So if that's a symptom thatyou've been dealing with for a
while and you can't reallyfigure out why, it would be
definitely a good time.
Super
SPEAKER_03 (15:12):
thirsty, peeing a lot because there's sugar in
your urine.
Is it true or is this a myththat that's what diabetes
mellitus, that's the whole nameof it, diabetes mellitus, means
sweet urine?
SPEAKER_02 (15:22):
Sure it does, yep.
SPEAKER_03 (15:23):
Is it also true?
Do you know?
Did doctors used to, I don'tmean in our generation, but did
they used to taste the
SPEAKER_02 (15:29):
urine?
I think they did.
Like 100 years ago?
That's how they would figure itout.
You'd stick your finger in theurine?
SPEAKER_03 (15:35):
and taste it, and if it tasted sweet, that was how
you diagnosed diabetes.
Okay, folks, we don't do thatanymore.
Yeah, yuck.
So how do you diagnose it?
SPEAKER_02 (15:45):
Good question.
So I'd like to add to thatsymptom question.
Actually, most people who arediagnosed with diabetes don't
have any symptoms.
So that's not
SPEAKER_03 (15:52):
that common that you have the polyuria and polydipsia
are the medical terms for
SPEAKER_02 (15:56):
peeing a lot and
SPEAKER_03 (15:57):
thirsty.
And
SPEAKER_02 (15:58):
your blood sugars have to be fairly high, often
above 180.
And I know that's kind of seemsarbitrary for a lot of people,
but that's higher blood sugars.
So to diagnose it, either if youhave symptoms, we can start
testing then or again like wetalked about screening ahead of
symptoms developing we can getdifferent tests so the most
common we talked about is thehemoglobin a1c
SPEAKER_03 (16:18):
does it matter if you're fasting when you get that
test done
SPEAKER_02 (16:21):
that test does not require fasting again it's
looking at how much sugar isstuck to a red blood cell and a
red blood cell lives for threemonths so fasting or not fasting
is not going to have a hugeeffect on that test
SPEAKER_03 (16:32):
you guys are going to be great at bar trivia
everybody listening to thispodcast how long does a red
blood cell live in the humanbody three There you go.
You're going to get it right.
You're going to impress all yourfriends.
Okay, so that's one way.
SPEAKER_02 (16:43):
That's one way.
Another way is called a fastingblood sugar test.
So that one does requirefasting.
It's right there in the name.
And if your blood sugar is 126or higher, that's diagnostic of
diabetes.
The third test is one we don'tuse a whole lot just because it
takes a long time and is not themost fun, but it's called an
oral glucose tolerance test,OGTT.
(17:06):
And we essentially give you abig drink that has a lot of
sugar in it.
a standardized amount of sugar.
You drink it and we measure yourblood sugar at two hours
afterwards.
And if that blood sugar is over200, that is diagnostic of
diabetes.
SPEAKER_03 (17:18):
So I almost never do that anymore.
Maybe you in a specialtypractice, do you do that very
much?
SPEAKER_02 (17:23):
I almost never do it.
I've just done it a handful oftimes.
Pregnant women sometimes.
Pregnant women do need aspecialized version of that
test.
It can be a great test forpostpartum women after they
deliver if they've hadgestational diabetes because
it's a sooner way to evaluatetheir risk of diabetes than
waiting three months to do theA1C, but it's just a little bit
more cumbersome, so it's notused often.
SPEAKER_03 (17:44):
But the other two are simple, fasting blood
glucose or an A1C.
Exactly.
And that's how you'rediagnosing.
Okay, so you've been diagnosed.
You're in with your doctor, yourprimary care doctor.
Hopefully, you're getting to seea diabetes specialist like you.
So we're going to talk abouttreatments now.
So I'm going to start out with,I know the answers to these, but
I want you to help us out.
Is there just a cure fordiabetes to make it go away?
SPEAKER_02 (18:07):
So if you think of a cure as like a medic you can
take one time, kind of like anantibiotic that just cures the
situation, makes it go away.
No, there's not a cure.
But there are a lot ofinterventions that can reverse
diabetes.
It can essentially kind of makeit go away with time and work.
But again, there's not really amagic pill that will just make
it go away forever.
(18:27):
That
SPEAKER_03 (18:27):
was a great way to put it though.
But there are theseinterventions now.
So let's talk us through those.
SPEAKER_02 (18:31):
So I think the biggest way to start treating
diabetes is with lifestyleinterventions.
There's actually studies thatshow us that lifestyle
interventions, when done, aremore effective than some of the
medications.
So that's huge.
We have to remember that we havethe power to reverse diabetes.
Again, easier if we catch itearlier.
SPEAKER_03 (18:52):
So lifestyle modifications.
Do I watch more TV?
Do I travel more?
SPEAKER_02 (18:58):
I wish, no.
So changing our diet and ourexercise, are the two biggest
things.
And when it comes to diet,there's no one perfect way, but
I think a big thing that peopleneed to focus on is reducing
portions, particularly of thecarbohydrate-rich foods that we
talked about, the starchy foodsand the sweet foods.
(19:19):
Another huge thing is justtrying to cut back on really the
processed foods if possible,because those foods have a lot
of extra sugar, salt, fat addedto them.
And if we eat a lot of those orin excess, it can essentially
kind of overwhelm our system andmake it harder for us to kind of
process the more natural or kindof carb foods that we eat.
SPEAKER_03 (19:41):
So I think I might know the answer to this, but
what is your take on pop?
And folks, we originate inMinnesota.
The correct term is pop, butsome of you might know it as
soda or soft drinks.
What about those?
SPEAKER_02 (19:55):
I love
SPEAKER_03 (19:57):
Coke.
SPEAKER_02 (19:57):
I know.
They taste good, don't they?
But especially the regular typesof sodas or pops like Coca-Cola
or Pepsi or Mountain Dew have aton of sugar.
And so something to think aboutis, you know, one 20-ounce
bottle of Coke has about 65grams of sugar.
And I know a lot of people don'tnecessarily think about grams,
(20:20):
but that is like triple theamount of sugar you should have
in a day.
And you're getting it in thatway.
So trying to really cut that outis a huge thing.
The other thing that might behard for some people to hear is
juice because juice seems like,well, it's made from fruit.
It's healthy.
But really, it's just the sugarextracted from the fruit.
(20:44):
And when you drink it, it canraise those blood sugars really
fast.
And I say it's so much better tojust eat the fruit if you want
that, you know, something sweetthat's kind of fruitful Yeah, I
am
SPEAKER_03 (21:00):
never
SPEAKER_02 (21:16):
one to say people have to cut things out
completely.
But again, I think a huge thingthat people need to learn is
portion sizes and kind of whatis a healthy portion size of
certain foods.
And it's hard.
It's hard to know that.
I think in our society, wenormalize really big portions
and you see billboards or ads,like you say, just showing these
(21:36):
huge meals.
And that's really about theamount of food that someone
should eat in a whole day, muchless a meal.
So learning about that'simportant.
And there's a lot of ways tolearn about it.
I think a really easy trick thatpeople can start with is using
what we call the plate method.
It's essentially starting withyour plate and a filling half of
(21:56):
that with non-starchy vegetablesor fruit, filling one quarter of
that with whole graincarbohydrates or kind of whole
foods, potatoes, brown rice,quinoa, those kinds of things,
and pasta too.
And then a quarter of that beingkind of lean meats or proteins.
(22:16):
So things like chicken, turkey,fish, or non-meat things like
tofu or lentils, legumes, thingslike that.
SPEAKER_03 (22:25):
And that's such easy to visualize advice.
You know, half the plate'ssupposed to be good vegetables
and colorful things.
And many of us have that plateand you fill it with pasta and
then you put like four little...
broccoli things in there or aquarter, three spinach leaves.
So it's probably not the rightproportions.
SPEAKER_02 (22:46):
Right.
And it's hard.
Again, you go to a restaurantand you order pasta and that's
what it is.
It's a whole mountain of pasta.
And that's a lot of pasta.
So kind of thinking about tryingto keep it to a quarter of the
plate.
And hey, it's okay if you go outand like those things from time
to time.
Just save some for the next fewmeals.
I was
SPEAKER_03 (23:02):
at Target Field.
That's the place where theMinnesota Twins play just last
week.
And this sounds so judgmentalbecause I was eating all bad
stuff too.
But people are coming by with ahuman-sized helmet.
Plastic helmet filled withnachos and things.
It's like a regular head-sizedhelmet.
And like everybody had one.
I thought, oh my goodness,that's probably not your best
(23:22):
portion size.
Maybe when you go to theballgame, maybe not every other
day.
SPEAKER_02 (23:26):
Exactly.
And that's just what it's allabout.
It's about moderation, right?
SPEAKER_03 (23:30):
Okay, so you talked about diet.
You also mentioned exercise.
Does that have something to dowith it?
SPEAKER_02 (23:35):
Yes, it's huge because over time, our lives
have become a lot moresedentary.
And so we sit around a lot andare less active.
And so just by incorporating alittle bit of movement into your
day, you really can help reduceyour risk of diabetes.
I was reviewing a study recentlythat looked at walking.
And so if you walk just at avery calm, slow rate, you can
(23:57):
reduce your risk of diabetes by15%.
It goes up to about 25% if youdo a little bit more of kind of
a natural walk.
SPEAKER_03 (24:05):
That's a lot.
SPEAKER_02 (24:05):
Yeah.
And if you are walking likebriskly about like a 15 minute
mile, so like four miles perhour, essentially, you can
reduce your risk by 40%.
That's huge.
And so again, moving your body,we kind of have a blanket
recommendation for most peopletrying to move your body 30
minutes a day, cardio, maybefive days a week, strength
(24:27):
training, two days a week.
But I always tell people to juststart where you're at.
If you're not exercising it all,jumping into five days a week is
going to be really hard.
So set some small goals, maybesay two days a week, you're
exercising for 15 minutes.
And after a couple of weeks, goup to three days a week, 15
minutes, and just slowlyincrease until your body can do
those things without feelingexhausted.
SPEAKER_03 (24:48):
Really good advice.
Really good advice.
I'm going to briefly talk aboutmedications.
We're not going to talk aboutdoses and all of that, but there
are a number of medications.
Just do you prescribe?
SPEAKER_02 (25:04):
So like you said, there's a lot of medications now
and some of them are pills.
So people may be taking pillsonce or twice a day.
A very common one, like yousaid, is metformin.
There's lots of new injectiontype medications that actually
aren't insulin but can help ourbody better regulate the blood
sugars and our own insulinproduction.
So those
SPEAKER_03 (25:24):
are for people with type 2?
SPEAKER_02 (25:25):
Exactly, yes.
And then we have injections thatare insulin and those can be for
people with type 1 diabetes ortype 2 diabetes.
Because like we talked about,sometimes people with type 2
diabetes make their own insulin.
They just can't make quiteenough to control the blood
sugars.
And so using insulin issometimes something we have to
do.
A
SPEAKER_03 (25:44):
lot of the ads people might see on TV are for
some of these new ones thatyou're talking about.
I don't think they advertiseinsulin.
I've never seen that.
But the ones I'm controlling myA1C and I'm carrying my pancreas
around in a little purse, thoseare these newer class of
medicines.
Could you say a little bit moreabout those?
Because those are on people'sminds.
Who should be on those?
SPEAKER_02 (26:03):
Yeah.
So those are calledglucagon-like peptide 1 agonists
or GLP-1 medications.
And they actually mimic anotherhormone in our body called GLP-1
that does a lot of things tohelp stabilize blood sugars,
helps our body produce a littlebit more insulin to control the
blood sugars.
They're really helpful forpeople who not only struggle
(26:24):
with diabetes, type 2 diabetes,but also obesity because they've
been shown to help lose weightover time and do Doing that goes
on to further help the diabetesand that insulin resistance.
So they're really greatmedications.
They're not for everybodynecessarily, but they can be
super helpful to managediabetes.
SPEAKER_03 (26:43):
Yeah, I often tell my patients, you know, after
you've done medicine for awhile, sometimes new medications
are just what we call, well,just an addition, a me too one.
A new drug company comes up withbasically what you already had.
And so the newer ones aren'talways better.
These seem to be pretty good,these GLP-1s.
And for listeners, we never onthis podcast or in our hospital
(27:05):
endorse any specific brands.
But I want to use the wordsbecause you've maybe heard of
them.
It's semaglutide and itscousins, but they go under the
brand name Ozempic.
And for weight loss, we go justso you know what we're talking
about here, although we don'tendorse any specific brands.
So they're expensive and they'renot for everybody.
When do you go to medicationslike that in your patients?
(27:28):
When do you start talking aboutmaybe you need one of these new
non-insulin injectables?
SPEAKER_02 (27:32):
Interestingly, it's becoming more and more of like a
first or second line medication.
It's
SPEAKER_03 (27:36):
really moved up the list.
SPEAKER_02 (27:37):
It's moved up the list because they're so
effective.
They really are effective.
And people can sometimes be onjust this medication or this and
one other medication, whereaswithout it, they might need
three or four medications.
So it can be really effective.
Again, we use it for people whostruggle with their diabetes
control and weight.
Interestingly, a lot of thesemedications have actually been
(27:58):
shown to have heart protectionbenefit and kidney protection
benefit.
Newer studies are looking atrates of fatty liver
infiltration, and they'reshowing benefit for that too.
So we really do look at aperson's whole medical history
and try to kind of pick out if acertain medication is really
going to help with things beyondjust the type 2 diabetes.
SPEAKER_03 (28:19):
What about weight loss in and of itself,
regardless of whether you did itby eating different exercise?
Hopefully both.
Or whether you did it by one ofthese medications that has some
weight loss benefits.
How does weight loss affectdiabetes?
I mean, just...
Does losing weight help?
SPEAKER_02 (28:35):
Yes.
When it comes to insulinresistance, losing weight will
help, right?
So we talked about how in type 2diabetes, we have more of this
resistance.
It's often associated withweight.
So as our weight goes up, theinsulin resistance goes up.
So losing weight by any meanslike you talked about is
typically going to help reduceour insulin requirements and
(28:56):
therefore is going to help us bemore effective at controlling
our blood sugars.
SPEAKER_03 (29:00):
So there's only so many of you, Ellie.
There's only so manyendocrinologists in the world.
When do you recommend thatsomebody see a specialist like
yourself?
SPEAKER_02 (29:07):
I want to say primary care doctors are amazing
at managing type 2 diabetes,diagnosing that.
So I think for most people whohave type 2 diabetes, especially
kind of in the earlier stages ormaybe requiring one or two
medications, it's totally fineto see your primary care doctor.
They're going to do a great job.
People who have type 1 diabetes,I really do recommend see an
(29:29):
endocrinologist.
People who have type 2 diabeteswho it's just really hard to or
they're on lots of medicationsor particularly insulin.
Again, not everybody on insulinneeds to see an endocrinologist,
but if you're on insulin andstill having a really hard time
controlling those blood sugars,I'd say at least getting it
stabilized with anendocrinologist is a good idea.
SPEAKER_03 (29:49):
Well, I have a lot of diabetes patients and many of
them are complicated.
So I really appreciate having anendocrinology office just down
the hallway from me.
We are happy to be there.
Ellie, before I let you go, whatwould you leave listeners with?
Because I'm actually quitehopeful about diabetes.
It's on the rise.
There's lots of people with it,but we have a lot more than we
did 10 years ago.
What message would you leave ourlisteners?
SPEAKER_02 (30:11):
I think that type 2 diabetes in particular is a
disease that we can fight withknowledge.
The more you know about how tobetter take care of your body,
the more we can prevent it, wecan treat it, we can reverse it
like we talked about.
And again, sometimes it gets toa point where no matter if
you're doing all the rightthings, it's hard to reverse it,
(30:31):
but you've got people here tohelp.
We've got great medicationsthere's new stuff coming out all
the time it's hard to keep upwith it and so you know just
getting seen by your primarycare doctor early to go through
those screening tests to learn Ialways say please be open to
learning because it's like afull-time job learning about
diabetes and so be patient withyourself but keep learning
(30:53):
because there's always more tolearn
SPEAKER_03 (30:55):
that's great tips about one of the most massively
important medical conditionswe'll talk about on this podcast
so Ellie thank you for beinghere
SPEAKER_02 (31:02):
thank you for having me
SPEAKER_03 (31:03):
we've been talking with Dr.
Dr.
Allison Estrada, she is anendocrinologist right here at
Hennepin Healthcare.
And listeners, if you need moreinformation, we could perhaps
put some links in the show notesto some resources for you.
And I want to thank you fortuning in, and I hope you'll
join us in two weeks' time forour next episode.
And in the meantime, be healthyand be well.
SPEAKER_00 (31:22):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(31:43):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program, and every case isunique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(32:05):
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_03 (00:18):
Hey everybody, welcome to episode 20 of the
podcast here in season four.
I am David Hilden, your host,and today we're going to tackle
a topic that affects literallymillions of people, that being
diabetes.
So today we're going to unpackwhat diabetes actually is, how
it affects your body, who's atrisk, and what you can do to
(00:38):
manage it.
To help us do that, I'm joinedby an expert in diabetes, Dr.
Allison Estrada.
She is an endocrinologist, andI'm maybe going to ask her to
tell us what the heck that is.
I I kind of know, but it's maybehelpful to find out what that
is.
And being an endocrinologist,she's an expert on diabetes and
other conditions of the body.
Allie, welcome to the show.
SPEAKER_02 (00:58):
Thank you so much for having me.
I'm excited to be here.
SPEAKER_03 (01:00):
Can you explain briefly what is an
endocrinologist?
SPEAKER_02 (01:03):
Sure.
We are hormone doctors, and Ithink a lot of people think
hormones and maybe think kind ofthe sex hormones like estrogen,
testosterone.
We do deal with that too, butthere are a lot of hormones in
our body.
So we'll talk today a lot aboutinsulin, which is a hormone
involved in diabetes.
There are hormones that comefrom the pituitary gland,
adrenal gland, all sorts ofstuff.
Did you know
SPEAKER_03 (01:23):
you wanted to be a hormone doctor when you went to
med school?
I think most people said, Idon't even know what that
SPEAKER_02 (01:28):
is.
No, I did not.
But I found it and I loved it.
And here I am many years later,practicing as an
endocrinologist, a hormonedoctor.
SPEAKER_03 (01:35):
And I see tons of diabetes in my clinic as a
primary care doctor.
So it is a huge issue in ourpopulation.
You do it as a specialist.
So could you dig back into themost basics of diabetes and
explain to us what that is?
Yes.
SPEAKER_02 (01:49):
Diabetes is a condition in which your sugar
level in your blood is elevated.
And there are different reasonswhy this occurs, but it usually
has to do with your body notmaking enough insulin or not
being able to use that insulineffectively.
SPEAKER_03 (02:04):
So you said sugar.
Well, I don't eat sugar.
What do you mean by sugar?
SPEAKER_02 (02:08):
Another really good question.
So to give a little context, Ilike to talk about carbohydrates
and sugars and how our bodybreaks them down.
So anytime we eat somethingstarchy or something sweet, our
body breaks it down to the kindof most basic building blocks.
The biggest one I'd say isglucose.
And that's kind of what we callsugar.
Blood sugar is glucose in theblood.
(02:29):
And that flows through all ourbody and it's used as fuel.
But in order to get that fuel sowe can use it, we need insulin.
SPEAKER_03 (02:39):
So that's where insulin comes in.
And insulin's the hormone that Ithink a lot of people have heard
about.
But insulin isn't sugar.
Insulin is your body's responseto blood sugars.
SPEAKER_02 (02:48):
Exactly.
How does it work?
Exactly.
So I have a nice little analogythat I like to think of.
Insulin is a key to a door andreally to like a storage unit, I
say.
So if you think about you're inthe hallway, your blood sugar,
your sugar that's in the blood,you're in the hallway and you
want to get inside the cell.
That's where we can use thatfuel again.
So insulin is like the key thatopens up this door and allows
(03:11):
the glucose to go inside thecell.
And the glucose can then be usedas fuel right away.
It can burn that glucose and wecan get energy out of it.
So you've
SPEAKER_03 (03:22):
mentioned sugar, glucose, carbohydrates, starch.
So you and I might think of allthose things as basically
sugars.
But when people think of acarbohydrate, their spaghetti
noodle or their potato, they'renot thinking that's sugar.
SPEAKER_02 (03:36):
That's right.
Are those the same?
They essentially break down tothe same thing.
So when we're thinking abouttable sugar, for example, that
you might sprinkle on something,that is a combination of glucose
and sugar.
and another version of a sugarcalled fructose, which in the
body, we often just change it toglucose.
And things like potatoes orbreads or noodles are mostly
(03:57):
made up of glucose moleculesthat just all break down.
So all these things look verydifferent on your plate, but our
body breaks them down to thesame kind of basic thing.
SPEAKER_03 (04:06):
So we have to eat these things and your body deals
with it by insulin.
So let's talk about when thatdoesn't work.
So the normal human body makesinsulin so that you can unlock
the key to the storage.
And I love that.
That analogy, by the way.
What is diabetes, the diseasethen?
SPEAKER_02 (04:22):
Yeah, so diabetes, again, is that either you don't
have the key to unlock the door,you don't produce it, or Or you
kind of think of it as likeresistance to that insulin.
So you need like four keysinstead of just one key to open
that door.
And if you can't open that door,the blood sugar just rises.
(04:44):
Those sugar levels go up and upand up in the bloodstream.
And that's when we can diagnosediabetes when the blood sugars
start to get high.
SPEAKER_03 (04:51):
So what?
So you got high blood sugars.
Is that a problem?
SPEAKER_02 (04:54):
It definitely can be a problem in the long run, yes.
So high blood sugars anduncontrolled diabetes are
associated with a lot ofdifferent health problems or bad
health outcomes, I would say.
The biggest things we thinkabout are our eye health, our
kidney health, and our nervehealth.
So you might have heard aboutpeople who develop blindness
(05:14):
from diabetes or kidney failureand have to be on dialysis or
people who have amputations.
Those can all be complicationsfrom these high levels of sugar
in the blood, really kind ofinjuring our blood vessels and
our different tissues in ourbody.
SPEAKER_03 (05:30):
There's all these types of diabetes, type 1, type
2, type 1 1⁄2, juvenile, adult.
There's all insulin dependence.
Could you break that down for
SPEAKER_02 (05:40):
us?
Yes, absolutely.
So kind of the simplest way tothink about type 1 diabetes is
that it is an autoimmunedisorder.
So your own body is attackingthe cells that make insulin.
And so people with type 1diabetes just really can't
produce insulin.
So they need to use insulin as amedication.
People with type 2 diabetesoften make quite a bit of
(06:02):
insulin.
But due to those other factorsthat I talked about, they have
more resistance.
They need more of that insulin,more of those keys.
And And so their body tries tocompensate and compensate by
making more and more and more,and they get to a kind of a
critical threshold where it justcan't keep up anymore, and your
blood sugars start rising.
And so that has more to do withresistance to the insulin.
SPEAKER_03 (06:21):
Insulin resistance.
So how common are these, the twoof them?
SPEAKER_02 (06:25):
Yeah.
In the United States, type 2diabetes is much more common.
Actually, about 10% of thepopulation, about 35 million
Americans roughly, have type 2diabetes as of the last kind of
big statistical count.
When it comes to type 1diabetes, it's about 1.8 million
or 0.5% of the population.
SPEAKER_03 (06:44):
So it's 10 times more common or 20 times more
common, type 2.
Exactly.
Why might that be?
SPEAKER_02 (06:50):
That's a really good question.
So there are a lot of riskfactors for type 2 diabetes.
Obesity is probably the biggestone.
As we as Americans are gainingmore weight, it becomes harder
for our body to, again, makeenough insulin.
We become more insulinresistant.
Genetics can play a part.
It actually, we see that type 2diabetes is a stronger genetic
(07:11):
disease than type 1 diabetes.
Age, as we age, we get a higherrisk of type 2 diabetes.
And then family history.
So we talked a but familyhistory, just thinking about if
you have a first-degreerelative, so that's a mom, dad,
brother, sister that hasdiabetes, you're two to three
times more likely than thegeneral population to develop
(07:32):
type 2 diabetes.
SPEAKER_03 (07:33):
I want to get more into risk factors and what
people can do to some of those.
You can't actually change, canyou?
But others, there are things youcan do.
Before I do that, we talkedabout type 1, small percentage
of people, but you don't makeinsulin.
We talked about type 2, insulinresistance.
Two other terms.
What is gestational diabetes andwhat is prediabetes?
SPEAKER_02 (07:52):
Yes.
So gestational diabetes is atype of diabetes that you can
develop during pregnancy.
So it really just affects womenand it typically occurs in the
second or third trimester.
And what's happening is that theplacenta is making a lot of
hormones that make our body moreinsulin resistant.
So it kind of is mimicking thistype 2 diabetes, but as soon as
(08:14):
the placenta is delivered, thenthat diabetes typically goes
away.
SPEAKER_03 (08:18):
Are they at higher risk for getting Type 2 diabetes
later?
SPEAKER_02 (08:21):
Yes, they are.
And it has to do with, again,placentas are going to make a
lot of extra hormones in everywoman, but not every woman
develops gestational diabetes.
So it is kind of this markerthat down the road there is a
higher risk because during thepregnancy they couldn't keep up
with that insulin production.
So down the road, even outsideof pregnancy, they might have
that risk as well.
SPEAKER_03 (08:40):
So here's a term that we didn't invent, but came
into practice pre-diabetes whileI've been practicing.
When I started out, we called itimpaired glucose tolerance.
That was 20-some years ago.
Somewhere along the lines, weused the word pre-diabetes.
And I think it was literallyjust to maybe raise more
awareness that, hey, you're atrisk for diabetes.
(09:02):
So what is pre-diabetes?
SPEAKER_02 (09:04):
I like to think of it all on a spectrum,
essentially.
And you're right, pre-diabetesis this condition where...
It's the same kind of underlyingdriving causes that bring us to
type 2 diabetes, but it's allbased on the numbers at which we
diagnose diabetes.
And people of prediabetes haveelevated blood sugars, but just
to a milder extent.
(09:26):
And it's important because itcan help us recognize who's at
risk for going on to developtype 2 diabetes.
And it can be a better time tointervene with lifestyle
measures and really be able toreverse that so you don't go
into type 2 diabetes.
SPEAKER_03 (09:42):
What do you recommend for people who don't
have diabetes to be tested thento see if they might have
prediabetes?
SPEAKER_02 (09:50):
Yeah, there's a lot of things that can increase your
risk of diabetes.
And so screening for diabetes isimportant.
We want to test and make sure ifthey have it, we can start
treating early.
And so people who are 35 yearsor older, people who have a
family history of diabetes,people who struggle with
overweight or obesity, people incertain ethnic backgrounds
(10:12):
should be screened earlierbecause, again, if we can
diagnose early, we can hopefullytry to reverse it.
SPEAKER_03 (10:17):
Just because it's more common in certain groups?
Exactly.
Who might it be more common in?
Yeah,
SPEAKER_02 (10:22):
so again, people who struggle with overweight or
obesity, when we think aboutethnicities, there is a high
risk of diabetes, type 2diabetes in people of Black,
Native American, PacificIslander, and Latino
populations.
You know, when we're thinkingabout percentages, you know,
white people have about an 8.5%risk of developing diabetes over
(10:48):
their lifetime.
But when we look at NativeAmericans, it's more like 16%.
So that's nearing double therisk over a lifetime.
So it's important to kind ofknow that and be able to Check
into it early.
SPEAKER_03 (10:59):
I'm glad you mentioned it.
We have to name healthdisparities so that we can do a
better job about that.
So I'm glad you named that.
Maybe you could talk to us aboutwhat are some of the short-term
bad things that can happen andthen what are some of the
long-term complications?
SPEAKER_02 (11:15):
So short-term, you can just feel crummy.
So when your blood sugars arehigh, you can have symptoms like
tiredness, feeling reallythirsty, having to pee a lot.
So those are kind of big signsthat if you're struggling with
that definitely see your doctor.
And in the short term, highblood sugars can also cause
things like increased risk ofinfection, increased risk for
(11:38):
hospital stays.
So we don't want that.
And like we talked aboutearlier, in the long run, when
you have blood sugar levels thatare high for many years.
Again, we get these risks ofdamaging the small nerves and
small arteries in the body thatleads to these symptoms like eye
problems, kidney problems, andnerve
SPEAKER_03 (11:58):
problems.
Do we know why that is?
I mean, at the nitty grittylevel, why does your little
nerves in your feet or in youreye, why do they get infected by
high blood sugars?
SPEAKER_02 (12:07):
It's a good question, but I kind of think of
it as like, you know, the mostvulnerable things in the body
sometimes are the smallestthings, right?
And in comparison to those smallnerves and small arteries, those
blood sugar molecules have aneasier time kind of affecting
the walls of those things, thecells of those things.
(12:28):
And the hard part is sometimesonce you get the damage, it
can't really be reversed.
So it's really important tocontrol the blood sugars to
prevent those complications fromhappening.
SPEAKER_03 (12:38):
So I want to ask you, how inevitable are those
complications for someone livingwith diabetes?
We'll talk about treatmentslater, but just Give us a
teaser.
Are those inevitable if you havediabetes?
SPEAKER_02 (12:48):
No, they're not.
We can definitely avoid those,again, with good blood sugar
control.
I will say I think there's somepeople who are more susceptible
for reasons that we don't alwaysunderstand.
But again, the more we cancontrol the blood sugars in the
long run...
the lower your risk of thesecomplications.
And that's why we have goals forour blood sugar management.
(13:11):
Many of you may have heard of atest called the hemoglobin A1c,
often just referred to as an A1ctest.
And, you know, in manypopulations, we try to get that
under 6.5 if, you know, they'renot really complicated or on a
lot of medicines because we knowthe risk of those complications
are going to be the very lowestif we can keep that number under
6.5.
SPEAKER_03 (13:31):
When we come back from a break, we're going to
talk more about that.
Who should be getting that testdone and then what you can do
about it to manage diabetes.
We're talking withendocrinologist Dr.
Ali Estrada all about diabetes.
And when we come back from thisshort break, we're going to talk
about some symptoms, how thedisease is diagnosed and
treated, as well as how you canpotentially avoid type 2
(13:52):
diabetes altogether.
So stay with us.
We'll be right back.
SPEAKER_01 (13:57):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(14:19):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou, and here for life.
Thank you so much.
SPEAKER_03 (14:35):
Ellie, we're going to talk now about symptoms,
diagnosis, and that kind ofstuff about diabetes.
So what symptoms might someonehave that would cause them to
think, oh, geez, this might bediabetes?
SPEAKER_02 (14:46):
So the symptoms that are the most common for diabetes
are actually feeling reallythirsty and peeing a lot.
And interestingly, it's becausewhen our sugars get high enough,
our kidneys have to kind of getrid of the sugar so that we pee
it out.
And when we pee out sugar, waterfollows it.
So we get diabetes.
And then we get thirsty, so wekeep drinking.
(15:07):
So if that's a symptom thatyou've been dealing with for a
while and you can't reallyfigure out why, it would be
definitely a good time.
Super
SPEAKER_03 (15:12):
thirsty, peeing a lot because there's sugar in
your urine.
Is it true or is this a myththat that's what diabetes
mellitus, that's the whole nameof it, diabetes mellitus, means
sweet urine?
SPEAKER_02 (15:22):
Sure it does, yep.
SPEAKER_03 (15:23):
Is it also true?
Do you know?
Did doctors used to, I don'tmean in our generation, but did
they used to taste the
SPEAKER_02 (15:29):
urine?
I think they did.
Like 100 years ago?
That's how they would figure itout.
You'd stick your finger in theurine?
SPEAKER_03 (15:35):
and taste it, and if it tasted sweet, that was how
you diagnosed diabetes.
Okay, folks, we don't do thatanymore.
Yeah, yuck.
So how do you diagnose it?
SPEAKER_02 (15:45):
Good question.
So I'd like to add to thatsymptom question.
Actually, most people who arediagnosed with diabetes don't
have any symptoms.
So that's not
SPEAKER_03 (15:52):
that common that you have the polyuria and polydipsia
are the medical terms for
SPEAKER_02 (15:56):
peeing a lot and
SPEAKER_03 (15:57):
thirsty.
And
SPEAKER_02 (15:58):
your blood sugars have to be fairly high, often
above 180.
And I know that's kind of seemsarbitrary for a lot of people,
but that's higher blood sugars.
So to diagnose it, either if youhave symptoms, we can start
testing then or again like wetalked about screening ahead of
symptoms developing we can getdifferent tests so the most
common we talked about is thehemoglobin a1c
SPEAKER_03 (16:18):
does it matter if you're fasting when you get that
test done
SPEAKER_02 (16:21):
that test does not require fasting again it's
looking at how much sugar isstuck to a red blood cell and a
red blood cell lives for threemonths so fasting or not fasting
is not going to have a hugeeffect on that test
SPEAKER_03 (16:32):
you guys are going to be great at bar trivia
everybody listening to thispodcast how long does a red
blood cell live in the humanbody three There you go.
You're going to get it right.
You're going to impress all yourfriends.
Okay, so that's one way.
SPEAKER_02 (16:43):
That's one way.
Another way is called a fastingblood sugar test.
So that one does requirefasting.
It's right there in the name.
And if your blood sugar is 126or higher, that's diagnostic of
diabetes.
The third test is one we don'tuse a whole lot just because it
takes a long time and is not themost fun, but it's called an
oral glucose tolerance test,OGTT.
(17:06):
And we essentially give you abig drink that has a lot of
sugar in it.
a standardized amount of sugar.
You drink it and we measure yourblood sugar at two hours
afterwards.
And if that blood sugar is over200, that is diagnostic of
diabetes.
SPEAKER_03 (17:18):
So I almost never do that anymore.
Maybe you in a specialtypractice, do you do that very
much?
SPEAKER_02 (17:23):
I almost never do it.
I've just done it a handful oftimes.
Pregnant women sometimes.
Pregnant women do need aspecialized version of that
test.
It can be a great test forpostpartum women after they
deliver if they've hadgestational diabetes because
it's a sooner way to evaluatetheir risk of diabetes than
waiting three months to do theA1C, but it's just a little bit
more cumbersome, so it's notused often.
SPEAKER_03 (17:44):
But the other two are simple, fasting blood
glucose or an A1C.
Exactly.
And that's how you'rediagnosing.
Okay, so you've been diagnosed.
You're in with your doctor, yourprimary care doctor.
Hopefully, you're getting to seea diabetes specialist like you.
So we're going to talk abouttreatments now.
So I'm going to start out with,I know the answers to these, but
I want you to help us out.
Is there just a cure fordiabetes to make it go away?
SPEAKER_02 (18:07):
So if you think of a cure as like a medic you can
take one time, kind of like anantibiotic that just cures the
situation, makes it go away.
No, there's not a cure.
But there are a lot ofinterventions that can reverse
diabetes.
It can essentially kind of makeit go away with time and work.
But again, there's not really amagic pill that will just make
it go away forever.
(18:27):
That
SPEAKER_03 (18:27):
was a great way to put it though.
But there are theseinterventions now.
So let's talk us through those.
SPEAKER_02 (18:31):
So I think the biggest way to start treating
diabetes is with lifestyleinterventions.
There's actually studies thatshow us that lifestyle
interventions, when done, aremore effective than some of the
medications.
So that's huge.
We have to remember that we havethe power to reverse diabetes.
Again, easier if we catch itearlier.
SPEAKER_03 (18:52):
So lifestyle modifications.
Do I watch more TV?
Do I travel more?
SPEAKER_02 (18:58):
I wish, no.
So changing our diet and ourexercise, are the two biggest
things.
And when it comes to diet,there's no one perfect way, but
I think a big thing that peopleneed to focus on is reducing
portions, particularly of thecarbohydrate-rich foods that we
talked about, the starchy foodsand the sweet foods.
(19:19):
Another huge thing is justtrying to cut back on really the
processed foods if possible,because those foods have a lot
of extra sugar, salt, fat addedto them.
And if we eat a lot of those orin excess, it can essentially
kind of overwhelm our system andmake it harder for us to kind of
process the more natural or kindof carb foods that we eat.
SPEAKER_03 (19:41):
So I think I might know the answer to this, but
what is your take on pop?
And folks, we originate inMinnesota.
The correct term is pop, butsome of you might know it as
soda or soft drinks.
What about those?
SPEAKER_02 (19:55):
I love
SPEAKER_03 (19:57):
Coke.
SPEAKER_02 (19:57):
I know.
They taste good, don't they?
But especially the regular typesof sodas or pops like Coca-Cola
or Pepsi or Mountain Dew have aton of sugar.
And so something to think aboutis, you know, one 20-ounce
bottle of Coke has about 65grams of sugar.
And I know a lot of people don'tnecessarily think about grams,
(20:20):
but that is like triple theamount of sugar you should have
in a day.
And you're getting it in thatway.
So trying to really cut that outis a huge thing.
The other thing that might behard for some people to hear is
juice because juice seems like,well, it's made from fruit.
It's healthy.
But really, it's just the sugarextracted from the fruit.
(20:44):
And when you drink it, it canraise those blood sugars really
fast.
And I say it's so much better tojust eat the fruit if you want
that, you know, something sweetthat's kind of fruitful Yeah, I
am
SPEAKER_03 (21:00):
never
SPEAKER_02 (21:16):
one to say people have to cut things out
completely.
But again, I think a huge thingthat people need to learn is
portion sizes and kind of whatis a healthy portion size of
certain foods.
And it's hard.
It's hard to know that.
I think in our society, wenormalize really big portions
and you see billboards or ads,like you say, just showing these
(21:36):
huge meals.
And that's really about theamount of food that someone
should eat in a whole day, muchless a meal.
So learning about that'simportant.
And there's a lot of ways tolearn about it.
I think a really easy trick thatpeople can start with is using
what we call the plate method.
It's essentially starting withyour plate and a filling half of
(21:56):
that with non-starchy vegetablesor fruit, filling one quarter of
that with whole graincarbohydrates or kind of whole
foods, potatoes, brown rice,quinoa, those kinds of things,
and pasta too.
And then a quarter of that beingkind of lean meats or proteins.
(22:16):
So things like chicken, turkey,fish, or non-meat things like
tofu or lentils, legumes, thingslike that.
SPEAKER_03 (22:25):
And that's such easy to visualize advice.
You know, half the plate'ssupposed to be good vegetables
and colorful things.
And many of us have that plateand you fill it with pasta and
then you put like four little...
broccoli things in there or aquarter, three spinach leaves.
So it's probably not the rightproportions.
SPEAKER_02 (22:46):
Right.
And it's hard.
Again, you go to a restaurantand you order pasta and that's
what it is.
It's a whole mountain of pasta.
And that's a lot of pasta.
So kind of thinking about tryingto keep it to a quarter of the
plate.
And hey, it's okay if you go outand like those things from time
to time.
Just save some for the next fewmeals.
I was
SPEAKER_03 (23:02):
at Target Field.
That's the place where theMinnesota Twins play just last
week.
And this sounds so judgmentalbecause I was eating all bad
stuff too.
But people are coming by with ahuman-sized helmet.
Plastic helmet filled withnachos and things.
It's like a regular head-sizedhelmet.
And like everybody had one.
I thought, oh my goodness,that's probably not your best
(23:22):
portion size.
Maybe when you go to theballgame, maybe not every other
day.
SPEAKER_02 (23:26):
Exactly.
And that's just what it's allabout.
It's about moderation, right?
SPEAKER_03 (23:30):
Okay, so you talked about diet.
You also mentioned exercise.
Does that have something to dowith it?
SPEAKER_02 (23:35):
Yes, it's huge because over time, our lives
have become a lot moresedentary.
And so we sit around a lot andare less active.
And so just by incorporating alittle bit of movement into your
day, you really can help reduceyour risk of diabetes.
I was reviewing a study recentlythat looked at walking.
And so if you walk just at avery calm, slow rate, you can
(23:57):
reduce your risk of diabetes by15%.
It goes up to about 25% if youdo a little bit more of kind of
a natural walk.
SPEAKER_03 (24:05):
That's a lot.
SPEAKER_02 (24:05):
Yeah.
And if you are walking likebriskly about like a 15 minute
mile, so like four miles perhour, essentially, you can
reduce your risk by 40%.
That's huge.
And so again, moving your body,we kind of have a blanket
recommendation for most peopletrying to move your body 30
minutes a day, cardio, maybefive days a week, strength
(24:27):
training, two days a week.
But I always tell people to juststart where you're at.
If you're not exercising it all,jumping into five days a week is
going to be really hard.
So set some small goals, maybesay two days a week, you're
exercising for 15 minutes.
And after a couple of weeks, goup to three days a week, 15
minutes, and just slowlyincrease until your body can do
those things without feelingexhausted.
SPEAKER_03 (24:48):
Really good advice.
Really good advice.
I'm going to briefly talk aboutmedications.
We're not going to talk aboutdoses and all of that, but there
are a number of medications.
Just do you prescribe?
SPEAKER_02 (25:04):
So like you said, there's a lot of medications now
and some of them are pills.
So people may be taking pillsonce or twice a day.
A very common one, like yousaid, is metformin.
There's lots of new injectiontype medications that actually
aren't insulin but can help ourbody better regulate the blood
sugars and our own insulinproduction.
So those
SPEAKER_03 (25:24):
are for people with type 2?
SPEAKER_02 (25:25):
Exactly, yes.
And then we have injections thatare insulin and those can be for
people with type 1 diabetes ortype 2 diabetes.
Because like we talked about,sometimes people with type 2
diabetes make their own insulin.
They just can't make quiteenough to control the blood
sugars.
And so using insulin issometimes something we have to
do.
A
SPEAKER_03 (25:44):
lot of the ads people might see on TV are for
some of these new ones thatyou're talking about.
I don't think they advertiseinsulin.
I've never seen that.
But the ones I'm controlling myA1C and I'm carrying my pancreas
around in a little purse, thoseare these newer class of
medicines.
Could you say a little bit moreabout those?
Because those are on people'sminds.
Who should be on those?
SPEAKER_02 (26:03):
Yeah.
So those are calledglucagon-like peptide 1 agonists
or GLP-1 medications.
And they actually mimic anotherhormone in our body called GLP-1
that does a lot of things tohelp stabilize blood sugars,
helps our body produce a littlebit more insulin to control the
blood sugars.
They're really helpful forpeople who not only struggle
(26:24):
with diabetes, type 2 diabetes,but also obesity because they've
been shown to help lose weightover time and do Doing that goes
on to further help the diabetesand that insulin resistance.
So they're really greatmedications.
They're not for everybodynecessarily, but they can be
super helpful to managediabetes.
SPEAKER_03 (26:43):
Yeah, I often tell my patients, you know, after
you've done medicine for awhile, sometimes new medications
are just what we call, well,just an addition, a me too one.
A new drug company comes up withbasically what you already had.
And so the newer ones aren'talways better.
These seem to be pretty good,these GLP-1s.
And for listeners, we never onthis podcast or in our hospital
(27:05):
endorse any specific brands.
But I want to use the wordsbecause you've maybe heard of
them.
It's semaglutide and itscousins, but they go under the
brand name Ozempic.
And for weight loss, we go justso you know what we're talking
about here, although we don'tendorse any specific brands.
So they're expensive and they'renot for everybody.
When do you go to medicationslike that in your patients?
(27:28):
When do you start talking aboutmaybe you need one of these new
non-insulin injectables?
SPEAKER_02 (27:32):
Interestingly, it's becoming more and more of like a
first or second line medication.
It's
SPEAKER_03 (27:36):
really moved up the list.
SPEAKER_02 (27:37):
It's moved up the list because they're so
effective.
They really are effective.
And people can sometimes be onjust this medication or this and
one other medication, whereaswithout it, they might need
three or four medications.
So it can be really effective.
Again, we use it for people whostruggle with their diabetes
control and weight.
Interestingly, a lot of thesemedications have actually been
(27:58):
shown to have heart protectionbenefit and kidney protection
benefit.
Newer studies are looking atrates of fatty liver
infiltration, and they'reshowing benefit for that too.
So we really do look at aperson's whole medical history
and try to kind of pick out if acertain medication is really
going to help with things beyondjust the type 2 diabetes.
SPEAKER_03 (28:19):
What about weight loss in and of itself,
regardless of whether you did itby eating different exercise?
Hopefully both.
Or whether you did it by one ofthese medications that has some
weight loss benefits.
How does weight loss affectdiabetes?
I mean, just...
Does losing weight help?
SPEAKER_02 (28:35):
Yes.
When it comes to insulinresistance, losing weight will
help, right?
So we talked about how in type 2diabetes, we have more of this
resistance.
It's often associated withweight.
So as our weight goes up, theinsulin resistance goes up.
So losing weight by any meanslike you talked about is
typically going to help reduceour insulin requirements and
(28:56):
therefore is going to help us bemore effective at controlling
our blood sugars.
SPEAKER_03 (29:00):
So there's only so many of you, Ellie.
There's only so manyendocrinologists in the world.
When do you recommend thatsomebody see a specialist like
yourself?
SPEAKER_02 (29:07):
I want to say primary care doctors are amazing
at managing type 2 diabetes,diagnosing that.
So I think for most people whohave type 2 diabetes, especially
kind of in the earlier stages ormaybe requiring one or two
medications, it's totally fineto see your primary care doctor.
They're going to do a great job.
People who have type 1 diabetes,I really do recommend see an
(29:29):
endocrinologist.
People who have type 2 diabeteswho it's just really hard to or
they're on lots of medicationsor particularly insulin.
Again, not everybody on insulinneeds to see an endocrinologist,
but if you're on insulin andstill having a really hard time
controlling those blood sugars,I'd say at least getting it
stabilized with anendocrinologist is a good idea.
SPEAKER_03 (29:49):
Well, I have a lot of diabetes patients and many of
them are complicated.
So I really appreciate having anendocrinology office just down
the hallway from me.
We are happy to be there.
Ellie, before I let you go, whatwould you leave listeners with?
Because I'm actually quitehopeful about diabetes.
It's on the rise.
There's lots of people with it,but we have a lot more than we
did 10 years ago.
What message would you leave ourlisteners?
SPEAKER_02 (30:11):
I think that type 2 diabetes in particular is a
disease that we can fight withknowledge.
The more you know about how tobetter take care of your body,
the more we can prevent it, wecan treat it, we can reverse it
like we talked about.
And again, sometimes it gets toa point where no matter if
you're doing all the rightthings, it's hard to reverse it,
(30:31):
but you've got people here tohelp.
We've got great medicationsthere's new stuff coming out all
the time it's hard to keep upwith it and so you know just
getting seen by your primarycare doctor early to go through
those screening tests to learn Ialways say please be open to
learning because it's like afull-time job learning about
diabetes and so be patient withyourself but keep learning
(30:53):
because there's always more tolearn
SPEAKER_03 (30:55):
that's great tips about one of the most massively
important medical conditionswe'll talk about on this podcast
so Ellie thank you for beinghere
SPEAKER_02 (31:02):
thank you for having me
SPEAKER_03 (31:03):
we've been talking with Dr.
Dr.
Allison Estrada, she is anendocrinologist right here at
Hennepin Healthcare.
And listeners, if you need moreinformation, we could perhaps
put some links in the show notesto some resources for you.
And I want to thank you fortuning in, and I hope you'll
join us in two weeks' time forour next episode.
And in the meantime, be healthyand be well.
SPEAKER_00 (31:22):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(31:43):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program, and every case isunique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(32:05):
Until next time, be healthy andbe well.
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