October 2, 2023 • 12 mins
Understanding diabetes and your risks for developing diabetes can be challenging and a little scary, especially when diabetes runs in your family. What's the difference between prediabetes, type 1 diabetes and type 2 diabetes? If people in my family have it, is it inevitable I will get it, too? How will I know if I have diabetes? Dr. K answers these questions and more in this episode of Q&A with Dr. K.
Additional resources for this episode:
Your primary care doctor!
https://diabetes.org/
https://www.mayoclinic.org/diseases-conditions/diabetes/
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Beth Brown (00:10):
Welcome to Q&A with Dr. K. A podcast by Mountain
Pacific Quality Health, where wesit down with Dr. Doug
Kuntzweiler and get your healthquestions answered. Because on
Q&A with Dr. K, the doctor isalways in.
(00:34):
Hello, everyone, this is BethBrown, your host and hello to
Dr. Consuela. Oh, always apleasure to get to talk with
you. And today we're going todive into our patient question,
which is about pre diabetes anddiabetes. So here's the
question. Diabetes runs in myfamily. My mom had it, my
grandmother had it, and mybrother currently has it. I have
tested in out of pre diabetesnumbers, but continue to try to
(00:56):
keep my blood sugar down withdiet and exercise. Sometimes,
though, I feel like this mightbe a lost cause. Is it
inevitable that I will getdiabetes at some point? So
there's the question. So just aquick stat for you here, Dr.
Kay, I read that diabetesaffects 415 million people
worldwide. And that's accordingto the Centers for Disease
Control and Prevention or theCDC. So let's first start what
(01:21):
is diabetes?
Dr. Doug Kuntzweiler (01:22):
Well, there are a couple of different
types. But in general, diabetesis failure of the body to
control its blood sugar, levelof sugar in the bloodstream.
There are actually a number ofdifferent types. The first type
that we usually think about iswhat we used to call juvenile
diabetes or type one. And theseare people who their their
(01:46):
pancreas just quits makinginsulin. Insulin is a hormone
that's made by the pancreasflipped around in our
bloodstream after we eat a meal.
And that helps sugar get intoour cells so that our cells can
use it as fuel with the sugarcan't get into those cells, and
the cells can't absorb it andthe sugar level in the
(02:07):
bloodstream just keeps mounting.
And that has a whole variety ofbad outcomes. That's the first
type is where you don't haveenough insulin. Type two
diabetes, which is actually muchmore common is where your
pancreas still makes sense onwhat your cells don't use it
very effectively, your cellsbecome somewhat resistant to
(02:31):
insulin, and the outcome is thesame blood sugar rises and flips
around and can't get used. Andthen there are a bunch of others
that are not as common asgestational diabetes, which is
elevated blood sugar only whenyou're pregnant. That usually
resolves after the baby is stillthere. There are some people who
(02:56):
are sort of somewhere in betweenthat they don't manufacture as
much insulin as they should, andtheir bodies are resistant to
it. Those are sort of in betweentype syndromes. But that's in a
nutshell, it's an elevated sugarfrom a variety of causes.
Beth Brown (03:13):
And so our patients question mentions pre diabetes,
where does that fall in inthere?
Dr. Doug Kuntzweiler (03:17):
Yeah, so pre diabetes. There are people
who are beginning to haveresistance to insulin and so
their blood sugar's beginning torise a little bit. There are
some markers that are used todetermine complete diabetes. And
(03:40):
that has to do with what yourfasting blood sugar is, in the
morning before you eat anything.
It has to do with a test calledhemoglobin a one C, which is
sugar is attracted to red bloodcells and will coach them. And
if you look at the red bloodcells and see how much sugar is
(04:00):
coated on them, it gives you anidea of what the average blood
sugar has been over the last fewweeks. And if that's elevated,
then that is diagnostic ofdiabetes. There's another test
called the glucose tolerancetest, where your provider will
give you a known amount of sugarand then two hours later, check
the sugar in your bloodstream.
(04:24):
And if everything's workingright, your pancreas will pick
out some insulin and sugar willgo into your blood cells and you
won't have an elevated level.
But if you have diabetes thatwill be elevated. So in pre
diabetes, all of these tests areslightly abnormal, not high
enough to diagnose difficultdiabetes, but high enough to be
worrisome and, and usually ifyou don't do something like diet
(04:47):
and exercise or sometimes evenmedication, you're going to go
on and develop and abuse so it'snot inevitable but you
definitely even inevitable atall. Type Two Diabetes
yours does tend to run infamilies, much more so than type
one. So I understand thequestion that, you know, my
(05:09):
whole family has, it looks likeI'm going to get it too. But,
you know, that's, that's good.
That's a warning sign. And whatwe know is that activity Trumps
genetic. So even though you mayhave the genetic background to
get it, if you eat a healthydiet, and you exercise
regularly, and you take care ofyourself, you don't necessarily
have to get diabetes.
Beth Brown (05:30):
Okay. So are there symptoms? Can people recognize
diabetes?
Dr. Doug Kuntzweiler (05:36):
Yes, or no type one, usually Yes, because
they don't have any insulin atall. And they usually get very
sick. And this typicallypresents at a young age school
age or early adulthood, butsometimes we'll see it later in
life. But those peoplebecause the sugar level is so
high, the kidneys have to getrid of it. And it takes water to
(05:57):
make urine. And so these peopleget very dehydrated. So they're
passing urine all the time,they're dying of thirst, they
get, you know, into a shockstate where they are so
dehydrated that they get very,very sick. That tends not to
happen so much and type twodiabetes has the same phenomenon
(06:19):
is going on, but it goes on at aslower pace. And so it's not as
easy to recognize. But someother things that do show a
blurry vision, a high bloodsugar kind of interferes with
how our lenses work in our eye.
And so you can have sometroubles, blurry vision,
(06:41):
headache, fatigue, kind of vaguesymptoms, but ones that you
shouldn't ignore.
Beth Brown (06:49):
So let's talk about trying to stave off pre
diabetes, which it sounds likethat's a type two diabetes
situation. Now the type onediabetes. So you mentioned if
you eat healthy, what does thatlook like? As far as does it
matter? Do you still eat thesame way with type one or type
two? I'm assuming that type oneyou're managing, and maybe type
two is prevention or managing
Dr. Doug Kuntzweiler (07:11):
Type one, you can take insulin and uncover
your diet. So you can eat prettymuch a well balanced diet. Type
Two, the devil is carbohydrates.
And you really have to cut downon carbs to control type two
diabetes. In type one, you caneat carbs in a reasonable
amount, as long as you cover itwith insulin. I did add that if
(07:33):
that doesn't work out so well.
And so you really have to watchyour carbohydrate intake. You
know, you also you want to eathealthy protein, you want to get
a lot of fiber in your diet. Sosomething like a Mediterranean
diet that's heavy on vegetablesand fruits, heavy, whole grains
(07:54):
and pretty light on processedfoods, very light on sugar, and
light red meat. Those are whatis usually recommended.
Beth Brown (08:04):
Okay, darn. Everyone loves carbs. I don't know
somebody who does not lovecarbs. So that's a tough one.
So, you know, I talked aboutthat 415 million people world
worldwide have diabetes. And I'msure because the symptoms can be
tricky. Probably more than that,that don't know it. What are we
doing here? Or is theresomething we can be doing that
(08:25):
doctors can be helping withthis? Why is this so prevalent?
Dr. Doug Kuntzweiler (08:30):
Because of our lifestyle. Yeah, type two
diabetes is is an industrializedcountry problem for the most
part. But as we see developingcountries adapt to more Western
diet, especially fast food thatwe see in other parts of the
(08:51):
world as well. It has to do withhigh sugar, highly processed
foods, highly sugary drinks, anda more sedentary lifestyle.
People aren't as active as theyget industrialized, we go to our
cars, we don't walk as much aswe used to.
Beth Brown (09:13):
Okay, so we could all be eating better. We need to
make sure we're staying active,we need to be careful about
sugar, especially those trickycarbs. Are there other things
that we should be doing to tryto help stave off diabetes,
either as mankind or just us asan individual?
Dr. Doug Kuntzweiler (09:32):
No, it's not rocket science. Watching how
many calories you eat, andburning them off by exercise is
kind of the answer.
Beth Brown (09:42):
Okay. How does diabetes affect you as you get
older?
Dr. Doug Kuntzweiler (09:47):
It has a lot of negative effects. It is
very hard on your kidneys. Andso one of the primary causes of
people having kidney failure andhaving to go on dialysis is
diabetes. It has very adverseeffects on our heart and blood
vessels. So it makes you at highrisk for heart attack, high risk
(10:12):
for stroke. And it also isdetrimental for nerve function.
So people lose sensation intheir feet in their fingers. And
when you don't have sensation,then you you tend to have
injuries that you don't notice.
So people get infections,especially with the hands into
gangrene, they wind up havingtoes amputated, and feet
(10:36):
amputated legs amputated. Soit's pretty devastating. I
neglected another one. It's, asI mentioned, it's hard on the
heart and on blood vessels, andit's very hard on the tiny blood
vessels in our eyes. It's aleading cause of blindness is is
diabetes.
Beth Brown (10:59):
And so sugar is the main cause it does all that.
Okay, so that's hopefully scaryenough for somebody to cut down
how many Snickers bars orwhatever there. But where can
people get more informationabout diabetes or pre diabetes?
Dr. Doug Kuntzweiler (11:14):
There is an American Diabetes Association
and it has a website that'squite good. You can always, of
course, talk to your primarycaregiver because they should be
familiar with treating diabetessince it's so calm. The Mayo
Clinic website has a lot of goodinformation. And CVS CDC website
has a lot of good informationabout Cleveland Clinic. So
(11:36):
there's, there's a lot ofsources.
Beth Brown (11:39):
Okay, great. Well, thank you, Dr. K. That's it. And
thank you for listening. We'llput some of those diabetes
resources for you along withthis episode. And if you have a
question for Dr. K, please emailus at QandAwithDrK@mpqhf.org.
And that email address will bewith this episode as well. Send
us your questions the doctor isalways in
Welcome to Q&A with Dr. K. A podcast by Mountain
Pacific Quality Health, where wesit down with Dr. Doug
Kuntzweiler and get your healthquestions answered. Because on
Q&A with Dr. K, the doctor isalways in.
(00:34):
Hello, everyone, this is BethBrown, your host and hello to
Dr. Consuela. Oh, always apleasure to get to talk with
you. And today we're going todive into our patient question,
which is about pre diabetes anddiabetes. So here's the
question. Diabetes runs in myfamily. My mom had it, my
grandmother had it, and mybrother currently has it. I have
tested in out of pre diabetesnumbers, but continue to try to
(00:56):
keep my blood sugar down withdiet and exercise. Sometimes,
though, I feel like this mightbe a lost cause. Is it
inevitable that I will getdiabetes at some point? So
there's the question. So just aquick stat for you here, Dr.
Kay, I read that diabetesaffects 415 million people
worldwide. And that's accordingto the Centers for Disease
Control and Prevention or theCDC. So let's first start what
(01:21):
is diabetes?
Dr. Doug Kuntzweiler (01:22):
Well, there are a couple of different
types. But in general, diabetesis failure of the body to
control its blood sugar, levelof sugar in the bloodstream.
There are actually a number ofdifferent types. The first type
that we usually think about iswhat we used to call juvenile
diabetes or type one. And theseare people who their their
(01:46):
pancreas just quits makinginsulin. Insulin is a hormone
that's made by the pancreasflipped around in our
bloodstream after we eat a meal.
And that helps sugar get intoour cells so that our cells can
use it as fuel with the sugarcan't get into those cells, and
the cells can't absorb it andthe sugar level in the
(02:07):
bloodstream just keeps mounting.
And that has a whole variety ofbad outcomes. That's the first
type is where you don't haveenough insulin. Type two
diabetes, which is actually muchmore common is where your
pancreas still makes sense onwhat your cells don't use it
very effectively, your cellsbecome somewhat resistant to
(02:31):
insulin, and the outcome is thesame blood sugar rises and flips
around and can't get used. Andthen there are a bunch of others
that are not as common asgestational diabetes, which is
elevated blood sugar only whenyou're pregnant. That usually
resolves after the baby is stillthere. There are some people who
(02:56):
are sort of somewhere in betweenthat they don't manufacture as
much insulin as they should, andtheir bodies are resistant to
it. Those are sort of in betweentype syndromes. But that's in a
nutshell, it's an elevated sugarfrom a variety of causes.
Beth Brown (03:13):
And so our patients question mentions pre diabetes,
where does that fall in inthere?
Dr. Doug Kuntzweiler (03:17):
Yeah, so pre diabetes. There are people
who are beginning to haveresistance to insulin and so
their blood sugar's beginning torise a little bit. There are
some markers that are used todetermine complete diabetes. And
(03:40):
that has to do with what yourfasting blood sugar is, in the
morning before you eat anything.
It has to do with a test calledhemoglobin a one C, which is
sugar is attracted to red bloodcells and will coach them. And
if you look at the red bloodcells and see how much sugar is
(04:00):
coated on them, it gives you anidea of what the average blood
sugar has been over the last fewweeks. And if that's elevated,
then that is diagnostic ofdiabetes. There's another test
called the glucose tolerancetest, where your provider will
give you a known amount of sugarand then two hours later, check
the sugar in your bloodstream.
(04:24):
And if everything's workingright, your pancreas will pick
out some insulin and sugar willgo into your blood cells and you
won't have an elevated level.
But if you have diabetes thatwill be elevated. So in pre
diabetes, all of these tests areslightly abnormal, not high
enough to diagnose difficultdiabetes, but high enough to be
worrisome and, and usually ifyou don't do something like diet
(04:47):
and exercise or sometimes evenmedication, you're going to go
on and develop and abuse so it'snot inevitable but you
definitely even inevitable atall. Type Two Diabetes
yours does tend to run infamilies, much more so than type
one. So I understand thequestion that, you know, my
(05:09):
whole family has, it looks likeI'm going to get it too. But,
you know, that's, that's good.
That's a warning sign. And whatwe know is that activity Trumps
genetic. So even though you mayhave the genetic background to
get it, if you eat a healthydiet, and you exercise
regularly, and you take care ofyourself, you don't necessarily
have to get diabetes.
Beth Brown (05:30):
Okay. So are there symptoms? Can people recognize
diabetes?
Dr. Doug Kuntzweiler (05:36):
Yes, or no type one, usually Yes, because
they don't have any insulin atall. And they usually get very
sick. And this typicallypresents at a young age school
age or early adulthood, butsometimes we'll see it later in
life. But those peoplebecause the sugar level is so
high, the kidneys have to getrid of it. And it takes water to
(05:57):
make urine. And so these peopleget very dehydrated. So they're
passing urine all the time,they're dying of thirst, they
get, you know, into a shockstate where they are so
dehydrated that they get very,very sick. That tends not to
happen so much and type twodiabetes has the same phenomenon
(06:19):
is going on, but it goes on at aslower pace. And so it's not as
easy to recognize. But someother things that do show a
blurry vision, a high bloodsugar kind of interferes with
how our lenses work in our eye.
And so you can have sometroubles, blurry vision,
(06:41):
headache, fatigue, kind of vaguesymptoms, but ones that you
shouldn't ignore.
Beth Brown (06:49):
So let's talk about trying to stave off pre
diabetes, which it sounds likethat's a type two diabetes
situation. Now the type onediabetes. So you mentioned if
you eat healthy, what does thatlook like? As far as does it
matter? Do you still eat thesame way with type one or type
two? I'm assuming that type oneyou're managing, and maybe type
two is prevention or managing
Dr. Doug Kuntzweiler (07:11):
Type one, you can take insulin and uncover
your diet. So you can eat prettymuch a well balanced diet. Type
Two, the devil is carbohydrates.
And you really have to cut downon carbs to control type two
diabetes. In type one, you caneat carbs in a reasonable
amount, as long as you cover itwith insulin. I did add that if
(07:33):
that doesn't work out so well.
And so you really have to watchyour carbohydrate intake. You
know, you also you want to eathealthy protein, you want to get
a lot of fiber in your diet. Sosomething like a Mediterranean
diet that's heavy on vegetablesand fruits, heavy, whole grains
(07:54):
and pretty light on processedfoods, very light on sugar, and
light red meat. Those are whatis usually recommended.
Beth Brown (08:04):
Okay, darn. Everyone loves carbs. I don't know
somebody who does not lovecarbs. So that's a tough one.
So, you know, I talked aboutthat 415 million people world
worldwide have diabetes. And I'msure because the symptoms can be
tricky. Probably more than that,that don't know it. What are we
doing here? Or is theresomething we can be doing that
(08:25):
doctors can be helping withthis? Why is this so prevalent?
Dr. Doug Kuntzweiler (08:30):
Because of our lifestyle. Yeah, type two
diabetes is is an industrializedcountry problem for the most
part. But as we see developingcountries adapt to more Western
diet, especially fast food thatwe see in other parts of the
(08:51):
world as well. It has to do withhigh sugar, highly processed
foods, highly sugary drinks, anda more sedentary lifestyle.
People aren't as active as theyget industrialized, we go to our
cars, we don't walk as much aswe used to.
Beth Brown (09:13):
Okay, so we could all be eating better. We need to
make sure we're staying active,we need to be careful about
sugar, especially those trickycarbs. Are there other things
that we should be doing to tryto help stave off diabetes,
either as mankind or just us asan individual?
Dr. Doug Kuntzweiler (09:32):
No, it's not rocket science. Watching how
many calories you eat, andburning them off by exercise is
kind of the answer.
Beth Brown (09:42):
Okay. How does diabetes affect you as you get
older?
Dr. Doug Kuntzweiler (09:47):
It has a lot of negative effects. It is
very hard on your kidneys. Andso one of the primary causes of
people having kidney failure andhaving to go on dialysis is
diabetes. It has very adverseeffects on our heart and blood
vessels. So it makes you at highrisk for heart attack, high risk
(10:12):
for stroke. And it also isdetrimental for nerve function.
So people lose sensation intheir feet in their fingers. And
when you don't have sensation,then you you tend to have
injuries that you don't notice.
So people get infections,especially with the hands into
gangrene, they wind up havingtoes amputated, and feet
(10:36):
amputated legs amputated. Soit's pretty devastating. I
neglected another one. It's, asI mentioned, it's hard on the
heart and on blood vessels, andit's very hard on the tiny blood
vessels in our eyes. It's aleading cause of blindness is is
diabetes.
Beth Brown (10:59):
And so sugar is the main cause it does all that.
Okay, so that's hopefully scaryenough for somebody to cut down
how many Snickers bars orwhatever there. But where can
people get more informationabout diabetes or pre diabetes?
Dr. Doug Kuntzweiler (11:14):
There is an American Diabetes Association
and it has a website that'squite good. You can always, of
course, talk to your primarycaregiver because they should be
familiar with treating diabetessince it's so calm. The Mayo
Clinic website has a lot of goodinformation. And CVS CDC website
has a lot of good informationabout Cleveland Clinic. So
(11:36):
there's, there's a lot ofsources.
Beth Brown (11:39):
Okay, great. Well, thank you, Dr. K. That's it. And
thank you for listening. We'llput some of those diabetes
resources for you along withthis episode. And if you have a
question for Dr. K, please emailus at QandAwithDrK@mpqhf.org.
And that email address will bewith this episode as well. Send
us your questions the doctor isalways in
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