'We're seeing a phenomenon of type 1 plus type 2 diabetes' - Dr Jairo Noreña - Type 1 on 1 | Diabetes Stories

Episode Transcript
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Speaker 1 (00:00):
This episode of Type one on one is sponsored by Dexcom.
More on that later. Just to say, as with every
episode of Type one on one, nothing you hear within
this podcast episode is intended to be nor should be
taken as medical advice, and you should absolutely seek the
advice and guidance of a healthcare professional before making any
changes to your diabetes management. If you want to come

(00:21):
and say hi, you can do so at Studio type
one on one on Instagram and I I'd love to see
you there. Hi, everyone, and welcome to Type one on one,
a podcast that delves into the obscure, complex and challenging
world of life with type one diabetes. I'm Jen Greeves,
and each week, with the help of some brilliant guests,

(00:44):
I'll be showing that there is no normal when it
comes to handlingk this whopper of a chronic condition, because
we're all pretty much figuring out the messiness of day
to day life with diabetes as we go, and most
of all, even though it doesn't always feel like it,
we are absolutely not alone. My guest today is doctor

(01:05):
Hiro Norenya. Hiro is an Endo Chronology fellow at Stanmford University,
originally from Medine, Columbia. After training as a physician, Hiro
moved to the States to continue dedicating his life to medicine,
with a triple specialization in internal medicine, endocrinology and obesity medicine,
as well as long standing fellowships at prestigiush universities including Harvard,

(01:28):
Columbia and of course Stanford. To say Hiro has a
wealth of expertise in endocrinology and diabetes would be an understatement.
So I am absolutely honored that he's bringing it to
the podcast today. Welcome Hiro to type one on one.

Speaker 2 (01:44):
Thank you, Jan, I'm very happy to be here and
thank you for this amazing introduction and looking forward that
we have today and amazing conversation.

Speaker 1 (01:54):
Yes, I am super excited. It's so wonderful to meet
you and connect with you. And I know you're joining
me from sunny California. It's the start of your day
to day. But how are you today? I assume the
sun is shining at the very least.

Speaker 2 (02:08):
I'm doing great, so beautiful here in California. Its sonny
and I can hear the birds here being around, so
I can complain definitely wonderful.

Speaker 1 (02:17):
And I mean I've just given the listeners a taste
in the introduction, but the breadth of your work and
also the depth of your work, the way you've dedicated
to yourself to this is just like I kind of
don't really know where to begin. So I think maybe
a good place to start would be to hear in
your words, a little introduction about who you are and

(02:42):
what it.

Speaker 3 (02:42):
Is that you do.

Speaker 2 (02:43):
Well. Thank you. So I will start probably from Colombia.
My name is heid and Radia. I was born in Colombia.
I leave. I was born in Cali, the Sata cd
fron from our country, and then you I moved to Medigen,
where my parents are from, and that's where I completed

(03:04):
my medicine studies and I had the opportunity to work
for a few years, and that's the place where I
found my passion for entrochnology, for diabetes, for working for
underserved communities. And in fact, I had two years in
my careers going into the mountains and I was the doctor,

(03:26):
the only doctor in town, and I was having the
liveries and I was being the eedy doctor and the
clinic doctor and the impatient doctor. Basically you take care
of everything, and it was a very driping experience and
definitely after that, I was ready to take an extra
step and I went to marriaging to working one of

(03:47):
our academic centers, and that's where I had this curiosity
for deeping into diabetes, diabetes and education. And at the
time I started to also work with media and start
posting certain things in YouTube on Instagram. But my curiosity
was there and I started to look opportunities for moving

(04:09):
forward and learning, and that's how I was able to
get a position to come to the US and I
came to Boston for the first time, where Harbor opened
me the doors to do some research and I continue
to do it. At the time, I was working with
diabetes mostly tied to and I had the opportunity to
deepen my knowledge into cognitive decline and cognition improvement with

(04:34):
international insulin. That was a beautiful, beautiful study and it
was my first contact with this American health care system.
And that's where I fall in love with how the
things are done here and how research is done and
how can I try Definitely, and that took me to
continue my next steps in my career and I decided

(04:54):
to stay in the US.

Speaker 3 (04:56):
Wow.

Speaker 1 (04:57):
Incredible, I'd love to touch on that time in the
more remote communities just a little bit, as I imagine,
you know, you were just embarking on your career, must
have been super superformative. Are you still bringing some of
those lessons from kind of having to be the point
of contact for absolutely every health concern extreme and you

(05:18):
know otherwise, are you still kind of utilizing that experience today,
you know, these years in a very different environment.

Speaker 2 (05:26):
Yeah, definitely. And we say, or we expect that when
you come to the US, is going to be like
the way to say, maybe you're coming from their world
to us old the resources. But the reality is that
we also have populations in the US that don't have
access the way we wish, and they don't have the

(05:48):
knowledge we we we normally think about, and there is
a strong opportunity, and especially with Hispanic communities where there
are many barriers in language, in education, we have a
lot of social determinants of hell that make this population
get seeker than usual, and there is a lot of

(06:10):
opportunity to teach and educate these communities. And bringing this
experience from doing a lot with little from Colombia is
something that certainly happens here. And I'm very glad to
bring these resources and find a way to help these communities,
and that's something that I certainly do recently. For example,

(06:32):
at Stanford, I realize a few years ago that many
of our Hispanic patients, they don't know nothing when someone
is started on insulin in general, but when you are Hispanic,
you go through the struggle that someone is teaching you
a lot of things in two little times. So you
need to learn how to use insulin, how to do fingersticks,

(06:55):
how to take care of the hyperplastimians, how do it healthily,
how to exercise, and somebody's trying to explain you this
in English when you don't speak the language and you
have an translator personal interpreter. But trying to understand the
culture is something that is challenging sometimes and sometimes you
miss some of the education when you are not able

(07:17):
to understand the culture. So considering this, I did a
QI project, a quality improvement project where I with my
girlfriend basically in my living room, we recorded a lot
of videos with a real screen and I got some
supplies from our Davieta spliny and basically I went one
video after the other teaching all of these important details

(07:42):
of the education and we made this possible and we
puild this as part of the smart phrases that we
use in our medical records, and now many providers in
Teennet Medicine, GI people and the crinology are using the
smart phrase for the education of our patients. So bringing
this basic knowledge that I was considering to be tiny

(08:07):
maybe from Colombia is definitely making a huge impact right now.
And I couldn't believe that after a few years this
can be spread and it's being used in an institution
as it's down for right now.

Speaker 3 (08:21):
Yeah, incredible.

Speaker 1 (08:22):
And you mentioned they're kind of spreading the information digitally.
You know, you have a huge social media presence. You've
got your YouTube lack behind you, which is incredible. I'm
wondering how that was first met. You've been doing this
for many years in terms of making sure that this
information is out there in a way that people can access,

(08:44):
can understand to use it to the benefit of their
own health. I'm wondering what the response was like initially
from other people, your peers around you. As I assume
that this is something that you know for a long time,
kind of was an alternative way of of getting that
information out there.

Speaker 2 (09:02):
That's a great question, and it was very challenging time
for me. I would say where I started to dig
into something that was very new normally for me, was
very new for society. And it takes me back to
Colombia about ten years ago, and there were no doctors
in social media that was not something trendy. We didn't

(09:24):
have TikTok, we barely were starting to use Instagram, and
our main platforms were YouTube, and I think Facebook wasn't
even trendy with videos at this time. So and everything
came from this need to educate and because the time
was little and education is something very important that I

(09:48):
was trying to teach my patients basically in clinic how
to do certain education topics. And I noticed that they
were forgetting what I was teaching them. They were coming
back to me a few weeks later and I said, okay,
how are you taking care of your hyph publicity? As
are you applying the rule of the fifteen? I said, no, doctor,

(10:08):
I don't remember what's that. So maybe coming from this
frustration and need is this combination of factors. It that's
how I just took my phone with no lives, no microphones,
no experience no, tryput. I just was holding my phone
and I recorded these videos and I started to post
them online. And when they were coming to me, I

(10:31):
was writing down at the bottom of my prescription the
YouTube channel. I was asking my page, do you have
YouTube or do you have internet? You have a cell phone?
Actually some of them didn't even have a cell phone,
but they were were their grandchild or their song and
they had a phone. So I said, Okay, this is
your prescription, and most importantly at the end, you're going
to go to this YouTube channel and you're going to

(10:53):
start watching the videos. I explained you this now. But
if you need to Represulting fifty, to jump in and
you're going to find here all the questions that you
are going to be asking yourself. And yeah, that was
kind of disruptive for me, and people that were not
my patients out of the nowhere starting to jump in,
and they started to ask questions like, Hey, what happened

(11:17):
if I have this GI synptom, or what happened if
I don't have this diagnosis but I do this diet.
So they started to give me the content based of
the questions. I started to span the content and then
a few months later I found a need to teach

(11:37):
the patients online and at that time, tell health was
not a trenditing it actually didn't exist and what it
was doing this in Colombia. But I found out maybe
using the Skype at that time was a way to
do it and teaching patients how to it properly, how

(11:58):
to exercise and guide them. And I called this in
the Very Star as diital Health. I started just to
promote this kind of doing medicine and something disruptive, but
something that I was feeling was helping the patients, even
if this was creating a noise maybe for some other

(12:18):
providers who didn't agree too much that a doctor was
using a video to educate patients. And I was even
labeled as unethical because it was something that disruptive ten
years ago that people was not used to seets at
something that we actually needed. It turns out after a
few years, these doctors came back to me and they

(12:42):
were asking me how to start their own YouTube channel
and their own Instagram and how to do the same thing.
And it became a movement. It became a reality, and
that's our reality right now. That's where we are.

Speaker 1 (12:54):
Yeah, absolutely, and for you to be progressive enough to
see that not only do we need to embrace these changes,
but actually they you know, this is a way to
reach people. You're going where they are, this is the
kind of consumer behavior that they have. Whether it's entertainment
or healthcare is almost irrelevant because healthcare, you know, these
are outcomes that you can impact, You can affect when

(13:17):
you're going where they are and bringing the information in
a way that they feel comfortable consuming it. Because I
do feel that sometimes even in the same language, a
healthcare appointment can be quite intimidating, depending on what you're
going in to talk about, your state of mind, how
maybe nervous or scared you are about these topics, or

(13:39):
how culturally acceptable it is to even have these conversations
in the first place. So I'd love to hear a
little bit about your thoughts on that and like the
experiences you've had within clinic settings in terms of ensuring
that patients do feel more comfortable within those appointments.

Speaker 2 (13:58):
Okay, I think to go to my clinic and my
realized patients face to face encounters, there was something that
I remember that marked me and made me remember or
maybe change the way I was doing my videos. It
was this motor from Venezuela, and at the time, Venezuela

(14:20):
was in this healthcare crisis, political crisis with lack of
access to providers and lack of information. And I made
this video once about how to get hydration when someone
is seek using a basic solution of water, salt and
sugar and how to do it at home. And I

(14:42):
got this message from this mom that she told me
she was in a village away from my main hospital
and she had her kid. It was like a five
years old kid who was having GI symptoms. He was
feeling very bad. He wasn't able to take anything orally,
she didn't have an access to a doctor. And then

(15:02):
she was telling me that she didn't know about how
important it was to be hydration. For some reasons, she
jumped into my video and she just followed my instructions
about keeping the kid hydrated for these three plus days
that he couldn't see a provider. And basically when she

(15:22):
went to the provider a few hours away from that village,
the key was orrey dehydrated, but was certainly being able
to keep with his disease because her mother started yearly
on the process. The rehydration and she was writing this message,
I was very doushing and she was thanking for posting

(15:46):
this video and being able to hydrate her kid or
while she wouldn't have done something like this, and we
don't know what will be the outcome of this kid.
So that was something that made me believe that Internet
at that time is going to make a huge difference
for people. And that was one of these triggers for
me to keep moving forward. And that's when I say, Okay,

(16:10):
I need to do this for my patients, but also
for my community and why not for society. And I
decided at this time I was a student Columbia. My
goal is to expand this below the clinic and try
to reach as much audience as I can. And for
my patients, I was learning on a day by day

(16:32):
and they were telling me their needs and definitely following
what they were asking me for was kind of my
main trigger for doing the videos. And that's how I
keep going Right now, I keep listening to my audience,
I keep reading them. I can't keep listening to their needs.
And also I follow what is trending right now, what

(16:54):
is needed, Like if the CDC is asking to get
a chot right now, how important it is, or we
have a missiles outbreak in Texas has recently happened here,
that's certainly a need for our society, and it's a
need for me to spread and to find mis information.

(17:17):
And that's what I keep doing on a day by
day with this content.

Speaker 1 (17:22):
It just strikes me as you're speaking there, that you're
dealing on the ground on the day to day with
one patient at a time and how you can help them.
But you have this scope and this understanding and the
awareness of how your work can impact on a national
scale or even a global scale. How do you kind
of work with that in your own mind because you

(17:43):
know that's a huge, huge scale of health need if
you like, that's a great question.

Speaker 2 (17:51):
And as physicians, clinicians, as or board certified physicians, we
have a social responsibility right now, ethical, moral, however you
want to call it. But we have to be present
in social media because there is a lot of misinformation
that harms patients, and there is lack of information that

(18:15):
harms patients. And the only way to reduce this gap
is by having real providers jumping into media and that's
what I advocate for and we said after this podcast,
any other providers or cynicians, dietitians, nurses that are there

(18:37):
take the lead to stand and start producing content in media.
It's not about how many followers you have, It's about
the life you can transform. And as I said it
once a long time ago, I wasn't looking for a
big audience. I was staying with at least one person

(18:58):
that learned how to change life tis and prevent complications
such as diabetes or obesity or cardious clar issue. I
am going to be transforming the world, and I am
quite confident that it's been more than one person right now.
And if as clinicians we stand up and we start

(19:22):
massively being present, definitely our voice is going to be heard.
We're going to contribute to this gap that we have
right now. So the balance comes from the needs and
from my patience and the society who really need something
like this.

Speaker 1 (19:40):
I can really see that it comes from the heart,
and it's so powerful to hear. Different healthcare systems in
different countries obviously operate very differently. I, you know, grew
up with a public healthcare system. My perception of the
US healthcare system is that it's this behemoth, and you
enterta to that and you said at the beginning that

(20:03):
you were surprised and you found that it wasn't a
perfect system, and it also inspired you to stay and
improve that system. So can you speak to me a
little bit coming into the US healthcare system what you
found and.

Speaker 3 (20:18):
What you see.

Speaker 1 (20:19):
As the positives of that kind of system, but also
some of the challenges.

Speaker 2 (20:26):
So this Hancer system is great in terms of accessing
emerging things or hospital admission and surgery. You're going to
get it. However, the cause behind this is something that
is going to come back to the patient at some point,

(20:46):
and you know everybody's going to be able to afford it.
I believe the Hancre system here is great in terms
of technology and the newest medications, the newest research, and
someone who has a great insurance is going to be
definitely able to afford it. And we have a great
public system here as well for those in need and

(21:10):
for those that have certain disabilities. This is what we
call the Medicare Medicaid. Right now, it works great, but
it's something that can change over the time and have
sometimes certain limitations, and still this population can have access
and there is this there group of people that is uninsured.

(21:32):
That definitely that's where we see some of the limitations
because the out of the pocket cost is very, very
very high, and that's where we start to see this
population struggle because there is no way that you can
afford it. And that's what we see in a day

(21:53):
by day with certain populations. They have to peek between
getting heavily grosser is or affording for the copy of
an insulin or a certain medication. They need to decide
whether to take an uber right to come to the apployment,

(22:15):
but that's going to basically reduce the chances that they
can afford food the next day, and they don't come
to the appoyment. So and finally they don't have access
or didn't have the access to the education they need
they to understand many of the conditions that are going on.
Sometimes they underestimate their disease or the important of their

(22:39):
therapist and that makes everything more complicated. So advocacy for
these populations it need is something that we need and
fortunately there are a few organizations, providers and people like
me that we are definitely working with this population that struggled.

(23:02):
The health care system is going to be there, but
definite empowering the patients is going to be one of
our strongest ways to do it. And advocating for prevention
is something that can make a difference because we are
supposed yes, we have the health care system, but we
are supposed to an environment that can be harmful as well.

(23:22):
And information and powers about the decisions that we take
in terms of what we eat, how we exercise, how
we move, what we consume, are we what we don't consume?
So that's my journey right now, and that's how we
can try to work around the health care system that
we have right now.

Speaker 1 (23:44):
Yeah, And in terms of your journey, I'm curious as
someone who is so passionate and is doing a lot
and working in a lot of different areas and how
you what your day to day and your week week
looks like. I know, you know you're embedded in the
social media as you say, and news appearances and the
research and writing books and you know one to one

(24:08):
clinic patients. Can you speak to me just a little
bit about what that looks like for you?

Speaker 2 (24:13):
Well, so I'm complete my fellowship in June. And fellowship
is a training where you have to meet like not
only hours of war demand, but also learning time. And
it's kind of a journey that starts very early in
the morning, maybe fight eighty six am, where I have

(24:36):
to study sometimes in the morning, or just go after
my breakfast straight to the hospitally in the morning to
take care of a large list of patients. But at
the same time that are teaching activities, lectures that as
a fellow you have to attend, either as a preinee
or as a teacher for students, where I I'm on

(25:00):
the other side and I have to mentor and guide
some of the trainees as well. And after that, definitely
I take care of myself. I always try to work
out and find this balance and that's something that I
promote in media as well. Like as doctors, we have
long work hours and we care about the people, but

(25:22):
definitely we need to care of ourselves, and that's something
that is a paritive for me, and the nice for
me become like my only chance to catch up with
academic activities, to do my research, to study, to prepare
for the bores, and if it's possible, do some media
activities and that's my day by day. Definitely, there is

(25:46):
excitement sometimes we have weekends off and I can do
the regular titties that everybody does, hiking, going out and
discording a new city. That's something that certainly can happen
back during fellowship. You are looking for these two years
video to do the best as much as you can

(26:07):
and take advantage of all the resources that you have.
I'm glad that I have been able to do it properly.
I have been able to try during these two years
at Stanford, and I'm ready for my next step as
an attending in July. And if you need to bring
in all these skills that I get to the community.

Speaker 1 (26:30):
Yeah, and congratulations on completing my fellowship. That is an
incredible amount of dedication. How do you feel about the
system in terms of you know, you've mentioned that it's
a priority for you to take care of your health,
and it strikes me as sometimes a bit of an
irony that the people who are working so hard to
look after us sometimes they have to sacrifice their own

(26:50):
health needs in the process. Do you feel like that
balance is tipping, that that's being addressed, that it's acknowledged
within the system.

Speaker 2 (27:01):
Okay, so certainly institutions like mine, definitely at book very
strongly and make sure that we are always ask hey
are you sleeping the hours that you need. We have
a system where we had to log in the hours
that we work. Nobody can go more than eighty hours

(27:21):
per week, for example, and there are these certain number
of seminars that we have over the year remember us
how important is wellness in a balanced diet, And it
happens that, Yeah, they definitely care about this because it's
been a struggle for many years in this system. In

(27:43):
my personal case, I have been always an advokay of
healthy lifestyles and that's my priority definitely, and I strongly
believe that if I don't take care of myself, I
will never be able to take care of somebody else.
And diet for me is kind of the hiller along
with good quality sleep and exercising, and that's one thing

(28:06):
I definitely don't miss. I don't miss my breakfast in
the morning. You make sure that to have may twenty
twenty five minutes at least, to just wake up earlier,
but real last, enjoy the sunset, listen to the pir shirping.
And that makes a huge difference in terms of someone
who also has led five hours and is rushing getting

(28:29):
a coffee and running arriving late to work. That definitely
makes a huge difference on how you start in your
day and how you're going to be taking care of
your patients. So for those who are there who are
not being able to do it, definitely is a priority
that we should be taking care of. And there are
certain ways and certain resources, and definitely check with your

(28:53):
institutions to see what are the resources that you guys
have there to find a way to these pilots.

Speaker 1 (29:01):
Yeah, I think it's really interesting as myself and the listeners,
most of us are end users, but we also have
people who through living with health conditions that I know
are listening, who have been inspired to enter the healthcare system.
So I just think it's it's an incredible reminder. You know,
you sit in front of me as a picture of health,
and I'm like, I need.

Speaker 3 (29:20):
To do what the doctor is doing.

Speaker 2 (29:23):
Do you know what.

Speaker 1 (29:25):
This guy knows what's up? You're an endocrin specialist. So
as we have been talking about making health more understandable
and digestible for people, I don't think I've actually ever
asked anyone what the endocrime system actually is. Despite the
fact that type one diabetes is an end acrin disorder,

(29:48):
if you like.

Speaker 3 (29:50):
So, you know, we live in this world, we breathe
this world.

Speaker 1 (29:53):
But I think a lot of us living with health
conditions kind of do what we need to do to
be able to move through life, you know. And so
it may sound like a silly question, but I'd love
it if we could explain, If you wouldn't mind explaining
what we actually mean by the endocrine system or endochronology.

Speaker 2 (30:13):
Well, that's a great question, and it's a beautiful system.
Endocrine take cares of the hormones, and hormones are everywhere.
We have like a main boss that is in our
brain is the pititary plant, and the peditary gland is
in charge of communicating with different organs across our body.

(30:35):
And that includes the thyroid, that includes the pancreas, includes
the adrenals in incluse. The reproductive system, includes the growth system,
includes the producting, the breastfeeding system. So hormones are everywhere,

(30:57):
and understanding this physiology is something that definitely it's very
exciting and very cool because there are a lot of
feedbacks and mechanisms that can affect one way or another.
The hormones and definitely the environment could be closely correlated
with many of the hormones. And we are alike because

(31:18):
of the hormones. So endochenology takes care of fixing an
issue where you have an increased production of hormones or
you have a deficit in the hormones. And that can
be as broad as just focusing on pititary gland or
just in the thyroid, or jos in the dreams or

(31:41):
pankerts with diabetes, or just taking care of all these
systems and that's the beauty. There are many special ties
in endocinology, and my institution there are areas as focused
as well in my personal side. I think focusing everything
right now is something that I feel very excited about.

(32:03):
But particularly diarroid PSID and metabolic disorder is something that
makes me feel very excited and that I feel that
I can contribute to U see my media platforms considering
that cardioster disease lifestyle changes are very closely related to
this feel and I can create an impact in something

(32:26):
that is making our society seek.

Speaker 1 (32:30):
Yeah, and can you speak a little bit to how
these different hormones relate to each other, because well, I
know now twenty nine years in that Well, first of all,
insulin is a hormone which I did not understand for many,
many years. But secondly, you know, there are so many
links with other autoimmune conditions and type one diabetes and

(32:53):
lots of correlations there. So do you think there's well,
is there increasing research into these relationship hips and what
have you sort of gleaned in terms of how you
can put that.

Speaker 3 (33:04):
To real world used to help the people that you serve.

Speaker 2 (33:08):
Okay, yeah, that's that's only so. There is a close
correlation of many of the hormones, and we can see
these for example in automium conditions where i wan dabidy
is one of them. As you mentioned, our immunity can
affect other hormones, for example tyride, and we can see
certainly that people with taiwanability at some point can struggle

(33:31):
with hype piridism as well. They have crossed our immunity.
But outside of the endocrine system, Taiwana bilitiness has a
very factor for our immunity for having city a disease
or bit I legal disorders in the scheme, so that's
something that exists. Tiripe, for example, is a gland that

(33:52):
is closely related also with emotions, and I recently wrote
this article for Medscape, one of our media that we
use in our field, where I did the review of
what happens with our emotions, and there is a close
correlation of anxiety and having these emotional triggers in our

(34:15):
life with for example, expressing a disease like grace disease,
that is an increased title production when there is an
emotional trigger, and so one has a predisposition for the
audi munich. Let's say, for example, you carry the antibody
that can affect your thyroid. You don't have a clinical disease,
but you have this emotional trigger and this can basically

(34:39):
be the final step for having a clinical manifestation of
title disorders. And we're still trying to understand how this
happens with other hormones with diabetes, with cydient disease, but
definitely there is a close correlation. And again it is
an invitation to live a healthy lifestyle. And if we

(35:00):
know that diabetes, for example, have three stages when people
can have initially antibodies but no clinical disease and they
have in a pre diabetes speature and then at a
stage where you can have diabetes properly and the happies
for the case of T one dabetes. We don't know
exactly how these mechanisms can impact, but we know that

(35:22):
they are benefical to delay sometimes the progression of certain
diseases of type one dabetes, title disorders, and advocating for
healthy lifestyles epinically something that we need to keep doing,
doesn't matter what.

Speaker 3 (35:36):
Yeah, yeah, back to the basics.

Speaker 1 (35:38):
I just want to thank you because for so many years,
just speaking from my own personal experience, which is really
where I mean this podcast came from, or certain iterations
even speaking online about my health condition came from not
understanding that there is an emotional link to this very
physical condition and feeling like I was the only one

(36:00):
in the world who you know, was struggling or not
even understanding that. You know, hormones and cycles and stresses
and all these things they all contribute to how we
are equipped to deal with our conditions, but also actually
the outcomes the results of things like glucose levels and such.
So yeah, thank you for kind of just putting that

(36:23):
out there, because I know a lot of listeners will
just be breathing a sigh of relief.

Speaker 3 (36:26):
Because we can feel like we are, you know.

Speaker 1 (36:30):
Going mad at some point where where it just isn't
all making sense, and with that we're not sleeping properly,
or we feel stressed by this condition and we're not
necessarily articulating that to anyone. So yeah, I think from
a personal standpoint, I just want to thank you for that.

Speaker 2 (36:47):
Absolutely.

Speaker 1 (36:51):
This episode of Type one on one is sponsored by Dexcom.
Using dex coom CGM has given me so much confidence
to make informed diabetes treatment decision in the moment. You
can choose to wear it on your arm or your abdomen,
which is so great to give those sites a break.
And all dex commcgms have the share and Follow feature
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(37:13):
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Always read the user manual for important product aspects and limitations.
Talk to your doctor for diabetes management terms and conditions
and terms of use. As part of your research at Stanford,

(37:36):
I know in particular you're looking at the effects or
have been for many years looking at the effects of
GLP one and specifically at the moment in protecting bone
health in weight loss. So I'd love to hear a
bit more about what other potential dangers for example of
losing weight quickly or losing a lot of weight when

(37:57):
it comes to bone health.

Speaker 2 (38:00):
Well, Lusing weight is something that is getting trending, and
only because we have over sixty percent of our population
dealing with overweight obesity numbers are increasing. It's a need
for the society. But now because we have these new
therapists that are basically changing and it's the first time
in the US that we have a trend of reduction

(38:23):
of this prevalence of obesity after decades where the trend
keeps going up and now we're going down because we
have to get P oneagonists that are wonderful medications when
they're used with the right indication and the right guidance.
Losing weight doesn't matter how you do. It is something
that is going to lead to losing most of mass

(38:46):
and losing bone mass. And that's when having the right
guidance by a dietitian, a doctor, and maybe a trainer
is going to be a physical trainer it's going to
be very important just to compensate thesecluses and try to
focus on losing only fat. That will be the idea goal.

(39:06):
And because of this, we know so far also that
extreme methods that are very effective and making people losing
weight and reducing all these carbugas risk, like the surgical
interventions can did also to losing bond density or bond
mass and increasing the res of fractures. And we know
this from glastic bypass or piatric surgery where no, only

(39:31):
you're losing weight and you're losing mass because of this reason,
but also the absorption of the micronutrients, the calcium, everything
that you need to create bond is basically impair because
the absorption in your GI system is limited after these surgeries.
So with DLP once this question was not address and

(39:54):
we're broadly using these medications and I was wondering and
talking to my mentors at Stanford, we don't have data
for this. Let's just work on this and let's try
to find an answer. And that's how we recently evaluated
retrospectively over ninety two thousands subjects on sem magnetite that
is branded as a same peak or we going versus

(40:17):
people who get a sleep strictomy that is not that
large surgery as is the bypass, but also there is
a certain degree of reduction of the stomach surface and
the absorption and compare what happens with these methods of
were loss and we found that there was twenty six

(40:39):
percent lower risk of fractures when someone is losing weight
with sem magnutine. And it take us to the rodence
models where these medications have been evaluated, and in rodents
we have seen actually the bone formation happens and the
bone resourtion or way to call it maybe a destruction

(41:02):
is reduced and the rodents were able to gain bond masks.
So we don't know in humans how this mechanism or
this can be helping or reducing the fracture is, but
it's a fact so far with this evidence that GLP
ones may protect the bones slightly. So people with GLP

(41:24):
ones are still having fractures, but the structures are significantly
less and twenty six percent lower fracture reduction is something
that can make an impact and that quarantees for the
research that we are working on it right now to
try to understand this better. So JLP ones are amazing
when they are prescribed with their right indication. They reduce

(41:45):
cardiositor disease, they reduce mortality per se, they reduce kidney
disease progression, and they are being used in more and
more indications know only for die to they or obesity,
and we keep exploring these areas where GP ones can
give us some benefits as well.

Speaker 1 (42:07):
Yeah, it's really interesting there how you're kind of balancing
their scale there between your mentioning of a healthy lifestyle
and really focusing on the basics, but making room for
these therapies that do have the potential to improve lives
and reduce you know, negative health outcomes for you as

(42:29):
a physician, as a specialist, Where is that balance? Can
you know where do you strike it in terms of
the work you're doing and allowing space for both if
you like.

Speaker 2 (42:42):
The core of these is going to be always life
that changes, and if life style changes don't happen, don't
even go to a medication because you better regain your
weight if you don't change the core issue. Right, So,
watching your diet that includes basically curting sugar like drinks

(43:03):
that come with sugar, ultra process food, best about oils
that's something that we certainly need to eliminate from our
diet and go back to the core of how our
ancestry is used to eat, Like cooking at home with
real food is gonna make a huge difference. Following our

(43:25):
chronal biology for example, like we are mammals that follow
this online and we are not done to be eating overnight.
And I know you are in Spain where there is
a culture of eating late. Unfortunately, Spain has healthy diet
in many aspects. You guys have many aspects of the
Mediterranean diet, and that's probably something that doesn't make the

(43:47):
chronobiology play a negative role. But in our cultures where
we are supposed to that, many different choices and many
of them are not great. Following the chron biology is
something that we should be doing, and that includes basically
having your breakfast when the sun rise happens and having

(44:09):
your last meal before it's dark. That's mandatory because our
body is hormones respond to the sunlight and respond to
the point that when we see the sun in the morning,
we are spiking our first corti is all amount in
our body that is helping us go to our day.

(44:29):
We have a pancreas that is producing me insulin that
is very sensitive to handle all the food that we
have during the day and is helping us to take
the most advantage of the nutrients that we're taking during
the day. But at the end of the day, the
post it happened, the cortes should be resting, should be zero.
And if we are eating layover night, for example, the

(44:49):
cordus so it's going to be spiking and the healing
process of our cells, our immune system, our most our
body percent is not going to happen. Following tennobiology is
something that I always highlight as the core and definitely
having healthily a sleep. Sleep is one of the cores

(45:10):
for living longer, definitely, and sleep deprivation has never been
a great option for anything, not even for productivity, because
your brain function is going to be created day after
And finally, exercising and physical activity we broadly recommend doing

(45:31):
more than a hundred and fifty minutes per week is
going to be mandatory if you want to have some
cardioscular prevention. Cardiostracticis prevention and exercising lifting ways two or
three times per week is something that we need to do.
So once my patients are applying all this and wave

(45:52):
loss is not happening. That's when the GLP one agonist
should be considered. And as stated by the FDA here
in the US, we have some indications having a BMI
of more than thirty percent. The BMI is this mad
that we make between the high and the weight and
having a BMI more than thirty or more than twenty

(46:14):
seven we order medical conditions such as take to the DDS.
High cholester higher pressure are indications for in these medications
for someone who was not able to lose weight with
the standard lifstack changing modifications.

Speaker 1 (46:30):
Yeah, and when it comes to kind of the hype
about GLP ones out there, I think, as you alluded
to earlier, there is so much information out there now,
and not necessarily all of it comes from people who
are qualified to talk about these different aspects of health
and wellbeing. We hear weight loss drugs, you know, in

(46:54):
celebrity culture, etc.

Speaker 3 (46:56):
I'm just wondering.

Speaker 1 (46:57):
For you what that's like to to witness it and
see it ripple through and how you try and cut
through that noise to make sure that the right information
is getting to the right people. When it comes to
things like this that can sort of be leveraged.

Speaker 3 (47:15):
In terms of media, news and fads if you.

Speaker 2 (47:20):
Like, there's a thing really that is no charcout, and
that's something I advocate for. We have studies that say
someone who doesn't change less guys is going a GEDP one,
so in a those way, but then once this person
is stopping the medication, you're going to have way regain
In one or two years, you're going to be back

(47:40):
when you started before the medication. Something that I work
and I try to do that podcast is to remember
people this is an anti obesity medication, is not a
weight loss or cosmetic medication. And praising it the right
way since the beginning makes a huge different to bus
the weight loss. If you have a BMI of twenty

(48:03):
seven and you wanna lose weight for a band, a wedding,
or occasions, that's not the way to do it. That's
gonna expose you first is someone who is not going
to go to the right provider, because a board certified
provider is not going to prescribe you this medication and
these conditions. Second, that's going to expose you first to

(48:25):
don't get the right medication and the right dosing. The
like those titration and there probably this person is not
going to be giving you the right guidance in terms
of what you should be eating, what are your targets
of weight loss, how do you should be those into
physical activity, how you should be watching for your bond
held for your muscle mass to prevent all the adverse

(48:46):
consequences of GLP once. And that's when it comes to
these news that we see people it's using LP once
and it's having adverse reaction. They are having gastro parasis,
they are having nausechat, they are having hospital admissions, losing moscles.
Is because they are using the medications outside of the
indication without the right guidance. So I advocate for this

(49:10):
in news local news here, or in media here because
that's the reality which should just go by what the
things are done for lifestyle changes is going to be
again the care for these people that is using medications
outside of the indication.

Speaker 1 (49:31):
Yeah, and I know they're not yet FDA approved for
typewan diabetes, but you are prescribing GP one's in relation
to type one diabetes.

Speaker 3 (49:43):
So can you kind of shed.

Speaker 1 (49:45):
Some light on why gop wants might be helpful in
the treatment of type one diabetes specifically.

Speaker 2 (49:53):
Yes, diffinity, that's a great question. And so in academic
institutions we have the opportunity to do initial trials for
maybe like new therapists, and that's how something is finally
say approved for X or white reasons. In the US
we have average like eight point four medium or in

(50:15):
the world we have eight point four medium people living
with thai Wan dabetes and the prevalence is no increasing
that much as type two we have a zero point
thirty four percent incidents increase annually as compared to type
two diabetes that is growing and growing. However, we are
seeing a phenomenon of Thai one plus type two diabetes,

(50:37):
and this is when someone who has Tai one diabetes
starts to develop insulin resistance. They start to have liber
resistance to the insulin and also issues with the gradation
of the glucagon. The pancreas has like two main cells.
One is the beta cell that produce the insulin and

(50:59):
the alpha cells produce the g look acont and when
someone has Taiwan dabetes, basically the insulin production by the
beta celle is definitely gone, but the alpha cell is
still there. And that's something that produces glucagon, and glucagon
is a hormone that increases glucose and make people have
hyperglycemia and make patients need more insulin to compensate. This

(51:24):
hyperdecemia that happened mostly after eating. We call this post
prandial hyper dacemo. So the need of more insulin is
going to make these patients with Taiwan dabetes gain weight.
So with the time, they are not going to be
struggling only with more weight, but also with more insulin
resistance and more need of insulin. And it's a cycle

(51:44):
that is hard to break when never they start gaining weight.
Does it happened to all the Taiwan diabetes, But definitely
when the life that changes are not great and we
have all this hard fund fool in our environment, that's
something that we certainly see. And that's where JLP one
is a word for this population. Glp ones they work
in the brain and they go to the hungry centers

(52:08):
to make you feel society. They also reduce the gastric
empty making you feel more full with this food. But
importantly also the impact in this glucagon spike and prevents
this glucagon to spike after do it, and that's how
the LP wanes start to make a contribution for these populations.

(52:28):
We always are very clear with the patients that GLP
ones are not approved for Taiwan diabetes, but there is
people with Taiwan diabetes that also have tie two diabetes,
and in this case is where GLP wants become relevant,
and that's going to be impacting not only on insulin
needs for these patients, but also in cardiovascular risk because

(52:52):
we know tie to diabetes is very important in terms
of increasing more strokes, more hard issues, more peripheral actory disease,
Taie one diabetes a certain degrees also causing some of
these complications over the time. So a medication this one
makes a huge difference when someone has these combined TAIE

(53:13):
one plus two Tie two diabetes.

Speaker 1 (53:16):
I'm not sure as well that you could actually have
type one and type two diabetes. Is that like clinically
you could diagnose this double diabetes if you like.

Speaker 2 (53:28):
That's definity definity And we can see subjects with TAIE
one diabetes that gain weight and the Tie two comes
from these insulin resistance, like you require higher proses of insulin.
You used to have a total daily dose of let's
say twenty units as Taiwan, and then suddenly your requirements

(53:48):
start to go up as your way goes up. You're
requiring forty sixty units. That's something that is not normal
of a person who has Tie one diabetes alone. And
that is a phenomenon in suit in resistance where you
require more and more those of this medication and does
where you clinically there is no BYO market or a
specific lab as we do in Taiwan diabetes where you

(54:10):
check a SEPEP tie and you see that is low
or you have antibiodies that are positive. In TAIG two
is something on the physical exam on the evolution of
these symptos for the patients, the weight and sometimes clinical
findings like instant resistance like a cantosisnegri cans that is
when they make it darker, are guiding us of the

(54:33):
need of something else more than insulin for these populations.

Speaker 1 (54:38):
Wow, you mentioned there about the hunger and fullness hormones
signals if you like, sorry, is it Latin and Grellin that.

Speaker 3 (54:46):
You're referring to.

Speaker 2 (54:47):
That, that's correct, that's correct.

Speaker 1 (54:51):
I'm curious, just you know, anecdotally, I guess I've heard
that type one diabetes, and maybe it goes back to
that question earlier about how these different hormones relate to
each other.

Speaker 3 (55:01):
As someone living with type one diabetes, are your hunger hunger?

Speaker 1 (55:05):
Are your hunger and fullness cues disrupted, interrupted, massed around with.

Speaker 2 (55:12):
So that's something that will be independent of it. Type
one diabetes, you will have lettin, you will have grilling.
Latin is the society hormone and basically produce latin and
it goes to our hypothalamus until our hypothalamus that's enough

(55:33):
you should stop eating. But definitely for so wes TAI
one dabetes that is exposed to inflammatory food, ultra process
food like this environment independently of having or not TAI
one diabetes. That when we start to see this phenomenon
where the latin is kind of disrupted and it starts

(55:54):
producing these lower capacility to block the society or in
the society. Also there is like a huge communication of
our emotions and our like the regulation systems with the
dopamine and the frontal area of the brain where the

(56:15):
capacity to lose the control of this impulse desire to
eat is also impaired. But that also happens with the
food and the choices that we make, and that will
be a phenomenon independently of the Taiwan dabetes. So I
would say Taiwan diabetes may be almost close to equally

(56:36):
affected as people without Taiwan diabetes for this kind of
disruption in Latin and grilling.

Speaker 1 (56:44):
Interesting and in terms of cortisol, you know, again it's
something we're hearing about online a lot trending topic, you know,
redusial cortisol, corteso spike hair and here, and as it
pertains to Taipewan diabetes is like I anecdotally have seen
my glucose levels raised when I am more stressed. Is

(57:05):
there anything that you can offer people in terms of,
you know, the listeners who are majority living with or
touched by connected to type one diabetes in terms of
what that link is and maybe in some ways that
we can be reassured that when we see those numbers

(57:26):
climbing for whatever reason on the glucose meters, to not
put that extra pressure on ourselves in terms of a
response that may actually then raise glucose levels more, you know,
kind of taking the pressure and that kind of I
don't know a lot of self criticism that a lot
of people can carry in terms of having to manage

(57:49):
and handle a very stressful chronic condition on a daily basis.

Speaker 2 (57:54):
I think you're phrasing it very very well. Jain Is like,
so we shouldn't be afraid of court. This cortesil is
as survival hormone. And basically people that in our institution
loses the adrenalgelands for extra ye surgery. If you don't
have cortus, you're going to have an adrenage crisis and
you need this for survival. Basically you need cortis and

(58:17):
we actually need to give these patients court or hydro
cord is. And as a medication, cortuss is normal and
it's important for many processes. We need it and cortuso
we need a normal geek when we wake up, as
we mentioned in chronobiology before, once we wake up, we
have a biggest spike of cortus that we need to

(58:37):
activate our body, our system to start working and going
through the day. And then we have a second spike
of cortis all around two three pm after lunchtime, where
also we get a second energy boost to go through
our day. But the end of the day is when
the court is level, starts going down and a mina

(58:58):
in theory, court is actually close to zero, because that's
when we want to find this balance. And cortesol is
great for survival and for going today. But if we
have access cortisol, we're going to have issues with sugar control,
with metabolism in general, we're not going to be able
to repair or activeaty many repair mechanisms. And when we

(59:22):
impair the circadian rhythm of the cortess, that's when the
issues happen. And that's when you say we don't we
shouldn't be having self criticism. We should still advocate for
having a healthy lifestyle where we try to regulate our
stress because stress is a normal response. Stress is something

(59:43):
that make us go through hard situations where stress and
we are being chased by a bear in the mountains.
We need this cortisol that's going to give you the
energy you need to be able to run away. But
when you are chronically stressed and you have this cortisol
and you don't have these arcadant rhythm is when the

(01:00:03):
issues start to happen in our body. And you can
see that as you mentioned in because control so definity
finding this balance between meditation trying to have greatest sleep.
We need affinity to sleep eight hours. There's no way
out for eskeeping a sleep that let our courtes rest.

(01:00:26):
That's something that is going to make an impact. There
is a lot of misinformation in social media is getting
very trending. U. They are talking about men of pous
and recommending men of pause. Woman not to exercise in
the morning because you have your cortico spy, you're going
to make it more spiky. Does completely Uh, there is

(01:00:48):
completely a lot of misinformation into this. So we should
definitely read about cortisol with the right people. And the
message that we be taking is that cortisort is cool.
Just make sure to don't spike it when it shouldn't
be spiking, and that's at nighttime or when we are stress.

(01:01:09):
We have to take care of finding a way to
reduce these continuous spikes by leftlock chains.

Speaker 1 (01:01:16):
Yeah, and what would you suggest in your expert opinion
for people with busy lifestyles, who are managing chronic conditions,
who are raising families, and we live in this constant
state of connectivity with this misinformation, and you're hearing one
thing and then the next contradictory thing, and it can
be hard to know where to go in terms of

(01:01:38):
what your needs are. It can be hard to kind
of just take a step back. What do you recommend
for people who are trying to balance busy lifestyles with
a chronic health condition and have an interest in making
sure that they are looking after their health as much
as possible in this modern world.

Speaker 2 (01:01:57):
Yes, in this modern world, this is a challenge that
any of us struggle with. And having the family having
keys efinitely is always going to be challenging. Definitely. The
first thing is having a support group. Having someone that
is going through the same that you're going is something
gonna that is something that is going to always keep

(01:02:18):
positive to feel back, give you ideas, or even find
a workout body or a milk pread body. The supper
group also is going to make a huge difference. So
I think that's a start. Reality is that sometimes people
is struggling with good time but trying to have a

(01:02:40):
protected time. It's not about perfection, It's about consistency what
we should be advocating for. So even if I can
do a five minutes of squad at home or exercising,
that's going to be more impactful on the long term
as someone who is trying to look for the perfect

(01:03:01):
routine at the team with the best membership, going a
few times per week, because it's not something that is
going to be possible for this person. So I think
when we have this struggle, definitely, consistency in small doses
it will be my best advice. And finding a super

(01:03:21):
system is going to always help you with the difficulties
and help you overcome these challenges.

Speaker 1 (01:03:28):
I love the idea of a supergroup and a supersystem. Yeah,
a lot of what you've said here, like it strikes me.
You know, it's sleep that so many of us overlooked,
and you've talked about connection, You've talked about you know,
the basics of eating non processed foods. I'm wondering what
your thoughts are on whether we've or how much we've

(01:03:51):
kind of.

Speaker 3 (01:03:52):
Overcomplicated the keys to a healthy lifestyle.

Speaker 1 (01:03:55):
Do you perceive that to be something that we need
to maybe pay attention.

Speaker 2 (01:04:02):
To you, Yes, definitely, Complexity doesn't bring solutions for real
life the way we would expect. And going back to
the basics, and I mentioned it before, to our eating

(01:04:22):
like the way our Grandpa used to eat many years ago.
Going back to our roots, go to real food. It's
going to make a huge difference. So it's not that
complicated if we simplify the things and we remove these
tractors from our environment, and that includes removing things that
we don't need. We don't need to be scrolling in

(01:04:44):
social media five hours per day. We don't need this
screen time night when we are in bed, we don't
need to be watching TV. Lay night, sometimes going to
the basics or in a time to decompress, taking a
shower at the end of the day, reading a book,

(01:05:04):
doing the lights a little bit, relaxing before going to it,
waking up to the sun and having a breakfast. Embrace
the day with gratitude, like see where you're waking up,
who is around you, what do you have in your
plate in front of you? Enjoying all these little details
make a huge difference to your day and to definite

(01:05:27):
in packing your health. Don't look for the perfect game,
don't look for the perfect timing. Just do it. If
you are walking, go and do it. Walk as fast
as you can. That's the best you can do. Do
it the stuff for this perfection that definitely is going
to take you away from a real positive outcome. And definitely,

(01:05:48):
one step by a time, it's going to take you
to get closer to that goal that you may have
at some point. By definitely, we gratitude stay by step,
we're going to be reaching more that are doing more
than we willdn't be doing at a wise.

Speaker 3 (01:06:04):
Basically, yeah, nice, And there's a lot of.

Speaker 1 (01:06:09):
Energy around presence there, and I think living with techno diabetes,
it can be hard to stay present because it's always
kind of in the.

Speaker 3 (01:06:16):
Back of your head. But equally, there's nothing that will.

Speaker 1 (01:06:18):
Bring me back to the present moment then knowing that
I need to save my own life right now, like
everything stops. There's an interesting dichotomy, and I think that's
something that I personally is someone living with a health condition,
often I'm faced with two sides of this very crazy coin.
For you personally, you've mentioned that you just graduated from

(01:06:41):
your fellowship and you're moving on to the next chapter.
What is next for you in terms of this work
you're doing and the mission that you're so driven by.
I'm just curious to know what's next for you.

Speaker 2 (01:06:54):
Definitely, and it goes again to this passion for working
for underserve communities. I'm going to have the opportunity to
work very close here in the Bay Area with a
community that belongs to Alamida Health is a highcard system

(01:07:15):
where we're very close to the people, we are very
close to community in need. We have a large population
of Spanics I would say more than forty percent that
are struggling with the access to resources to Spanish education,
that are in need and where I feel that I

(01:07:35):
certainly can contribute. So I'm very excited to move forward
to this state where I'm going to be associated division
chief and be able to contribute to these communities, not
only in the clinic having a one to one encounter,
but also contributing by the way the teams are doing

(01:07:56):
in the major scale, and definitely continue to advocate for
Hispanics in the US. It's going to be one of
my priorities and I look forward to keep collaborating with
media across the US and keep working on my social
media to make a positive impact for these populations in need.

Speaker 3 (01:08:16):
Yeah, amazing.

Speaker 1 (01:08:18):
Is there anything else that you'd like to touch on,
or anything close to your heart or anything that you're
working on that's really exciting for you? At the moment
that you'd like to share with the audience.

Speaker 2 (01:08:29):
I definitely I want to tell the audience that everybody
has their own struggles. Definitely, media is going to be
always there to give us resources and we sometimes look
for solutions in media. And as a educator in media,
I will say always try to follow the right people

(01:08:54):
or learn from the right people. Don't compare your process
with other people's process, because you are living your own
life and you shouldn't be comparing with other people, and
that's gonna lead to frustrations sometimes in the process. So
be kind to yourself, be patient to yourself, find the

(01:09:18):
right guidance and find always the right support, and that's
gonna be the best way to take care of you
and to find the best positive outcome for your condition.
And definitely, if you are a hispanic over there, I
will be more than happy to see you in my
media and learn from my videos, where I will be

(01:09:41):
more than happy to teach you in Spanish and educate
you as I have been doing for the last few years.

Speaker 1 (01:09:49):
Incredible, and speaking of educating and following the right people,
where can people find you if they want to see
more about what you're up to? And this education that
you're breading farm wide.

Speaker 2 (01:10:01):
Definitely, so they can find me on YouTube or on
Facebook as doctor hiro Narenia doctor str And on Instagram
as Ironbi. This is my first name and all from
my last name Arania and Vee from my second last name,

(01:10:23):
hiro Nobi, and I look forward to see you all.
I continuously collaborate with different Chinese across the US and
look forward to CEEO as well in your locale Hispanic
TV talking about relevant copies that are going to be
imparting your health.

Speaker 3 (01:10:45):
Thank you so much.

Speaker 1 (01:10:46):
I think this has been a really eye opening discussion
for people not only in terms of their own health conditions,
but the needs of communities and voices that are underrepresented
and have these challenges when they're just trying to get
the healthcare that they need. Yeah, so thank you so
much for your work, and thank you so much for
speaking to me today.

Speaker 3 (01:11:05):
I really appreciate it.

Speaker 2 (01:11:07):
Thank you, Jenney's you know, wonderful time and definitely very
happy to have been spending be staying with you today
and with your audience.

Speaker 3 (01:11:16):
Thank you so much. Glad to ask that me in
for I've learn Englaz good idea as.

Speaker 1 (01:11:25):
I hope you enjoyed this episode of Type one on one.
Please remember that nothing you hear on this podcast should
be taken as medical advice. I'm definitely not a healthcare professional.
If you like what you hear, hit subscribe and do
leave a little review on iTunes if you have time.
It really helps to spread the word about type one diabetes,

(01:11:46):
and thank you so much for listening.

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'We're seeing a phenomenon of type 1 plus type 2 diabetes' - Dr Jairo Noreña

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}'We're seeing a phenomenon of type 1 plus type 2 diabetes' - Dr Jairo Noreña