Transcription:

Melanie Cole (Host): An estimated 29 million Americans have diabetes, and 382 million people have it worldwide. Diabetes has become one of the nation’s top chronic health conditions. My guest today is Dr. Parveen Verma. She’s an Endocrinologist with Lourdes Health System. Welcome to the show, Dr. Verma. First, people hear the word diabetes, and they’ve heard about – what they used to call, or still call – juvenile diabetes, type one, and then type two, which again, used to be called adult-onset, but now we see kids with this type of diabetes. Explain the difference between these two types.

Dr. Parveen Verma (Guest): Sure, no problem. The majority of people that we see have type two diabetes. This is a disease where there’s two different deficits. The body is not making enough insulin, and the insulin that it does make, the body is resistant to its effects. It typically affects older individuals. Most people do have a genetic risk that’s aggravated by lifestyle issues such as lack of activity, or dietary habits. As opposed to type one diabetes, which is an autoimmune disease, the body basically turns against its own pancreas and the cells that make insulin are no longer functional. These individuals always rely on insulin for treatment as opposed to type two patients who can respond, very successfully, to pills, or a combination of insulin and pills.

Melanie: So, we’re going to stick closer to type two since it is quite a bit more common, and you mentioned a few of the risk factors. Does genetics play a role in type two, and then you mentioned sedentary lifestyle, so speak about some of the things that would predispose somebody to type two diabetes.

Dr. Verma: Absolutely. Family history is definitely a risk factor for type two diabetes. This can be aggravated by obesity, lack of activity, and dietary choices, so environmental factors can also trigger the onset earlier than just having genetic risk as their main risk factor.

Melanie: Okay, so we’ve got all of these things, how would someone know, Dr. Verma, is this something that you test for regularly if someone goes in for their annual physical, would it show up on their blood work? Are there specific screenings for it, or would we know by some symptoms?

Dr. Verma: So a combination of all of that, absolutely. Annual blood work in individuals who are at high risk, so who have those risk factors that I mentioned earlier, blood work will detect both prediabetes, which is a blood sugar that falls between 100 and 125 on a fasting set of blood work, or overt diabetes, which is a fasting blood sugar over 126. Not everybody has symptoms when they are in early stages of diabetes, but if they’ve had it for a while and they haven't had blood work done to evaluate, they may have some symptoms such as increased thirst, waking up at night to urinate, feeling weak, unexplained weight loss, or blurry vision. These are typical symptoms of someone who’s had very high blood sugars over a period of weeks to months.

Melanie: So then let’s talk about the first-line of defense. Type one is an insulin-dependent type but type two, not necessarily. What do you tell people as the first line of defense if you detect that they have prediabetes, or full-on?

Dr. Verma: These are patients that I always appreciate seeing in my practice. If I can prevent the progression by simple lifestyle changes, we can either delay or prevent the onset of over diabetes. People with those risk factors, we talk about lower carbohydrate intake, really watching your carbohydrates, the starchy foods in your diet, and increasing activity. There have been studies supporting the benefits of 30 minutes of exercise at least five days a week can actually delay progression to overt diabetes in a predisposed population by a significant percentage, by almost 60 percent. Lifestyle modification is so important, and something that people can take ownership of, and participate in, to reduce the risk.

Melanie: Now, you mentioned carbohydrates and not all carbohydrates are created equal. People with prediabetes or overt diabetes are afraid of carbohydrates, even though a carrot is considered a carbohydrate and will not give them diabetes. Explain how you explain the difference between the carbohydrates they really do need to steer clear of and what they’ve heard about in the media.

Dr. Verma: Absolutely. Food definitely, and carbohydrates can definitely aggravate underlying risks for diabetes, and there are very different types of carbohydrates. Typical things we talk to patients about are the obvious things, the cakes, the cookies, the sugars that can really aggravate, and are unhealthy, but overall, it’s a matter of understanding portions. So yes, a carrot is a carbohydrate, so we talk to patients about the appropriate amounts of carrots in a meal, versus utilizing, or having within their diet, a combination of carrots, mashed potatoes, bread all in one meal. All of these are starches, and it’s just a matter of knowing the portion that’s appropriate for a meal. Although there are different types of carbohydrates, it’s really how you distribute those carbohydrates within your diet that can aggravate and raise blood sugars.

Melanie: Where does exercise fit into this picture?

Dr. Verma: As I mentioned earlier, from prevention to treatment, exercise is so important. I tell my patients that exercise, in most cases, is as important as the medication that we prescribe, because exercise also allows a way to reduce blood sugars. It helps to keep patients’ cardiovascular health stable, as well as improve blood sugars and help them to reduce weight, so from many aspects, it’s going to help in their overall treatment plan. I always encourage patients, as mentioned earlier, a minimum of 30 minutes, five days a week, walking on a treadmill, walking outside, staying at a pace that they're not losing their breath, but they feel like they’re getting a workout is certainly advantageous.

Melanie: And certainly exercise does have that insulin-like effect, and I’m so glad that you pointed out about cardiovascular exercise being so good for diabetics. Now, when it comes to medicational intervention, what is involved in type two?

Dr. Verma: It’s usually multiple avenues that we take. As I mentioned earlier, it’s talking to patients about lifestyle, talking to them about diet, and then integrating appropriate medications. For many patients, a combination of pills that work synergistically to lower blood sugars is usually the initial approach. People who have had type two diabetes for a long period of time, or if their blood sugars are significantly elevated, may require insulin. The longer you have diabetes – it is a chronic disease, where there’s ongoing destruction of the cells in the pancreas that make insulin, so over time patient’s with type two diabetes may need insulin, so we will use a combination of pills and insulin to keep the blood sugars at goal. Now, having diabetes, we have so many different combinations of medications that we can use. If one medication doesn’t work, patients shouldn’t get discouraged. They should bring that information back to their doctor, talk to them about what side effects they might be experiencing, and there’s usually a different type of medication that’s helpful. Many of the medications that we use today also have some other beneficial effects, such as weight reduction, some may slightly improve blood pressure, and some of the newer agents also have some indications to reduce cardiovascular death. When we approach a patient for diabetes, it’s not just about their blood sugars, but also looking at their overall health from blood pressure to obesity, and taking that all into account and figuring out a medication regimen that can address many of those, primarily the blood sugars, but depending on what their other issues are, we may pick a medication to assist with weight loss as well, for example.

Melanie: And as people do have these comorbidities that go along with diabetes and put them at risk for other things like heart disease, Dr. Verma, what do you tell them if they ask you, “Can this be cured? Will I ever be able to stop taking this medication, or be able to look to other treatments that may not be medicationally involved?”

Dr. Verma: I usually tell patients it’s very difficult to cure diabetes. There’s no way to completely cure the deficit, such as insulin resistance, and a decrease in insulin production, but you can certainly delay progression, and you can stabilize the disease. If patients do lose weight, often times we are decreasing the amount of medication that they need because they become more sensitive to insulin and can use their body’s insulin more effectively. Although it cannot be cured, it certainly be stabilized, so that patients can still lead a very active, functional life and delay their progression and their risk for other comorbidities.

Melanie: And Dr. Verma, in just the last few minutes, wrap it up for us, with your best advice, what you tell people every single day about diabetes, preventing diabetes, and why they should come to Lourdes Health System for their care.

Dr. Verma: My best advice would be to take ownership of your own healthcare. See your primary care provider, get your blood work regularly, and know your risk factors. Everyone should engage in regular activity, and if you have diabetes don’t be afraid to monitor your blood sugars to that you’re in the know and you can control this disease. At Lourdes, we have a multidisciplinary approach to managing diabetes. We have diabetes education that’s provided through the A-B-C program. In our office, we have a team that sees every single patient, and we create a plan and keep the patient engaged so that they can reduce their risk of this progressing.

Melanie: Thank you, so much, for being with us today, Dr. Verma. That’s great information. You’re listening to Lourdes Health Talk, and for more information, you can go to LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole. Thanks, so much, for listening.