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Traveling Well Through Life with Diabetes

Taking steps to manage your diabetes does more than lower your blood glucose and improve your health. It significantly reduces your risk of serious long-term complications and helps build the confidence you need for successful lifelong diabetes management.

The Diabetes Care Program at Marin General Hospital provides a continuum of expert care and resources for diabetes patients, their families, and caregivers. With the proper education, support, and medical supervision, patients can learn to successfully manage their diabetes and live healthier lives.

In this segment, Linda Gaudiani, MD, Medical Director of the Diabetes Care Program and Braden Diabetes Center at Marin General Hospital explains how Marin General Hospital partners with you to help make life with diabetes a full and satisfying journey.
Traveling Well Through Life with Diabetes
Featuring:
Linda M. Gaudiani, MD
Dr. Gaudiani is the president of Marin Endocrine Care and Research a specialty practice in Endocrinology, Diabetology and Metabolism since 1985 and now part of the Marin Health Care District. In addition to her endocrinology practice, she co-directs the Marin Endocrine Bone Density Services.

Learn more about Linda M. Gaudiani, MD
Transcription:

Bill Klaproth (Host): Living with diabetes can have its challenges, but each day presents a new opportunity to improve your health. Learning to manage your diabetes can help you feel better physically and emotionally and help you avoid serious complications over time, and here to talk with us about traveling through life with diabetes is Dr. Linda Gaudiani, an endocrinologist and the medical director of the Braden Diabetes Center and Inpatient Diabetes Care Program at Marin General Hospital. Dr. Gaudiani, thank you for your time. So, who is at risk for developing type 2 diabetes?

Dr. Linda Gaudiani, MD (Guest): Anyone --

Bill: Anyone?

Dr. Gaudiani: Anyone is -- type 2 diabetes and this a very common gene in most populations. There are some ethnicities that are more burdened with this genetic risk than others, but there's no one who can say, "Well, because I’m thin, and I exercise, and no one in my family has diabetes; I couldn't possibly get it." We know that it's so common that there's regular screening and a lot of awareness that we need to pass on to our community to make sure that we don't miss this disease in its early silent stages.

Bill: I have a friend of mine. He is tall and slender; doesn't fit the model of what you would think somebody with type 2 diabetes has, and when --

Dr. Gaudiani: Right

Bill: -- he told me he has type 2 diabetes, I looked at him and went, "What? What? How? Wait a minute."

Dr. Gaudiani: Right

Bill: That doesn't make sense. Usually, it's obese people, right? And he goes, "No."

Dr. Gaudiani: Right,

Bill: -- It’s not –

Dr. Guadiani: -- and I think that’s something that we really need to correct because it almost gets to be an embarrassment for overweight people. They think they're the only ones who can get diabetic symptoms and diabetes, and it's kind of another just another burden that they carry around, and they don't realize this disease is about insulin deficiency – and this disease is about insulin resistance. Now, there are certain features that can worsen resistance to insulin and by that term resistance, is what I mean, there are factors that keep our bodies from using insulin more efficiently, and if that factor continues and there are multiple factors that cause us to be unable to use our insulin efficiently, that can lead to diabetes, but you can’t get diabetes without some element of insulin deficiency as well. There are some extremely obese patients that live their whole lives and never get diabetes or high blood sugars. Those patients have ample insulin production. So, I think, it's important to take the guilt away from diabetes. It's a genetic card to begin with, and you can play that card well, or you can play that card poorly by adding or subtracting to the risk factors that you may or may not have genetically, but we don't always know, after all --

Bill: Ummm hmmm

Dr. Gaudiani: -- parents didn't always know their histories, right? And our great grandparents and grandparents certainly didn't know when they had many of these chronic illnesses. They just got sick and died of complications way before they even knew they had the disease --

Bill: Ummm hmmm

Dr. Gaudiani: So, I would say to answer that a little bit more fully – I’d just spend a minute talking to you about insulin and the insulin receptor and then we can talk about some of the features that aggravate resistance to insulin or aggravate our insulin not working as well.

Bill: Right. So, I was going to ask you then, is it our poor lifestyles then that ultimately lead to type 2 diabetes?

Dr. Gaudiani: They aggravate it. As I said, it's a common gene, and you have to have the genetic predisposition, but that said, just having the genetic predisposition may never lead to expression of the disease if we are lucky enough to choose and be able to empower a lifestyle that limits our risks by improving our sensitivity to insulin. So, let's say, we're an individual with a genetic risk. We don't know that, what we have -- somewhat of a decreased capacity to make lots and lots of insulin, and let's say that we're very, very sedentary and because we're working hard and we're sedentary, we don't get out, get any exercise and because we are not educated about diet and make poor dietary choices, and that leads to overweight and inactivity chronically, that could certainly bring on diabetes because then you have the two cards that you need to have for diabetes to be expressed. You have insulin deficiency and insulin resistance. If we can fix the insulin resistance, we can often pull back the diabetes completely or in fact even prevent it which is what we're trying to do at the Braden Center every day.
What are the things that you can do to lessen your risk because we don't always know whether we have the genetic risk? Certainly if you do know diabetes runs in your family, you are at risk. If you do know you’ve a history of gestational diabetes -- which is gestational diabetes -- diabetes that occurs during pregnancy. If you know that you have had high blood sugars in the past during times of stress such as surgeries, illnesses. If you do know that you've had several members in the family come down with diabetes, then you would do very well to listen up to what the other things you can do in terms of lifestyle to prevent the onset of diabetes.

Bill: Well, that makes sense and the other part of the problem is there really are no symptoms usually associated with the disease, right? People a lot of times don't know they have it.

Dr. Gaudiani: No, you're absolutely right. This is a huge problem and why the incidence of diabetes was largely was missed in years gone by because you can have hyperglycemia or mild diabetes for five or ten years before it expresses itself in its later stages in association with symptoms. How do we know that? We know that because in large studies that were done on type 2 diabetics on the day that they were diagnosed, they were also already found to have a major complication such as eye disease or kidney disease or nerve disease. So there's no way they could have had a complication on the very first day that they were diagnosed. So, we know that they actually had the disease for some -- many years prior to that in order to be able to develop those side effects or those complications, I should say. So, that's very, very important to us, and it’s what's led to the big push on patients number one, being aware of the risk factors, getting screened if you are at risk, and then even if you're not known to be at risk, following sort of lifestyle prevention strategies -- for one thing because they really work. It's been shown in a large diabetes prevention trial that was done in Britain and subsequently has been studied -- those patients have been studied and followed for over a decade -- that lifestyle that results in significant changes in dietary intake and body weight and then exercise can work just as well to treat early high blood sugars as medications. It's just as potent and so if we can treat with lifestyle and hold off on starting medications that can have complications and that are costly and that can have side effects, why of course we'd want to start with the lifestyle.

Bill: Absolutely, and I think what you said there is very important, those three things: being aware of your genetic predisposition, getting screened, and then employing lifestyle prevention strategies, and prevention, management, and support is very important. So, can you tell us about the Braden Diabetes Center and the multiple services you offer?

Dr. Gaudiani: Well, the Braden Diabetes Center is very exciting. It's a personal -- it was a personal goal when I went into practice some 30 years ago, and I realized leaving the university that even then, there were diabetes teaching programs so coming out into -- even an affluent community -- and finding that there was nothing was rather discouraging, and so I started working on it then and little by little over the years I was finally able to cofound this with our philanthropist, Mr. Bruce Braden, who's a long-time patient -- one of the first patients I had in my practice over 30 years ago and in cooperation with Marin General Hospital's current administration, we were able to get the resources together to really say we need a line of service called diabetes services and it's going to start with the Braden Diabetes Outpatient Clinic which is really devoted to helping people live well and travel well with diabetes, and we made our visual “Travel on a Journey” because diabetes is not something you can swat like a fly. It's not something you can take out with surgery, and it's over. You kind of have to live with it, but you can live really well with it. You can often prevent it, and you can very often prevent the complications, which is really what's important.

Bill: Well, that's so good to hear and that support is very important. Well, Dr. Gaudiani, thank you so much for talking with us about diabetes risks and symptoms. For more information, visit maringeneral.org. That's maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth. Thanks for listening.