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Deborah Howell (host): Hello. Welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell. Today's guest is Linda Kerr, a nurse practitioner and certified diabetes educator. Kerr specializes in diabetes management across all settings including private practice, acute outpatient care, and community programs. Kerr is the diabetes program director at Long Beach Memorial where she developed a comprehensive diabetes education team committed to providing diabetes-related resources, clinical interventions, and education to hospitalized patients. She developed the Adult Outpatient Diabetes Program achieving American Diabetes Association (ADA) recognition in spring of 2012 and led the team to achieve the Joint Commission's Advanced Inpatient Diabetes Disease-Specific Care certification for Long Beach Memorial in fall of 2012. A lot of big words but it just means she really loves what she does. Welcome to you, Linda.

Linda Kerr (guest): Thank you, Deborah.

Deborah: Okay. Let me set things up and then I'm going to let you roll. We will be talking about diabetes today. Nearly 26 million Americans have diabetes according to new estimates from the CDC. In addition, an estimated 79 million US adults have pre-diabetes, a condition in which blood sugar levels are higher than normal. Okay. Now diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to suffer from complications like heart attacks, strokes, high blood pressure, kidney failure, blindness, and amputations of feet and legs. It just goes on and on and on. So Linda, my first question to you today is what is pre-diabetes?

Kerr: Pre-diabetes is what people used to call borderline diabetes. It's that place in between where you don't have diabetes and the place where you do have diabetes, the diagnosis. And it just means that at some place in your day or in your week, your sugars run higher and they just don't trend back down into a normal pattern. The nice thing about pre-diabetes is that you can hold off diabetes indefinitely with lifestyle changes.

Deborah: Okay.

Kerr: And that just means paying attention to good nutrition and being active and looking after your blood pressure and your cholesterol, making sure that your numbers there are within the recommend target, and you can live healthfully indefinitely without progressing onto diabetes. What people need to know about pre-diabetes, however, is that it does carry with it, if untreated, as high a risk for heart attack and stroke as diabetes.

Deborah: That's incredible. And I bet many, many people are walking around with pre-diabetes that don't even know it.

Kerr: Many people are. So it's just a simple blood test now. We call it a hemoglobin A1c. The doctor can order it and add it on to your labs. You go to the lab to get your blood drawn and it's just one of the blood tests that can be done. And it could really tell your physician and you where you are in the diabetes spectrum.

Deborah: Boy, if more people did that, they could really, really help themselves out.

Kerr: This is true. And people sometimes are nervous about knowing whether they have diabetes or pre-diabetes, blood pressure, cholesterol. And yet, if you are armed with knowledge and the goal to make good nutrition choices, to make yourself a little bit more active, and just the knowledge that you can make really good changes in your health with very small adjustments really.

Deborah: And you'll feel better mentally, too, right?

Kerr: Absolutely.

Deborah: What are the signs and symptoms of diabetes?

Kerr: It sort of begins with a discussion of what is diabetes. And we think of diabetes as either type 1 or type 2. And type 1 diabetes is an individual that just doesn't make insulin at all. So they have to bring their insulin in with shots. And symptoms for somebody with type 1 diabetes onset, it's very dramatic, it's very noticeable – thirst, blurred vision, lots of urination, a big weight drop, a very rapid weight drop, and maybe 10 or so pounds in a week. It's very noticeable. For type 2 diabetes, now, this is a person who makes still their own insulin. Maybe they make plenty of insulin but they just can't get over there and use it very efficiently. We call that insulin resistance. And about 80 percent of people with Type 2 diabetes have insulin resistance and this by far is the most common type of diabetes. So actually, I forgot where my question was going.

Deborah: That's okay.

Kerr: I got talking along about types.

Deborah: No, that was a great description. We were talking about signs and symptoms.

Kerr: There you go. And so, what I wanted to say about Type 2 is that the symptoms are therefore very subtle and quiet. You can have Type 2 diabetes for 5 to 10 years and never know that you have it. And it's because your fasting blood sugar holds normal for a very long time. And when you go to get your labs drawn, you go to get your blood drawn, your doctor tells you to go fasting. And so the blood sugar looks pretty good for a long time. It's your two-hour post meal blood sugar that goes up and stays up.

Deborah: I see.

Kerr: And so therefore, a lot of times with Type 2, you're not really aware that you have the slow onset of blurred vision or thirst or that you're urinating more, you're getting up more in the middle of the night to go to the bathroom. But these things are kind of creeping up slowly.

Deborah: That's fascinating. Okay. So what if your father has diabetes? Does that raise your risk?

Kerr: The interesting thing about Type 2 diabetes, it does have a strong link to genetics. And if you do have a family history of diabetes, likely you're hardwired with the ability to go on and develop Type 2 diabetes. So therefore, it's just more information. It's good information to know, "Look, I have it in the family and therefore I have to look after a few things. I have to make good nutrition choices. I have to stay active. As a female, I would like my waist circumference to be less than 35 inches. As a male, I'd like my waist circumference to be less than 40 inches. And just stay healthy because I know in the family, I have diabetes."

Deborah: Can diet or exercise really prevent diabetes?

Kerr: Diet and exercise are very excellent lifestyle interventions that one can do. This is empowering to an individual because this is something that we have control over. So it makes a very large difference. Exercise, just a 30-minute walk most days of the week, will adjust your blood sugar from something a little bit higher to a little bit lower. And it's just so much better than once a week an hour in the gym.

Deborah: Even if you're working around the house, you almost do that 30 minutes in a day anyway.

Kerr: Sustained activity. That's exactly right. If you're cleaning the house and you have a sustained activity of 20 or 30 minutes going around and vacuuming and dusting and doing all of those things, it's all beneficial.

Deborah: So what steps can people take to create a healthy eating plan to help control their blood sugar and manage their weight in addition to the exercise?

Kerr: Nutrition is a very big topic and this is a topic that most people who have diabetes or have pre-diabetes and they'd like to make some good changes, these are the big questions for people with diabetes. And I will tell you that everything that I know about nutrition and all of the pearls and the really good stuff, I picked up from my dietitian friend. And so I really encourage people with diabetes to make that connection with their dietician because they're just going to learn so much. The things that I share broad stroke with the patients are three categories – decrease and monitor the amount of carbohydrates that you have per meal.

Deborah: Okay.

Kerr: A carbohydrate is anything that's a starch, bread, pasta, rice, potato, all your fruits, your vegetables, your milk, your cereals. You would like to have as a female two to three servings of carbohydrates per meal, a male, three to four servings of carbohydrates per meal.

Deborah: Okay.

Kerr: And you would like your choice of carbohydrate to have lots of good natural fiber, and that's why we say fresh fruit, fresh vegetable, whole grains. Because that fiber is going to break down very nicely in your system and not allow all of that sugar to absorb over into your body.

Deborah: Wonderful information. Now, for our listeners who may have diabetes, we are out of time, but I think we have time to get information about any support group that you'd like to share.

Kerr: Excellent. We have both English and Spanish support groups. The English support group meets on the 4th Monday of each month. The Spanish support group meets on the 4th Tuesday of each month. Those support groups meet at the Columbia Building here on the Long Beach Memorial Hospital campus and we are in suite 210.

Deborah: Thank you so much.

Kerr: And the address is 2840.

Deborah: Thank you so much, Nurse Linda Kerr. You can get more information on the MemorialCare Healthsystem website. We want to thank you so much for being on the show and wish all of our listeners a very fantastic day. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness.