Transcription:

Melanie Cole (Host): Untreated high blood sugars can cause many problems for diabetics and cause future complications. Recognizing the signs of high blood sugar levels and knowing how to lower them can help you prevent these complications and increase the quality and length of your life. My guest today is Dr. Nicholas Mezitis. He’s an endocrinologist with Memorial Health System. Dr. Mezitis let’s start with explaining to the listeners what happens when we eat? Why do we need to understand insulin and blood sugar and their relationship?

Nicholas H. E. Mezitis, MD (Guest): It’s very important to understand that high blood sugars come along with repercussions for the system. The system is set up to have a blood sugar in the range of 100 mg per deciliter. That is kind of a score we keep in mind. And swings high above this particular number even below has results that are undesirable. Low blood sugars as many of the listeners may be aware, have issues that cause changes in mental states, confusion and sometimes even unconsciousness and worse. High blood sugars as we frequently see with diabetes can have repercussions that relate to damage to blood vessels, nerves, or for that matter, problems that relate to immune deficiency and infections and other issues. So, all of our strategies are based on trying to keep our numbers as close to that marker that I mentioned.

Melanie: If someone has type 2 diabetes and that’s pretty much what we are talking about. Type 1 is a whole different ballgame. But if they have type 2, why is it so important for them and do they need to be concerned with both as you say low, hypoglycemia and hyperglycemia? Do both of those things – can they both cause complications for a type 2 diabetic?

Dr. Mezitis: Yes, as a matter of fact, and that’s an interesting question because a lot of people who have type 2 diabetes, don’t necessarily experience some discomfort or pain for that matter. So, the damage is being done but, yet they are not picking up on the fact and very frequently we see people who come in with very high blood sugars and had no clue whatsoever. It happened to be picked up because of some other chance event when things were checked. So, the reminder is that people don’t necessarily have to expect that they are going to feel something. They need to be checking their blood glucose, if the diagnosis has been made, in order to make sure that they are in the proper range and that’s as you said very important for the patient who has type 2 diabetes. In the case of type 1 diabetes, things are a little different because there they are more likely to feel very uncomfortable if their blood glucose is drifting and they are missing out on their insulin.

Melanie: And also, with type 1, they were probably diagnosed at some point in their life, so they know exactly what’s going on whereas type 2 people might even be unaware that they have prediabetes. How often should people who are told that they have prediabetes, should they be checking their blood sugars and then if you are told you have full-blown diabetes, how often do you want people to check?

Dr. Mezitis: Well prediabetes is a very big issue particularly because in regions like ours here in Appalachia, many, many of our patients have family members who have had or have diabetes. Therefore, once that’s in the family genetic lines so to speak; we need to be always vigilant and everyone who has a first-degree relative with diabetes certainly should be monitored periodically to make sure that they are not developing this particular problem. Also, blood glucose results that are chance findings but are a little bit offline, again they might not necessarily have reached the point where we can make the formal diagnosis, but we can see that they are offline, that they are actually drifting, and certain interventions are indicated. In other words, we need to take measures and these measures we will discuss but they relate primarily to lifestyle at the stage of prediabetes.

Melanie: Then let’s talk about how you keep track of your blood sugars and what you can do to actually keep control of them. So, why don’t you start with exercise since it has an insulin like effect and it is such an important part of managing diabetes symptoms and blood sugar.

Dr. Mezitis: And that’s an excellent point because what happens, and we are very much aware; exercise has an effect like giving an insulin injection if you will. So, for people who happen to be taking medications or insulin; exercising immediately has effects as if they have taken medication and therefore, we view it as medication and therefore, we also like to give an exercise prescription. And currently, the guidelines are that people should engage in exercise, active exercise for about 150 minutes a week. That would make 30 minutes on five days a week that they need to be engaged in exercise or more simply put perhaps 10,000 steps a day for people who walk to make sure that they get that equivalent because this level of activity makes the insulin that the body produces work better and certainly, works to also prevent blood sugars from rising into dangerous ranges. And that we know follows when people put on weight and when they are inactive. So, these things are of great importance and that’s why we use exercise as the first step in our management plan together with a diet.

Melanie: Let’s talk about diet then, because people have heard even if they are just trying to lose weight; that carbohydrates are the enemy, or we heard fats are the enemy, well not all carbohydrates are created equal, so which ones are the ones for diabetics that they do need to watch out for because not all sugars are equal?

Dr. Mezitis: And that’s another excellent point you are making Melanie. The fact that the diet needs to be viewed with a level of sophistication in other words, not all carbohydrates are a problem and not all fats are a problem, not all proteins are equal. We need to understand that certain foods are beneficial to us and certain foods should be restricted. And when it comes to carbohydrates, we make a distinction between what we call complex carbohydrates. These would be carbohydrates such as those we see in vegetables or unprocessed grains because those seem to not cause the blood glucose to spike as readily as those other refined, simple comfort foods, if you will that have carbohydrates. So, we need to be careful when we say about carbohydrate restriction. The term is used very broadly, but again, we try to encourage vegetables to be a large part and when I instruct patients, I remind them that half of their plate should have vegetables and then around that we build other components of the plate including the protein and the fat and also some of these simple carbohydrates that may include certain fruits and such.

Melanie: So, now that you’ve pretty much discussed a little bit about the low glycemic index with those carbohydrates that don’t have that sugar rush to them; doctor, explain a little bit about where fiber or water or some of these kinds of things fit into this picture.

Dr. Mezitis: Well, we have to be reminded that when we are eating, we are feeding the microbiome. So, the microbiome are the trillions of bacteria that populate our gut. They do the work of digestion and obviously, these have to be fed in a special way because they eat grass, they eat the fiber. They are the ones that we feed with our vegetables and such and even though we view those components as not being nutrients per se; they have a very vital role, the fiber that is. Because for the bacteria in the gut, they are critical components in their nutrition and also, they form the bulk of the stool. They also are there to cleanse the gut and all of these roles are important and at the same time, they also stabilize, and they delay if you will, the absorption of carbohydrate from the gut through their presence. So, fiber is of vital importance and a very simple way to take fiber is to get it through our vegetables and our unprocessed grains. Obviously, there are people for a variety of reasons, they need extra fiber, they may be constipated or have other issues and that can also be given in a powder form to be added to the meal, but I think it’s much more palatable and acceptable to incorporate it for most people as a salad. So, a generous portion with each meal.

Melanie: Now, stress. Because people don’t typically think of stress as something that might raise or lower your blood sugar levels or really even have an effect on managing your diabetes. So, just speak a little bit about our stress levels, because that also plays into the exercise portion of this.

Dr. Mezitis: And that’s very true. Because that’s the one element that’s been neglected. It has been neglected in the sense that we are focused very much on medications, a little bit on the diet and less on exercise. But that that’s been totally neglected has been the stress-sleep element. And unfortunately, for the majority of the population these days, there are many issues that they confront so whether they are financial or family or social or whatever issues that bring on stress and when you have stress, you also have certain hormones that are produced in response to stress, we know that. And we also know that the hormones that are released when people are under stress; are generally hormones that are what we call contra-insulin hormones. In other words, they work against the insulin. So, whatever insulin is trying to do in terms of disposing of blood glucose properly, lowering blood sugar levels, making us use our fuel efficiently; these hormones are going to interfere with that process and they are going to generate more sugar in the blood stream, because that’s just what they do as part of the stress-flight response. Now we would like to diffuse that situation because it makes no sense to throw medication at the problem when in reality, the fire is being sustained by these other processes and more importantly, if people are also sleep-deprived, or have sleep hygiene which is not proper; we know that when sleep is interfered with especially in the proper cycle in other words, during the dark period, we should be sleeping and when the sun is up, we should be awake. So, when that cycle is interrupted through shift work or through other; that, in and of itself, generates a big stress response. The body normally settles in, blood pressure drops at night, cortisol levels drop at night, go back again up in the morning. When we try to reverse that, we try to override it, we use coffee and other stimulants because we need to be up for our shift or whatever we are doing; that, in and of itself, creates probably the most fundamental destructive influence in the whole process and virtually guarantees that this individual is going to have metabolic problems. It may be diabetes, but frequently it could be something else including cholesterol problems, blood pressure problems or worse.

Melanie: In summary, doctor, it is such great information, what else would you like people to know about diabetes, controlling their blood sugar and even including as you wrap up, the monitors that are out there, because there are so many, and some people think oh, I’m not going to have to do a blood stick or I’m not going to have to do this. So, just kind of wrap it up for us with your best advice about controlling blood sugar and the monitors available.

Dr. Mezitis: Well, there are many monitors available. Usually they involve a fingerstick in order to draw a blood sample, very small perhaps, but we still need a little blood in order to run the test, if you will, and this is home testing which is very reliable and can allow us to track the response to a particular meal, to see how things are when we wake up in the morning. So, the first step of course is to monitor and to develop a little bit of a profile, a little bit of a diary so that we can see how our particular lifestyle and habits impact on the blood sugar. That realization is going to permit us to make the changes required because if we don’t know what that number is, or what a particular meal does for us; then we won’t really be able to make a decision or to make changes and then again take a look. So, that’s very important. Now I did mention that we need to stick the finger, but now with more new technologies; we have the ability to wear a particular type of patch or device that measures the blood sugar without doing fingersticks, so we could have the equivalent of 50 blood sticks a day without sticking the finger, because it just reads it. It’s a monitor that sits on the skin and does this. So, some of our concerns about fingersticking can now be dealt with if we have the ability to make use of this new technology. So, be that as it may, that monitoring is an integral first step.

The second thing that I advise patients is of course what we discussed that has to do with the diet and meal planning, but more importantly the time and that’s the most fundamental. Patients need to realize that the day begins at 4 in the morning for the body’s metabolism and pretty much ends around 4 in the afternoon. And things then go into a rest period. So, unfortunately, with our lifestyle, we do the reverse, not much in the morning in terms of meals and then we build up so that in the evening, we are consuming the majority of our calories for a variety of reasons. And that of course, is a guaranteed recipe for obesity and all sorts of problems with blood glucose control. So, the two things that one needs to remember is number 1, to monitor the blood sugar so that they themselves can convince themselves of what strategy is best and number 2, to remember that the bulk of the meals should be for breakfast, lunch should be generous and anything that we do for supper because that’s a better term to use; supper should be light so that we can rest peacefully and start our day the next morning with a good profile.

Melanie: Great information doctor. So important and so beautifully put. Thank you so much for being with us today. You’re listening to Memorial Health Radio with Memorial Health System. For more information please visit www.mhsystem.org, that’s www.mhsystem.org. This is Melanie Cole. Thanks so much for listening.