Selected Podcast

Diabetes and Thyroid care

John Blake Epling, MD discusses the correlation between diabetes and thyroid care, and the management and treatment options available at Memorial Health System.
Diabetes and Thyroid care
Featured Speaker:
John Blake Epling, MD
Dr. John Blake Epling graduated from Marshall University, Joan C. Edwards School of Medicine in Huntington, West Virginia. He completed a residency in internal medicine at the West Virginia University School of Medicine in Morgantown, West Virginia. He also completed a fellowship in endocrinology at Marshall University, Joan C. Edwards School of Medicine, in Huntington, West Virginia. He started with Memorial Health System in the Marietta Memorial Hospital Department of Endocrinology on October 1, 2018.
Transcription:

Melanie Cole (Host): People with diabetes may have an increased risk of developing a thyroid disorder. How do those two connect? My guest here to tell us about this today is Dr. John Blake Epling. He’s an endocrinologist with Memorial Health System. So, Dr. Epling I’d like to start with a little background on diabetes for the listeners. What happens when we eat and why do we need to understand insulin and blood sugar and hormones? Why is that important to know?

John Blake Epling, MD (Guest): So, in a normal situation, if you are not – it’s important to understand the physiology, if you aren’t diabetic that helps to understand the problem when you are diabetic. So, normally when you eat and you start to digest foods in your stomach and breakdown carbohydrates that are in food; your stomach and gastric acids will break these things down into more simple sugars which are then released into your bloodstream. So, as your body starts to notice that your blood sugar is rising, specifically your pancreas; it will increase the insulin production to try to bring your sugars down and keep it within a normal range. So, that’s just the gist of what happens in a normal physiology situation. Now if you are diabetic, your pancreas basically, in type 2 diabetes cannot keep up with keeping your sugars regulated. So, despite it making more and more insulin; it still can’t keep your sugar in those normal ranges.

Host: Okay so we understand a little bit about the pancreas, insulin resistance, it can’t keep up is what you are saying; so, how do we tie the thyroid into this? What does the thyroid even do?

Dr. Epling: So, thyroid hormone actually affects every cell in your body. It controls your metabolism for everything. So, specifically hypothyroidism which is low thyroid hormone levels; it slows your metabolism. So, if you slow your metabolism, you don’t utilize insulin as well and it makes it even more difficult for your pancreas and your body to bring your sugar levels down.

Host: So, then explain a little bit about the effect of thyroid issues. If somebody is told that they are diabetic, type 2 diabetes, how does a thyroid that’s not properly functioning have an effect on diabetes management?

Dr. Epling: So, it depends on which type of thyroid problem you are having. So, if your thyroid is underactive which is hypothyroidism; again, that will slow your metabolism and it can make you less sensitive to your own insulin or even insulin if you are taking insulin. So, to have your thyroid hormone replaced to an adequate level; that’s very important. So, you are kind of fighting a losing battle if your thyroid hormone set point doesn’t have your metabolism at a normal range already. So, your thyroid levels need to be normal so that your body metabolism is able – you are giving your body the best chance to take care of your blood sugars.

Host: Now is this the same, I know we are generally talking about diabetes type 2; but in diabetes type 1 which is an autoimmune disorder; is there more of an increased risk of developing something with the thyroid?

Dr. Epling: Yeah, so definitely. The most common thyroid disorder is Hashimoto’s thyroiditis. Most people that have low thyroid levels such as take Levothyroxine or Synthroid; they actually have Hashimoto’s thyroiditis. That’s the name for it. A lot of them haven’t been told that. But that’s an autoimmune disorder so your immune system has reacted to something in your body as abnormal when it shouldn’t have so it’s kind of an aberrant incorrect response. And patients that have any autoimmune disease, so that includes Hashimoto’s; they are statistically more likely to have another autoimmune disease. So, patients that have type 1 diabetes; that is an autoimmune disorder. So, those patients are more likely to have Hashimoto’s thyroiditis, Crohn’s disease, psoriasis, any of those issues. And vice versa. Patients with Hashimoto’s are more likely to have any of the other autoimmune problems than the general population.

Host: So, if somebody knows they have type 1 or type 2; should their thyroid function be evaluated every year or so and who would they go to have that done?

Dr. Epling: Yeah so, a primary care doctor can check those. I definitely in type 1 diabetics, I check their thyroid function test every year again because statistically they are more likely to have thyroid disease than the general population and it seems from clinical experience type 2 diabetics have more hypothyroidism also. I usually do more patient specific or symptom specific monitoring in type 2 diabetics, so I’m not going to check their thyroid function test every year just for surveillance. But if they seem to be having symptoms suggestive of a thyroid problem; I will check them quickly usually. More than I would the general population.

Host: So, you just said Dr. Epling symptoms suggestive of a thyroid problem. What would those symptoms be?

Dr. Epling: So, we will just start – again, it depends if you are low thyroid level or high thyroid level. They are kind of on opposite ends of the spectrum. And if you think about the thyroid controlling metabolism; that’s kind of the easiest way to understand so, if your hormone level that controls metabolism is very low, so hypothyroidism; then things slow down. Everything slows down. Patients are constipated, their blood sugar is more difficult to control, they usually feel cold, so in a room where everyone might be wearing a T-shirt, they might think oh my gosh, I wish I had my jacket, I’m freezing cold, I’m having chills and then a lot of nonspecific hair, skin and nail problems also with thyroid issues, with low thyroid. So, conversely, if you do high thyroid levels so hyperthyroidism which you might get with something like Grave’s disease or toxic multinodular goiter; that would be when the thyroid hormone level is too high, so your metabolism gets too quickly. Those patients often have unintentional weight loss, sweating, they are feeling hot all the time, difficulty sleeping, irritability, those sorts of things.

Host: Can symptoms of thyroid conditions be sometimes confused with some of the symptoms of diabetes or attributed to other circumstances?

Dr. Epling: Yes, I mean for sure. So, generally, like fatigue, there is a high rate of depression in type 2 diabetics, those types of issues, they can definitely be confounded. So, you can only determine those with lab tests. Yeah, some of the symptoms are overlapping.

Host: So, what would you like people to know if they are someone who has lived with diabetes their whole life, if they are type 1, they have had it a long time, they have had to learn about managing it. There’s a lot that goes into that autoimmune disorder. But if they are type 2 diabetics, what would you like them to know about watching for some of these symptoms of thyroid and keeping an eye on their metabolism so that they don’t exacerbate their diabetes?

Dr. Epling: Yeah, I mean if you have these symptoms of hypothyroidism and you are diabetic also; obviously you should be tested. So, primary care doctor can do that, if you are seeing an endocrinologist, they can do that. But any of the symptoms I mentioned if you have those, we will be prone to test you more quickly than the general population for a thyroid problem.

Host: And what about pregnant women, gestational diabetes. Is that a thing as well?

Dr. Epling: Definitely it’s a thing. Gestational diabetics, they have a higher risk for type 2 diabetes in their lifetime. So, sometimes we kind of look at it like that was the warning signal like whenever a patient is pregnant, if they are diagnosed with gestational diabetes which we have specific tests to diagnose that; but it’s kind of like an endocrine stress test when you are pregnant. So, if we find out when you are pregnant that you just couldn’t maintain your sugars in a normal way, that your pancreas just couldn’t keep up with the insulin production or you became so insensitive to insulin that you just couldn’t keep your sugars normal; that’s a sign that you are statistically more likely to have type 2 diabetes in your lifetime and you should probably just go ahead and take all the precautionary measures of lifestyle modification and diet modification like we would for a diabetic. We would obviously, screen you frequently if you have gestational diabetes so, you move into a more high-risk category for type 2 diabetes at that point. And we would test your – the diagnostic test for diabetes like hemoglobin A1c and fasting sugar; we would check those every one to three years.

Host: And as a wrap up and we are talking about diabetes and thyroid disorders, kind of putting them together in the risks and symptoms, what would you like listeners to take away from this as far as keeping a healthy thyroid, knowing the symptoms that could come along with diabetes or be in adjunct with it and what would you like them to know about healthy lifestyle to hopefully prevent diabetes in the first place?

Dr. Epling: So, as far as the thyroid with diabetes, again, we do think there is some relationship between the two, being that diabetics seem to be more likely to have thyroid disease. We usually go looking for thyroid disease in diabetics. I mean I will screen up front with every patient I see to make sure they don’t have a thyroid problem. But after that, it’s mostly symptom-based or if we are – it’s really just not making sense if the patient’s doing everything that they can to control their diabetes, they are compliant with medications and lifestyle modifications and we still don’t have things controlled; if it just seems like it is just too difficult like there must be something else at play, then obviously, I will check it at that time. So, that’s what I would say about that.

As far as lifestyle and diet modifications or to prevent diabetes; anyone with an A1c between 5.7 and 6.4 on screening labs, that is prediabetes or borderline diabetes, or a fasting sugar between 100 and 126. Now we usually have to repeat those tests, so we usually have to have two tests that are abnormal. But if you are in the prediabetic or borderline diabetes category; there is a lot of misinformation about that most patients just don’t do anything about that or they aren’t instructed to do anything about it. But it’s really important at that time to think about prevention and the best way is with diet, so we go ahead and tell people to do diabetic diets. So, try to limit your snacks to 15 gm of carbohydrates or less, emphasize fiber and complex carbohydrates and then no more than 40-60 gm of carbohydrates with meals, and then obviously try to get on some sort of exercise regimen, three to five days per week at least thirty minutes. But I get whatever I can take. So, if a patient will do anything, just try to get them to do that and it usually helps. And then the last thing I would say that people usually underestimate even minimum weight loss, if you could lose five or ten pounds and you are prediabetic; that seems to delay things drastically. So, just a little bit of weight loss makes you more sensitive to your own insulin and seems to delay the onset of type 2 diabetes.

Host: That’s great information and thank you for coming on with us today and kind of explaining for us very well, how these could be related and symptoms to watch out for because that’s what’s so important for listeners to hear and that’s what they are always interested in is what should I be on the look out for and such great advice. Thank you again, Dr. Epling 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.