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What You Need to Know About Diabetes

Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood.

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy.

Dr. Kresge will provide a basic overview of diabetes and treatments available at Stoughton Hospital.
What You Need to Know About Diabetes
Featured Speaker:
Dean Kresge, MD
Dean Kresge MD, is a family medicine physician at the Stoughton Dean Clinic.
Transcription:

Melanie Cole (Host):  We have heard the word “diabetes” in the media nearly every single day, but do you really understand what it is, its complications, and what it means for a long, good quality of health? My guest today is Dr. Dean Kresge. He’s a family medicine physician at the Stoughton Dean Clinic. Welcome to the show, Dr. Kresge. Tell us a little bit about the two types of diabetes and what symptoms we might see that would signal a red flag that would get somebody to the doctor. 

Dr. Dean Kresge (Guest):  Well, there are actually four types of diabetes, with two of the most common. There is the type 1 diabetes that used to be called juvenile diabetes and type 2, which used to be referred to as adult onset diabetes. The type 1 diabetes is a more serious condition where basically the person’s system for making insulin fails. The beta cells do not make insulin anymore, and they can become quite ill quite quickly. Typical symptoms with type 1 diabetes would be increased thirst, increased urination, loss of weight, appetite goes away, abnormal growth pattern in children, infections become more common, and in the severe form of type 1, typically become sick to the point they have to be hospitalized with vomiting and inability to really retain fluids, and it can go into a coma. Type 1 is very severe, usually fairly intense onset that becomes quite obvious that the person’s quite ill.  

Melanie:  At what age? What typical age with type 1 would we notice those symptoms? 

Dr. Kresge:  Really, we don’t call it juvenile onset anymore because age doesn’t really determine type 1. You can have type 1 at any age. Type 2 is more likely to occur as an adult. If you develop diabetes as a child, it’s going to be the type 1 type most often, but you could be elderly and develop a type 1. 

Melanie:  Sure, because we’re seeing type 2, and as you said, it used to be called adult onset. But now, with this obesity epidemic we’re seeing, I know that we’re seeing type 2 even in children as young as nine these symptoms that you’ve described mostly for type 1. Now, what about type 2? If you’re an adult and you’re sedentary or you’ve been told that you might be pre-diabetic, what are some things you would notice? 

Dr. Kresge:  Well, again, probably a milder form of what you would see with type 1. You’d be more thirsty and urinating more often, trying to get rid of the extra sugar. You may actually gain weight with type 2 or not have the weight loss that you would see with type 1. Blurred vision you can see in both types of diabetes. The sugar affects how you see and will affect the shape of your lens structure, cornea somewhat. The infection thing, getting frequent infections that do not clear as quickly as they used to are also these symptoms that will be common with type 2. 

Melanie:  Then if you get those and you go to see a doctor, how do you determine that they have diabetes? Is it simply a blood test to check glucose levels, or how do you determine somebody has it? 

Dr. Kresge:  Really, it’s based on a blood test. And there are two types of blood tests that you do. One is a fasting blood sugar or blood glucose. The other is a test called the hemoglobin A1c. Generally, I issue diagnoses based on the fasting blood sugar. It’s the first test you do. If your blood sugar is over 126 on several tests, you probably do have a form of diabetes. This would be without having eating food after the time actually fasting. Then there’s the blood test called the hemoglobin A1c that’s used more for monitoring how well your diabetes is controlled. However, we do use this somewhat to help support a diagnosis of diabetes. 

Melanie:  So what’s the first thing you would do with someone, Dr. Kresge, if you do diagnose them as diabetic? Or if you’ve told them that maybe they are pre-diabetic and it’s something you need to really keep an eye on, what do you do for them? Do they start with medication? Do they start with lifestyle? What’s the best treatment? 

Dr. Kresge:  It depends a little bit probably on how that sugar is. If the fasting blood sugar is less than 250, you would start with diet and exercise and weight loss. Pre-diabetics who have blood sugars between 100 and 126 basically, if they lose 7 percent of their weight, go on a diabetic diet and exercise often will not go on to become a diabetic. Those again with a lower fasting blood sugar, less than 250, often diet, exercise, weight loss is maybe all you have to do. 

Melanie:  Okay. It’s a lifestyle thing, truly. Now, not necessarily for type 1 diabetes. Tell us a little bit about insulin and what is that meant to do. For the listeners, Dr. Kresge, explain to them about when they see people and hear about insulin shots and what those even are intended to do. 

Dr. Kresge:  Well, insulin is a normal chemical within the body that allows sugar to get into other cells. It’s kind of a key to allow sugar to get into muscle cells and fat cells and the rest of the body. Type 1 diabetes, the individual no longer has any insulin. The blood sugar stays within the bloodstream, can’t get into the cells, and that leads to the problems. In type 2 diabetes, the insulin isn’t as effective as it used to be for a number of reasons. Obesity, family history, lack of exercise, sedentary lifestyle, and all that will make yourselves less sensitive so as a result, the insulin you have isn’t as effective and your blood sugar will increase. An individual with type 1 definitely needs insulin or they will succumb and die from their diabetes. Type 2 diabetics will not need insulin right away, although many of them will or the majority will eventually. When you’re a type 2 diabetes, the cells that make the insulin are the lower level probably when you first have the type 2, so you do it at a lower level of the insulin, and over time, you make less and less with type 2. And that’s why a lot of people who have type 2 do end up on insulin eventually. There are medications in type 2 that will make your cells more sensitive to the insulin that you are making so you would not need insulin right away. When you do receive insulin, again it’s a natural product that allows sugar access to a muscle and fat cells and other cells. When you have to go on insulin, you’re really placing a natural product that just is not at the correct level or the level of that is not enough to do that. 

Melanie:  One thing people seem to get confused about, we all know exercise is good for everyone, not just diabetics, but exercise has an insulin-like effect. It’s something that can help you regulate those levels. But what about diet, Dr. Kresge? People get very confused. Diabetics say, “I’m not allowed to have that piece of bread,” or, “I’m not allowed to have that particular grain; it’s got too much sugar.” Clear up just a little bit the diet recommendations that you recommend for your diabetics. 

Dr. Kresge:  Well, still a lot of people think that sugar caused them to have diabetes, that eating sugar was the cause of the diabetes. That’s really not the case. Sugar again is the problem in the bloodstream, so if you’re eating the true sugars, refined sugars, so the sweets of the world will add more blood sugar to your bloodstream. So those need to be moderated and decreased in the diet. Complex carbohydrates are usually recommended. They just lower the sugars and they won’t result in a jump up in your blood sugar as much as the true sugars will or the straight sugar. 

Melanie:  Well, I’m glad you pointed that out. I’m glad you pointed out the difference between the complex carbohydrates. People hear the word “carbohydrate,” and right away they say, “I can’t have that because I’m a diabetic.” We just have about a minute and a half left. Give your best advice for people with diabetes or people that have been told they might be pre-diabetic and why they should consider coming to Stoughton Hospital for their care. 

Dr. Kresge:  Well, diabetes is a very common disease that does have very severe complications which we did not get into. It increases your risk of heart disease greatly, stroke, damage to nerves, damage to your eyes, damage to your kidneys. It can be treated and needs to be diagnosed, and you need to be on a complete program that will involve physicians, pharmacists, nurses, ophthalmologists, diabetic educators, a lot of people to control it. Although it can be treated, it’s somewhat complicated. The things that need to be done when you have diabetes that are outside the sugar, which means there are times it will make your diabetes much more damaging to you, including things like smoking, high blood pressure, high cholesterol, and lipids. Those in combination with the sugars are much more damaging to the organs than we mentioned. But coming to Stoughton Healthcare Community, the diagnosis would be made and plan will be laid out for you which would involve certainly your participation in diet and exercise, and that would be explained in more detail. And then medications would be started when necessary. And generally, people are seen every six months when they have diabetes because of all the life-threatening complications that can eventually come to pass if things are not controlled adequately. 

Melanie:  It’s great information. Thank you so much, Dr. Kresge, and it’s important to keep your relationship with your family physician at Stoughton Hospital so that you can get really the best care for your diabetes. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.