Diabetes is the seventh leading cause of death in the United States.
Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults.
Unhealthy weight and physical inactivity, also significant national health problems, are both contributing factors to the rising incidence of type 2 diabetes.
If you have diabetes, screening for early diagnosis is essential.
The earlier that you diagnose diabetes, the better chance you can decrease the risk of developing diabetes complications, and treating it appropriately.
Maisara Rahman, MD, is here to explain the importance of early diabetes screening and how you can manage your diabetes for a better quality of life.
Selected Podcast
Managing Your Diabetes
Featured Speaker:
Learn more about Maisara Rahman, MD
Maisara Rahman, MD
Maisara Rahman, MD, is a Family Medicine specialist at Temecula Valley Hospital.Learn more about Maisara Rahman, MD
Transcription:
Melanie Cole (Host): Have you been told that you have diabetes or are pre-diabetic? My guest today is Dr. Maisara Rahman. She’s a family medicine physician and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Rahman. Tell us about diabetes. Can it be caught in the pre-diabetic and early phases and how important is that?
Dr. Maisara Rahman (Guest): Diabetes can be actually caught early if your physician screens the patient when they go in if they have risk factors of getting diabetes. We do screen patients who are asymptomatic and many of the times we do have results that come back as pre-diabetes.
Melanie: What are you screening? What are you looking for?
Dr. Rahman: We’re looking for patients who have pre-diabetes. The way we screen for pre-diabetes – there are many ways to screen for it. We can do just a fasting blood sugar that tells us what the fasting blood sugars are. What’s normal is anything below 100. Anything from 100-125 fasting blood sugar, that’s considered pre-diabetes. If your doctor chooses to do a different type of screening test which is called the hemoglobin A1C. That is a test that we do to give us a really good average of your blood sugars for the past three months. This is the test that I usually use on my patients. It’s pretty effective and it’s pretty specific to catch patients who have pre-diabetes. If your A1C comes back as from 5.7 - 6.4 this puts you in the pre-diabetes range.
Melanie: Why are you trying to catch it early? What do you want to tell patients about the importance of catching it early?
Dr. Rahman: There are a lot of benefits from catching diabetes early. One of them is to prevent a lot of the microvascular and macrovascular disease processes that can happen as a result of diabetes. Most of the patients that are diabetic, by the time that they are diagnosed diabetic they already have the complications of diabetes. That includes retinopathy. That means eye disease and, also, kidney disease as well as nerve disease--neuropathy, which affects the nerves to your legs. Most patients come in complaining of a pain and that’s actually a complication of uncontrolled diabetes.
Melanie: If someone hasn’t been told they have pre-diabetes or they haven’t been checked, are there some symptoms that people might look for because Type II – which is what we’re discussing – used to be called “adult onset”. It’s not anymore. Are there some symptoms that people could look for in their children, even, to help identify whether or not they have diabetes?
Dr. Rahman: Unfortunately, with pre-diabetes, the patients usually don’t have any symptoms. As they get closer to an A1C of 6.5, they may start to urinate a lot more frequently or they may want to drink more fluids than usual and they may feel a little bit of dehydration. In Type II diabetes, it frequently goes undiagnosed for many years because the hyperglycemia develops gradually. In the earlier stages, it’s not severe enough for the patient to notice the classic diabetes symptoms.
Melanie: When we’re talking about Type II, please just give a little difference, for the listeners. They hear the word “diabetes”. What is the difference between Type I and Type II?
Dr. Rahman: Type II diabetes is a type of diabetes where the patient is still making insulin but the pathophysiology of it is multifactorial. One, obesity can cause it. Two, it can be a genetic predisposition to getting the Type II diabetes. The majority of the time, in our society, it’s mainly obesity.
Melanie: And with Type I?
Dr. Rahman: And with Type I diabetes, this is more of where the pancreas for some reason stops producing insulin. Most of the time, when they do get the Type I diabetes, you can’t give them any oral medication to help them make insulin because their pancreas is pretty much shot. Most of the time, it’s an autoimmune process which kills the cells of the pancreas that make the insulin.
Melanie: If you do determine that someone is pre-diabetic, what is the first thing you tell them that they need to do or change in their lifestyle to help them from possibly having it turn into full-blown diabetes?
Dr. Rahman: The most important thing when I diagnose somebody with pre-diabetes is, we talk about lifestyle modifications. Once we call our patients “pre-diabetic”, it’s mainly a wakeup call for the patient. It’s an opportunity to prevent the complications of diabetes. That means we talk about weight loss. It’s been shown that if the patient loses more than 7% of their body weight, it can actually reverse it in the beginning stages of pre-diabetes. We also talk about exercise. It is recommended that patients walk more than 150 minutes per week. Depending on the patient, we’ll talk about ways that they can achieve that goal. With every patient, they have different lifestyles so some patients will choose, at times, to walk maybe 10 minutes a day or 30 minutes three times a week. It’s really important for physicians to work with that patient and individually work on self-management goals to help them lose weight and increase their activity.
Melanie: When does Type II diabetes become insulin dependent? What are some of the treatments that you give people besides exercise and healthy diet?
Dr. Rahman: For pre-diabetics, I usually start treating them with Metformin after their A1C usually gets to about 6, in addition to their lifestyle modification. In somebody who is Type II diabetic, I start insulin if their A1C stays above 9. Here’s an important thing with treating a Type II diabetic: if you are recently diagnosed, studies have shown that we need to get control as soon as we can on that patient because if we let the diabetes go on uncontrolled, it can cause a lot of complications down the line. In patients who are recently diagnosed, we talk about different treatment options. The treatment options vary, depending on that individual that you are treating. Some patients, I may choose to start insulin. Some patients who don’t want to start on insulin, I usually start on oral medication. I have to individualize the treatment plan because there are a lot of indications and contraindications in the usage of many different oral hypoglycemic agents.
Melanie: If somebody adopts a healthy lifestyle, is there a chance if they were insulin dependent to become noninsulin dependent or to see their diabetes stave off a little bit?
Dr. Rahman: That’s a great question because most of my diabetic patients actually ask me the same question. Here’s the deal. With somebody who has chronic diabetes and they’re already on insulin the chances of them reversing it is pretty slim. What I can say is that, if they do lose weight they may require less insulin.
Melanie: That’s a very good answer. Now, in just the last few minutes give your best advice or your best tips for eating healthy when you have diabetes. People don’t know what to eat and they’re not sure what a carbohydrate is or should they be eating more protein or, really, how to eat healthy when they have diabetes.
Dr. Rahman: I think for patients who have diabetes, it is really important to understand what they’re eating and how the types of foods their eating can affect their diabetes. What I could say, is eating more fibrous foods, cutting down on the carbohydrate portions. Most patients say when then come in that they really want to start that diet, just for a short time, but what I usually tell them, “This is no diet. This is going to be your lifestyle for the rest of your life.” Don’t think about this as a diet only to control your diabetes for the next month or following month. This is a lifestyle. Eating healthier is every day and it’s not just temporary. I teach them a lot about the good carbs versus bad carbs. I also send them to a nutrition class and a diabetes education class if I feel the patient may need more instruction from a nutritionist on how they should improve their diet.
Melanie: Dr. Rahman, what should people with diabetes be thinking about when seeking care?
Dr. Rahman: When they seek care, it is important to ask a lot of questions when you go in and talk to your doctor. What does your A1C mean? I think patients need to discuss three things with their primary care doctor. One is their A1C goal. They need to know what their goal is. Every patient has a specific and an individualized A1C goal depending on their age and their co-morbidity. B would be their blood pressure. They need to make sure that their blood pressure is also on the low side. C is their cholesterol. They need to make sure that their cholesterol is at goal. If they take care of their A-B-C’s on every visit, I can assure you that they are on the right track in terms of lowering their risk for cardiovascular disease and also cardiovascular events.
Melanie: Dr. Rahman, why should they come to Temecula Valley Hospital for their care?
Dr. Rahman: Temecula Valley Hospital, in my opinion, is a great hospital for patients because what I do is, I’m also a hospitalist there. I take care of patients both in the out-patient setting and also in the in-patient setting. From what I see, what I do is, I admit a lot of patients who have diabetes and complications of diabetes. What’s great about Temecula is they have an informal team that takes care of their diabetics. You have the physician, you have the nutritionist, you have the social worker, case manager. We’re all working together to make sure that the doctor adjusts their medication, the nutritionist talks to the patient about their goals and their nutrition, and then, the case manager and the social worker really help us with coordinating that patient’s care to out-patient to make sure that there’s no gaps in their care as we send them home and have them to continue to follow up with their primary care physician.
Melanie: It’s a real multi-disciplinary approach. Yes?
Dr. Rahman: It is definitely a multi-disciplinary approach and we work as a full healthcare team from the nurses to the nutritionists, to the case managers--we all work together.
Melanie: Thank you so much for being with us today, Dr. Rahman. It’s great information. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information please visit TemeculaValleyHospital.com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
[END OF RECORDING]
Melanie Cole (Host): Have you been told that you have diabetes or are pre-diabetic? My guest today is Dr. Maisara Rahman. She’s a family medicine physician and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Rahman. Tell us about diabetes. Can it be caught in the pre-diabetic and early phases and how important is that?
Dr. Maisara Rahman (Guest): Diabetes can be actually caught early if your physician screens the patient when they go in if they have risk factors of getting diabetes. We do screen patients who are asymptomatic and many of the times we do have results that come back as pre-diabetes.
Melanie: What are you screening? What are you looking for?
Dr. Rahman: We’re looking for patients who have pre-diabetes. The way we screen for pre-diabetes – there are many ways to screen for it. We can do just a fasting blood sugar that tells us what the fasting blood sugars are. What’s normal is anything below 100. Anything from 100-125 fasting blood sugar, that’s considered pre-diabetes. If your doctor chooses to do a different type of screening test which is called the hemoglobin A1C. That is a test that we do to give us a really good average of your blood sugars for the past three months. This is the test that I usually use on my patients. It’s pretty effective and it’s pretty specific to catch patients who have pre-diabetes. If your A1C comes back as from 5.7 - 6.4 this puts you in the pre-diabetes range.
Melanie: Why are you trying to catch it early? What do you want to tell patients about the importance of catching it early?
Dr. Rahman: There are a lot of benefits from catching diabetes early. One of them is to prevent a lot of the microvascular and macrovascular disease processes that can happen as a result of diabetes. Most of the patients that are diabetic, by the time that they are diagnosed diabetic they already have the complications of diabetes. That includes retinopathy. That means eye disease and, also, kidney disease as well as nerve disease--neuropathy, which affects the nerves to your legs. Most patients come in complaining of a pain and that’s actually a complication of uncontrolled diabetes.
Melanie: If someone hasn’t been told they have pre-diabetes or they haven’t been checked, are there some symptoms that people might look for because Type II – which is what we’re discussing – used to be called “adult onset”. It’s not anymore. Are there some symptoms that people could look for in their children, even, to help identify whether or not they have diabetes?
Dr. Rahman: Unfortunately, with pre-diabetes, the patients usually don’t have any symptoms. As they get closer to an A1C of 6.5, they may start to urinate a lot more frequently or they may want to drink more fluids than usual and they may feel a little bit of dehydration. In Type II diabetes, it frequently goes undiagnosed for many years because the hyperglycemia develops gradually. In the earlier stages, it’s not severe enough for the patient to notice the classic diabetes symptoms.
Melanie: When we’re talking about Type II, please just give a little difference, for the listeners. They hear the word “diabetes”. What is the difference between Type I and Type II?
Dr. Rahman: Type II diabetes is a type of diabetes where the patient is still making insulin but the pathophysiology of it is multifactorial. One, obesity can cause it. Two, it can be a genetic predisposition to getting the Type II diabetes. The majority of the time, in our society, it’s mainly obesity.
Melanie: And with Type I?
Dr. Rahman: And with Type I diabetes, this is more of where the pancreas for some reason stops producing insulin. Most of the time, when they do get the Type I diabetes, you can’t give them any oral medication to help them make insulin because their pancreas is pretty much shot. Most of the time, it’s an autoimmune process which kills the cells of the pancreas that make the insulin.
Melanie: If you do determine that someone is pre-diabetic, what is the first thing you tell them that they need to do or change in their lifestyle to help them from possibly having it turn into full-blown diabetes?
Dr. Rahman: The most important thing when I diagnose somebody with pre-diabetes is, we talk about lifestyle modifications. Once we call our patients “pre-diabetic”, it’s mainly a wakeup call for the patient. It’s an opportunity to prevent the complications of diabetes. That means we talk about weight loss. It’s been shown that if the patient loses more than 7% of their body weight, it can actually reverse it in the beginning stages of pre-diabetes. We also talk about exercise. It is recommended that patients walk more than 150 minutes per week. Depending on the patient, we’ll talk about ways that they can achieve that goal. With every patient, they have different lifestyles so some patients will choose, at times, to walk maybe 10 minutes a day or 30 minutes three times a week. It’s really important for physicians to work with that patient and individually work on self-management goals to help them lose weight and increase their activity.
Melanie: When does Type II diabetes become insulin dependent? What are some of the treatments that you give people besides exercise and healthy diet?
Dr. Rahman: For pre-diabetics, I usually start treating them with Metformin after their A1C usually gets to about 6, in addition to their lifestyle modification. In somebody who is Type II diabetic, I start insulin if their A1C stays above 9. Here’s an important thing with treating a Type II diabetic: if you are recently diagnosed, studies have shown that we need to get control as soon as we can on that patient because if we let the diabetes go on uncontrolled, it can cause a lot of complications down the line. In patients who are recently diagnosed, we talk about different treatment options. The treatment options vary, depending on that individual that you are treating. Some patients, I may choose to start insulin. Some patients who don’t want to start on insulin, I usually start on oral medication. I have to individualize the treatment plan because there are a lot of indications and contraindications in the usage of many different oral hypoglycemic agents.
Melanie: If somebody adopts a healthy lifestyle, is there a chance if they were insulin dependent to become noninsulin dependent or to see their diabetes stave off a little bit?
Dr. Rahman: That’s a great question because most of my diabetic patients actually ask me the same question. Here’s the deal. With somebody who has chronic diabetes and they’re already on insulin the chances of them reversing it is pretty slim. What I can say is that, if they do lose weight they may require less insulin.
Melanie: That’s a very good answer. Now, in just the last few minutes give your best advice or your best tips for eating healthy when you have diabetes. People don’t know what to eat and they’re not sure what a carbohydrate is or should they be eating more protein or, really, how to eat healthy when they have diabetes.
Dr. Rahman: I think for patients who have diabetes, it is really important to understand what they’re eating and how the types of foods their eating can affect their diabetes. What I could say, is eating more fibrous foods, cutting down on the carbohydrate portions. Most patients say when then come in that they really want to start that diet, just for a short time, but what I usually tell them, “This is no diet. This is going to be your lifestyle for the rest of your life.” Don’t think about this as a diet only to control your diabetes for the next month or following month. This is a lifestyle. Eating healthier is every day and it’s not just temporary. I teach them a lot about the good carbs versus bad carbs. I also send them to a nutrition class and a diabetes education class if I feel the patient may need more instruction from a nutritionist on how they should improve their diet.
Melanie: Dr. Rahman, what should people with diabetes be thinking about when seeking care?
Dr. Rahman: When they seek care, it is important to ask a lot of questions when you go in and talk to your doctor. What does your A1C mean? I think patients need to discuss three things with their primary care doctor. One is their A1C goal. They need to know what their goal is. Every patient has a specific and an individualized A1C goal depending on their age and their co-morbidity. B would be their blood pressure. They need to make sure that their blood pressure is also on the low side. C is their cholesterol. They need to make sure that their cholesterol is at goal. If they take care of their A-B-C’s on every visit, I can assure you that they are on the right track in terms of lowering their risk for cardiovascular disease and also cardiovascular events.
Melanie: Dr. Rahman, why should they come to Temecula Valley Hospital for their care?
Dr. Rahman: Temecula Valley Hospital, in my opinion, is a great hospital for patients because what I do is, I’m also a hospitalist there. I take care of patients both in the out-patient setting and also in the in-patient setting. From what I see, what I do is, I admit a lot of patients who have diabetes and complications of diabetes. What’s great about Temecula is they have an informal team that takes care of their diabetics. You have the physician, you have the nutritionist, you have the social worker, case manager. We’re all working together to make sure that the doctor adjusts their medication, the nutritionist talks to the patient about their goals and their nutrition, and then, the case manager and the social worker really help us with coordinating that patient’s care to out-patient to make sure that there’s no gaps in their care as we send them home and have them to continue to follow up with their primary care physician.
Melanie: It’s a real multi-disciplinary approach. Yes?
Dr. Rahman: It is definitely a multi-disciplinary approach and we work as a full healthcare team from the nurses to the nutritionists, to the case managers--we all work together.
Melanie: Thank you so much for being with us today, Dr. Rahman. It’s great information. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information please visit TemeculaValleyHospital.com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
[END OF RECORDING]