Selected Podcast

Taking Control of Your Diabetes

According to the Centers for Disease Control and Prevention (CDC), as many as 29 million people in the United States have diabetes. If you are one of the many, you may have questions about how best to manage it, and how to live a healthier lifestyle.

Karen Muchowski, MD, is here to share her expertise on how to live with and manage Diabetes, or possibly prevent it in the first place.
Taking Control of Your Diabetes
Featured Speaker:
Karen E. Muchowski, MD, FAAFP
Dr. Karen E. Muchowski is a board certified Family Physician with a special interest in Women’s Health, Pediatrics, and Chronic Pain issues and a member of the medical staff at Temecula Valley Hospital.

Dr. Muchowski received her undergraduate degree in Physiology from U.C. Davis in 1992, where she graduated Summa Cum Laude. She was accepted into the U.C. Davis School of Medicine and earned her medical degree in 1996. As a medical student she was elected a member of Alpha Omega Alpha, a national honor society for medical students that promotes student leadership, community service, and excellence in academics. She completed her Family Medicine residency program at Oregon Health Sciences University (OHSU) in 1999. While maintaining a medical practice, Dr. Muchowski has also continued her work as an educator and clinical researcher. She has authored various articles on Women’s Health and Pediatric Issues published in leading scientific journals. She remains active in academics, and most recently was an Assistant Professor within the Family Medicine Residency Program at the Naval Hospital at Camp Pendleton, Uniformed Services University of Health Sciences. She is also a frequent guest lecturer for the American Academy of Family Physicians (AAFP) and other organizations, at the national, regional and local level.
Although her writing and lecturing experience has helped her better comprehend the science of medicine, her experience with patients has led her to understand that every person has a different path to health. Dr. Muchowski feels that her job is to guide patients through the science of medicine to help them find their own paths to a better life. Dr. Muchowski is a fellow of the AAFP and is certified by the American Board of Family Practice. She is a Diplomate of the National Board of Medical Examiners. She speaks and writes fluent Spanish.

Melanie Cole (Host): According to the Centers for Disease Control and Prevention, as many as twenty-nine million people in the United States have diabetes, and if you're one of the many, you may have some questions about how best to manage it, and how to live a healthier lifestyle. My guest is Dr. Karen Muchowski, she's a board-certified family physician and a member of the medical staff at Temecula Valley Hospital. Dr. Muchowski, what happens? Give us a little physiology lesson. What happens when we eat as far as insulin and blood sugar, and what's different with somebody with diabetes?

Dr. Karen Muchowski, MD (Guest): So if everything is working correctly, when you eat, food goes into your stomach and gets digested into sugar, and then your pancreas, which is an organ in your stomach, creates insulin. And the job of insulin is to take sugar, put it in your bloodstream, and then move it to all your cells because every cell that we have lives on sugar. So if your body is working correctly, then that's the process. Once you become diabetic, what happens is instead of the sugar going to your cells, it stays in your bloodstream, and that's in the case of type two diabetes mostly because your body has now become resistant to insulin. So it doesn't work the way it should, and you have more sugar in your blood vessels. The problem with that is that blood vessels don't like having high sugar levels in them, and over time that can cause damage to blood vessels.

Melanie: What causes diabetes type two? Do we know?

Dr. Muchowski: There are a lot of different things that can cause type two diabetes, and every person is a little bit different, but certainly genetics can play a role. So if you have family members that have diabetes, you are at higher risk for developing diabetes yourself. If you are above your ideal body weight, that increases the risk of diabetes. Rarely there are some medicines that we can prescribe to patients that increase diabetes, but that's probably the least common type of type two diabetes. And certainly what we're finding now is that the environment when you were in your mom's womb can also play a role, and we're not quite sure how much of that plays a role.

Melanie: Who would be at highest risk? And just to make it clear to the listeners, we're not talking about type one diabetes which can be a juvenile onset and a different disease as it were, but we're talking about type two. So who is most at risk?

Dr. Muchowski: So the people most at risk, there are certain ethnic groups that seem to have higher rates of diabetes. So African American, Latino, Native American; so patients that are part of that ethnic group, they have higher rates of diabetes. And then patients who are above their ideal body weight, those two seem to be the biggest risk factors for developing diabetes.

Melanie: So if somebody comes to you with some symptoms, what would they come to describe as any symptoms? Would you even know if you were pre-diabetic? Is there anything that would send up a red flag?

Dr. Muchowski: So when you are pre-diabetic, it does not have any symptoms. When you are diabetic, if you're still- if your sugars are not out of control, and that's how most people present is actually before their sugars are out of control, they have no symptoms. And so that's why it's important if you have any risk factors for diabetes, that you go to your doctor to see if you might have this.

Once your diabetes is out of control, then people start having symptoms like being thirsty all the time, urinating all the time, losing weight even though they don't want to try to lose weight.

Melanie: How is it diagnosed? I mean we've heard of glucose testing, and you have to fast and such at your physical, but how do you determine that someone does have diabetes or is pre-diabetic?

Dr. Muchowski: So the ways that we determine this are with blood tests. There are three different types of blood tests that you can do. The first one is what's called a Hemoglobin A1c. A Hemoglobin A1c is the average of what your sugar has been for the past six weeks. So we have certain set numbers that if you are above that, then you are diabetic. There's also criteria for using a fasting blood sugar, and again there are certain numbers that if you reach, you're diabetic. And then the third way to check for diabetes is you can do what's called an oral glucose tolerance test where you'll drink very sweet water, and then you'll have your blood checked right before you drink it, one hour later, and two hours later. So those are really the three main ways that we diagnose diabetes.

Melanie: What's the first line of defense? If you tell a patient, "You know what? I think you're pre-diabetic, or you have full on diabetes," what is the first thing you tell them to do to start to manage this and take control?

Dr. Muchowski: So we try to tell people who are pre-diabetic to do the same things as far as diabetes except for medications. But the most important thing really are lifestyle changes. So there are a lot of lifestyle changes that will help you not become diabetic, and once you are diabetic it will help manage your diabetes.

So the lifestyle interventions are regular physical activity, nutritional healthy diet, and weight loss if you are above your ideal body weight.

Melanie: Let's talk about diet for a minute, Dr. Muchowski. People hear carbohydrates, they think right away terrible. Terrible if you're pre-diabetic, but not all carbohydrates are really equal, are they? So explain a little bit about how diet affects diabetes.

Dr. Muchowski: So you're correct, certain foods when you eat them will increase your sugar very rapidly, and there are other foods that when you eat will slowly increase your sugars and they don't go as high. So carbohydrates are a group of foods that can increase blood sugar, but they do it through different levels. So if you have a simple carbohydrate, let's say potatoes or rice, those carbohydrates increase your sugar very rapidly. Things that are more complex carbohydrates like vegetables, brown rice, whole wheat pastas, those are less likely to increase your sugar.

Melanie: And where do protein, fats, and even alcohol- because that process is different and can become sugar even quicker, but it's a little bit different. So where do these other foods fit in?

Dr. Muchowski: So proteins have very low what's called a glycemic index. Glycemic index is how fast a food will increase your sugar or how high it will increase your sugar. So proteins actually have a relatively low glycemic index. Alcohol is essentially a sugar, so it has a higher glycemic index and increases your sugars.

Melanie: How often should somebody with diabetes check their blood sugar?

Dr. Muchowski: So that's actually a controversial topic currently. We used to have all diabetics check their blood sugars relatively frequently, sometimes a couple times a day. But what's interesting is that studies are now showing that in most diabetics who are not requiring insulin, that it really doesn't- that patients don't really need to do this because it doesn't really change the management and the overall outcomes of their diabetes. So most of us now are using sugar- checking their sugar maybe early in diabetes when we want people to learn how foods can change their sugar. So we might use it initially and then we also use checking blood sugars on anybody that would be on insulin.

Melanie: Speaking of insulin, you got right to my next question, when does it come down to medication, and is insulin always the end sight for somebody with diabetes, or not necessarily?

Dr. Muchowski: So the question of when medication starts is very individual. There's a group of medicine what's called Metformin that actually is now recommended for all diabetics, whether or not their sugars are high. So there is one group of medicine that's been shown to be beneficial regardless of your blood sugar. Insulin is used in some patients, but absolutely it's not an end point for everybody. So only a small group of patients will need insulin, and those are ones where we have a harder time controlling their blood sugar.

Melanie: What are some things and comorbidities that you would like somebody as we're talking about diabetes and ways to manage and control these symptoms, there are other things that can go along with it like foot health, or eye exams, wounds that don't heal, high blood pressure, heart disease, all of these things. Speak about these kinds of comorbidities and what you tell your patients about monitoring them.

Dr. Muchowski: Sure, so like we talked about, diabetes is when you have blood sugar and that vessels don't like having a high sugar environment. So if you can see any place in your body that you have a vessel, then you can have a complication of diabetes. So your heart is a big blood vessel, so patients with diabetes have higher rates of heart attacks. Your brain has blood vessels in it, and if one of those get clogged, that's when you have a stroke, so there's higher rates of stroke in patients with diabetes. Your kidneys are big blood vessels, so also higher rates of kidney failure. Same with the back of your eyes, because that's a big network of blood vessels.

What's important for patients to know though, is that the rates of complications with diabetes can dramatically go down if they are able to manage their sugar. So it's not a foregone conclusion that everybody with diabetes will end up with a complication.

Melanie: Wrap it up for us with your best advice about lifestyle, and management, and possibly even prevention, what you would like people to know about diabetes, and living with it, and taking care of their symptoms.

Dr. Muchowski: So the most important thing to realize is that the basics really do make a difference on whether you will become diabetic, or once you are diabetic, how well you can manage your diabetes. So really going back to the basics of having a good healthy diet, getting regular exercise, and keeping your weight at the ideal place are going to do a lot to help prevent you from becoming diabetic, or if you already have diabetes, those things will help to make your diabetes not as severe.

Melanie: And tell us about why they should come to Temecula Valley Hospital for their care.

Dr. Muchowski: Well, Temecula Valley is a small community hospital, and is very in the forefront of educating patients about their own disease. We really like patients to be involved in the decisions, and this is part of one of those ways that we show this; talking to patients about diabetes, trying to get them involved in lifestyle changes, and so providing this type of education to our community.

Melanie: Thank you so much, Dr. Muchowski, for being with us today. It's really important for people to hear these lifestyle and behavioral tips that you offered today. Thank you for sharing your expertise. You're listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit That's 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.