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Diabetes Education

Dr. Maisara Rahman discusses the difference between type I and type II diabetes, who is a risk, how exercise and diet impacts those at risk, and the current state of diabetes today.
Diabetes Education
Featured Speaker:
Maisara Rahman, MD
Maisara Rahman, MD graduated from the American University of the Caribbean School of Medicine. She completed her Family Medicine Residency Training at Riverside County Regional Medical Center and became the Chief Resident.  She is board certified with the American Academy of Family Physicians and is president of the California Academy of Family Physicians for the San Bernardino-Riverside Chapter.

Learn more about Maisara Rahman, MD

Melanie Cole (Host): If you’re one of the many people that suffer from diabetes, you may have questions about how best to manage it and how to live a healthier lifestyle. There are so many questions. My guest today is Dr. Maisara Rahman. She’s a family medicine physician and a member of the medical staff at Temecula Valley Hospital. Dr. Rahman, let’s just start with what happens when we eat sugar, and when we eat anything really. Why do we need to understand what insulin and sugar and the relationship to our glucose levels really even is?

Dr. Maisara Rahman (Guest): Yeah I think it’s really important to understand just a simple way of how we process sugar in our body and how it can affect us long term. So a lot of our patients, they have a vary brisk diet in carbohydrates and sugars, and when we eat carbohydrates, that is converted into glucose which is sugar and what happens is our bodies produce insulin and insulin is a fat storing type of hormone, and what it does is it works as a key to ourselves to allow ourselves to take in that sugar to produce energy, and with type 2 diabetics, unfortunately they are insulin resistant because of one of the major reasons is obesity, and so a lot of our diabetics are insulin resistant and so they are unable to process the sugars in their body resulting in high blood sugars and complications of type 2 diabetes.

Host: While we’re mainly talking today, Dr. Rahman, about type 2 diabetes, explain to the listeners a little bit of the difference between type 1, which can show up in children, juvenile diabetes, or type 2 which used to be called adult-onset, but as a result of the childhood obesity epidemic, and what we’re seeing today, it’s now type 2 diabetes. Explain the difference for us if you would.

Dr. Rahman: Yes, so type 1 diabetes is also called insulin-dependent diabetes, and type 1 diabetes is an autoimmune condition that’s mainly caused by our bodies attacking our organ that makes insulin, leading to the destruction of the cells that make insulin, which causes them to have insulin deficiency, and this has mainly caused – patients who do get type 1 diabetes they might be also genetically predisposed, and type 2 diabetes, this is mainly – it was formerly called non-insulin dependent or adult onset, but like you said, we have been seeing a lot of our adolescents and children develop type 2 diabetes because of physical inactivity and diet, a very poor diet.

Host: So how is that happening? Who is at risk? You mentioned sedentary lifestyle and a very poor diet. What are we doing to ourselves, Dr. Rahman, that so many people are now coming up with type 2 diabetes?

Dr. Rahman: So again, type 2 diabetes can be caused by a variety of factors. Being overweight, being physically inactive, and causing our bodies to have an inability to properly use the insulin, causes the complications of this – patients going from obesity, which leads to prediabetes, and then type 2 diabetes, and one of the main reasons that we are seeing this is because of our lifestyle. Our lifestyles are becoming more and more inactive. Patients are not moving as much. Most of the patients that I see in our clinic, they have a very sedentary lifestyle. Their jobs are mainly desk jobs, they don’t have time to exercise. They have a very poor diet, so those are some of the more major I think risk factors of getting type 2 diabetes. Even if you have a genetic predisposition and you have a healthy lifestyle, you can avoid getting prediabetes and diabetes if you have a really healthy diet.

Host: Then how is it diagnosed? Would somebody know if they had prediabetes or diabetes? And when we get our annual physicals every year, Dr. Rahman, they test our blood and we do that fasting blood glucose, what do those numbers mean? The A1c that we see or the estimated A1c – what do these numbers mean and what do we do if you tell us that we have prediabetes, that we’re kind of on the line there?

Dr. Rahman: When I see patients in our clinic and we run these lots, we do – the majority of my patients meet the screening to screen them for prediabetes, and if you get a blood sugar number fasting anywhere from 100 to 125, that is considered prediabetes. Any number from 5.7 to 6.4, that is prediabetes, and an A1c of 6.5 or higher is considered type 2 diabetes, and what this means is if you are – if you have high blood sugars in the morning ranging from 100 to 125, that is considered prediabetes, and the main thing that you need to do is it’s kind of a wake up for our patients to really look at their lifestyle, their diet, and to really take care of themselves at home and to make sure that they don’t progress to getting type 2 diabetes on the complications of type 2 diabetes.

Host: Then what? Then what do we do if you tell us that we get that warning sign, which is actually a good thing to get that warning sign so you know that this is where you’re headed – what do we change first? We exercise, we start with diet, what is it that you want us to do as far as those things are concerned?

Dr. Rahman: So for most of my patients who are prediabetic, the main thing that I tell them is that they need to lose weight because we know that they have prediabetes because most likely they have central obesity, they’re overweight or obese, so just by losing weight alone you’re decreasing the insulin resistance in your body; therefore, your body is allowed – is able to metabolize the blood sugars a lot better and you don’t have elevated blood sugars throughout the day. So losing at least 7% of your body weight, increasing physical activity, 30 minutes, three times a week, has been shown to prolong the onset of type 2 diabetes, so you can avoid going from prediabetes to type 2 diabetes just by losing at least 7% of your body weight, becoming more active, and in becoming more active what happens to our bodies is that we’re bringing down inflammation, one. Two, we’re also allowing our bodies to breakdown all the sugars and carbohydrates that we put into our diet and unfortunately we eat more than what we burn, and as a result all that excess food is going to turn into fat. Excess fat around the stomach especially or the belly causes dysfunction in fat cells, which again causes a lot of the complications of prediabetes and diabetes.

Host: Such great information. So exercise and taking care of our diet are really two of the most important things, and then what? Does type 2 diabetes become insulin dependent? It’s an insulin resistant type diabetes, but can it become dependent on insulin? Are there medications? What do you do for patients for whom exercise, diet, lifestyle changes are not controlling those blood sugar levels?

Dr. Rahman: So patients who have type 2 and they’re progressively not controlled despite increasing medications, or the patient is not losing weight and helping out with that insulin resistance that they have – if they are considered morbidly obese, we have other ways of helping them to lose weight, and that would be an evaluation for bariatric surgery, that most of the time if you are a patient who has type 2 diabetes, it is so important to follow up with your primary care physician because type 2 diabetes is a progressive disease. So if there are no lifestyle changes and your A1c is continuing to increase and it’s not controlled, you will get complications with type 2 diabetes, that includes blindness, limb amputations, and cardiovascular disease. So it’s really important to come into your doctor every three months, check your A1c to make sure that we adjust that medication so we can prevent complications of type 2 diabetes.

Host: As we wrap up, Dr. Rahman, it’s such important information for people to hear. Give us your best advice about diet and lifestyle, things that you would like us to know because people get confused about which sugar is bad and which sugar is good, and are all carbohydrates bad? You know, people have so many questions about those things. Give us your best advice. What do you tell people every single day that they should be doing right now to hopefully prevent or manage their diabetes?

Dr. Rahman: I think the cornerstone of any healthy lifestyle is to stay active, eat right, and primary prevention, and primary prevention is – means you don’t wait until you get the disease. You want to try to avoid the disease process and that’s by staying active, eating healthy, and being mindful of what you put into your bodies and making sure that you get your yearly exams. Even though you have a genetic predisposition to getting type 2 diabetes, we are there to help you pick it up early so we can help you lose that weight or counsel you on weight loss and diet, and I think primary prevention is key, and if you do have diabetes type 2, you can always – it’s never too late to start losing the weight, even if you’re on insulin and other medications. If you do start to lose weight again, you will decrease that insulin resistance, you will require less medications to help you control your blood sugars. So the key to everything is prevention and preventing getting prediabetes and type 2 diabetes, and if you do have it, trying to lose weight and making sure that you exercise and stay healthy, that would be my advice.

Host: Thank you so much Dr. Rahman for coming on and educating us about diabetes and the things that we can do to hopefully prevent it in the first place. It’s great information. Thank you again for joining us. You’re listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit 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 tuning in.