Transcription:

Caitlin Whyte: Welcome to Aspirus Health Talk. I'm Caitlin Whyte. And today we're discussing diabetes and how to manage it. Joining us with some tips is Gayle Maslakow, a nurse practitioner and certified diabetes care and education specialist. So Gayle, if you've been recently diagnosed with diabetes, I assume many lifestyle changes will be occurring to get your health back on track. Can you tell us about some of those initial changes?

Gayle Maslakow: For newly diagnosed type 2 diabetes, lifestyle management and modification is always first line. We typically recommend increasing activity to equal around 150 minutes per week. You would want to go over and above 150 minutes per week if you're looking to lose weight. Some of the recommended weight loss is around five to seven percent of overall total body weight, making the goal somewhat smaller than what some people think they should lose, which sometimes can be overwhelming. So when we discuss maybe losing 5%, it makes it much more manageable for people.

We also recommend a change in diet to include less simple carbohydrates and more complex carbohydrates. Carbohydrates are what break down to sugar in the patient's body, thus increasing the blood sugar. We also like them to improve and increase lean fats, healthy proteins in the diet, increasing water to 48 to 64 ounces daily. And that can be with flavored waters. We do ask them to refrain from too much artificial sweeteners. A recommended daily amount of artificial sweeteners should be between two and three servings per day.

Some of the other things that we'll recommend is reduction of stress. taking a look at our overall lifestyles, it could be a stressful job or not having enough time in the evenings and afternoons, and trying to make time for oneself to decrease stress. Stress can actually cause the body to pump out more stress hormones, which in turn increases blood sugar.

And sleep. Sleep is a big factor with blood sugar control. As many people aren't really aware, if you don't get into the good deep sleep at night, you don't actually make enough growth hormone. And that's important in overall blood sugar control. So sometimes if we know that someone is having problems with sleep maybe related to sleep apnea, we might refer them on for further study regarding that.

Caitlin Whyte: Now talking about blood sugar, what are some things that can make it fall or crash?

Gayle Maslakow: So if you change your diet too much and aren't getting enough lean fats, healthy proteins, dairy fats, maybe nut butters, things like that to help hold the blood sugar up, and then you're increasing your activity, you can cause those low blood sugar crashes. So the best way to actually eat or devise your meals and snacks is to be sure you're getting a balance with a protein or fat along with some carbohydrate, which can give you some fuel, and then increasing activity as recommended.

Caitlin Whyte: And when we talk about diabetes, we often hear about A1c. What is that?

Gayle Maslakow: So A1c was actually discovered by a scientist many years ago, and it actually revolves around our red blood cells. Our red blood cells tend to live for 90 to 120 days in the bloodstream. And as they live, they attract sugar. And that's actually what we're measuring when we measure an A1c. It looks back over the last, oh, probably 90 days to look at overall sugar control. So we will measure those red blood cells to see just how much of it is saturated with sugar, so to speak, and say your A1c comes back at 8%, that's how much of that red blood cell has been saturated with sugars. so it's kind of a little track record of your body and how it's been collecting sugar.

A1c ideally for someone who does not have diabetes is going to be at 5.6% or less. For someone with pre-diabetes would be around 5.7 to 6.4%, thus knowing that you're getting a little closer to that type 2 diabetes range. And then if it's tested and it's over 6.5%, you've actually crossed into that type 2 diabetes range.

Caitlin Whyte: Now talking about diabetes, there's also pre-diabetes to consider. Tell us more about pre-diabetes.

Gayle Maslakow: So pre-diabetes is something that is just becoming another pandemic in our country. and I actually was just reading a study today about how our insulin has actually morphed a little bit over the last few years and just does not work as well in our bodies. We're seeing an increase in childhood pre-diabetes and adult pre-diabetes. A lot of it is due to obesity. and that we tend to blame on diet a lot and sometimes it's maybe a diet of convenience, because we are so busy in today's world.

So pre-diabetes can actually be prevented. We can work at it with the same lifestyle changes by incorporating activity, and that should equal 150 minutes a week, bumping up our water intake to 48 to 64 ounces a day, getting good sleep and decreasing those simple carbs in the diet and just plain eating better, incorporating more fruits and vegetables, low-fat dairy products and good options for nutrition. We can stop diabetes in its tracks. So if you are diagnosed with pre-diabetes, you can absolutely turn that around.

And some of us do treat prediabetes with some medications. Metformin has been proven to help prevent progression to type 2 diabetes.

Caitlin Whyte: How can they learn more about our diabetes? And why is education so important for new patients?

Gayle Maslakow: So education is tantamount for a new agnosis. The actual term that we use for, diabetes is self-managed, diabetes and allowing that patient all of the skills necessary to take control of this disease, which can affect every part of our body.

Education can be found on all kinds of websites, American Diabetes Association, American Association of Diabetes Educators is out there. American Family Physician has a lot of good resources. We have our local libraries who have tons of education available to us, and there's a good array of podcasts out there that one could listen to, again, if you're busy, but spend a lot of time maybe in your car traveling to and from work or to children's sports games and the like. The more that you know, the more that you can do to prevent complications from diabetes or transition to full-blown type 2 diabetes. So education is very important.

And one thing I'd like to mention is that most insurances for a newly diagnosed type 2 diabetic will cover diabetes education. And in the first year of diagnosis, most insurances following Medicare guidelines will allow for nine to 10 hours of education to use over the course of the next year. So I really encourage people to take advantage of that even if it's in small increments. You can schedule a half hour to an hour visit with your local diabetes education department, who also employs our nutritionists, registered dieticians, who just have a wealth of information.

Some of these seven self-care skills that we, encourage in diabetes education include medication management, healthy eating, activity, healthy coping skills, because sometimes it can be very frustrating and cause some depression within a patient due to the significant amount of lifestyle change. We also encourage skills for solving problems such as how to afford your medications or your appointments or sometimes just the blood tests that go along with managing diabetes.

We also encourage learning how to reduce your own risks. So knowing which of those tests you should be having every year or maybe every three months or six months so that you can also stay on top of things.

Caitlin Whyte: Great. Gayle, is there anything else you want to add in terms of just diabetes care and how we can manage it?

Gayle Maslakow: I would like to add that if you are looking for any specialized education or would just like to meet with your diabetes education department, go ahead and ask your provider. We can always make a referral and get you in for some extra education. And most likely your insurance is going to cover it.

There's lots of options out there in the diabetes world today, including great technology and things to help the patient manage this to the best of their ability.

Caitlin Whyte: Thank you for joining us today, Gayle. Find more information and podcast episodes at Aspirus.org. And if you enjoyed this episode, please, please subscribe and share it. This has been Aspirus Health Talk. I'm Caitlin Whyte. Stay well.