Transcription:

Scott Webb (Host): I'm sure that we all have some confusion about diabetes, especially the difference between Type 1 and Type 2 diabetes. And I'm joined today by registered nurse, Ashley Pickering-Brown. She's a Diabetes Nurse Educator at Emerson Hospital. And she's here to educate us about diabetes, including signs and symptoms, and the latest technologies that are helping people to live better with diabetes. This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. So Ashley, thanks so much for your time today. We're going to talk about diabetes, Type 1, Type 2, latest treatment options and so on. As we get rolling here, though, what is diabetes exactly?

Ashley Pickering Brown, RN (Guest): Well, diabetes, it's a problem when your body causes your blood glucose, that's the medical term or blood sugar levels as it's more commonly known, to rise higher than normal in your body. Basically what happens is when you eat, your body breaks food down and sends that sugar into your blood. Now your pancreas, which is an organ that kind of sits up behind your stomach, gets a little notification that says, hey, there's sugar in the bloodstream. And that pancreas releases a natural hormone called insulin. And the insulin enters your bloodstream and sort of acts like a key to the cells of your body, so that sugar that's in your bloodstream can move into the cells of your body. So your heart muscles, your heart can beat, your hair can grow, your lungs can breathe. All of those things can happen because of the energy from the blood sugar and so your body either uses that fuel for energy right away, or it stores that glucose, it stores that sugar as fat for later use.

Now in someone with diabetes, that process gets disrupted and the blood sugar remains in the bloodstream and over the long-term, causes damage to the blood vessels in the organs. So, if you have diabetes, your body either doesn't make enough insulin, or it can't use the insulin it does make, and oftentimes it's a combination of both of those things.

Host: Yeah, that sounds right. And what a great way of explaining that. So let's get into this because I know there's some confusion about this exactly. What are the differences between Type 1 and Type 2, and maybe towards the end of your answer, maybe you can get into gestational diabetes as well.

Ashley: Type 1 diabetes is an auto immune disorder. So, that means your own immune system kind of attacks the cells of the pancreas. So, those cells are destroyed and the pancreas no longer produces insulin. So in Type 1 diabetes, you always need to inject insulin because your body is no longer producing insulin.

One of the biggest misconceptions of Type 1 diabetes is that it is a childhood illness. And while it is true, that a lot of times it is diagnosed in a younger population, it can actually be diagnosed at any age. And we've seen patients as young as a few months old to as old as their eighties or nineties being diagnosed with Type 1 diabetes.

So it's important to be properly assessed when you're diagnosed. And then for Type 2 diabetes, the difference here is Type 2 diabetes is a metabolic disorder. And so what that means is your body is still making insulin. But it's not using it in a proper way. A lot of people may have heard this term it's called insulin resistance. And what this means is at first, when your sugar starts to rise, your pancreas starts to make a lot of extra insulin to help lower those blood sugar levels. But over time, your pancreas isn't able to keep up and it can't keep making that much insulin. And so eventually the blood sugars start to rise. So it's almost like you're trying to fill a gas tank with a hole in it, right. You're pumping gas into it, but it's leaking out the other side and not getting to the car in the way that it should.

Gestational diabetes is diabetes that develops in a pregnant patient and all of the hormones that are released in pregnancy that the baby, you know, help the baby grow and help keep the pregnant woman healthy, actually cause the body insulin resistant and the body requires more insulin during pregnancy. So, they get a combination of both things where they're not making enough insulin and their body is demanding more. And so that's where we get gestational diabetes and commonly the increased insulin demand happens around the beginning of the third trimester. So that's when women will often get diagnosed. That's when we start to do the testing around that time.

Host: Yeah. My wife had that when she was pregnant with our,

Ashley: Oh, yeah.

Host: Yeah. With our daughter. So I'm at least a little bit familiar with that. Certainly not as much as you are.

Ashley: And it's really common too, and that's one thing to stress for pregnant women is that it's one of the most common complications of pregnancy, and doesn't occur because women eat too much sugar. Pregnant women often blame themselves for that diagnosis. And you know, it's not because you ate a cupcake when you were 12 weeks pregnant. Right. It has nothing to do with that. It's really, really just about that imbalance of the hormones.

Host: Yeah, it really is. And yeah, I was sort of freaked out when my wife was diagnosed but the doctor said, she's going to be fine. And as you say, go ahead and have the cupcake. Maybe not too many, maybe not a lot of cupcakes, but the, the, the occasional cupcake you've earned it. You're carrying another human. You're carrying another human around inside of you, have a cupcake. So, what are the signs and symptoms of diabetes and what do we do if someone has those symptoms?

Ashley: Many people with diabetes, especially with Type 2 diabetes will not have any symptoms at all. And so that's why it's important to be monitored routinely by your primary care doctor, because often it's just caught in routine lab work. That's where we catch a lot of diabetes diagnoses. However, if the sugars have been elevated for a very long period of time, this is often, you know, months to years, or if someone is newly diagnosed with Type 1 diabetes, they can often present very symptomatic and they'll present as very sick. They'll have increased thirst. And by increased thirst, we're not saying you're just a little bit thirsty. We're talking like you're drinking gallons of water, and you're still feeling thirsty, frequent urination, you know, waking up every hour overnight to go to the bathroom. Hunger, fatigue, blurry vision, nausea, vomiting, weight loss is another one, which I know people are like, what do you mean weight loss? You know, diabetes is often associated with being overweight, but when the sugars are too high, you actually lose weight. And so sometimes these patients, it can be so bad that if you are having those symptoms of diabetes, you really need to be seen by a medical professional right away, whether it's your primary care doctor or going to an emergency room, depending on how severe the symptoms are.

Host: Yeah, and it sounds like there's every good reason to be seen if it's an emergency type situation, obviously go to the emergency department or at least schedule something with your primary as soon as possible. So, lots of good reasons there, because none of that sounds good for any of us.

And how is each sort of typically treated anyway? You know, I know my mom developed diabetes and when she was older and she was able to take a pill and some people have to give themselves shots. So maybe you can go through this for us.

Ashley: Yeah, so treatment for diabetes is very individualized, as you said. It can differ from person to person, but one of the first steps for managing any type of diabetes is going to be monitoring your blood sugars at home. So, this is going to be done with a glucometer or with a continuous glucose monitor. What these devices do, these devices allow you to monitor your sugars at home on your own, and it gives you insight into how your blood sugars respond to various things, to food, to activity, to different types of medications, to getting a good night's sleep versus not getting a good night's sleep. Seeing how your sugars respond and with this information that will allow any of the medical providers that are treating you, to know what kind of medication you may need.

So patients with Type 1 diabetes specifically, will need to take insulin either via injections or an insulin pump for the rest of their lives. So, that's something important to note is that with Type 1 diabetes, you will need to be on insulin for the rest of your life. This is because the body is no longer producing insulin. So, the only way to get it is to inject it. However, patients with Type 2 diabetes can be treated with a variety of different medications. So there are pills, there are injectables that are not insulin. And then of course, insulin if it's needed. One of the kind of misconceptions that people with Type 2 diabetes have is they believe if they go on insulin, they are going to be on it for the rest of their life.

And really that's not true. It's because of that Type 1 diabetes. So, people kind of have that in their mind, because people with Type 1 diabetes have to be on insulin for the rest of their lives, but that is not necessarily true for people with Type 2 diabetes and certainly with any type of diabetes, but particularly Type 2 diabetes, a healthy diet and exercise are going to be really important to help controlling your blood sugars.

Even small changes like switching from regular soda to diet soda, that can make all the difference. Small changes like that, and certainly stress reduction and a good night's sleep can also help keep the blood sugars in range.

Host: Yeah, it definitely can. And you mentioned, you know, diet soda there and the value of switching from sugar to no sugar or less sugar. Is it just that simple for many people especially with Type 2 with diabetes to just avoid sugar. Would that just make the whole thing a lot easier?

Ashley: Not necessarily, I wish it were that simple. So people with diabetes don't need to completely avoid sugar. In your body, all carbohydrates, that's the food group that encompasses sugar, all carbohydrates break down into that same molecule in your body. That molecule of glucose. It's all the same in the end. Your body doesn't know whether or not you're eating a cupcake or a sweet potato, right? If they have the same amount of sugar, your body recognizes them as the same amount of sugar, no matter what, however, what does happen is that your body digests food differently based on how complex the sugar is.

So for instance, you know, if you're eating a cupcake what's going to happen is because that cupcake is all sugar, you're going to eat it and it will get digested almost immediately, very quickly. And that sugar will dump into the bloodstream and spike your sugar up really high all within, probably in less than an hour. You'll see that big spike in your blood sugar. But if you have a more complex carbohydrate, such as a sweet potato, which does have sugar in it, but also has fiber and other nutrients in it; the body breaks that food down much more slowly. So, instead of the sugar, just kind of dumping into the bloodstream at once, it kind of trickles in a little bit and it's the difference between a pipe bursting versus having a leak in the pipe. You know, your body's much more able to manage that. And so it is important for people with diabetes to avoid those refined or simple sugars like juice or soda, desserts, you know, potato chips, things like that.

But, it isn't necessarily the right thing to just say, I'm not going to eat sugar at all anymore. I'm never going to eat bread again. I'm never going to eat potatoes again because oftentimes that's not sustainable either. So, it's really important to understand how to have a balance between eating well and making sure you're getting enough to eat, you know, while also balancing your diabetes and helping to control your blood sugars.

Host: Yeah, I see what you mean. Like it's just not sustainable. It's not maybe practical for some folks. And as you say, there's a difference between that like massive sugar rush, you know, that as that bursting of sugar and the slow process, the slower digestion, the foods that have other things like fiber and so on. And so a really great way of explaining all this to us. What are the implications if we just don't manage our diabetes well?

Ashley: So one thing is, is that diabetes is a progressive illness. So, it does take a lot of time for side effects to develop. So unfortunately, or maybe fortunately, it's not like a stroke or heart attack, which is very scary and happens suddenly, and can cause people to kind of change their whole life right away. Often people are diagnosed when they have no symptoms and they feel completely fine. So, they are like why do I need to make these changes? But the tough part of diabetes is that when those side effects do develop, they are extremely difficult to reverse. So, the goal of diabetes treatment is to prevent any type of damage.

Diabetes causes damage to the blood vessels and it's that damage that is associated with all of the problems with diabetes. So the things we worry about particularly, you know, of course, it's blood vessels, we're going to worry about an increased risk for a heart attack or a stroke, nerve damage, leading to wounds or amputation, the nerve damage can also lead to digestive problems and erectile dysfunction. It can also cause damage to the kidneys, you know, leading someone to be put on dialysis or needing a kidney transplant. And a lot of people don't know this, but diabetes is the leading cause of blindness because of vessels in the eyes are so small. It, doesn't take a lot for them to get damaged. And so if they get damaged, people can end up going blind. So eye care is big part of diabetes management. The good news about this is that all of these side effects and all of these problems take a long time to develop even years to develop.

So it is so important to be routinely monitored and make sure you're following up with your care team, taking your medications, making those changes to your diet right away. And if that's the case, we can often prevent all of these complications from even developing.

Host: Yeah. That's the best plan, really, as you say, you know, that prevention is key, early detection, early diagnosis, prevention. I want to, as we wrap up here, talk about the latest technologies between smartwatches, the phones and apps and all of that, you know, a lot has changed, like since my grandpa had diabetes, when I was a kid and he did almost lose his foot because of diabetes cause he had Type 2 and he didn't do what we're telling people to do, what you're telling them to do today, which is go to the doctor, be diagnosed, early prevention. Anyway, what's the latest technologies out there that folks need to know about?

Ashley: Diabetes treatment and technology has advanced so much in the last few years, even just in the years that I've been working in diabetes. It's amazing how quick things have started to develop. There are so many apps and food trackers, blood sugar trackers, available on any smartphone, even on the computer or on an iPad that allow you access to knowing your blood sugars and knowing your patterns. Imagine how powerful it is to see how your blood sugars respond to eating a big bowl of rice versus eating a salad with a whole grain roll on the side. Seeing that difference can really be motivating and help people make good choices when it comes to their diet and lifestyle. Additionally, insulin pumps. So those are the devices that continuously infuse insulin into your body instead of injecting insulin. They used to be really large and difficult to use and complicated.

Now, you know, they're as small as a deck of cards and as easy to use as a cell phone. There are some that don't even have tubes. You just wear them on your body, like a patch and they're amazing. And they have insulin injections so much easier and so much less complicated. Additionally I think the biggest change with diabetes technology are devices called continuous glucose monitors.

So these are devices that you wear constantly on your body and they check your sugars around the clock. They basically eliminate the need to check your blood sugars on your finger. That's is a standard of care now is to use a glucometer and check blood sugars on your fingers. But that's moving to eliminate that. And these devices, they basically beam your blood sugar over to your cell phone or your smart watch or any smart device that you're wearing. So that instead of having to prick your finger, you can just look at your watch and it'll say, oh, your blood sugar is 120. Your blood sugar is in a good range, your blood sugar is going up.

You know, maybe you should do something about that or your blood sugar is going down. You may want to eat something. It'll give you alarms and alerts and let you know that your blood sugars are changing rapidly. So it really kind of opens the doors, you know, for all those people who struggle with pricking their fingers, four or 5, 6, 7 times a day, really eliminates the need to do that.

And as a medical provider, these devices provide us with so much information. For instance, you know, when you bring in your device, we can download it in the doctor's office. And now we can see what your blood sugar is 24/7. We can see what's happening overnight, right, when you wouldn't normally check your blood sugar, we can now see what's happening and help come up with a better treatment plan based on the data from these devices.

And the good news is most of these devices are covered by insurance, they're well covered and even if they aren't covered, there's a lot of devices that are very inexpensive as well. And so even if they aren't covered by insurance, they're often affordable, just to pay cash out of pocket. So it's really amazing.

Host: Yeah, well, you use the word amazing there, and I've just sort of shaking my head, taking all this in. It really is amazing. I mean, nobody wants to have diabetes and maybe especially Type 1, but there is so much out there. We know so much more about it. The technology, as you say, just being able to monitor your blood sugar overnight while you're sleeping, which we could never do before. So really amazing, thank you so much for your time. You are a wealth of information. I found this to be really educational. Thanks so much.

Ashley: Thank you very much.

Host: And for more information about diabetes, please visit Emersonhospital.org/diabetes. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.