Doctors on Call - Diabetes
♪
DR. VITTORIO: GOOD EVENING AND
WELCOME TO "DOCTORS ON CALL."
I AM DR. HEATHER MR. AND I AM
YOUR HOST TONIGHT ON DIABETES,
DIAGNOSIS, COMPLICATIONS, AND
TREATMENT.
THE SUCCESS OF THIS PROGRAM
DEPENDS ON OUR VIEWERS.
SO PLEASE CALL IN WITH YOUR
QUESTIONS ON DIABETES AND WE
WILL DO OUR BEST TO ANSWER THEM.
THE TELEPHONE NUMBERS FOR YOUR
QUESTIONS CAN BE FOUND AT THE
BOTTOM OF YOUR SCREEN.
OUR PANELISTS THIS EVENING
INCLUDE DR. RYAN HARDEN, A
FAMILY MEDICINE PHYSICIAN WITH
THE GATEWAY FAMILY HEALTH CLINIC
IN SANDSTONE AND FACULTY MEMBER
AT THE MEDICAL SCHOOL IN DULUTH.
DR. MARY MOK, AN ENDOCRINOLOGIST
WITH ESSENTIA HEALTH.
AND DR. DARIN RUANPENG, AN
ENDOCRINOLOGIST WITH ST LUKE'S
ENDOCRINOLOGY ASSOCIATES.
OUR MEDICAL STUDENTS ANSWERING
PHONES TONIGHT ARE ANN
KLEINSCHMIDT OF DULUTH, ABBY
LINDSETH FROM BEMIDJI,
MINNESOTA, AND KYLIE MILLER FROM
BISMARCK, NORTH DAKOTA.
AND NOW ON TO TONIGHT'S PROGRAM
ON DIABETES, DIAGNOSIS,
COMPLICATIONS, AND TREATMENT.
SO BEFORE OUR PHONE START
LIGHTING UP TONIGHT, WHY DON'T
WE OPEN WITH BASIC QUESTIONS
EVERY PATIENT WANTS TO KNOW
ABOUT.
WHO SHOULD BE TESTED FOR
DIABETES?
DR. HARDEN: WHO SHOULD BE TESTED
IS A QUESTION I GET A LOT.
I THINK THAT PEOPLE WHO HAVE A
STRONG FAMILY HISTORY OF
DIABETES SHOULD BE TESTED FOR
DIABETES.
WOMEN WHO HAD GESTATIONAL
DIABETES SHOULD BE TESTED EVERY
THREE YEARS.
PEOPLE WHO HAVE SYMPTOMS OF
DIABETES, WHICH WOULD INCLUDE
URINARY FREQUENCY, HAVING TO
URINATE A LOT, EXCESSIVE HUNGER,
THIRST, RAPID GAIN OR LOSS OF
WEIGHT.
DIFFERENT GROUPS RECOMMEND
DIFFERENT SCREENING FREQUENCIES
FOR DIABETES.
THE ADA RECOMMENDS EVERY THREE
YEARS AFTER 45.
IF PEOPLE COME IN REQUESTING A
TEST, I ALMOST ALWAYS TEST THEM,
BECAUSE GETTING THEIR TEST
RESULTS IS A CONVERSATION PIECE
TO IMPROVE THEIR HEALTH, SO
ANYBODY WHO HAS CONCERNS ABOUT
DIABETES SHOULD TEST.
>> GESTATIONAL DIABETES IS
DIABETES THAT OCCURS WHEN A
WOMAN IS PREGNANT?
DR. HARDEN: THAT'S RIGHT.
>> ASSUMING WE WILL SCREEN, HOW
WILL WE TEST?
WHAT WILL THAT LOOK LIKE?
DR. MOK: THERE IS ONE WAY, THE
AVERAGE OF THE GLUCOSE IN THE
LAST THREE MONTHS.
WHEN IT IS HIGHER THEN 6.5%
, IT IS CONSISTENT WITH
DIABETES.
SETTING OFF THE SYMPTOMS,
FEELING THURSDAY, LOSING WEIGHT,
IF THE NUMBER IS OVER 200, THAT
IS ALSO CONSISTENT WITH
DIABETES.
LASTLY, IF THE GLUCOSE IS HIGHER
THAN 100 AND 26 -- 126, THAT IS
ALSO CONSISTENT WITH DIABETES.
>> CAN YOU EXPLAIN WHAT AN A1C
IS?
DR. MOK: THE AVERAGE OF THE
GLUCOSE IN THE PAST THREE MONTHS
AND HOW MUCH GLUCOSE IS ATTACHED
TO THE HEMOGLOBIN.
>> SO, THAT BRINGS US TO LET'S
ASSUME YOU HAVE NOW DIAGNOSED
HIM WITH DIABETES BECAUSE THAT
GLUCOSE WAS GREATER THAN 126.
THE POSSIBILITIES ARE THEY COULD
BE A TYPE 1 OR TYPE 2 DIABETIC.
WHAT IS THE DIFFERENCE?
DR. RUANPENG: TYPE 1 IS WHEN
YOUR BODY IS MAKING AUTOIMMUNE
IN YOUR BODY CAN'T SECRETE
ENOUGH INSULIN.
YOU BECOME INSULIN DEFICIT.
ON THE OTHER HAND, TYPE 2
DIABETES IS INSULIN-RESISTANT,
SO YOUR BODY IS MAKING INSULIN,
BUT YOUR BODY REQUIRES MORE.
IN THE GENERAL POPULATION, AND
SOMEONE WHO IS OLDER OR HAS
OBESITY, IT TENDS TO BE TYPE 2
DIABETES.
TYPE ONE IS KIDS OR SOME BUDDY
WITH THAT LEAN BODY MASS AND
DEVELOP DIABETES.
THAT IS A WAY TO CONFIRM THE
DIAGNOSIS, BECAUSE WE KNOW TYPE
1 IS WHEN THE ANTIBODY ATTACKS
THE PANCREAS, SO WE CAN HAVE A
BLOOD TEST AND CHECK THE
ANTIBODIES AND CHECK THE INSULIN
, LOOKING AT PEPTIDES, WHICH IS
A PROTEIN.
QUESTIONING EITHER TYPE 1 OR
TYPE 2, WE CAN TEST TO CONFIRM
THAT ANTIBODY TO MAKE A FIRM
DIAGNOSIS.
>> AND THIS WOULD BE THE
DIFFERENCE OF WHY SOME PEOPLE
IMMEDIATELY NEED TO USE SHOTS OR
INSULIN, AND OTHER PEOPLE CAN
TREAT DIABETES WITH PILLS, IS
THAT TRUE?
DR. RUANPENG: RIGHT, IN TYPE 1,
YOU NEED INSULIN.
THE BODY CAN'T MAKE ENOUGH.
FOR TYPE 2, IF IT IS SEVERE
ENOUGH, INITIALLY YOU NEED
INSULIN BECAUSE WE KNOW THAT
INSULIN IS THE MOST POTENT
MEDICATION TO BRING YOUR GLUCOSE
DOWN.
WHEN YOUR BODY HAS A HIGH
GLUCOSE, WE HAVE GLUCOSE
TOXICITY, YOUR PANCREAS, EVEN
THOUGH IT CAN PRODUCE INSULIN,
BUT UNDER THAT ENVIRONMENT OF
HIGH GLUCOSE IT CANNOT WORK
PROPERLY, SO IN TYPE TWO
DIABETES IF IT IS SEVERE ENOUGH
INITIALLY, SOME PATIENTS MAY
NEED INSULIN INITIALLY.
>> VERY GOOD.
WE HAVE QUESTIONS FROM VIEWERS
RIGHT NOW.
ONE VIEWER IS ASKING A
PRE-DIABETES DIAGNOSIS, A TERM
WE HEAR LOTS OF PEOPLE COME TO
CLINIC WITH OR ASK ABOUT, WHAT
IS PREDIABETES.
WHAT DOES IT MEAN?
COULD YOU TELL US IQ WOULD
DEFINE THAT AND WHAT IT MIGHT
MEAN?
DR. MOK: IT IS CLOSE TO WHAT I
MENTIONED PREVIOUSLY.
PREDIABETES, THE HEMOGLOBIN A1C
WOULD BE IN THE RANGE OF 5.7 TO
6.4%, FOR EXAMPLE.
ALSO, GLUCOSE LEVELS WOULD BE
125, ONE HUNTER 26.
IT IS NOT BELOW, BUT YOU ARE AT
HIGH RISK FOR DEVELOPING
EVENTUALLY.
>> IS THIS WHAT WE WOULD
CONSIDER FOR SOMEONE WHO WOULD
DEVELOP TYPE 2 DIABETES,
SOMETHING NOT ATTACKING THE
PANCREAS, BUT THE INSULIN IS NOT
WORKING APPROPRIATELY?
DR. MOK: CORRECT.
IF YOU HAD A PATIENT WITH
PREDIABETES, WHAT TYPES OF
THINGS MIGHT YOU RECOMMEND THEY
DO?
DR. HARDEN: THAT IS A GREAT
QUESTION, ESPECIALLY WITH HOW
COMMON IT IS.
WE DON'T WANT PEOPLE WITH
PREDIABETES TO DEVELOP
FULL-BLOWN DIABETES.
THERE ARE SEVERAL THINGS YOU CAN
DO.
THE MOST IMPORTANT, CHANGES IN
THE DIET TO LOSE WEIGHT AND
REGULAR EXERCISE.
EXERCISE IN AND OF ITSELF HAS
THE SAME EFFECT ON YOUR BODY'S
ABILITY TO ABSORB GLUCOSE OR
SUGAR FROM THE BLOOD STREAM AS
INSULIN, SO IT IS A SIGNIFICANT
EFFECT THAT REGULAR EXERCISE
WILL HAVE ON ELEVATED BLOOD
SUGARS CONSISTENT WITH
PREDIABETES.
SOME PHYSICIANS RECOMMEND
PATIENTS WITH PREDIABETES
INITIATE DRUG THERAPY TO PREVENT
THE DEVELOPMENT OF DIABETES, BUT
I TEND TO LEAN TOWARDS LIFESTYLE
CHANGES FIRST TO SEE IF WE CAN
GET IT UNDER CONTROL IN THAT
WAY.
>> EXCELLENT.
>> WE KNOW FROM A DIABETES
VENTURE STYLE, LIFESTYLE
MODIFICATION, WEIGHT LOSS, DIET,
HAD MORE EFFICACY COMPARED TO
MEDICATION.
I AGREE WITH THAT.
>> THAT IS TRUE FOR A NUMBER OF
RELATED CONDITIONS, LIKE
HYPERTENSION AS WELL.
IN GENERAL IMPROVING OUR
LIFESTYLES, IT WOULD DO A LOT OF
IMPROVING THE CONDITIONS OF
PERSON WHO WOULD DEVELOP
DIABETES MIGHT ACTUALLY HAVE.
THERE IS AN INTERESTING QUESTION
REGARDING DIET OR LIFESTYLE
CHOICES HERE.
WHAT IT IS IS, WHY DOES DRINKING
ALCOHOL LOWER MY BLOOD GLUCOSE?
I DON'T KNOW IF THIS IS
SOMETHING I HEARD BEFORE IN MY
CLINIC AND PROBABLY NOT
SOMETHING I WOULD NECESSARILY
THINK THAT EITHER, BUT WHAT
WOULD BE THE GENERAL
RECOMMENDATION FOR ALCOHOL
INTAKE FOR SOMEONE WITH
DIABETES?>
DR. HARDEN: FIRST OF ALL, THE
REASON PEOPLE WHO DRINK A LOT OF
ALCOHOL HAVE LOW BLOOD SUGAR IS
IF PEOPLE GET A LOT OF THEIR
CALORIES FROM ALCOHOL, AND THERE
ARE A LOT OF CALORIES AND
ALCOHOL, IF THEY GET A LOT OF
CALORIES FROM ALCOHOL, THAT
INTERFERES WITH THE LIVER'S
ABILITY TO MANUFACTURE GLUCOSE,
SO WHEN THEY HAVE BEEN EATEN
OVER A CERTAIN TIME, ALCOHOL
INTERFERES WITH THE LITTLER'S --
LIVER'S NATURAL ABILITY TO MAKE
GLUCOSE, THAT'S WHERE THEY HAVE
LOW BLOOD SUGARS.
AS FAR AS ALCOHOL USE AND
DIABETES, I DISCOURAGE PEOPLE
USING REGULAR ALCOHOL WHEN THEY
HAVE DIABETES, MOSTLY BECAUSE OF
THE CALORIES.
THEY HAVE TO CONSUME A LOT OF
ALCOHOL TO INTERFERE WITH BLOOD
SUGAR LEVELS, SO BLOOD SUGAR
LEVELS DROP COME OF IT THAT I
DON'T RECOMMEND ALCOHOL WHEN
SOMEONE IS DIABETIC.
>> HOW DOES DRINKING ALCOHOL IN
PACU USE OF MEDICATIONS?
HOW DOES THAT INTERFERE IF
YOU'RE ON MEDICATIONS?
IS THERE AN INTERACTION YOU
WOULD NEED TO BE WORRIED ABOUT?
>> IN GENERAL, YOU HAVE TO BE
CAUTIOUS IN ANYBODY USING
ALCOHOL WITH MEDICATION FOR ANY
THERAPY OR CONDITION.
>> I WOULD AGREE.
TEACHING AT THE COLLEGE OF
PHARMACY, ALCOHOL HAS A TENDENCY
TO DRASTICALLY ALTER HOW WE
METABOLIZE DRUGS WHEN NOT TO
MENTION IF WE ARE DRINKING
EXCESSIVELY, FORGETTING TO TAKE
MEDICATIONS, WHICH WILL CAUSE A
PROBLEM.
CAN TYPE 2 DIABETES EVER TURN
INTO TYPE 1 DIABETES?
DR. MOK: WELL, WE WOULD CALL IT
TRANSITION TO TYPE 1 DIABETES.
WE WOULD SAY IT IS
INSULIN-DEPENDENT.
EVENTUALLY AFTER THE PANCREAS
OVER COMPENSATES FOR SO LONG FOR
THIS INSULIN RESISTANCE IN THE
BACKGROUND OF TYPE 2 DIABETES,
IT WOULD RUN OUT OF INSULIN AND
PATIENTS BECOME
INSULIN-DEFICIENT AND
INSULIN-DEPENDENT.
>> THAT IS A GREAT POINT.
LOTS OF PEOPLE BELIEVE IF YOU
ARE ON INSULIN, YOU MUST BE A
TYPE ONE DIABETIC, BUT AFTER A
LONG TIME YOU CAN ONLY FORCE
YOUR PANCREAS TO MAKE SO MUCH
INSULIN, SO THE PILLS EVENTUALLY
DON'T WORK WELL, THEN YOU NEED
TO TRANSITION OVER TO INSULIN,
EVEN IF YOU ARE A TYPE 2
DIABETIC.
LET'S TALK ABOUT OTHER
COMPLICATIONS.
ONE VIEWER IS ASKING, HOW CAN
YOU AVOID THAT?
CAN WE SLOW THE DEVELOPMENT OR
PROGRESSION?
AND WHAT DO WE RECOMMEND FOR THE
TREATMENT OF THAT?
DR. RUANPENG: THE MOST EFFECTIVE
WAY TO PREVENT NEUROPATHY IS
DECREASING MICROVASCULAR
COMPLICATIONS.
YOUR EYES, YOUR KIDNEY, AND ALSO
THE NOSE, THE NUMBER ONE
PRIORITY IS TO GET THE A1C IN A
GOOD CONTROL.
IF IT IS NOT ENOUGH AND THE
PATIENT IS HAVING SYMPTOMS, WE
HAVE MEDICATION THAT COULD HELP
WITH THE PAIN.
>> ARE THERE PARTICULAR
MEDICATIONS YOU FOUND TO BE
HELPFUL TO TREAT DIABETIC NERVE
PAIN?
DR. HARDEN: THERE IS ONE OR TWO
THAT ARE AFFECTED TO TREAT
DIABETIC NEUROPATHY.
IN A TRIP TO LEAN -- THERE IS
ONE MEDICINE I FOUND TO BE QUITE
EFFECTIVE, BUT THE OTHER TWO ARE
THE MOST EFFECTIVE.
>> SO, LOTS OF GREAT QUESTIONS
TONIGHT.
ONE OF THEM, BECAUSE WE HAVE A
FANTASTIC FAMILY MEDICINE
PHYSICIAN AND TO ENDOCRINOLOGIST
HERE, DO I NEED TO SEE AN
ENDOCRINOLOGIST TO MANAGE MY
TYPE 2 DIABETES?
I THINK THIS IS A COMMON IDEA.
MY ANSWER TO THAT WOULD BE, NO.
BUT.
UNLESS.
SO MAYBE YOU COULD START BY
ANSWERING AT WHAT POINT YOU FEEL
SOMEONE WOULD NEED TO SEE AN
ENDOCRINOLOGIST, WHERE YOU WOULD
WANT THAT ASSISTANCE AND
CO-MANAGED CARE?
DR. HARDEN: THAT IS A GREAT
QUESTION.
THE PATIENT'S I HAVE WITH THE
FOLLOWING ENDOCRINOLOGIST IF IT
IS TYPE 1 DIABETES AND THEY ARE
ON INSULIN PUMP, INSULIN PUMPS I
DON'T TYPICALLY MANAGE.
THAT IS A PERSON I WOULD REFER
TO AN ENDOCRINOLOGIST.
SOMEONE WITH TYPE TWO DIABETES
THAT I WOULD REFER TO AN
ENDOCRINOLOGIST WOULD BE
SOMEBODY I HAVE IMPLEMENTED
MEDICAL THERAPY AND HAVE NOT
BEEN ABLE TO LOWER THEIR BLOOD
SUGARS, OR IF THEY ARE ON HIGH
DOSES OF INSULIN AFTER WE HAVE
EXHAUSTED ORAL MEDICATIONS TO
TREAT DIABETES, IF I PUT THEM ON
HIGH DOSES, I WOULD REFER THEM
TO ENDOCRINOLOGIST GOOD --
ENDOCRINOLOGIST.
>> WOULD YOU LIKE TO ADD TO
THAT?
ARE THERE SITUATIONS WHERE
ENDOCRINOLOGY AND ONE OR TWO
VISITS MIGHT BE HELPFUL?
>> WE ARE HAPPY TO SEE THOSE
PATIENTS WHO ARE VERY
COMPLICATED, WHO ARE DIFFICULT
TO CONTROL AND BRING THAT
HEMOGLOBIN A1C DOWN.
OR THOSE WHO NEED MORE
ASSISTANCE AND UNDERSTANDING ON
WHAT THE DISEASE PROCESS IS, AND
WE LIKE TO HAVE HIM JOIN US WITH
BASIC CARE, DIETITIANS.
WE HAVE THE TEAM AVAILABLE FOR
THAT.
>> I THINK SOMETIMES IT IS THAT
SUPPORT AND SPECIALTY CLINICS
THAT IS SOMETIMES DIFFICULT TO
PROVIDE IN OUTREACH CLINICS THAT
CAN PROVIDE A LOT OF HELP AT THE
BEGINNING.
>> I THINK WE ARE IN THE ERA OF
NEW TECHNOLOGY AND NEW
MEDICATION FOR DIABETES, AND
SOMETIMES PRIMARY CARE IS NOT
COMFORTABLE WITH THOSE
TECHNOLOGIES YET.
FOR EXAMPLE, MONITORING OR
MEDICATIONS WHICH WOULD BE
BENEFICIAL FOR ESPECIALLY TYPE 2
DIABETES OR UNCONTROLLED
DIABETES.
ONCE WE START THE MEDICATION OR
CONTINUE MONITORING AND THE
PATIENT IS COMFORTABLE, WE CAN
REFER THE PATIENT BACK TO
PRIMARY CARE.
>> THAT GETS BACK AT THIS WHOLE
IDEA OF A TEAM APPROACH TO
CO-MANAGED CARE.
IT IS USUALLY A COMBINATION OF
AN APPROACH.
A VERY ARE ODD AND LARGE --
BROAD AND LARGE QUESTION, BUT
ONE THAT HOVERS ALL PATIENTS WHO
HAVE DIABETES THAT WE SHOULD
APPROACH, WHAT IS THE
CORRELATION BETWEEN DIABETES AND
LIVER, HEART, AND KIDNEY DAMAGE?
I THINK ALL THAT HERE HAVE TAKEN
CARE OF PATIENTS WHO HAVE
DIABETES AND HAVE ULTIMATELY
DEVELOPED HEART, KIDNEY, AND
OTHER CONDITIONS.
DR. HARDEN: THE COMPLICATIONS OF
DIABETES ARE TYPICALLY IN
RETINOPATHY, AFFECTING THE EYES
AND VISION, NEUROPATHY, SO IT
CAN CAUSE PAIN IN THE
EXTREMITIES, BUT OTHER NERVE
DYSFUNCTION, AND KIDNEY PROBLEMS
BECAUSE IT AFFECTS THE SMALL
BLOOD VESSELS IN THE KIDNEYS,
WHICH CAN LEAD TO KIDNEY DISEASE
OR KIDNEY FAILURE, BUT THE WAY
DIABETES AFFECTS THE HEART IS
BECAUSE DIABETES ACCELERATES
WHAT IS REFERRED TO HISTORICALLY
AS HARDENING OF THE ARTERIES,
CAUSING A SIGNIFICANT INCREASE
FOR HEART DISEASE AND STROKE IN
PATIENTS WHO HAVE DIABETES.
>> AT ITS BASELINE, I REMIND MY
PATIENTS THAT DIABETES IS TRULY
A VASCULAR DISEASE.
IT IMPACTS THE BLOOD VESSELS,
BOTH LARGE AND SMALL, WHICH IS
WHY WE SEE THE EYE DISEASE,
KIDNEY DISEASE, AND START TO
DEVELOP HEART DISEASE.
ALL OF THOSE ARE REDUCED AS LONG
AS WE MAINTAIN GOOD CONTROL OF
OUR A1C.
WOULD YOU AGREE?
>> RIGHT, AND WE HAVE A
MEDICATION WITH A PROVEN
CARDIOVASCULAR BENEFIT IN
PATIENTS WITH TYPE TWO DIABETES,
IF THEY DON'T HAVE ANY
CONTRAINDICATION, IT WOULD BE
SOMETHING I WOULD ADD ON, THINGS
THAT HAVE PROVEN BENEFITS.
AN INHIBITOR TO REDUCE HEART
FAILURE AND PROTECTOR KIDNEYS
AND THINGS LIKE THAT.
>> CORRECT.
WE ARE GETTING NEW DATA THAT
SOME OF THESE ORAL MEDICATIONS
COULD HELP.
THEY COME WITH COMPLICATIONS,
BUT IT LOOKS LIKE THEY'RE
HELPING PREVENT SOME OF THOSE.
I'M SURE WE WILL BE GETTING
QUESTIONS ABOUT THOSE DIFFERENT
THINGS BECAUSE IT IS SUCH A
LARGE TOPIC THAT IT ALWAYS COMES
BACK TO KEEP HER DIABETES UNDER
CONTROL FINE EARLY SO WE CAN
START THERAPY AS QUICKLY AS
POSSIBLE.
IS THIS ONE REASON YOU PUT
PEOPLE IN MEDICATIONS IF THEY
ARE PREDIABETIC?
>> NOT SO MUCH PREDIABETIC
SPIRIT >> ONE QUESTION IS --
RE-DIABETICS -- PRE-DIABETICS.
>> THERE ARE SOME TRIALS THAT
HAVE PROVEDBASICALLY TREATING
PREDIABETES CAN SLOW DOWN THE
COMPLICATIONS WITH THE
PROGRESSION TO DEVELOPING TYPE 2
DIABETES.
WE DON'T DO IT IN REGULAR
PRACTICE, BUT IT IS SOMETHING WE
CAN CONSIDER IN SOME PATIENTS,
DEFINITELY.
>>
.
SO NOW A DIETARY -- EXCELLENT.
NOW A DIETARY QUESTION.
WITH THE KETO DIET BE BETTER
THAN CARB COUNTING IN TYPE 2?
>> THAT IS A COMPLICATED
QUESTION.
>> A KETO DIET IS RESTRICTIVE IN
CARBS.
I THINK THE LIMIT IS NO MORE
THAN 40 GRAMS OF CARBS PER MEAL.
-- PER DAY, ACTUALLY.
THAT IS WHY WE RECOMMEND IT IN
DIABETIC PATIENTS.
THE ISSUE COMES WHEN TYPE ONE
DIABETICS ARE RESTRICTING THE
CARBS SO MUCH THEY ARE AT RISK
OF DEVELOPING HYPOGLYCEMIA
BECAUSE THEY ARE ONLY EATING
LIMITED CARBS AND THEIR MEALS.
IT HAS RISKS AND BENEFITS.
>> THE AMERICAN DIABETES
ASSOCIATION DOESN'T HAVE ANY
RECOMMENDATION IN TERMS OF WHAT
KIND OF DIET YOU SHOULD FOLLOW.
IT IS VERY INDIVIDUALIZED.
WE KNOW THAT THE KETO DIET HAS
SOME BENEFIT, BUT WE DON'T KNOW
THE LONG-TERM EFFECT OF THAT.
I WOULD SAY WITH CAUTION, IF YOU
WANT TO.
>> DO YOU HAVE MANY PATIENTS,
KETO DIED IN YOUR PRACTICE WHO
HAVE DIABETES?
DR. HARDEN: THERE ARE A LOT WHO
ASKED ME ABOUT THE KETO DIET.
I DON'T RECOMMEND IT TO CONTROL
DIABETES.
IT IS EFFECTIVE AT WEIGHT LOSS,
BUT WHEN SOMEBODY GOES ON THE
DIET AND LOSES WEIGHT, THEY
SWITCH BACK TO THE REGULAR DIET
AND THE WEIGHT COMES RIGHT BACK.
I DON'T RECOMMEND IT FOR
DIABETES.
I THINK MOST PATIENTS WOULD
BENEFIT FROM SEEING A DIETITIAN
TO INDIVIDUALIZE THEIR DIET.
I DON'T RECOMMEND A SPECIFIC
DIET TO ALL OF MY PATIENTS WITH
DIABETES.
IT HAS TO BE INDIVIDUALIZED.
>> I THINK SEEING A DIETITIAN
CAN BE INCREDIBLY HELPFUL.
I DISCOVERED WHEN I'M TALKING TO
MY PATIENTS WITH KIDNEY DISEASE
WHO HAVE DIABETES AND I'M TRYING
TO EXPLAIN TO HIM FOODS THAT
COULD IMPACT THEIR BLOOD SUGARS,
I THINK THAT A LOT OF PEOPLE ARE
NOT AWARE OF HOW MANY DIFFERENT
PROCESSED FOODS CONTAIN EXCESS
SUGAR.
COMMON ONES THAT COME UP ARE
SPAGHETTI SAUCES, SOME OF THESE
OTHER THINGS WITH ADDED SUGARS.
EVEN SOME CANNED TOMATOES WILL
HAVE SUGARS ADDED.
SEEING A DIETITIAN WHO COULD
SORT THAT OUT WOULD BE VERY
HELPFUL.
WE HAVE TIME FOR ONE MORE BRIEF
QUESTION.
LET'S SEE WHAT WE HAVE HERE.
CAN MEDICATION INDUCED DIABETES,
AND IF SO, HOW.
-- HOW?
>> DEFINITELY.
IT CAN INDUCED DIABETES,
ESPECIALLY WHEN THE PATIENT IS
SICK FOR A LONG TIME.
WE SEE AUTOIMMUNE DISEASES IN
PATIENTS WHO HAVE TO BE ON
LONG-TERM STEROIDS.
YOU CAN SEE HOW GRADUALLY THE
GLUCOSE STARTS TO INCREASE IN
THE LONG TERM.
THEY END UP HAVING AN ELEVATED
HEMOGLOBIN A1C, FOR EXAMPLE.
>> DOES THAT GO AWAY IF THEY
STOP THE MEDICATION?
>> THE NUMBERS CAN IMPROVE, YES.
IT CAN EVENTUALLY CAN RESOLVE.
>> I THINK SOME OF THAT IS ALSO
DUE TO WEIGHT GAIN WE SEE WHEN
PEOPLE ARE ON LONG-TERM
STEROIDS.
THEY TENDED TO GAIN WEIGHT.
IF THEY LOSE THAT WEIGHT, THOSE
BLOOD SUGARS CAN IMPROVE AS
WELL, BUT THIS IS TRUE WITH
OTHER MEDICATIONS LIKE
TRANSPLANT MEDICATIONS.
POST KIDNEY TRANSPLANT
MEDICATIONS, SOME OF THE
MEDICATIONS THEY HAVE TO TAKE
ARE ASSOCIATED WITH TYPE TWO
DIABETES, SO SOMETHING TO WATCH
FOR, EVEN IF YOU HAVE HAD A
KIDNEY TRANSPLANT.
SOMEONE IS ASKING ABOUT A LINK
BETWEEN DIABETES AND CANCER.
ARE THERE ANY KNOWN ASSOCIATIONS
BETWEEN DIABETES AND CANCER?
>> THERE IS, ARE SOME STUDIES
THAT HAVE REPORTED INCREASED
RISK OF CANCER, SUCH AS BREAST
CANCER, FOR EXAMPLE.
THEY ARE LIMITED, BUT IT IS OUT
THERE THAT THERE IS INCREASED
RISK TO TWO DIFFERENT TYPES OF
CANCER.
>> WE HAVE COVERED A LOT OF
TOPICS TONIGHT.
I WOULD LIKE TO THANK OUR
PANELISTS, DR. RYAN HARDEN, DR.
MARY MOK, AND DR. DARIN
RUANPENG, AND OUR MEDICAL
STUDENT PHONE VOLUNTEERS, ANN
KLEINSCHMIDT, ABBY LINDSETH, AND
KYLIE MILLER.
PLEASE JOIN ME AGAIN NEXT WEEK
FOR A PROGRAM ON MEN'S HEALTH
AND KIDNEY STONES, WHEN MY
PANELISTS WILL BE DR. NICHOLAS
JOHNSON, DR. BENJAMIN MARSH, AND
DR. PAUL SANFORD.
THANK YOU FOR WATCHING.
HAVE A GREAT EVENING.
Dr. Heather Muster (Medical School Educator) hosts a conversation around Diabetes: Diagnosis, Complications & Treatment with Dr. Ryan Harden, Dr. Mary Mok and Dr. Darin Ruanpeng.