Latest / Pharmacy Podcast Network / Pregnancy and Diabetes: New Insights on Autoantibody Testing, OGTT, and Genetic Diagnosis with Dr. Tadeh Vartanian | MaternalRx

Transcript

Pregnancy and Diabetes: New Insights on Autoantibody Testing, OGTT, and Genetic Diagnosis with Dr. Tadeh Vartanian | MaternalRx · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
• 0:24
  Speaker 1: Welcome to the Maternal RX podcast on the Pharmacy Podcast Network.
• 0:28
  Speaker 1: I'm your host, Doctor Danielle Plumber, pharmacist and anti partum doula.
• 0:33
  Speaker 1: This series is to empower pharmacists to help turn around
• 0:36
  Speaker 1: the maternal morbidian mortality rates, which now constitute a public
• 0:40
  Speaker 1: health crisis. Pregnant women often fall into a whole in healthcare,
• 0:43
  Speaker 1: especially in antipartum care, and pharmacists are perfectly aligned to
• 0:47
  Speaker 1: fill this gap. We are the most accessible and trusted
• 0:50
  Speaker 1: healthcare providers. And today I am so excited to have
• 0:54
  Speaker 1: a guest on a topic that I have been waiting
• 0:56
  Speaker 1: for a very long time to discuss, that is off
• 1:00
  Speaker 1: and discussed among well every pregnant woman that exists and
• 1:04
  Speaker 1: they're obstetrician. But now we're bringing it to the beginning
• 1:07
  Speaker 1: of pregnancy and throughout the pregnancy and talking about the
• 1:10
  Speaker 1: various types that exist. What am I leading up to?
• 1:14
  Speaker 1: Diabetes and our special guest today is doctor Today Vartanian,
• 1:19
  Speaker 1: who serves as snofi's field medical expert for autoimmune diabetes.
• 1:24
  Speaker 1: Before joining Today, worked at various hospitals in southern California
• 1:29
  Speaker 1: as a clinical pharmacist, pharmacy supervisor, and later a pharmacy
• 1:34
  Speaker 1: manager at institutions such as CHLA and UCLA, among others.
• 1:40
  Speaker 1: Today saw the impact a delay and disease on set
• 1:43
  Speaker 1: could have on patient care and how that follows the
• 1:46
  Speaker 1: patient's journey in the healthcare setting. Today enjoys discussing all
• 1:50
  Speaker 1: things medical surrounding screening, clinical trials, new research guidelines, and
• 1:55
  Speaker 1: any other opportunity where medical understanding can make a difference
• 1:58
  Speaker 1: in patient's treatment before for diagnosis and Teddy, why this
• 2:02
  Speaker 1: is so exciting to me is because we often see
• 2:05
  Speaker 1: ads on TV or now your computer, social media, at
• 2:09
  Speaker 1: your pharmacy what medications are available, but very rarely do
• 2:13
  Speaker 1: I see clinical trials on these medications. And when we
• 2:17
  Speaker 1: talk about diabetes and pregnancy again, we have type one,
• 2:20
  Speaker 1: type two, just stational. You're going to talk about a
• 2:23
  Speaker 1: type I haven't heard of, and I'll lead that when
• 2:26
  Speaker 1: we get to it. What happens before pregnancy, during pregnancy,
• 2:30
  Speaker 1: following pregnancy, and how all of these different types of
• 2:33
  Speaker 1: diabetes can affect a pregnant patient and they're family who's
• 2:37
  Speaker 1: on that journey as well, So please share anything I
• 2:41
  Speaker 1: left out about the work you do and we'll get
• 2:43
  Speaker 1: started on this topic.
• 2:46
  Speaker 2: Yes, well absolutely, Danielle. First off, thank you for having
• 2:48
  Speaker 2: me on the on the show. You know, this is
• 2:51
  Speaker 2: something that all the everyone who's listening will probably maybe ask,
• 2:55
  Speaker 2: you know, what does this guy know about just the
• 2:57
  Speaker 2: gestational diabetes, let alone type one diabete, these type two
• 3:00
  Speaker 2: diabetes and off the list. You know. I think for me,
• 3:03
  Speaker 2: when I started my clinical pharmacy practice, that thought. Initially,
• 3:07
  Speaker 2: when we had the diabetes education right in school, it's
• 3:11
  Speaker 2: the medications is the disease, date is the condition, and
• 3:14
  Speaker 2: we kind of learn it. But I think diabetes almost
• 3:17
  Speaker 2: became in my clinical practice one of those most minute
• 3:20
  Speaker 2: to minute, hour by hour, day by day kind of
• 3:23
  Speaker 2: condition where it's all it became a numbers game. It
• 3:27
  Speaker 2: became a very much like detail oriented condition, you know,
• 3:33
  Speaker 2: not to say, obviously the other conditions aren't like really
• 3:36
  Speaker 2: meticulously look at, but I think diabetes is up there.
• 3:39
  Speaker 2: So I think it's really interesting that. You know, for
• 3:41
  Speaker 2: the past year I served again as the medical lead
• 3:44
  Speaker 2: for automune diabetes, really honing in on that condition and
• 3:48
  Speaker 2: kind of seeing the periphery within you know, the other
• 3:51
  Speaker 2: kinds of diabetes. You know, I think one of the
• 3:54
  Speaker 2: biggest lessons we can take probably at the end of
• 3:56
  Speaker 2: this is, you know, what is automune diabetes, what are
• 4:00
  Speaker 2: the other conditions for the different types of diabetes, and
• 4:03
  Speaker 2: really how to distinguish it because you know sneak peak
• 4:07
  Speaker 2: or you know passed forward. Even clinicians could sometimes get
• 4:12
  Speaker 2: that wrong. So love to dive.
• 4:14
  Speaker 1: In, especially because so many clinicians are not working with
• 4:19
  Speaker 1: this specialty specifically. But the patients are seeing all types
• 4:24
  Speaker 1: of clinicians. And that's the unique thing about pregnancy is
• 4:28
  Speaker 1: that it crosses so many different disease states. Yeah, obstetricians
• 4:32
  Speaker 1: are the main provider. These patients aren't seeing them if
• 4:35
  Speaker 1: it's a first pregnancy, off until ten weeks into the pregnancy.
• 4:39
  Speaker 1: We have maternal care deserts where there aren't obstetricians. You
• 4:43
  Speaker 1: may now be seeing a resurgence of midwiffery in the
• 4:46
  Speaker 1: United States. There's this huge need. But which type of
• 4:49
  Speaker 1: midwife you are depends on what state, what licensing there is.
• 4:53
  Speaker 1: You're going to see different initials after their name. Now
• 4:56
  Speaker 1: dulas are while they're not clinical are a support person
• 5:00
  Speaker 1: that are slowly being covered by insurances, often at labor
• 5:04
  Speaker 1: and delivery where it is much needed. But then there's
• 5:06
  Speaker 1: those rare people like myself that are saying, hey, we
• 5:09
  Speaker 1: have this first trimester that's been ignored that we could
• 5:12
  Speaker 1: potentially use to prevent things from escalating later in the pregnancy.
• 5:17
  Speaker 1: So I want to begin. You said, what is autoimmune diabetes?
• 5:21
  Speaker 1: What is autoimmune diabetes? What are we referring to here?
• 5:25
  Speaker 2: Yes, absolutely so. Diabetes, just as a blanket term, is
• 5:29
  Speaker 2: really any condition where there's basically a dysregulation of someone's
• 5:33
  Speaker 2: glucose levels blood sugar I e. Glucose. So many of
• 5:38
  Speaker 2: us have probably heard of type two diabetes. Everyone usually
• 5:42
  Speaker 2: if it said diabetes, colloquially, they often referred to as
• 5:46
  Speaker 2: type two diabetes just off the tip off the type
• 5:48
  Speaker 2: at and for good reason. They're about thirty eight million
• 5:51
  Speaker 2: type two diabetic patients in the United States and that
• 5:56
  Speaker 2: number keeps on rising. And then that's also not including
• 5:58
  Speaker 2: the pre diabetic individuals. So type two diabetes is what's
• 6:02
  Speaker 2: what's mostly defined as insulin resistance. The bodies, muscles, the liver,
• 6:09
  Speaker 2: the various organs that are that kind of serve as
• 6:11
  Speaker 2: glucose sinks and to have that response to insulin. Their
• 6:17
  Speaker 2: their insulin response is weaker. So in type two diabetes,
• 6:21
  Speaker 2: it's really a long term, oftentimes slowly progressing condition where
• 6:26
  Speaker 2: there's a strong level of insulin resistance and hence the
• 6:29
  Speaker 2: body is able to produce insulin. You know, the function
• 6:32
  Speaker 2: is still there, but the way that the insulin works
• 6:35
  Speaker 2: on those organs is you know, altered in some way,
• 6:38
  Speaker 2: shape or form. Now to answer your question, obviously with
• 6:42
  Speaker 2: type two diabetes, the question is, well, what happened to
• 6:45
  Speaker 2: type one? So type one diabetes is the one that's
• 6:48
  Speaker 2: termed as autoimmune diabetes. So that T one D as
• 6:53
  Speaker 2: well as called affects about two million people in the
• 6:56
  Speaker 2: whole US. It's about five percent ise or so of
• 6:59
  Speaker 2: the old diabetic population by five percent r T one D.
• 7:03
  Speaker 2: And that's what's called autoimmune diabetes. Where the patient's own
• 7:09
  Speaker 2: autoimmune immune system, right, the immune system that's used to
• 7:13
  Speaker 2: fight off infections back to viral and so forth, goes
• 7:18
  Speaker 2: against one's own body. So if that autoimmune process attacks
• 7:22
  Speaker 2: a thyroid, that can be autoimmune diroiditis, which also actually
• 7:27
  Speaker 2: is increase in rate during pregnancy if it attacts the
• 7:32
  Speaker 2: adrenal glands. It's called Addison's disease. The skin it's called vitiligo.
• 7:36
  Speaker 2: So in diabetes and type one diabetes, the attack or
• 7:40
  Speaker 2: the target is the beta cells within the prancrease. Beyond that,
• 7:44
  Speaker 2: there's also a whole host of other diabetes cases as well,
• 7:48
  Speaker 2: monogenetic diabetes. It's about one percent of the population of
• 7:52
  Speaker 2: all diabetes cases, and that actually is an area of
• 7:55
  Speaker 2: researching research right to differentiate and to see what's going
• 7:59
  Speaker 2: on for there and a whole host. But yeah, that's
• 8:03
  Speaker 2: a that's t one dy in a nutshell.
• 8:05
  Speaker 1: And now when we talk about pregnancy, gestational diabetes is
• 8:11
  Speaker 1: something that's a big concern. And what I had learned
• 8:14
  Speaker 1: because I worked with so many patients with hyperemises gravi jerreum,
• 8:17
  Speaker 1: so they're not eating anything yet they're still susceptible to
• 8:21
  Speaker 1: gestational diabetes, which sent me down a deep dive going
• 8:25
  Speaker 1: what is causing this and learned it's hormones being secreted
• 8:29
  Speaker 1: from the placenta that's changing this. But before we talk
• 8:33
  Speaker 1: about that, I want to circle back to some of
• 8:34
  Speaker 1: the things you just said. So type one diabetes when
• 8:38
  Speaker 1: I was a little girl. I had a friend who
• 8:39
  Speaker 1: had type one diabetes. We were both very young elementary school,
• 8:43
  Speaker 1: and I remember her having to give herself insulin shots
• 8:46
  Speaker 1: and my mind was blown because the thought of me
• 8:49
  Speaker 1: at the time looking at a needle was a nightmare.
• 8:52
  Speaker 1: And there she was just always, you know, as a
• 8:54
  Speaker 1: young child. And we're still friends decades later, and she's
• 8:57
  Speaker 1: doing very well in life, so you know, so this
• 9:00
  Speaker 1: is type one. I feel just you know, for anyone
• 9:04
  Speaker 1: who has to deal with this, it's a way of life, right,
• 9:06
  Speaker 1: and it is their life. And when I know parents
• 9:08
  Speaker 1: who have children with type one diabetes, their world changes.
• 9:12
  Speaker 1: As a parent, you're always concerned for your child, but
• 9:15
  Speaker 1: with the right care and management and tools, this is
• 9:18
  Speaker 1: something that you can have a wonderful, healthy life with
• 9:22
  Speaker 1: Type two, as you mentioned, is lifestyle potentially, right, it
• 9:27
  Speaker 1: happens later in life, and often we're seeing it now
• 9:31
  Speaker 1: more type two and younger children. Unfortunately, and when we
• 9:35
  Speaker 1: think about women of child bearing age who want to
• 9:37
  Speaker 1: become pregnant, that dysregulation can also affect the ability to
• 9:42
  Speaker 1: become pregnant. And I've seen women where they have type
• 9:46
  Speaker 1: two prior they want to have children. They get their
• 9:50
  Speaker 1: way under control, make healthier food choices, lifestyle choices, the
• 9:55
  Speaker 1: idea of carrying another life into this earth that has
• 10:00
  Speaker 1: made them change their own habits to be healthier. And
• 10:04
  Speaker 1: it's nice to see that when that happens, and then
• 10:07
  Speaker 1: to see those habits continue as well. When I was
• 10:10
  Speaker 1: growing up, we were told this is aging myself. But
• 10:13
  Speaker 1: we were told like two to four, four to six
• 10:17
  Speaker 1: times a day, three meals and three snacks and every
• 10:20
  Speaker 1: two to four hours. And what we've seen now since
• 10:23
  Speaker 1: the nineteen eighties is this has done so much damage
• 10:27
  Speaker 1: because we're constantly taking in glucose. Our body is constantly
• 10:31
  Speaker 1: trying to produce insulin to break down the glucose, get
• 10:35
  Speaker 1: it into the cells to work. And it's led to
• 10:37
  Speaker 1: this what you talked about insulin resistance. So we have
• 10:40
  Speaker 1: type one, we have type two. What is monogenic diabetes?
• 10:44
  Speaker 1: Because that's a phrase I have not heard before.
• 10:47
  Speaker 2: Yes, so, and this is all you mentioned something interesting, Daniel,
• 10:51
  Speaker 2: with regards to the individual who's pregnant, right, a pregnant individual. Now,
• 10:56
  Speaker 2: there's a wide window for which women get pregnant. I'm
• 11:00
  Speaker 2: sure I can always look up like what's the youngest
• 11:02
  Speaker 2: pregnancy and what's the oldest pregnancy, and I'm sure that's
• 11:04
  Speaker 2: going to be a wide window. But let's picture the
• 11:07
  Speaker 2: very typical, you know, ninety five percent bell curve of
• 11:11
  Speaker 2: an individual getting pregnant. The interesting thing about that is
• 11:15
  Speaker 2: they're kind of in a situation where if they develop diabetes, right,
• 11:19
  Speaker 2: it's really important for the clinician to distinguish what type
• 11:23
  Speaker 2: it is. Is it gestational diabetes, is it type one?
• 11:26
  Speaker 2: Type two? And to add to a touch upon what
• 11:29
  Speaker 2: you've just asked, monogenic diabetes. So monogenic diabetes, as the
• 11:34
  Speaker 2: name is kind of hinted, and there is diabetes that
• 11:37
  Speaker 2: is a result of a single gene mutation. Now it's
• 11:41
  Speaker 2: actually a consortium of about fifteen to twenty different types
• 11:46
  Speaker 2: of monogenic conditions that all in all from an umbrella
• 11:50
  Speaker 2: term is called it's called monogenic diabetes. Again, it's about
• 11:53
  Speaker 2: one to two percent of the entire diabetes category. But
• 11:57
  Speaker 2: one important thing I learned in getting you know, really
• 12:00
  Speaker 2: focused in diabetes care is when something is about one
• 12:04
  Speaker 2: or two percent of cases, it's really hard to diagnose
• 12:07
  Speaker 2: and it's really easy to miss. Right. So there are
• 12:11
  Speaker 2: a lot of monogenic diabetes patients who were initially labeled
• 12:14
  Speaker 2: as type two diabetes and then maybe they the clinician
• 12:19
  Speaker 2: may have thought, oh, well, maybe it's transient, and until
• 12:21
  Speaker 2: they get to like a really specialist, are they able
• 12:24
  Speaker 2: to do let's say, the genetic tests to see, okay,
• 12:27
  Speaker 2: is there an allele, what is the genetic profile, and
• 12:30
  Speaker 2: to basically screen for about a dozen plus different genes,
• 12:35
  Speaker 2: and if one hits as positive, it's considered monogenic. And
• 12:39
  Speaker 2: depending on what monogenetic diabetes type they have, the treatment
• 12:44
  Speaker 2: is fairly straightforward. Most of them are actually treated with insulin.
• 12:49
  Speaker 2: There's actually a certain type of monogenetic diabetes that's only
• 12:52
  Speaker 2: treated and responds really well with sulfonal ureas for example.
• 12:57
  Speaker 2: So the kind of takeaway from there is if there's
• 13:00
  Speaker 2: some case of diabetes that's just odd not responding well,
• 13:05
  Speaker 2: it doesn't paint that right picture, it doesn't respond to
• 13:08
  Speaker 2: a whole lot of therapies, it might be worth it
• 13:11
  Speaker 2: to get it screened. And that's really again a genetic
• 13:14
  Speaker 2: test that will be determined, And there's also a calculator
• 13:18
  Speaker 2: online that one can use and type in certain criteria
• 13:22
  Speaker 2: to kind of paint the clinical picture. Is it more
• 13:25
  Speaker 2: monogenic or not. Anyone who searches monogenetic diabetes calculator can
• 13:30
  Speaker 2: probably find it.
• 13:32
  Speaker 1: I have heard people, and I want to say the
• 13:33
  Speaker 1: past ten years or so talk about what they're calling
• 13:36
  Speaker 1: a type one and a half where they're adults, but
• 13:40
  Speaker 1: they're getting the autoimmune type. And I'm wondering if maybe
• 13:44
  Speaker 1: it is the monogenic that was just difficult to diagnose.
• 13:47
  Speaker 1: So interesting to see where that will lead and love
• 13:51
  Speaker 1: where you talk about. Let's talk about clinical studies and
• 13:54
  Speaker 1: what are you seeing now what's being studied for patients
• 13:56
  Speaker 1: with diabetes.
• 13:58
  Speaker 2: Yeah, absolutely, type two diabetes has really had its time
• 14:02
  Speaker 2: under the sun. Right There are a whole host of
• 14:05
  Speaker 2: other of different pharmacological agents that have come out, right,
• 14:08
  Speaker 2: the you know, the thaolidine dials, the SGLT two inhibitors,
• 14:14
  Speaker 2: and you go down the list of different types of
• 14:16
  Speaker 2: you know, products that are out there and different choices
• 14:18
  Speaker 2: that are out there. And the reason is because you're
• 14:21
  Speaker 2: going to remember, type two diabetes is a very insulin
• 14:23
  Speaker 2: resistance type of diabetes. And again it's a very large population,
• 14:28
  Speaker 2: so there's different ways to treat it. Now. Interestingly, type
• 14:32
  Speaker 2: one diabetes, as you kind of mentioned earlier, Danielle, or
• 14:35
  Speaker 2: you know, growing up, you had a friend you know
• 14:38
  Speaker 2: in the childhood years who had type one and they
• 14:40
  Speaker 2: were injecting in themselves with insulin.
• 14:42
  Speaker 1: Right.
• 14:43
  Speaker 2: What's interesting with type one diabetes is that historically it
• 14:48
  Speaker 2: was called originally it was called juvenile diabetes because it
• 14:51
  Speaker 2: was thought that only autoimmune type one diabetes can only
• 14:54
  Speaker 2: happen in children in kids, and it didn't happen in adults. Well,
• 14:58
  Speaker 2: the reason why that whole theory kind of came about
• 15:00
  Speaker 2: was because really many many of the tests that were
• 15:04
  Speaker 2: used to determine diabetes just in general was right. The
• 15:07
  Speaker 2: hemoglobin A one ce, fasting glucose I mean, if you
• 15:10
  Speaker 2: turn the clock more back, you're in Glucose tests were
• 15:14
  Speaker 2: the only options, and there was no what are called
• 15:16
  Speaker 2: auto antibody tests that were really available in clinical practice.
• 15:20
  Speaker 2: So what ended up happening was a lot of adults
• 15:23
  Speaker 2: actually were developed type one diabetes even back then. But
• 15:27
  Speaker 2: because adults who developed T and D tend to have
• 15:31
  Speaker 2: a slower progression of the diabetes condition as opposed to
• 15:36
  Speaker 2: children who get T and D and the disease progresses
• 15:38
  Speaker 2: really fast, adults are a little slower onset. Adults tend
• 15:43
  Speaker 2: to also have a little bit more waxing and waning
• 15:46
  Speaker 2: of their auto immune condition, and that's true really for
• 15:49
  Speaker 2: all kinds of auto mune conditions. If you look at
• 15:51
  Speaker 2: lupus in children and adults, if you look at celiac
• 15:55
  Speaker 2: in children and adults, it's a very different picture. The
• 15:59
  Speaker 2: children oftentimes progress much much quicker and in a fairly
• 16:03
  Speaker 2: straight linear format. Adults progress a lot slower, and they
• 16:06
  Speaker 2: may go, you know, relapsing, remitting, non relapsing, and so forth.
• 16:11
  Speaker 2: So that's kind of for the adult picture. So juvenile
• 16:14
  Speaker 2: diabetes is kind of no longer used because now we
• 16:16
  Speaker 2: found out a lot of adults have type one diabetes.
• 16:20
  Speaker 2: And so for that gestational patient, it's going to be
• 16:23
  Speaker 2: an interesting case because I mean, there's a portion of
• 16:28
  Speaker 2: pregnant individuals who are seeking medical care, maybe for the
• 16:31
  Speaker 2: first time of their lives. So there could be this
• 16:33
  Speaker 2: thought that they were already diabetic at for several years,
• 16:36
  Speaker 2: but they're just now seeking medical care. So that's like
• 16:39
  Speaker 2: one scenario. The second is, obviously it could be just
• 16:43
  Speaker 2: stational diabetes. But again they're right now at that prime
• 16:46
  Speaker 2: age of the teen years, in their twenties, in their
• 16:50
  Speaker 2: thirties where that automune diabetes can really start and kick
• 16:54
  Speaker 2: off and with pregnancy being a sort of pro immune
• 16:59
  Speaker 2: kind of state, if you will, Right, the mother's immune
• 17:03
  Speaker 2: system is adjusting quite in a much different way than
• 17:06
  Speaker 2: obviously pre and postpregnancy, and it's not just weight gain,
• 17:10
  Speaker 2: it's a complete immune shift in that individual. Then that
• 17:13
  Speaker 2: could be the opportunity or the setting, if you will,
• 17:17
  Speaker 2: where we really need to look at autoimmune conditions. And
• 17:20
  Speaker 2: so my recommendation for all pregnant individuals who may have
• 17:25
  Speaker 2: to experience or come across a diabetes case is like,
• 17:28
  Speaker 2: you know, let's always also consider or bring at least
• 17:31
  Speaker 2: bring up the conversation of T one D and the
• 17:34
  Speaker 2: beauty is that you know we can screen for it.
• 17:36
  Speaker 1: Now we're really changing the script on how we talk
• 17:39
  Speaker 1: about diabetes and pregnancy. I've never heard anyone say, let's
• 17:44
  Speaker 1: screen for type one in this age range, in this
• 17:47
  Speaker 1: patient population. So thank you so much for bringing that
• 17:49
  Speaker 1: to like, type one diabetes screening, what would that entail?
• 17:53
  Speaker 1: Is it the same as type two? We know, justational
• 17:56
  Speaker 1: screening is different. So what would you share with that?
• 18:00
  Speaker 2: Yes, absolutely so, patient who has type two diabetes because again,
• 18:05
  Speaker 2: as we discuss, this is a fairly slower progressing diabetes
• 18:09
  Speaker 2: case relatively speaking, so for the most part, checking someone's
• 18:13
  Speaker 2: hemoglobe and AEC on an annual basis. If they're high risk,
• 18:17
  Speaker 2: we can go like every six months. In other words,
• 18:21
  Speaker 2: glycemic measures are what's used to one diagnosis diabetes, but
• 18:25
  Speaker 2: also to to monitor it and to catch What that
• 18:28
  Speaker 2: means is if someone's ae C is normal, fasting is normal,
• 18:31
  Speaker 2: everything looks great on the glycemic end, that's a fairly
• 18:36
  Speaker 2: good enough marker for monitoring those individuals clinically in the
• 18:41
  Speaker 2: in the in the real world right with to see
• 18:43
  Speaker 2: if they are at risk or are they or do
• 18:45
  Speaker 2: they have type two diabetes? Now with type one diabetes,
• 18:49
  Speaker 2: because it's a faster progressing uh oftentimes condition, especially in children,
• 18:57
  Speaker 2: historically the same measures were always used a one C
• 19:00
  Speaker 2: fasting and you know, maybe some individuals, if they had
• 19:03
  Speaker 2: a first degree relative with type one, maybe the clinician
• 19:06
  Speaker 2: would just measure a monitor a little more frequently. But
• 19:09
  Speaker 2: the interesting thing with what are called screening measures is
• 19:13
  Speaker 2: there's actually not that new. It's been around for a
• 19:16
  Speaker 2: quite a while in the research setting, and it's really
• 19:19
  Speaker 2: getting traction in the clinical setting. Is measuring for auto antibodies. Now,
• 19:24
  Speaker 2: what auto antibodies are is when type one diabetes occurs
• 19:28
  Speaker 2: and there's that autoimmune reaction, the body is attacking its
• 19:31
  Speaker 2: own pancreatic beta cells, right, they're the ones being killed off. Well,
• 19:35
  Speaker 2: just like how the body kills off a staff aureus
• 19:38
  Speaker 2: infection and forms antibodies towards a staff aureous infection, you know,
• 19:43
  Speaker 2: as a way of a memory immunity, When the body
• 19:47
  Speaker 2: attacks the pancreatic beta cells, it forms antibodies to the
• 19:51
  Speaker 2: beta cell antigens as a form of memory. Right, It's
• 19:54
  Speaker 2: just how the body's immune process works. And so when
• 19:57
  Speaker 2: those autoantibodies are formed, what we can actually detect those
• 20:03
  Speaker 2: blood tests up to ten years before actually the T
• 20:06
  Speaker 2: one D condition manifests itself because that automing process is started.
• 20:12
  Speaker 2: It's being attacked and those antibodies are forming, and the
• 20:16
  Speaker 2: patient really develops type one diabetes when about seventy or
• 20:20
  Speaker 2: eighty percent of the pancreatic beta cells are already killed off.
• 20:23
  Speaker 2: That's when the patient actually feels something. But five percent
• 20:27
  Speaker 2: gets killed off, ten percent, twenty percent those antibodies are there,
• 20:30
  Speaker 2: the patient still feels fine. So that gives us a
• 20:33
  Speaker 2: really many years of a window of opportunity to test
• 20:36
  Speaker 2: for these there are five auto antibodies to test for.
• 20:40
  Speaker 2: It's all ordered in a panel to really catch those
• 20:43
  Speaker 2: patients early.
• 20:45
  Speaker 1: And would patients go to an endocrinologist for this or
• 20:48
  Speaker 1: how would they even know to go about to get
• 20:50
  Speaker 1: the screening done?
• 20:52
  Speaker 2: Right, So, this type of screening can actually be ordered
• 20:55
  Speaker 2: by any clinician. Primary willbe gude. Any clinician can order it.
• 21:00
  Speaker 2: You know, health plans or health system won't have a
• 21:03
  Speaker 2: restriction to only endochronology to order the test, but it
• 21:08
  Speaker 2: is a test that the patients would have to, you know,
• 21:11
  Speaker 2: ask up and request. A lot of individuals who may
• 21:14
  Speaker 2: have a first degree relative a type one diabetes can
• 21:17
  Speaker 2: on often do do this because you know they have
• 21:20
  Speaker 2: they know that they have a risk genetic risk to
• 21:22
  Speaker 2: develop T and D themselves. But even those who don't
• 21:26
  Speaker 2: have a genetic risk to develop T and D and
• 21:29
  Speaker 2: don't have a first to gree relative, the chance is
• 21:31
  Speaker 2: still there. And so if if the patient speaks up
• 21:35
  Speaker 2: and ask for that test, you know they can do it.
• 21:37
  Speaker 2: And there are multiple ways to get the test done.
• 21:40
  Speaker 2: What I refer to is you know commercial labs so
• 21:44
  Speaker 2: prime the physician, their primary the ob guide and then
• 21:47
  Speaker 2: they order a test through a commercial lab, but there
• 21:51
  Speaker 2: are also various organizations and ways to get tested that
• 21:55
  Speaker 2: can definitely go over as well, and some can even
• 21:58
  Speaker 2: send kits to your home as well to do that.
• 22:01
  Speaker 1: Yes, that's a dream for most pregnant women. Anything that
• 22:03
  Speaker 1: can be done in the home, if you don't have
• 22:05
  Speaker 1: to take time off from taking care of other children
• 22:07
  Speaker 1: or take off from work, or if you're not feeling well,
• 22:10
  Speaker 1: especially early in pregnancy, which is where you would want
• 22:13
  Speaker 1: to identify this to be done at home. Yes, please
• 22:15
  Speaker 1: go ahead and tell us about these tests.
• 22:18
  Speaker 2: Yeah. So first, if you have a first degree relative
• 22:22
  Speaker 2: who has type one diabetes as well as up to
• 22:26
  Speaker 2: a second degree relative and I believe the age cut
• 22:28
  Speaker 2: off is twenty, there's an organization called trial NEET. So
• 22:32
  Speaker 2: Trial neet is a nonprofit organization that's a consortium and
• 22:37
  Speaker 2: developed by the NIDDK, which is under the National Institutes
• 22:43
  Speaker 2: of Health Organization bottom line is a consortium of various hospitals,
• 22:48
  Speaker 2: health systems and academic centers that do specifically Type one
• 22:53
  Speaker 2: diabetes research. So individual can actually go on the trial
• 22:57
  Speaker 2: net site, they can you know, put in all their
• 23:00
  Speaker 2: information and get an at home test kit sent to them. Again,
• 23:04
  Speaker 2: that's for individuals who have a first degree relative. They
• 23:08
  Speaker 2: do a fingerpoke stick, put blood and a dried blood
• 23:11
  Speaker 2: spot or a DBS you know those kind of cardboard
• 23:14
  Speaker 2: like placards, mail it out and get the results. The
• 23:18
  Speaker 2: other way is through the Autoimmunity Study for Kids, the
• 23:22
  Speaker 2: ASK program, and it was called ASK K for kids
• 23:26
  Speaker 2: because initially it started off for children and it has
• 23:29
  Speaker 2: since expanded into adults as well too, so adults can
• 23:32
  Speaker 2: get auto antibody screening for kids and for adults as well.
• 23:36
  Speaker 2: That is also done through the University of Colorado, but
• 23:40
  Speaker 2: they can send out these test samples throughout anywhere in
• 23:43
  Speaker 2: the United States. Again, the kit is mailed to the individual,
• 23:46
  Speaker 2: blood spot, put in the card, send it out and
• 23:49
  Speaker 2: get the results. And that one is unique because the
• 23:53
  Speaker 2: first degree relative is not a requirement a piece to
• 23:56
  Speaker 2: get that, so anyone in the general population could just
• 24:00
  Speaker 2: and do it. So yeah, there's ways to do it.
• 24:03
  Speaker 1: So let's turn out a gestational diabetes. This is to
• 24:06
  Speaker 1: me the me of the topic because prednant women get
• 24:09
  Speaker 1: poked and prodded and put through so much, and here
• 24:12
  Speaker 1: they get to this time and their pregnancy about halfway
• 24:15
  Speaker 1: through and they're told you have to drink huge amount
• 24:18
  Speaker 1: of sugar. There are some alternatives, but there's not agreement
• 24:22
  Speaker 1: on those alternatives from ACOG and the overseeing agencies. It
• 24:27
  Speaker 1: is well known how important it is to identify pregnant
• 24:31
  Speaker 1: patients with gestational diabetes and what can happen through the
• 24:35
  Speaker 1: pregnancy and they're soon to be child if they're not
• 24:39
  Speaker 1: diagnosed and treated from this moment in time. But I
• 24:43
  Speaker 1: would love to hear what are your expert insights on
• 24:45
  Speaker 1: the gestational diabetes testing.
• 24:48
  Speaker 2: Well, you've referenced a couple pieces on that, Danielle. First
• 24:52
  Speaker 2: is just the difficulty of taking these ogtts or glucose
• 24:56
  Speaker 2: tolerance tests. Again, they're a test that's to be done
• 25:01
  Speaker 2: during pregnancy. But again because during pregnancy to consume a
• 25:07
  Speaker 2: large glucose load and you know, wait for a period
• 25:10
  Speaker 2: of time while the measurements are done. On the glucose
• 25:13
  Speaker 2: end of things, you know a lot of individuals and
• 25:16
  Speaker 2: patients one are either are not able to do it
• 25:19
  Speaker 2: just physiologically. Second, they just say, you know, I don't
• 25:24
  Speaker 2: have time because hey, I have a have two other kids,
• 25:27
  Speaker 2: I'm on my third pregnancy. I don't have time. The
• 25:30
  Speaker 2: other piece obviously is that, you know, just from the
• 25:32
  Speaker 2: convenience aspect, it's a big ask for patients. And then
• 25:35
  Speaker 2: kind of the fourth piece as well, it's a big
• 25:38
  Speaker 2: piece for the clinics as well too. Many of obi
• 25:41
  Speaker 2: Guian clinics naturally will have a certain number of chairs,
• 25:44
  Speaker 2: certain you know, scheduling structure that's needed. So to kind
• 25:48
  Speaker 2: of book a several hours piece for a patient, you
• 25:52
  Speaker 2: know that that does require some scheduling and coordination too
• 25:55
  Speaker 2: on their end. The other piece you mentioned is different
• 25:58
  Speaker 2: societies have differ from recommendations. So like a COG the
• 26:02
  Speaker 2: American Diabetes Association US Preventative Services Task for all these
• 26:07
  Speaker 2: organizations discuss and talk about the you know, the need
• 26:11
  Speaker 2: for gestational diabetes diagnosis testing, but they all may have
• 26:15
  Speaker 2: different recommendations. Some say, you know, do the one step
• 26:19
  Speaker 2: seventy five gram load, others say do a two step.
• 26:24
  Speaker 2: There may be also some pieces in betweens as well.
• 26:26
  Speaker 2: But bottom line is there's some differences in the recommendations
• 26:29
  Speaker 2: and there's no consensus among the organizations on the best
• 26:33
  Speaker 2: single test because they always have to balance being able
• 26:36
  Speaker 2: to be clinically you know, valid, while also balancing patient convenience.
• 26:42
  Speaker 2: Piece as well. I would say one thing is many
• 26:45
  Speaker 2: patients ask why do we have to actually do this right?
• 26:48
  Speaker 2: The A one C is measured. You know, I go
• 26:50
  Speaker 2: in from my annual check. You know, why is this
• 26:53
  Speaker 2: have to be the way to be measured? And the
• 26:56
  Speaker 2: short answer is the oral glucose tolerance test technically speaking,
• 27:00
  Speaker 2: is the gold standard for all cases for diabetes diagnosis.
• 27:04
  Speaker 2: So per the ADA guidelines, diabetes can be diagnosed in
• 27:08
  Speaker 2: a few different ways, whether it's a hemoglobe and A
• 27:11
  Speaker 2: one C, a fasting glucose, or the OGTT or oral
• 27:16
  Speaker 2: glucose tolerance test, and specifically the glucose level at the
• 27:20
  Speaker 2: one hundred and twenty minute mark or the two hour mark,
• 27:23
  Speaker 2: and so technically, with regards to how well it's correlated,
• 27:27
  Speaker 2: the OGTT technically is the best gold standard. And the
• 27:31
  Speaker 2: way that the A one C and fasting glucose can
• 27:34
  Speaker 2: be kind of used or gone away with is because
• 27:37
  Speaker 2: if someone's doing it every year, even though there are
• 27:40
  Speaker 2: some inaccuracies and maybe some issues, and you know, is
• 27:43
  Speaker 2: the patient really fasting and is the last three months
• 27:46
  Speaker 2: really indicative of a patient through their A one C
• 27:49
  Speaker 2: bottom lizes because they're getting their glucose checked every year,
• 27:53
  Speaker 2: those kind of imperfections sort of level out, if you will.
• 27:57
  Speaker 2: But since the OGTT is the one time, are the
• 28:00
  Speaker 2: one hit that we can get to catch that gestational diabetes,
• 28:04
  Speaker 2: you know, they go with the ogtts the recommendation.
• 28:07
  Speaker 1: That actually explains a lot why that's used in guidelines
• 28:10
  Speaker 1: for every pregnant patient. It is the gold standard. We
• 28:13
  Speaker 1: talked about how much is the glucose load in that
• 28:17
  Speaker 1: can of what looks like orange soda right which we're
• 28:19
  Speaker 1: told a pregnancy as pregnant patients don't drink soda or
• 28:24
  Speaker 1: minimize how much like maybe one a day, and then
• 28:26
  Speaker 1: here's like here, drink this massive loads glucola comes as
• 28:30
  Speaker 1: either fifty grams well you mentioned the seventy five or
• 28:33
  Speaker 1: one hundred grams of glucose, depending if it's the one
• 28:36
  Speaker 1: hour test or the three hour test. And what's important
• 28:41
  Speaker 1: is that you do get tested. Ideally, when you find
• 28:45
  Speaker 1: out you're pregnant, get a ditby screening test done right away,
• 28:50
  Speaker 1: so we can then if somebody is at risk or
• 28:54
  Speaker 1: does have undiagnosed type two or as you mentioned, this
• 28:58
  Speaker 1: type in between, right, we can identify those patients early
• 29:01
  Speaker 1: on and then when they're halfway through the pregnancy, we
• 29:04
  Speaker 1: can go ahead and find their risk and if they
• 29:07
  Speaker 1: do come back positive or borderline, which happens to many women,
• 29:12
  Speaker 1: we can get that patient under specific care to their
• 29:17
  Speaker 1: needs and make sure that the best outcomes are in
• 29:20
  Speaker 1: line for them in that pregnancy. If it goes undiagnosed
• 29:24
  Speaker 1: to the outcomes, they can just be very scary for
• 29:26
  Speaker 1: both mommy and baby.
• 29:28
  Speaker 2: Yeah. Absolutely, absolutely, the earlier the better. But naturally, to
• 29:33
  Speaker 2: throw something at you, Daniel, and maybe ask you a
• 29:35
  Speaker 2: question as well, is my understanding is first trimester is
• 29:39
  Speaker 2: oftentimes the most when patients may experience nausea and emetic symptoms.
• 29:46
  Speaker 2: What are your thoughts on that in that setting? You know?
• 29:50
  Speaker 1: Did you know you're touching my heartstrings here right, Having
• 29:54
  Speaker 1: had three pregnancies where I suffered from severe nausea and
• 29:58
  Speaker 1: vomiting known as hyperremsys gravity, I mean for me, when
• 30:01
  Speaker 1: they told me I had to drink this glucola like,
• 30:03
  Speaker 1: there was no way I was keeping that down. It
• 30:06
  Speaker 1: was it was just pure torture. That first trimester guidelines
• 30:10
  Speaker 1: were created many many, many decades ago, where ideally there's
• 30:15
  Speaker 1: not much you can do in the first trimester. Now
• 30:17
  Speaker 1: we know better, and ACOV did just recently update their
• 30:20
  Speaker 1: guidelines to say it's not one size fits all when
• 30:24
  Speaker 1: you should see an obstetrician from the time you become
• 30:26
  Speaker 1: pregnant to the time you deliver and post op care
• 30:29
  Speaker 1: which is pretty much non existent in the United States.
• 30:32
  Speaker 1: So now we're looking at this first trimester. And what
• 30:35
  Speaker 1: I learned what I mentioned earlier, was that if I
• 30:38
  Speaker 1: am vomiting everything, I'm not keeping any food down, how
• 30:42
  Speaker 1: could I be borderlined gestational diabetes? And that happened actually
• 30:46
  Speaker 1: to me and my third pregnancy did not need insulin, fortunately,
• 30:49
  Speaker 1: but it sent me down this like rabbit hole of information.
• 30:54
  Speaker 1: I see now many women posting in support groups online
• 30:58
  Speaker 1: asking the same question. I'm not eating anything, I can't
• 31:01
  Speaker 1: keep any food, any nutrients, I'm malnourished. Yet I'm told
• 31:07
  Speaker 1: I'm borderlined or I have just stational diabetes. How is
• 31:10
  Speaker 1: that possible? And from what I found, it's hormones that
• 31:13
  Speaker 1: are being secreted from the placenta. Even knowing that it's
• 31:18
  Speaker 1: not a matter of changing your diet per se, but
• 31:21
  Speaker 1: getting under the right care and if you need treatment
• 31:24
  Speaker 1: at that point or monitor more frequently as you had
• 31:28
  Speaker 1: mentioned starting earlier in the pregnancy. By the time you
• 31:31
  Speaker 1: hit that twenty week then you should be in good shape.
• 31:33
  Speaker 1: Better shape if we use the rights IV therapies, nutrition
• 31:39
  Speaker 1: antimetics as you mentioned, other supportive care therapies. Maybe we
• 31:44
  Speaker 1: can use nutrients in a way and lifestyle to help
• 31:49
  Speaker 1: prevent this from escalating. But knowing it is from the placenta,
• 31:53
  Speaker 1: those patients where the other modifications are not going to
• 31:55
  Speaker 1: make a difference, they need insulin. The sooner they get
• 31:59
  Speaker 1: that care, the better off both mom and baby are.
• 32:01
  Speaker 2: Going to be. Absolutely I'm not going to add more
• 32:04
  Speaker 2: to that. I couldn't agree more.
• 32:06
  Speaker 1: Thank you, so so much so diabetes care in pregnancy
• 32:10
  Speaker 1: in general today. Is there anything we missed that you
• 32:13
  Speaker 1: would like to add?
• 32:14
  Speaker 2: I think with regards to you know, the other piece
• 32:16
  Speaker 2: as well too, is you kind of touched on maternal
• 32:19
  Speaker 2: health and obviously just by the extension of that, it's
• 32:25
  Speaker 2: the child's health, right, So there's a whole host of
• 32:28
  Speaker 2: data and there's always more coming up with regards to
• 32:32
  Speaker 2: the impact that the glucose level and the glucos load
• 32:35
  Speaker 2: would have on the child's weight, risk of complications, risk
• 32:40
  Speaker 2: of blood laws, percentage of C section, all those kinds
• 32:44
  Speaker 2: of like markers, if you will, at the end, it's
• 32:47
  Speaker 2: always correlated. So I think that's the always big thing
• 32:50
  Speaker 2: that we always want to look at is sometimes we
• 32:52
  Speaker 2: always just want to treat the number and the glucose level,
• 32:55
  Speaker 2: and that certainly has the impact right downstream. To remember that.
• 33:00
  Speaker 2: I think the other important thing to always remember with
• 33:03
  Speaker 2: regards to anyone who has whether it's gestational or again
• 33:06
  Speaker 2: undiagnosed Type two or Type one that's sprouting out is
• 33:10
  Speaker 2: the risk of hypoglycemia, and oftentimes that's not discussed as
• 33:14
  Speaker 2: often as hyperglycemia. So one thing that we learned actually
• 33:19
  Speaker 2: with regards to glucose monitoring, let's say individuals who wear
• 33:23
  Speaker 2: a continuous glucose monitor and what the guidelines are shown
• 33:26
  Speaker 2: from their is if you look at the recommendations on
• 33:29
  Speaker 2: where someone with diabetes what their range should be. Interestingly enough,
• 33:34
  Speaker 2: you know, they say time and range is great and
• 33:36
  Speaker 2: it's important. And what's interesting is they give about a
• 33:40
  Speaker 2: twenty five percent allotment to being in hyperglycemia and about
• 33:44
  Speaker 2: a five percent allotment for being or less for being
• 33:48
  Speaker 2: in hypoglycemia. So I think that's always you know, going
• 33:51
  Speaker 2: back to what we said earlier, diabetes is a numbers
• 33:53
  Speaker 2: game and it's a very like detail oriented kind of condition.
• 33:57
  Speaker 2: And again that's the other big thing that we always
• 33:59
  Speaker 2: want to here and be careful with, because individuals who
• 34:02
  Speaker 2: are pregnant will already at risk for let's say, a
• 34:05
  Speaker 2: fall or lightheadedness for conditions outside of diabetes, and afia
• 34:10
  Speaker 2: at diabetes, there's also that risk for hypoglycemia for patients
• 34:14
  Speaker 2: to also be careful with us well too.
• 34:17
  Speaker 1: You brought up an amazing point. I have never heard anyone,
• 34:20
  Speaker 1: just in conversation or on pregnancy support forums or in
• 34:24
  Speaker 1: the medical community in general, talk about hypoglycemia in pregnancy.
• 34:29
  Speaker 1: Thank you for bringing that to light. In it reminds
• 34:31
  Speaker 1: me of one of the patients I was working with
• 34:33
  Speaker 1: with hypermeses. She was on met foreman prior to becoming pregnant.
• 34:38
  Speaker 1: When she became pregnant, had this horrible disease, couldn't keep
• 34:42
  Speaker 1: anything down, also could not keep her medications down, and
• 34:46
  Speaker 1: she was so worried about having high sugar levels because
• 34:49
  Speaker 1: she couldn't take her met forman. When she actually went
• 34:52
  Speaker 1: into the hospital and got testing done, she was hypoglycemic.
• 34:56
  Speaker 1: Had she been taking her met foreman, she would have
• 34:58
  Speaker 1: dropped even lower or even worse. And something to keep
• 35:02
  Speaker 1: in mind. So as you brought up and asked about, well,
• 35:05
  Speaker 1: what about that first trimester if you're sick? I mean
• 35:08
  Speaker 1: up to seventy eighty ninety percent of women have some
• 35:11
  Speaker 1: nausea at least in that first trimester. How many go
• 35:15
  Speaker 1: on to have extreme versions? I've seen anywhere from two
• 35:18
  Speaker 1: to ten percent. Your medications might need adjusting during that
• 35:22
  Speaker 1: time and throughout each trimester. And as you mentioned this
• 35:26
  Speaker 1: plethora of testing that should be done again, circling back,
• 35:31
  Speaker 1: let's get this care the screening done early, preferably even
• 35:35
  Speaker 1: before you become pregnant. If you are in the planning
• 35:39
  Speaker 1: phase to become pregnant, please do put glucose testing sugar
• 35:44
  Speaker 1: levels on your list of questions to ask your provider about.
• 35:48
  Speaker 1: I have a question for you that I meant to
• 35:50
  Speaker 1: ask earlier. What are your thoughts on continuous glucose meters
• 35:54
  Speaker 1: or using a patch to monitor sugar levels in pregnancy.
• 35:58
  Speaker 2: Yeah, that's a good question. Well, Daniel, over the last
• 36:01
  Speaker 2: several years, continuous glucose monitors or CTMs have just massively
• 36:06
  Speaker 2: exploded in terms of their use and utilization both in
• 36:10
  Speaker 2: type one as well as individuals with type two and
• 36:13
  Speaker 2: other diabetes, as well as individuals in the health and
• 36:16
  Speaker 2: wellness space as well for kind of that you know,
• 36:18
  Speaker 2: really detail oriented health monitoring, you know, type of persona
• 36:23
  Speaker 2: if you will. Personally, I think it's a wonderful idea,
• 36:26
  Speaker 2: right because just think of what diabetes technology, how it
• 36:30
  Speaker 2: all started in the nineteen twenties when insulin was first
• 36:34
  Speaker 2: isolated from animal sources. As the whole diabetes technology is
• 36:38
  Speaker 2: kind of the epitome of you know, what medicine can do,
• 36:42
  Speaker 2: and that it is a process, but that each year,
• 36:45
  Speaker 2: each decade, things do improve in the types of insulince
• 36:48
  Speaker 2: that are available. Again, as I mentioned before, glucose meters,
• 36:53
  Speaker 2: let's say that are available, there were glucose strips, and
• 36:57
  Speaker 2: type one diabetic patients you urine glucose strips to monitor
• 37:03
  Speaker 2: their glucose in real time, which, as you can imagine,
• 37:06
  Speaker 2: is just you know, you're not going to get anything accurate,
• 37:09
  Speaker 2: let alone time appropriate in terms of what's going on
• 37:12
  Speaker 2: at that moment. Bottom line is we're at that era
• 37:15
  Speaker 2: where now continuous glucose monitors are available and they provide
• 37:18
  Speaker 2: a plethora of data, not just in terms of you know,
• 37:22
  Speaker 2: just the numbers, but if you really think about it,
• 37:24
  Speaker 2: we can have a patient come in with their hemoglobe
• 37:27
  Speaker 2: and a one C fantastic, right, you know, you know,
• 37:30
  Speaker 2: five point four percent. And they can also come in
• 37:34
  Speaker 2: and they're fasting, could also be great too. But what
• 37:37
  Speaker 2: if their glucose just goes up, down, up, down all
• 37:40
  Speaker 2: the time, or you know, I actually had a very
• 37:42
  Speaker 2: good colleague even telling me this is an interesting story
• 37:45
  Speaker 2: of you know, there are some individuals who, you know,
• 37:49
  Speaker 2: they culturally they don't like to eat alone. They love
• 37:52
  Speaker 2: to eat with the family as part of their culture.
• 37:54
  Speaker 2: So they actually have very low calorie intake during the
• 37:58
  Speaker 2: week and then they have a big intake during the
• 38:01
  Speaker 2: weekend when family's over. And so those individuals glucose will
• 38:05
  Speaker 2: have perfect day one seed, they'll have perfect fasting. But
• 38:08
  Speaker 2: their glucose magic is actually quite horrible because they're in
• 38:12
  Speaker 2: hyperglycemia hyperglycemia and that's just not caught. The cgms catch
• 38:16
  Speaker 2: that because it's day by day, you know, hour by hour.
• 38:19
  Speaker 2: It updates allow them every few minutes. Now, the thing
• 38:23
  Speaker 2: is that American Diabetes Association still requires a diabetes diagnosis
• 38:28
  Speaker 2: with the fasting or A and c or OGTT, so
• 38:32
  Speaker 2: diabetes diagnosis can't take place with the CGM, but it's
• 38:35
  Speaker 2: a great indicator for someone to be on and that
• 38:38
  Speaker 2: if the clinicians see something, you know to follow up
• 38:42
  Speaker 2: with appropriate tests. I personally like it.
• 38:45
  Speaker 1: I actually tried it out. There's a couple of manufacturers
• 38:48
  Speaker 1: that came out with over the counter versions. You don't
• 38:51
  Speaker 1: need a prescription for them. Knowing I had borderline in
• 38:54
  Speaker 1: my third pregnancy, I am at higher risk for diabetes
• 38:58
  Speaker 1: later in life, so I just wanted to make sure
• 39:00
  Speaker 1: everything was good in it. The results are quite fascinating.
• 39:03
  Speaker 1: They don't have the capabilities that somebody with a prescription
• 39:06
  Speaker 1: does have, but they're brand new to market, just within
• 39:08
  Speaker 1: a year now, and the way technology is evolving, I
• 39:11
  Speaker 1: think good things are to come. So I just looked
• 39:14
  Speaker 1: up ACOG's guidelines and they still recommend traditional blood glucose
• 39:19
  Speaker 1: meters so the fingerstick ones for monitoring, and notes that
• 39:23
  Speaker 1: CGM data is still being evaluated for its use in
• 39:27
  Speaker 1: all types of pregnancy related diabetes. One of the other
• 39:31
  Speaker 1: rep that I'd spoken to often talks about the use
• 39:34
  Speaker 1: of their CGM for pregnancy as I mentioned pregnant, when
• 39:38
  Speaker 1: we're just poked and prodded throughout that entire time, and
• 39:41
  Speaker 1: so to add fingerstick, it's just one more thing and
• 39:43
  Speaker 1: it's quite time intensive, and the most important thing that
• 39:46
  Speaker 1: you mentioned is it's not catching the fluctuations throughout the day,
• 39:51
  Speaker 1: and they're huge. And when I tried this one out,
• 39:54
  Speaker 1: and I remember when night I was out with my
• 39:57
  Speaker 1: team and we were up late and they went to
• 39:59
  Speaker 1: a fast food chain your by and I was like,
• 40:01
  Speaker 1: get me fries. My glucose spiked from those fries. I
• 40:04
  Speaker 1: know I have to always have protein first. Again, I'm
• 40:07
  Speaker 1: not pregnant, but I learned a lot from this. There's
• 40:10
  Speaker 1: other things I learned from it as well. So I
• 40:12
  Speaker 1: would recommend if anyone's just curious, get one of those
• 40:14
  Speaker 1: over the counter ones and try it out and see
• 40:17
  Speaker 1: how it changes whether you're pregnant or not. For those
• 40:20
  Speaker 1: who are pregnant, the guidelines are saying still do the fingersticks.
• 40:23
  Speaker 1: But we do have this other resource that is just
• 40:27
  Speaker 1: really really, from my experience and from others that I've
• 40:30
  Speaker 1: spoken to, a really phenomenal resource, and I think it
• 40:33
  Speaker 1: will come to time, hopefully soon that ACOG and the
• 40:37
  Speaker 1: ADA are going to say that we no longer have
• 40:41
  Speaker 1: to do fingersticks in these patients. ADA does say it
• 40:44
  Speaker 1: recommends CGM for pregnant individuals with type one, but not
• 40:48
  Speaker 1: yet for type two or just stational. So thank you
• 40:51
  Speaker 1: for adding that. I'm only so curious. And new technology
• 40:54
  Speaker 1: comes about and we're all on our smartphones all the time,
• 40:57
  Speaker 1: and you can monitor that, and I know how often,
• 41:00
  Speaker 1: and the c gems are updated does vary by which brand. Again,
• 41:03
  Speaker 1: it's not like a stick in the morning or later
• 41:05
  Speaker 1: in the day or you know, hour before two hours
• 41:08
  Speaker 1: after you eat to monitor that. It just seems like
• 41:11
  Speaker 1: such an antiquated way to look at sugar levels. Any
• 41:14
  Speaker 1: last pieces of wisdom you'd have for somebody either who's
• 41:17
  Speaker 1: citing to become pregnant or are pregnant or recovering from
• 41:21
  Speaker 1: agestational diabetes that you would like to add.
• 41:24
  Speaker 2: Yeah, I mean I would say the big action item
• 41:26
  Speaker 2: is screen right, you know, in terms of everyone has
• 41:30
  Speaker 2: to be their own health advocate for a whole host
• 41:32
  Speaker 2: of pieces. Right, as you mentioned, it's pregnant individuals get
• 41:35
  Speaker 2: pricked the product all the time. I think the big
• 41:37
  Speaker 2: takeaway and the action item for individuals who can are
• 41:40
  Speaker 2: in that planning pregnancy, in pregnancy even postpartum right gets
• 41:46
  Speaker 2: screened for type one diabetes. If something is off, bring
• 41:49
  Speaker 2: up the conversation for monogeg diabetes. Really getting that right
• 41:53
  Speaker 2: diagnosis in just gets you to the next step, you know,
• 41:57
  Speaker 2: so much easier.
• 41:58
  Speaker 1: And Taddi, thank you so much. If any one would
• 42:00
  Speaker 1: want to connect with you or learn more about your work,
• 42:02
  Speaker 1: what's the best way for them to reach you?
• 42:05
  Speaker 2: Yeah, LinkedIn is the best way. Just search for me,
• 42:08
  Speaker 2: todda Bartanian. Best way to connect this there.
• 42:11
  Speaker 1: Thank you so much, and for everyone listening, I hope
• 42:14
  Speaker 1: you learned something from our conversation today on diabetes, being
• 42:18
  Speaker 1: pregnant or not so much new information coming out, Teddy,
• 42:22
  Speaker 1: thank you again. Keep us updated on the clinical trials,
• 42:25
  Speaker 1: new information, and we know we're in a danid right
• 42:28
  Speaker 1: now where it might be a little bit difficult to
• 42:30
  Speaker 1: get truth, factual, evidence based information. And I myself and
• 42:34
  Speaker 1: I'm going to speak on our listeners. We are just
• 42:36
  Speaker 1: grateful for the work you are doing. Thank you again.
• 42:39
  Speaker 2: Thank you