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Transcript

Is Prediabetes Reversible? · Bryan Health Podcasts

• 0:03
  Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.
• 0:05
  I'm Melanie Cole.
• 0:06
  And today, we're going to learn about prediabetes and really what it means
• 0:11
  for you if you've been told that this is something that you have.
• 0:15
  Joining me is Gretchen Johnson.
• 0:17
  She's a registered dietician at the Bryan Diabetes Center.
• 0:22
  Gretchen, thank you so much for joining us today.
• 0:25
  So, as I said in my intro, we're going to learn about it.
• 0:28
  So, tell us what is prediabetes.
• 0:31
  How common is that?
• 0:33
  Gretchen Johnson: Yeah.
• 0:33
  So, prediabetes is when we see that our blood sugar levels are running
• 0:37
  higher than normal, but they're not at the range yet where we have diabetes.
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  So, It might not be a lab that everyone's familiar with, but usually the one that
• 0:46
  we find with prediabetes that your doctor might check is your hemoglobin A1c.
• 0:51
  So, we see when that gets to a range of 5.7
• 0:54
  to 6.4,
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  that's in our range for prediabetes.
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  And it's very common.
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  So, according to the CDC, it's estimated around 115.2
• 1:03
  million US adults have prediabetes.
• 1:06
  And older individuals over that age of 65 are usually the most affected, around 31.3
• 1:13
  million or about 52%, so a lot of the US population.
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  When we think about kind of the cause or maybe what's going on in our body
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  with prediabetes, it's often our body's not properly using glucose anymore.
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  So when we eat, our body breaks that down into sugar that enters
• 1:30
  our bloodstream, and our body wants to use that sugar for energy.
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  In prediabetes, what we see is that our cells are not as open to it.
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  So, they need insulin to bring that sugar into our cells.
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  And what we see with prediabetes is we're a little resistant to insulin.
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  So, we need more than we used to.
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  Usually, I try to think of, or when I talk with patient's about prediabetes, insulin
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  is that key that helps to open our cell.
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  And insulin resistance, I almost think of our lock is rusty
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  or the key doesn't quite fit.
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  So, it's kind of that we're needing more insulin than we used to.
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  So, that's kind of what's going on in our body.
• 2:07
  Melanie Cole, MS: Yeah.
• 2:07
  Wow.
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  And we're going to talk a little more about A1c in a minute.
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  But as we think of the obesity epidemic that's going on in the country today,
• 2:15
  Gretchen, and how many people are getting diabetes, when you're told that
• 2:21
  your A1c is high and that you are a prediabetic, Does that mean that the
• 2:27
  person's automatically going to get diabetes if they don't do any sort
• 2:32
  of treatment or lifestyle behaviors, which we're going to talk about?
• 2:36
  Gretchen Johnson: Yeah.
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  So, it's definitely different for everybody.
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  I think for some people it would potentially progress quicker than others.
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  But no, it does not automatically mean.
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  If we don't make any changes, it does mean, you know, maybe we are
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  on that trajectory of our body's not doing the best job of managing
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  our blood sugar levels anymore.
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  So if we kind of keep our same habits and we don't make any changes, down the
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  line, we will develop type 2 diabetes.
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  . Melanie Cole, MS: So, when we think of prediabetes risk factors, do
• 3:06
  we know what the actual cause do we know who's affected the most?
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  Gretchen Johnson: We're not exactly sure what maybe causes
• 3:14
  someone to become prediabetic.
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  There's a mix of, , family history, genetics, and a lot
• 3:19
  of different lifestyle factors.
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  being overweight, so kind of the more fatty tissue that we have, the more
• 3:26
  resistant our cells are to insulin.
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  Kind of related to that with waist circumference, when we see that our
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  waist, for men is over 40 inches, or for women larger than 35 inches, we have an
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  increased risk of that insulin resistance.
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  a diet high and those sugar-sweetened beverages and kind of more
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  highly processed meats and other highly processed foods.
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  And then, we also see inactivity.
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  Not doing formal exercise, but then also just having a more sedentary
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  lifestyle, having more of an office job where we're sitting all
• 3:57
  day, that can increase our risk.
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  And then, some other ones: smoking can; having gestational diabetes, so
• 4:04
  that's diabetes during pregnancy, we see that as a risk factor for developing
• 4:08
  prediabetes, and then also high blood pressure and high levels of triglycerides.
• 4:14
  Melanie Cole, MS: So, that's quite a list.
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  Now, Gretchen, at the very beginning, you mentioned A1c, hemoglobin A1c.
• 4:21
  This is our marker.
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  And you mentioned the numbers 5.7,
• 4:24
  6.4.
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  I'd like you to speak a little bit about A1c.
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  How do we test for it and why is it important to know this number?
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  What does it even really mean?
• 4:35
  Gretchen Johnson: So, hemoglobin A1c, it's a blood test, so when you
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  go to your doctor, oftentimes, at like a yearly physical or wellness
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  check, it'll be a part of those labs that your doctor is taking.
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  Not every doctor, but most will.
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  And it correlates to your blood sugar levels on average.
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  So, what it's looking at is how much sugar is on your red blood cells.
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  And our red blood cells live for about three months in our body.
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  So, it can give us a picture of the past three months, what have your
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  blood sugar levels been running at.
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  So then, from that we can see, okay, if it is higher than we're expecting,
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  That shows that, you know, in the past three months, our blood sugars are
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  running higher than they're supposed to be, or higher than we're wanting
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  them to be, if that makes sense.
• 5:19
  Melanie Cole, MS: It does, and that's really important So now, the big
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  question, the million-dollar question.
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  If someone is told that maybe they're at 6.0
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  or even a little higher, they're told that they have prediabetes,
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  what is the first-line of defense?
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  What are you doing for them at the Bryan Diabetes Center?
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  Gretchen Johnson: Our first thing that we want to do is we're trying
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  to think of ways, okay, how can I increase my insulin sensitivity?
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  And that's through kind of a bunch of different lifestyle changes.
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  When we lose 5-7% of our body weight, so not a huge amount of body weight, that
• 5:55
  can help to increase our sensitivity.
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  So most of the time, we're targeting a little bit of weight loss and
• 6:00
  then also increased activity.
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  What's really cool about activity is we have this kind of broken process where.
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  We have a little bit more sugar in our blood than we want, and our insulin
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  is maybe not doing as good of a job, you know, we're still resistant.
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  When we use our muscles, that can use the sugar.
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  So, we're kind of bypassing that process of not having enough insulin
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  and that can help to bring our blood sugar levels down as well.
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  So, those are kind of the first things that we want to look at, is how can
• 6:27
  we lose some weight, change our eating habits and increase our activity.
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  Melanie Cole, MS: So Gretchen, tell us a little bit about the
• 6:33
  Bryan Diabetes Prevention Program.
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  Tell us about what it includes, some of the class details, and information for
• 6:41
  listeners, like does Medicare cover this?
• 6:44
  Gretchen Johnson: Our diabetes prevention program, it runs for about a year and
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  it's composed of 22 different sessions.
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  it starts out meeting every week for about eight weeks and then it tapers off to
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  that last six months of just once-a-month check-in mostly for accountability.
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  Those main focuses that we're looking at is 5% to 7% loss of body weight,
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  so looking at some weight loss, and then also increasing exercise.
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  So, we go back and forth between me, a registered dietician, and then we
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  have an exercise specialist as well.
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  , We hit all those different topics, what to eat, how to eat, when to exercise,
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  what exercises are going to be the best.
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  And then, we also incorporate different things too about how to get back on
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  track or how to stay motivated, managing stress and other things as well.
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  , We really try to cover that whole picture.
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  In terms of coverage, if you meet that eligibility of having that, diagnosis
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  of prediabetes and having a BMI of 25 or above, Medicare does cover the
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  program, which is great . And then, some other insurances may cover it.
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  It just depends on the insurances, if you are eligible with
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  that diagnosis of prediabetes
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  Melanie Cole, MS: Well, thank you for that.
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  So, tell us about the results that people who take these classes see.
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  What have you seen?
• 7:58
  Gretchen Moll: So, I've seen a lot.
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  Right now, I have two classes , and I think at least half of them, if not
• 8:03
  more, have reached that 5% loss of body weight, which is super exciting to see.
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  I've had a couple that have reached that 7% or even 9%.
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  And then, from a class that already finished, we've had a couple that have
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  dropped their A1c, you know, in that pre-diabetes range to within those
• 8:20
  normal limits, which is really exciting.
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  I think we had one gal that went from 6.4,
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  so right on the edge of almost being diabetic, to 5.4
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  in that normal range, which was really, really exciting to see
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  Melanie Cole, MS: As lifestyle management remains basic to long-term
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  diabetes and certainly prediabetes management, Gretchen, there's
• 8:40
  certainly no one-size-fits-all rules.
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  So, speak a little bit about the latest recommendations for
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  prediabetes if lifestyle management doesn't seem to move the needle.
• 8:54
  Gretchen Johnson: That is kind of what we're going for lifestyle management.
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  Some doctors will potentially do a metformin medication, which is
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  also used in diabetes that can help to tell your liver to not give
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  you as much of that extra sugar.
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  So, sometimes people will start with that.
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  Another thing that I've kind of been starting to do as well that I think
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  can be really helpful for people to see is maybe trialing wearing a continuous
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  glucose monitor, and just kind of being more aware of what they eat and how
• 9:22
  that's impacting their blood sugar levels.
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  That can kind of give patients a really clear picture of, "Okay, I didn't realize
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  that that's what This is doing to my blood sugar levels" and can kind of help
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  them to make those practical changes.
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  But right now, it really is lifestyle and in some cases it is some metformin or
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  potentially, you know, if they have some other comorbidities, potentially like
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  a GLP-1 or something like that as well.
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  Melanie Cole, MS: Can it be reversed?
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  Gretchen Johnson: Yes.
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  So, there are definitely ways to bring our levels back down into that normal
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  range we don't always say reverse, just because, you know, if we stopped
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  doing all of those lifestyle changes we made or if we lost weight, we changed
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  our eating habits and then we went back to our old habits, it potentially
• 10:06
  would come back, if that makes sense.
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  So, sometimes it's not necessarily that it's a hundred percent gone because we're
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  doing all these great things to manage it.
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  But yes, it can definitely be managed.
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  We can lower our levels, and we can no longer be in that prediabetes range.
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  Melanie Cole, MS: See, that's what's so great to learn here today, Gretchen.
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  And as a registered dietician, do you have some food advice?
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  You really spoke about sweetened beverages and eliminating those.
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  But people hear that word carbohydrate and right away they think, "Oh, I
• 10:37
  can't have any of those now that I'm prediabetic or have prediabetes."
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  But not all carbohydrates are created equal, right?
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  . When you work with your patient's every single day, how do you help them
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  with the diet portion with some foods that can actually help regulate those
• 10:54
  blood sugar levels and some foods that are really, really bad for it.
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  Gretchen Johnson: It really is how we balance our meals, and also
• 11:01
  what carbohydrates we're choosing.
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  One of the main things that we work on is just how to balance our meals.
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  So, we know that carbohydrates impact our blood sugar levels.
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  But when they're paired with a source of protein and some fat and also
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  some fiber, that helps to balance it, and then we're not going to
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  see as high of a blood sugar spike.
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  So, it's going to prevent our blood sugar levels from going high.
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  So usually, a lot of problem solving or thinking of ways of how can I build a
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  really balanced meal and making sure—a lot of times I talk about, "Okay, let's
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  not have carbohydrates by themselves."
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  We always want our carb to have a buddy to have a protein or fat.
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  So even if that's an apple, you know, can I have a little bit of
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  peanut butter or a string cheese with that to balance that together?
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  And just thinking of ways to incorporate protein and our fat.
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  I think a lot of times it can be easy to overdo our carbohydrates.
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  So just thinking about, "Okay, I just want to have one source of carbohydrate
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  and I want it to be a healthy option."
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  So, I don't think people need to be scared of fruit or our starchy
• 12:02
  vegetables or our whole grains.
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  We always want to go for those as carbohydrates.
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  But we do want to limit cookies, candy, regular soda, a lot of those
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  more simple carbohydrates that aren't really giving us much nutrients
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  or anything, and they're going to impact our blood sugar levels a lot.
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  Melanie Cole, MS: great advice.
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  As we wrap up when we see our provider, what questions would you
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  like them to ask their doctors?
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  What would you like people to ask?
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  And can it be prevented?
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  Your best advice here, Gretchen, for lifestyle management and
• 12:36
  prevention altogether, so we don't have to do any of these things.
• 12:40
  Gretchen Johnson: If you're having these multiple risk factors for prediabetes
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  or even if it's just something that you're really concerned about asking
• 12:47
  them for an A1c when you come in.
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  A lot of times they'll also do a fasting and that one's, you know, a little bit
• 12:53
  simpler lab, a little bit cheaper lab.
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  And that fasting can also show us a little bit of how your
• 12:58
  blood sugar levels are running.
• 12:59
  So, I think really just asking them about that and then letting them
• 13:03
  know that, "Maybe I'm concerned about diabetes, it runs in the family.
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  I'd really like to be proactive and start checking this," even if you haven't
• 13:11
  been diagnosed with prediabetes yet.
• 13:13
  I think it could be helpful just to start looking at it then.
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  So for thinking about can it be prevented, we know that there are risk
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  factors for prediabetes that can't be controlled: family history, your age, you
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  know, we can't control how old we are.
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  But there are risk factors that can be controlled, thinking about our
• 13:29
  activity level, thinking about our diet, what we're eating, our weight,
• 13:33
  our management of that, and even other things as simple as like smoking or
• 13:37
  kind of cutting out that regular soda.
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  They're all things that we can control.
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  And then, that can be helpful in preventing those prediabetes.
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  It's hard because, you know, it's not always a one-size-fits-all.
• 13:48
  But I think if we're practicing these healthy lifestyle changes, that's for
• 13:52
  sure going to help us to prevent a lot of health complications in the future.
• 13:57
  Melanie Cole, MS: That's great advice.
• 13:58
  And it's certainly true.
• 13:59
  There are things that we can do and lifestyle management, as you said,
• 14:03
  and that is what you are doing at the Bryan Diabetes Center with people.
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  So, I'd love to thank you, Gretchen, for joining us today.
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  And I'd also like to thank our Bryan Foundation partner,
• 14:14
  Riverside Technologies.
• 14:16
  To listen to more podcasts from our experts, you can always
• 14:19
  visit bryan health.org/podcasts.
• 14:22
  And that wraps up this episode of Bryan Health Podcast.
• 14:25
  Please remember to subscribe, rate, and review Bryan Health podcast on Apple
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• 14:33
  You know, share these shows with your friends because we are learning from
• 14:36
  the experts at Bryan Health together.
• 14:39
  I'm Melanie Cole.
• 14:40
  Thank you so much for joining us