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Your First Line of Defense Against Diabetes: Your Primary Care Doctor · Meaningful Medicine with Novant Health

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  Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm your host, Maggie McKay.
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  Joining us today is Dr.
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  Kerry Alexander internist to talk about why your primary care doctor is your
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  first line of defense against diabetes.
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  Thank you so much for joining us.
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  Carrie Alexander, MD: Hi Maggie.
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  Thank you so much for having me.
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  I'm excited to, talk with you about this topic.
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  Maggie McKay (Host): Me too.
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  so let's just dive in.
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  Why is primary care such a critical part of detecting diabetes early
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  often before symptoms even appear?
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  Carrie Alexander, MD: Sure.
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  primary care is where most patients would come when they're thinking about
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  getting a physical or being checked out.
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  So, Standard screening protocols, call for diabetic screening, and all people
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  over the age of 35, and in people under the age of 35 who meet certain
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  criteria, like obesity or overweight or high risk with a family history.
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  so primary care is often the first stop for a patient for getting
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  checked out for the routine problems.
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  Maggie McKay (Host): There are different types of diabetes.
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  Could you please explain the differences between type one and
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  type two and which is preventable or not, and the role of heredity.
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  Carrie Alexander, MD: Sure, I'll start with type one diabetes.
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  type one diabetes is what we used to consider childhood diabetes.
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  we have learned that sometimes adults can be diagnosed with type one diabetes
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  as well, but in type one diabetes, your pancreas, the organ that makes
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  your insulin has quit working.
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  There is a genetic role for type one diabetes.
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  We think about 5% of people whose parents have type one diabetes will
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  develop type one diabetes, and maybe 10% of people who have a sibling with
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  diabetes will develop type one diabetes.
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  So it's not just genetic.
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  there's a possibility that a virus could attack the pancreas
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  in effect, production of insulin.
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  But it is a different disease than type two diabetes.
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  there is a lack of production of insulin in type one diabetes,
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  therefore patients with type one.
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  Have to take insulin every day.
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  and they would not be treated with the other medicines for diabetes
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  that you might have heard of, especially the very popular ones.
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  Now, that would also help with weight loss.
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  Type one diabetics would not be treated with those medications.
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  type two diabetes also can be genetic.
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  it is more what we have thought of as adult onset, but as obesity rates
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  increase and are affecting children, we are seeing type two diabetes
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  in children as well as adults.
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  that is not a problem with production from the pancreas of insulin.
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  It is more a problem of the body not responding to the amount
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  of insulin is being made or.
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  Too much sugar coming in for the amount of insulin that is being made.
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  There is a genetic component to type two diabetes.
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  it is not as directly linked.
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  we will see some very strong family histories of, type two diabetes,
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  but they call it poly genomic.
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  So we can't say you have x percent of chance of having diet.
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  Diabetes type two if your family member has it.
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  and of course, diet and exercise also play a much bigger role in type two
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  diabetes, whereas type one diabetes, it's not as related to diet and exercise.
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  Maggie McKay (Host): Dr.
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  Alexander, what are the most.
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  Common signs or risk factors that you watch for during routine visits.
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  Carrie Alexander, MD: Sure.
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  Like if I'm asking patients questions about looking for symptoms of diabetes,
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  then I might ask them if they've noticed increased urination increased.
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  Thirst, blurry vision.
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  numbness in the toes or the fingers.
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  if the diabetes is advanced, they may actually be having
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  weight loss from the diabetes.
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  maybe recurrent infections because diabetes can increase
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  your risk of infection.
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  Those might be some of the symptoms I would inquire about.
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  Maggie McKay (Host): Once someone is diagnosed, how does a primary care
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  provider guide day-to-day management and help prevent serious complications?
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  Carrie Alexander, MD: boy, there's a lot of things to talk about with diabetes.
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  maybe we should focus on type two diabetes 'cause it's such a broad
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  topic when we talk about, what I would be recommending for our patients.
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  so to start with, I would need to know probably how severe
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  their diabetes is to help guide.
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  medications if they need to be started immediately.
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  Sometimes it might be mild diabetes or pre-diabetes, and I would
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  really be focusing on talking to the patient about increasing their
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  exercise or some dietary changes.
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  if the diabetes is to the point that I feel like we need to add medication
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  to the diet and exercise, I like to give my patients options, discuss
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  the risk and benefits of each of the medications and give them, options.
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  And I also like to focus on why it's important to treat diabetes.
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  Like what, are the long-term complications of diabetes?
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  'cause I want my patients to have buy-in.
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  and really, want to participate in getting their diabetes under good control.
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  Maggie McKay (Host): And it seems like there's a lot of fear and
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  misinformation around diabetes.
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  How do you help patients feel supported and confident managing their health?
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  Carrie Alexander, MD: Sure that can be very hard.
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  when I have to give a patient a diagnosis of diabetes, I'm oftentimes watching
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  their facial expressions because I know some people have had family members
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  who had, significant complications from their diabetes and they, can become
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  quite scared about the diagnosis.
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  and we have to walk people through it in different ways, depending
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  on their concerns and how they wanna approach the disease.
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  So I, think, there are a lot of different ways I approach it based
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  on how my patient is feeling.
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  I think one of the biggest things that I like to do is, give
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  patients options about, ways they want to address, the diabetes.
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  And really try to give them a lot of information about, what foods
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  to eat and what exercise to do.
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  Maggie McKay (Host): Speaking of that, what role do lifestyle.
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  Of changes like diet, movement, stress, play alongside medications and monitoring.
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  Carrie Alexander, MD: Oh, I think I have seen them play a huge role before.
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  It depends on how motivated the patient is and.
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  Where their starting point is.
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  some patients eat a very healthy diet and exercise and still
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  develop diabetes, and that may have a stronger genetic component.
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  But I've had some patients who have had significantly high blood sugars
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  that were able to bring them down with, exercising 30 minutes every day and
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  really making an overhaul of their diet.
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  There are different ways that your body responds to those different things.
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  So for instance, if you change the amount of sugar that you're eating,
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  then your body's insulin can be more effective because it doesn't have as much
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  sugar to, to manage with that insulin.
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  So that is one route we can help our body.
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  With the diabetes, and if we add exercise to that, that allows the
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  cells in the body to utilize the insulin that you have, better.
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  So it's kind of like the one two punch of treating diabetes.
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  So both things work in different ways, but they add on to
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  each other and how they work.
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  Maggie McKay (Host): And what message do you want listeners
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  to hear about preventing diet?
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  Diabetes or living well with it once diagnosed.
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  Carrie Alexander, MD: I think really learning, About diet and
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  exercise, healthy diet and exercise.
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  when I talk to patients about what foods they should be eating, whether
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  it's diabetes or high cholesterol, or gout or any of these conditions, I
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  like to talk about eating whole foods.
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  So I, like to use the phrase.
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  Eat foods that look the way God made them.
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  So not the things and the bags and the boxes, just to make it
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  quick and easy for patients.
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  Like, should I eat this?
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  No, it looks processed.
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  So staying away from the processed foods is one, really easy thing I
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  like to talk to my patients about.
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  and then I like to give them goals for exercise.
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  So American Heart Association recommends 30 minutes, five times a week for
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  exercise, and I think that's a great goal recommendation for our diabetic.
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  Patients, so I think, or patients who don't wanna become diabetic.
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  So I think that either way, whether you're diagnosed or to try to prevent
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  being diagnosed, I think healthy diet and exercise can definitely, improve our blood
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  sugar in the way our body handles it.
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  Maggie McKay (Host): In closing, is there anything else you'd like to add
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  or you would like patients to know?
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  Carrie Alexander, MD: I'm a big believer in diet and exercise for a lot of
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  conditions, and I think in America we have a really hard time knowing
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  what is healthy and unhealthy and there is a lot of misinformation on,
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  Foods and what we should be eating.
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  But there is a lot of online information to help, patients
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  select some healthy foods.
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  I for one, love the Dash diet, websites, dash DASH.
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  It's actually the Blood Pressure Diet, but I find it's has a lot more information
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  that's easy to understand online and I think that's a good source for starting
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  to look, for ways to eat better.
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  Maggie McKay (Host): Great.
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  Thank you so much for sharing your expertise.
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  This has been so informative.
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  We really appreciate it.
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  Carrie Alexander, MD: Well, I appreciate your time tonight, Maggie.
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  Thanks so much for having me.
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  Maggie McKay (Host): Absolutely.
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  Again, that's Dr.
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  Kerry Alexander.
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  To find a physician, visit novant health.org.
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  And for more health and wellness information from our experts,
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  visit healthy headlines.org.