.

Good evening.

Thank you so much for watching PBS Fort Wayne and HealthLine tonight.

>> I'm Mark Evans, your host.

Tonight we'll be talking about diabetes across life stages and we have a very special guest.

>> She's been on our show a few times in the last few years.

Emily Shrader, a medical doctor as well as a Ph.D.

or an endocrinologist before we get started in the diabetes, what's an endocrinologist chronologies or physicians who specialize in treatment of disorders caused by different hormones?

>> So I mean one is diabetes but also thyroid disease, pituitary disease, adrenal disease.

So a wide range of things.

OK, well we're so glad you're here tonight because November 15th of course the show is in November but the 15th November is World Diabetes Day and it's sponsored by the World Health Organization and the theme for twenty twenty five is diabetes across life stages as I mentioned before and we'll get to that in just a moment.

But just in case we have some viewers who don't realize what diabetes is, we'll get the summarization from you.

But I do want to go ahead and plug that telephone number because we are an interactive television television program.

Of course the number is on your screen 866- (969) 27 to zero.

Please call that at any time if you have any questions whatsoever for yourself or somebody you care about about diabetes.

>> So what is diabetes?

Yeah, so diabetes is a condition in which there's either not enough insulin or the insulin in the body doesn't work well enough insulin isn't a hormone that's very important in terms of helping your body use the glucose and carbohydrates that you consume .

So one type of diabetes is type one diabetes that usually is diagnosed in child hood and it's an autoimmune condition in which the pancreas isn't able to make enough insulin.

>> So folks with Type one diabetes need to be on insulin lifelong type two diabetes is more a problem of insulin resistance so the pancreas can make insulin but for a variety of reasons it doesn't work as well as it should.

>> So both of those can lead to elevated blood sugars and then there's a third type gestational diabetes that can develop in pregnancy and usually resolves after the end of the pregnancy.

>> Yeah, the baby has diabetes.

>> The mother does OK.

Yes.

All right.

Thank you for breaking those down and of course what is the message of this particular theme this year?

>> Diabetes across life stages.

So really diabetes pre diabetes and the conditions that predisposed to diabetes can develop at any point in life and people at different stages in their life need different assistance and help and diabetes impacts their life differently.

So for example, a child with diabetes needs a different set of help and guidance than an adult or elderly person with diabetes.

And how would you describe the differences between the children and the adults?

>> Yeah, so some of it has to do with diabetes prevention and some of it with treatment.

>> So if you're thinking about diabetes prevention to help prevent children from later on developing Type two diabetes as they get older, you want to encourage them to be physically active, to eat healthy foods, support healthy foods in school and just an environment that supports them being active and eating foods that are going to help them maintain their health lifelong.

>> And then of course adults should know how to eat but we all have phalluses.

So if for instance a patient has been diagnosed with diabetes type two in particular what type of training with that person need?

>> What kind of coaching would they need?

Yeah, so it's different for every person.

So sometimes what folks need is more education about the types of food and activity that is healthy for them but often we know what we probably ought to do but it's difficult to make ourselves do that.

So sometimes personal health coaches can be helpful enlisting the support of your friends and family so it's a lot easier to maintain some of these healthy habits.

>> True if you have the support of those around you.

Yeah, yeah.

That support is very important.

>> Here comes the big one.

Can you provide some stats?

>> How many Americans are actually diabetic?

Yeah, so it's a huge number.

So in terms of adults with diabetes it's about thirty eight million Americans with diabetes.

That's kind of a hard number to wrap your head around.

Yes, that's about 11 percent of the adult population in the US has diabetes and then another large proportion have pre diabetes and together it's about a half of Americans have either diabetes or pre diabetes.

>> Well what determines if you have pre diabetes, what is the fine line between between pre diabetes and diabetes?

>> Yeah, so there are different blood tests that can be used to diagnose whether you have diabetes or pre diabetes.

So in prediabetes your blood sugars are a little bit elevated but you haven't yet crossed that line into diabetes and for the adult onset it is mainly diet and lack of exercise so it has to do with lifestyle factors diet, exercise and there's also a genetic component.

>> I was going to ask my mother type two diabetes is there a pretty good chance that I might have that or get it?

>> So there is increased risk if you have family members who have Type two diabetes and I will say my family physician is keeping an eye on that but I'm not diabetic yet.

Let's not have that happen.

>> But I'm in good hands I'm sure if I do.

We already talked about the three different types of diabetes.

Which one would you classify as being probably the most serious or most severe?

So type one diabetes because it's an autoimmune problem that disrupts destroys the cells in the pancreas that make insulin.

If you have type one diabetes you need to be on lifelong insulin so and in that sense it could be considered more severe type two diabetes because it's also associated with being overweight.

Having excess body weight tends to also be associated with things like elevated cholesterol, high blood pressure.

So is sort of a constellation of things that can develop together with Type two diabetes.

>> Just recently I was at a large gathering with a lot of friends and these friends had children and one of the children I think probably 10 or 11 he had an insulin pump are those fairly common?

>> They are becoming more common and they are becoming I say more technologically advanced as things go on as time goes on.

The other thing you might see your folks were in continuous glucose monitors.

So these are sensors you can wear usually on your arm.

>> Yes.

That have a little like plastic tubing that helps measure glucose levels every five minutes or so and some of the insulin pumps can sort of talk through technology with sensors and adjust how much insulin you're getting based on what your blood sugar.

>> That's fascinating.

It really is.

And it was only about this big and he was wearing it on his belt so I thought that was pretty.

>> Some of them have tubes, some of them don't have tubes and I'd say they're getting smaller and smaller every year.

Yeah, And I was asking them some questions and he's just one it's just part of life, you know and and he certainly had hope that maybe he wouldn't have to wear that anymore down down the road.

So I'm hoping that for him as well.

Let's talk about how we've kind of touched on this a little bit like to get into deeper how diabetes can be prevented.

>> So Type one diabetes there's been made there's been sort of a different approach to that for Type two diabetes.

>> So we don't have a cure for Type one diabetes or a way really to prevent it for type two diabetes.

>> There's a number of things folks can do in terms of like we mentioned, lifestyle changes.

So changing diet becoming more physically active.

>> There are classes you can take called the diabetes Prevention Program which sometimes can be covered by Medicare that helps kind of coach people provide that education and then it's often a group class.

So it provides you with folks that you can work with together to kind of help incorporate those changes.

>> You know, and that's something because I've been doing the show for sixteen, seventeen years and we've talked about diabetes even back then and I truly amazed with the technology advances and also the medical advances in diabetes.

>> What kind of research is going on in there?

Are we adamant about trying to figure out if we can get a cure or not?

>> What's happening?

Yeah, so there's a lot of research into new medications to help both to help with weight loss for folks with pre diabetes folks who might not yet have diabetes but have excess body weight.

>> Um, there's also been a lot of work into medications that can help in Type two diabetes so that folks don't need to take insulin.

So people are working on that and then people are working on for Type one diabetes.

Are there ways to prevent that autoimmune condition and help preserve those cells in the pancreas?

You just hit on a point.

I know a lot of diabetics especially if they're afraid of needles.

One of the and you certainly know about this about some of the patients you've had to coach giving themselves injections and some people have to give them injections because they just can't do it themselves.

And I can tell that that's pretty arduous and but we were talking back in the green room before the show that there's hope for getting around that coming up with an inhalant of insulin.

>> So there is an inhaled insulin.

It's not used a ton because there are specific requirements for folks who might be good candidates for it.

So for now mostly what we have are insulin sometimes and insulin pumps there also our kind of insulin patches sit on the skin and deliver insulin.

Oh, that's so there are different insulin delivery mechanisms.

Yeah, we're still working on that as well.

>> How are those patches working and that sounds like a great idea.

So it's sort of like an insulin pump but without kind of the different settings and programs they kind of can there are different versions.

>> Some continuously deliver a small amount of insulin and others when you press a button then it gives you a larger oh I see it's kind of a time release thing but yeah.

>> Oh I see.

Where you going?

Oh I'm so sorry.

We've got a phone call and of course those phone calls do you take priority by the way if you have a question please call that number on your screen 866- (969) 27 two zero.

We're talking to Dr.

Emily Schrader who is an endocrinologist and a specialist when it comes to diabetes.

So please have those phone calls coming in just as James has and James is asking one look over here at this particular screen.

>> Can you explain prediabetes?

Can it be reversed in the reversal is a very good question.

>> That is an excellent question.

So prediabetes is when patients start to have slightly higher blood sugars but they're not yet high enough that we would consider it to be diabetes and usually that is due to increasing insulin resistance we would say so the pancreas makes insulin but the cells in the body, in the muscle and the liver don't respond as well to the insulin.

There are ways to reverse diabetes.

>> So one of one important thing is to try to prevent developing diabetes.

So if you have pre diabetes you're at increased risk of developing diabetes.

So a lot of effort is put to try to prevent development of diabetes but you can also potentially reverse pre diabetes and get back to normal blood sugars and usually that has to do with making diet changes, increasing physical activity if you're able to to do that and sometimes some medications can help as well to help with weight loss help improve that glucose metabolism .

And I'm going to use myself as a testament testimony I should say when it comes to this.

I went to my physician as I do every year and two years ago he says you're just this close to being prediabetic excuse me.

And at that time I was about twenty five pounds heavier in the process the last two years I've lost that twenty five pounds and I've got a little more to go.

I will admit but I'm out of that danger zone and it just took a matter of losing some weight and of course dietary changes as well.

>> Yeah so yeah and Doctor was very proud of me I will say don't you find gratification in that when people take your advice and they turn their lives around isn't that great.

>> Yes.

Yeah OK let's talk about the fact we're going to talk about the dietary needs and changes the dietary changes that would make a diabetic patient need to undergo to get a blood sugar in the back back to the level where it needs to be and also that weight range and I would imagine that would be fairly simple.

>> It's a matter of eating sensibly, right?

>> It is.

And I would say different diets work better for different people.

So what you really want is something that's going to be sustainable for you both.

Too often folks need to lose weight to decrease the calories that they're eating but also to make sure that they're eating less processed food, more kind of whole foods if they're able to decrease the amount of carbohydrates they're eating especially those processed sweets and so forth can be helpful as well.

>> What about alcohol?

>> So alcohol we often think of as sort of empty calories so I would say in moderation yeah.

>> There's a lot of alcohol that don't have carbohydrates but they do have calories.

Yeah, everything in moderation.

I kept hearing that too as I was preached to by my family physician everything moderation Mark OK, we have more calls coming in.

>> I love seeing those.

Tom is asking what exactly makes a person insulin resistance.

>> So that's a good question.

It's can be caused by a number of different things or most commonly an interaction of a lot of different things.

>> So one of those would be being overweight, having excess body weight that will increase insulin resistance.

There's certain medications that people take that also will increase insulin resistance.

So for example, steroids like prednisone but are also other medications that can increase your insulin resistance.

And then we know there's also a genetic component to it as well.

>> Yeah, and I want to ask you about that too.

And we were talking about some of the causes of diabetes and it can be handed down to you as I mentioned earlier in the show about the type two with my mother developing.

>> She wasn't born with it.

But if you have a parent who is actually type B type one, is there a good chance that you could be type one?

Would you know that eventually or would you know it soon early in your life ?

>> Yeah.

So there is both a genetic predisposition to Type one diabetes and type two diabetes, different genes and we don't fully understand the interaction of all of those.

>> But you would be at increased risk and type one diabetes even though we think of it as a childhood onset diabetes actually can develop at any age.

So it's not uncommon or unheard of for adults to develop type one diabetes.

>> OK, very good.

Another call coming in and it's a Lenny Lenny is asking I have heard Cinnamon is effective at curbing diabetes.

>> Is that true?

So there are a lot of supplements out there.

Cinnamon is kind of more of a spice than a supplement that talk about their ability to decrease insulin resistance.

>> Those things don't have as much data or studies behind them as medications.

So it's hard, you know, to kind of recommend one way or the other.

>> Yeah, I would imagine I guess it's worth a try anything in moderation.

Yes.

There you go.

All right.

We're still taking your phone calls.

We still have approximately ten minutes left in the program.

So please call the number on your screen talking about diabetes and of course as I mentioned earlier at the top of the show, November 15th is World Diabetes Day sponsored by the World Health Organization.

The theme for this year is diabetes across life stages.

So the underlying message here is once you have diabetes there's a good chance you're going to have this the rest of your life .

>> So we need to be able to deal with that number one number to how to treat it and try to get those levels back to normal.

>> Yes.

And to see your doctor on a regular basis.

>> Yeah.

All those things come into play one of the symptoms of diabetes so sometimes there can be no symptoms.

So that's why it's important to make sure that you're checking in regularly with your family doctor signs and symptoms of very high blood sugars.

>> People can get very thirsty and you tend to out a lot of glucose in your urine.

>> So people think of just peeing frequently and then as a result being very thirsty is something people will notice.

Blurry vision can be another thing.

Feeling weak can be another thing.

But often with type two diabetes there really aren't any symptoms and that's why it's important.

Like I said, to see your family doctor regularly make sure you're getting any recommended blood tests.

>> Are there any implications as far as mental how do I phrase that?

>> Does diabetes have anything to do with your disposition, your moods so it can so people will notice mood changes if their blood sugars are very high or very low.

>> So if you're on medication for diabetes that makes your blood sugars low.

People often get confused can can even lose consciousness if their blood sugars are low enough and also when blood sugars are high, people also don't don't feel well.

>> Yeah, OK.

The other question I had you you might have diabetes.

You don't know you're going to go to the doctor.

How is it going to be diagnosed ?

So it's diagnosed through a blood test.

There are actually a few different tests that can be used kind of depending on the circumstance but through one of those blood tests that's usually blood drawn.

>> Oh, I see.

OK, um where should one start?

>> And people are probably saying yelling this answer is there watching but it's very important.

But where should one start if they believe they have those symptoms diabetes and they want to see if they have it or not?

>> Yeah so I would recommend starting with your family doctor and they can talk to you about what symptoms you have, what risk factors you might have for diabetes and then determine what testing would be appropriate.

>> OK, and you have to be necessarily referred to a specialist not necessarily so most folks with Type two diabetes do not need to or do not end up seeing an endocrinologist usually the family doctors can manage but type one is a different story type one most folks with type one we do have see endocrinologist they'll be on insulin sometimes insulin pump so it can be a little bit more complicated.

>> I see.

And what about the ladies who have the gestational diabetes?

>> How is that treated during their pregnancy?

So sometimes that can be treated with diet changes alone, sometimes with oral medications and sometimes with insulin and that's usually will be diagnosed by your O.B.

or family doctor during pregnancy and sometimes people will see maternal fetal medicine as well.

>> The next thing I would ask and in fact their caller Kathy has a question regarding this I let that question take precedence before I ask this, but I want to get into the effects of diabetes to the body and possibly to the brain if you don't have it treated.

But Cathy is asking can type to cause skin problems like ulcers.

>> It can so diabetes can cause a number of different conditions.

Some of those affect small blood vessels so that can and nerve so you can develop neuropathy where you're not able to feel well at the bottom of your feet you can develop retinopathy so damage to the eyes and so folks can also get what we call peripheral vascular disease.

>> So poor circulation to the legs and so that combination of poor circulation to the legs and then also the neuropathy not being able to feel the bottom of the feet as well can definitely predispose folks foot ulcers, other kind of ulcers and then diabetes also can sometimes impair wound healing.

>> So once you at the ulcer it can be hard and it can also be hard on the organs.

Yes, other organs.

So that part increases risk of coronary artery disease or heart disease and also increases risk of stroke.

>> Oh wow.

Oh yeah.

We're talking serious stuff here.

How many people you think walk around?

We talked about the percentage about ten percent of Americans having diabetes.

>> But how many of that percentage no.

They have yes the ten percent are folks who've been diagnosed with diabetes and then there's another group of folks who have not had testing, don't see a doctor regularly and so don't know that they have diabetes.

>> So the people who don't really know they have diabetes but probably do what are their reasons for not having those symptoms checked out?

>> So there can be a number of reasons.

Like I mentioned, some people don't have any symptoms so they are not aware that they need to get any testing.

>> True.

Other folks don't have a family doctor that can be for a variety of reasons sometimes that can be due to, you know, not having a lot of family doctors near where you live, difficulty getting to the doctor, difficulty having health insurance or you being affordable to go to the doctor so there can be a variety of reasons can diabetes be fatal?

>> It can so both have blood sugars get very high or very low but then also due those other kind of complications, the other organs that can also be quite serious.

>> Yeah.

So we know that there are treatment options as well as ways to prevent diabetes but do we see a cure on the horizon?

>> So a lot of people are doing a lot of research into diabetes and sort of approaching the cure from different aspects.

So I think really it's going to have to be multifactorial both addressing the issue of preventing Type one diabetes and then also how to prevent and cure type you diabetes.

I will say we've made a lot of progress especially on treatments for Type two diabetes and then technology like insulin pumps and so forth.

>> Yeah, we've talked about the insulin pumps, the patches, the insulin injections wasn't there at one time a pill that you could take like an insulin pill.

>> So not an insulin pill but there are other oral medications for type two diabetes that can be quite, quite helpful and there are also some injectable medicines for type two diabetes that are not insulin.

So those are other options.

So we really have a lot more treatment and also prevention options than we used to have and I would imagine that because we're all individuals, everybody has their own case.

>> No two people are exactly.

Yeah.

Yeah.

OK, we have a couple more minutes left in the program and I wanted to ask you if somebody had some questions and before they even called their doctor to check out symptoms and also learn more about diabetes, what is the best source for that right off the top of your head?

>> So there's a number of great resources.

>> The World War the World Health Organization has some great information also known as hoo hoo WHL.

>> The Centers for Disease Control also has a lot of statistics and information about diabetes and the American Diabetes Association also has a lot of information on their websites and of course your family doctor and people like you are well versed on that as well and so with the last minute or so in our program where I guess the question would be what would you like to tell our viewers as maybe some what I call take home points about diabetes in general?

>> Yeah, so and we've talked about kind of the three main types of diabetes we've talked about the fact that sometimes folks might not have any symptoms or you could have symptoms from diabetes.

So important to be seeing your family doctor regularly to get checked out both for diabetes and for other things and then just to be aware that there are a number of things we can do if folks have pre diabetes to help try to prevent development of diabetes and the different treatment options for diabetes as well.

>> Yeah, very good.

Well, you've been very informative.

We thank you for coming on the program tonight and we thank you for watching and for all the questions we had as well.

Of course we are here every Tuesday night at seven thirty four HealthLine on PBS Fort Wayne, we thank you very much for your phone calls and your viewership and of course your support for the station until next time.

>> Good night and good