>> Lori: Just ahead on Being Well, we'll talk about diabetes and what you need to know to both prevent and treat this disease.

My guests are registered dietitian Jan Coombs, and RN Leighsa Cornwell from the Paris Community Hospital Family Medical Center, so don't go away.

Ladies, thanks for coming on Being Well, we are talking about a very important topic today, and that's Diabetes, and we want to get everybody up to speed on what the disease is, how to prevent it, and if you have it, how to manage it.

But let's first start talking about, tell us what is diabetes, exactly?

>> Leighsa: Diabetes is an endocrine disorder.

First of all your body needs energy to do its day to day functions.

You get that energy from eating foods.

When you eat these foods, especially Carbohydrates you body breaks them down in to Glucose, it goes into your bloodstream, and in order to get the glucose from your bloodstream, into the cells to provide energy, you have to have insulin, and that is a hormone produced by your pancreas.

Insulin is the key that unlocks the door to the cells.

When you have diabetes, when you first get it, you are a type 2 diabetic, your cells become resistant to the insulin, therefore your glucose can't get into the cells to provide energy and that's where you get your high glucose.

Eventually as the disease progresses, or if you are a type 1 diabetic, your pancreas stops producing insulin altogether, and that's when you have to do like the insulin shots, to treat that.

>> Lori: So, why is it that, what does it do to the body if you have diabetes?

Why is it so hard on your body and your system?

>> Leighsa: High blood glucose over time has many complications.

It damages the small blood vessels in your body, especially in your eyes.

You can develop retinopathy that eventually leads to blindness, neuropathy in your feet and your legs, loss of sensation, can lead to amputation, kidney damage, you know eventually leads you to kidney dialysis, and/or transplant, and eventually death if you don't take care of yourself.

>> Lori: So a lot of things.

It may sound like a simple disease, if you are diagnosed with it, but it can get complicated as time goes on.

Let's talk about some of the people out there who are at risk for getting it.

Talk about some of the risk factors.

>> Jan: Obesity is one of the major ones.

People who have been gestational during their pregnancy, and maybe had to go and use insulin during that nine-month time period, they are more prone to becoming diabetic after their children are a little more older.

>>Lori: Other Risk Factors?

>> Leighsa: Genetics play a huge role.

If you have a sibling or a parent who has diabetes, that puts you at increased risk.

Also, sedentary lifestyle.

>> Lori: Yes, and we'd talked earlier about some of the, you'd talked about the numbers, it's really astonishing how many people have it, or are going to get it.

Can you talk about that?

>> Leighsa: Absolutely.

Currently here in the United States, there are roughly 26 million people who have the diagnosis of diabetes.

Of those 26 million, seven million people have it and don't even know they have it yet.

Every 24 hours, there are 4100 new cases of diabetes diagnosed, and it's a growing epidemic.

>> Lori: That's a lot.

So, what can we do to before we start talking about it you have it, what can we do now to prevent it in the first place?

>> Leighsa: Eating right.

>> Jan: Well, you know, it's really interesting when you go in to see the doctor for routine visit, oftentimes now they will take blood work and we are now trying to reach people at that stage we call pre-diabetes so that we can help them even more, earlier on, so the damage will not be as progressed as quickly.

>> Lori: Well, we started talking about you know we do pre-hypertension numbers, now there are starting to test for pre-diabetes.

What are you know we know, we talk about high blood pressure, of course, what are the number for blood sugar?

What's normal, what's pre-diabetes, and what diabetes?

>> Jan: 70-100 is what we hope everybody is at.

When we see it go to, oh, what are we looking at now, 120, we are full blown diabetic at that point.

>> Leighsa: 101-125 is pre-diabetic, and then anything over 126 or greater on two or more occasions is considered diabetic.

>> Lori: Ok. Now we often hear that there's a connection between diabetes and heart disease.

Can you explain why those two are so connected?

>> Leighsa: Absolutely.

When you have diabetes, it increases your risk of the cardio-vascular disease, heart attack and stroke, one major reason that is, is because when you have high blood glucose in your blood vessels, over time that damages the lining of the arteries, and your blood vessels.

Therefore, it is easier for the plaque to build up, such as cholesterol, and when we know when cholesterol builds up in our arteries, it causes heart attack and stroke.

>> Lori: Is that, will a majority of people who have diabetes have heart problems as well?

>> Leighsa: If you don't take care of yourself.

They key there is exercising, eating right, >> Jan: And what we find over time is that blood pressure issues, cardiovascular problems and diabetes kind of walk hand in hand.

And if you can work with one, and get it under control, you can help work those other two into not getting worse at the speed that they might accelerate otherwise.

>> Lori: You had mentioned earlier about Type 1 and Type 2.

Can you clarify for our viewers what's the difference between Type 1 and Type 2 diabetes?

>> Leighsa: Sure.

Type 1 diabetes used to be more referred to as Juvenile diabetes.

When our younger population our children get diabetes, typically it's Type 1.

Young adults can be diagnosed as Type 2, but what Type 1 is, is basically your pancreas does not produce any insulin whatsoever.

Therefore, you have to do the multiple daily insulin injections, and/or an insulin pump.

Type 2 happens in our obese adult population most often.

And it's where you body produces insulin, but your cells become resistant to it for one, and two, over time you can actually stop you know, making insulin.

Type 2 diabetes is happening more and more in our overweight children population.

>> Lori: Yeah, that's what I was going to talk about.

Talk about what's happening, you are probably seeing younger patients more and more.

>> Leighsa: It's definitely a growing epidemic with our younger, overweight children.

>> Jan: Grade school, Junior high, high school.

And they often show with elevated blood pressures, they may even have elevated cholesterol levels, which is reflective of possibly the diet that they are consuming.

And they utilize the fast food restaurants as much as they do.

>> Lori: So, let's talk a little bit about there are some signs for diabetes.

Can you talk about those?

>> Leighsa: Yes.

Signs are being extra thirsty, frequent urination, extreme fatigue, unusual weight loss, blurry vision, there are several signs that you know, signs and symptoms that go into it, but many Americans don't have any signs or symptoms at all.

And that not, I mean, that's why there are seven million walking around who don't know that they are diabetic because they don't have these signs and symptoms.

>> Lori: How much does your chance of getting diabetes increase if it's a family history?

Do you have any idea of predisposition to it?

>> Jan: I would say there's an elevated risk for it, and oftentimes, you will see people who are Type 2 diabetics, who will have a younger sibling, or maybe a mother, or grandmother or grandfather, there's really, it doesn't discriminate, everybody seems to be open to the possibility.

And some of them just realize it over time.

It's likely going to happen to them.

And some of them are more accepting of it, and others, but it is something that does go through families pretty much all the time we see it.

>> Lori: Let's talk accepting or not accepting.

Do you see people that just are in denial about it, or just think, oh, no, it's not that bad.

You know, I can take insulin, I can take a pill and it'll be fine.

>> Jan: Well, unfortunately, that's the thing that we see quite often.

A lot of the times, the people who accept it and embrace it, will realize that there is something that they can do about it, those are the patients that we work with that generally do very well.

And they will be able to monitor their sugars over time, and keep them in check and do the right thing by themselves.

SO there is a way to adapt to a healthier lifestyle.

And we do see it.

>> Leighsa: We do see it.

>> Jan: And we get excited when we see it.

>> Lori: Well, that brings my next question.

Let's talk about managing diabetes.

If you have it, give our viewers some tips on what they can do to better manage their diabetes.

>> Leighsa: First of all, it's going to be eating healthy.

Eating a well-balanced diet.

Two is exercise.

Get moving.

Recommendations are thirty minutes most days of the week.

And diet and exercise alone in maintaining a healthy weight, healthy body-mass index will greatly reduce your risk, and help manage if you already have diabetes.

>> Jan: And It's important to let people know that they can do housework, and it counts.

Doing windows, vacuuming, keeping active burning calories is really the heart of the issue of activity.

And of course, we would love everybody to get on a treadmill, but that isn't always the case.

But even people who live in multistory house, they can do stairs, like purposeful trips up and down the stairs to do things, and that a part of keeping the calorie burn going.

Which is what we are trying to do.

>> Lori: That's right.

Speaking of calories and food, you brought some things together to, can you explain your demonstration for us?

>> Jan: Well, probably the most important thing for patients to realize is that the fuel source that provides them with energy is carbohydrate based.

And most people will come in to Leighsa and myself and they will wonder about completely giving up carbohydrates, which is erroneous idea, because carbohydrates are the fuel.

What patients need to learn over time is that the type of carbohydrate is what is really, really important, and the more nutrient dense those carbohydrates are, the more they are complete in their nature, with the fiber intact, and more closely attuned to where they came from in their cycle as garden vegetable, or starches, those are healthier carbohydrates.

And they are essential to everyone's life.

So, leaving the refined sweets, the things that we think of as snacky foods, those are things that if people can put those aside, they can be worked into daily diet in small amounts, but they power of their carbohydrates is so strong that it actually works against their blood sugar numbers on a daily basis.

>> Lori: So, for diabetics, when you look at food levels, carbohydrates, that's probably most important thing to look at?

>> Jan: It's a dovetailing thing.

Because we see people having all the different aspects, the blood sugar issues, and the cardiac problems, we know that people need to keep their routines lean, know that they need to be looking at fats, that are the healthy ones, as opposed to their hydrogenated that come in a lot of processed foods.

So, if they can look at those two components of the macronutrients and then get into gear the right kind of carbohydrates, they are going to be successful.

>> Lori: So, on this plate you have some things to show us to compare carbohydrates.

Why don't you go through that?

>> Jan: Absolutely.

Leighsa and I both work with calorie levels.

That's unique to patients.

So once we realize that a patient needs to start watching their calories, and carbs, we can determine how many carbs they are after on a daily basis.

And just the aspects of looking at food as you see it here, there's a reason I put everything in a measuring cup, because measuring is really important.

>> Lori: And portion sizing.

>> Jan: I liken this unto gasoline going into a car.

That people know exactly how much fuel is entering their gas tank before they leave the gas pump.

If you know how much carbohydrates are going into you tank, you can better realize how you are going to function.

And so as you look at vegetables, as you see here, these are each worth about 5 grams of carb apiece.

The slice of bread is worth about 15, so if I see three different servings of vegetables, which I am really keen on having people eat, because they are an intact nutrient, they are going to get as much blood sugar expression from this piece of whole grain bread, 15 carb, as they will from three vegetable servings.

>> Lori: So, if you are interested in volume of food, the three, these vegetables are going to give you more volume, make you feel a lot more full, than the one piece of bread.

>> Jan: Absolutely.

>> Leighsa: But the bread is not a bad thing.

>> Jan: The bread is not a bad thing.

When people come in and they are worried about whether they should eat pasta anymore, and it's actually a matter of amount, and by learning what those carbohydrate amounts are that are appropriate, they can make the choices themselves, how they put those into their system.

>> Lori: So, for diabetics, I know it is probably different for everybody, but is there a recommended grams of carbohydrates that they should shoot for everyday?

>> Jan: Absolutely.

It's based on their weight, on their age, and their activity level as well.

SO the more active they are, the more they can justify eating more carbs, which is kind of a nice thing.

When you are looking at poundage, the average woman, middle aged, can probably tolerate about 1500 calories a day.

Her carb needs at that point are about 60 to 65 grams of carb per meal, and that allowing three meals per day, plus a snack before bedtime.

>> Lori: Ok. >> Jan: Which we do recommend.

>> Lori: Which really for people who don't have diabetes, probably not a bad plan to follow anyway.

So, >> Jan: It's not a bad plan to follow.

>> Lori: You know, if you've got a family where your spouse has diabetes, it's really not a bad-eating plan for anybody.

>> Jan: You are really hitting it on the head, right there.

Because we do find that if people in the lifestyle situation will allow their family members to be active participants everybody gets healthier, and it's really much more positive for the person who has to watch what they are doing.

>> Lori: Well, let's talk a little, continuing on food, you know, there's certainly a lot of sugar-free substitutes out there, is that a free food for diabetics, because it doesn't have sugar in it?

>> Jan: That's really a very interesting question.

And glad you bring it up.

When we are looking at how the body utilizes carbohydrates and nutrients, what we find is that the clean-burning fuels, are the really, really good nutrient dense ones.

People are adding artificial sweeteners into their diet, and it might be through pop, it might come through a diet pudding or a gelatin, it might be in sugar free pie, what people need to do is learn to determine the carbohydrate content of food, because, just because it says sugar-free, and may have artificial sweeteners in it, it may not in fact, be carbohydrate free.

Because of the other components of macronutrients in that product.

Do you want to add to that?

>> Leighsa: No, I think you did a great job.

A lot of people do think though as they come in to talk to me, well, I ate this and it's sugar-free, and we always have to correct them and make sure that like Jan said, it's carbohydrate free.

And that's what you have to watch.

.>> Lori: And if you think about sugar-free pie, the crust is a lot of carbohydrates in it.

>> Jan: Well, and the fact that the fillings may have a dairy product if it's a cream pie, so it's something that with their level of understanding becoming proficient, they become more adept at those choices.

And we learn strategies, and we teach strategies, to help them make those little tweaky moves that are going to make much appropriate for what their needs are down the road.

>> Lori: All right.

Well, let's talk about blood glucose meters.

Because there are several styles and models available.

And it's an important part of every diabetic's life.

>> Leighsa: When you are diabetic, it is very important to test your blood sugar depending on what stage you are in diagnosis, and what medication, you are taking.

People normally test anywhere from once a day to four times a day.

These are some examples of the glucose meters, and they work by putting one of these strips that match your meter in, you have a lancet that draws the blood from your finger, and basically it tells you right then and there, within a few seconds what your blood glucose is.

Basically all these models here, do the exact same function, it just depends on the insurance company, which one is going to be the best route for you.

>> Lori: And the technology if you've been a diabetic for a long time, technology always gets better, and makes it easier.

>> Leighsa: It does, and these actually most of them come with a kit that we can hook up to our computer, and it actually prints out trends, graphs, so we can see over time what your blood glucose is doing.

>> Lori: So, even it, and I know there's probably nothing, no such thing as mild diabetes, but if you are diagnosed right away, you need one of these, correct?

>> Leighsa: Yes.

>> Lori: And you need to test everyday.

>> Leighsa: From the time they find out you are diabetic, that your levels are high, you need to be watching it, you need to be testing.

>> Lori: So, there's no such thing as I have a little diabetes.

You either have it or you don't.

>> Leighsa: That is correct.

And a lot of people think that I just have a slight case of it, or I have a touch of sugar, is what they refer to it as, but you either are non-diabetic, pre-diabetic, or you are diabetic.

>> Lori: But, not everybody needs insulin.

>> Leighsa: Correct.

>> Lori: Let's talk about the different stages that you can go through.

You can control it with diet, first of all.

>> Jan: Early on, most of the physicians will try people with diet.

and a lot of times, it has to do with the patient's eagerness.

Can I try this with diet?

And of course, that is a piece of it.

Your emotional aspects of life play into it, so does you physical activity.

So, it's not just the food, but food is a big part of it.

So, for a while we can get by with the food, but then oral medication can appear, and Leighsa, won't you talk about the metformin?

Every body goes on metformin.

>> Leighsa: When diet and exercise quits working, and quits controlling your sugars, the first, or the next line of defense, I should say, is a pill called Metformin.

And what Metformin does, it basically makes your cells more susceptible to the glucose in the insulin that is in your body already.

That's the next line of defense.

People often continue on Metformin even when they progress on to insulin, just because it helps them use less insulin.

There are other oral medications to help treat diabetes, or help control I should say, instead of treat, help control diabetes, when the Metformin quits working, and then when you go through the Metformin, the other oral medications, then comes the Lantus, or comes the insulin, you have Lantus, which is long term basil acting insulin, and then you have your mealtime insulin as well.

>> Lori: Ok, and you brought you an insulin pen, which is something new.

>> Leighsa: I did.

It used to be when you are on insulin, you had to have a vial of insulin, and a syringe with a needle, as you said, technology is always changing, and now you can get your insulin in a pen.

And you know this can stay at room temperature, you can throw it in your purse, it's very easy just to dial up your dose, and then, you know, the needle on this is much smaller than the old syringe and needle that we use, >> Lori: I mean, when you held it up before, I could hardly see the needle, it's very, very small.

>> Leighsa: And when somebody becomes a diabetic and I am discussing the progression of the disease, and the progression steps of treatment, I always point this out, because it calms a lot of fears.

Because they are used to the syringe, and needle, and when I hold this up, and then can hardly see it, then it kind of calms their fears a little bit, but very convenient, very easy to use.

>> Lori: So, that's good to know.

Let's talk about, and we've got about four minutes left, do people, if they are diagnosed with it, it's got to be a very frightening, you know, you think about long-term, you've got to change your lifestyle, give people out there, some advice or some tips for you know, how they can manage this disease, and live a long and healthy life.

>> Jan: Well, the first thing I would recommend is become knowledgeable.

Learn all you can about the disease, and realize the team members, including your doctor, our nurse educators, and myself, dietitian.

WE really do enjoy becoming team members with the patient and their caregiver, and getting everybody in to a regular appointment so that they have a chance to ask questions, follow through on it, makes them feel more confident with going through with the practice of controlling it.

>> Leighsa: Depression also is a big factor with diabetes.

A lot of people with diabetes have depression, just because it gets frustrating, and they feel down, you know, dealing with this disease.

SO talking about that, if you have feelings of depression, and feeling down, definitely talking to your physician can help with that, diabetic support groups, there's even diabetic support groups online, to help just talk, and kind of vent frustrations that go along with the disease to other people who are experiencing the same.

>> Lori: And what about for family members, or spouses, you know, children of diabetics, what can they do to help you know, mom or dad who has it, or a sibling?

>> Jan: I think one of the features of working as we do at Paris at the Hospital and the clinic, invite family members to attend with the patient, and that's really a big part of it, to let them all learn, as mom or dad, or brother or sister goes through the process of understanding it themselves, that just gives them an insight into what is going on.

Having them help in the kitchen, I find is valuable.

Letting them go grocery shopping, look around for what's the carbohydrate content in some of the foods that we enjoy and see what we can fit in.

Because everybody likes pizza night, everybody wants to you know, keep things normal, but they need to learn how to strategize those family times.

>> Leighsa: Be supportive, help them get motivated, adjust, say hey mom, hey dad, I am gong to go for a walk, will you go with me?

Helping them get motivated and active and just being supportive all the way around.

>> Lori: So, with proper management, this is something that people can live a long and active life with?

I mean, it is a scary disease, >> Leighsa: Scary.

>> Jan: Very, very frightening, >> Lori: But with the help of family members, and people like you, people should be able to live the life they intended to.

>> Leighsa: On one of the seasons of "The Amazing Race", there was a contestant who was a Type 1 diabetic, has been since she was real little, on an insulin pump, they won.

They won the Amazing Race, and you know, I've had the great pleasure of hearing her speak, and talk about her challenge, and they didn't give her any special treatment, so if, you know, if somebody on the Amazing Race, being a diabetic and being on an insulin pump, diabetics can do anything.

>> Lori: Well, I'm a cyclist, and the gentlemen that I bike with is a Type 1 diabetic, and he can beat us all up the hill anytime, he is an amazing athlete, and you know, just takes really good care of himself, you know, eats right, and exercises and just keeping it all in check so that you can continue to live life like you want to.

Well, thank you both for coming on and sharing such good information with us today.

>> Jan: Thank You >> Leighsa: Thank you.