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Hello, I'm Jennifer Blomquist.

Thanks so much for tuning in to HealthLine tonight.

I appreciate that and I have the privilege of just being up excuse me being the host of the show tonight we have a guest who's with us tonight who's an endocrinologist.

She's fabulous.

She's been with us before.

A lot of people out there are dealing with endocrinology related issues in particular we're going to talk about diabetes because it's diabetes awareness Month for November.

So perfect timing with that.

So take advantage of getting some really good advice tonight.

Maybe you have an issue for yourself or maybe you have a loved one or friend and you want to ask a question so everything tonight is free including the toll free phone call that you can make.

It's (969) 27 two zero.

That's if you're in Fort Wayne .

If you're outside of Fort Wayne it's still free putting an 866- in front of their will make a toll free call and we are live here in the studio right now.

So you have a question can I ask you a question live?

You can do it that way by calling the number you can also when you call in relay a question to the call screener and then they can give it to me and I will ask the guest the question for you so two ways to& do it.

>> It's great if you can ask it live because then you can interact with the doctor and maybe get more information.

So let me go ahead and introduce you to our our guest tonight.

This is Dr. Emily Shrader.

She is an endocrinologist like I said, she has been with us before.

>> Great to have you back.

Thank you.

Thanks.

Glad to be here.

Well, I we wanted to talk about diabetes and I would imagine pretty much everybody watching either knows somebody who has diabetes or has it themselves but there's a lot more to it.

>> There are different kinds of diabetes and lots of different things maybe you could do to manage it or maybe prevent it.

>> So why don't we start with what what diabetes is and the different type?

Yeah.

So diabetes is a condition in which patients blood glucose or blood sugar is elevated and that can be for different reasons and then those high blood sugars can cause other problems or heart problems damage to nerves, eyes, kidneys and so forth.

There's two main types of diabetes.

So Type two diabetes used to be sort of thought as diabetes that comes in when people are adults.

But we've also been seeing increasing numbers among adolescents.

So that's where the main problem is that the body can't use insulin properly.

There's insulin resistance and then type one diabetes used to be thought of as childhood diabetes.

That's an autoimmune problem in which the body makes antibodies that attack the cells in the pancreas that make insulin.

So that most commonly occurs in children but also can be diagnosed in adulthood as well.

And people with type one diabetes require insulin treatment and people with Type two diabetes.

>> There's a wide range of treatments that people can receive and that is on the list& gestational diabetes which I did work with a man whose wife had that and it was very difficult.

>> So that's just during gestational diabetes is diabetes that develops during pregnancy.

So during pregnancy there's naturally an increase in insulin resistance and sometimes that's can the insulin resistance can be too much in people's blood sugars can become high.

So that's treated during pregnancy and then often blood sugars will go back to normal after the end of the pregnancy.

>> But sometimes people can then develop type two diabetes later on in life .

>> OK, and I was shocked at the number because you gave me some statistics.

>> Diabetes affects thirty seven million Americans.

It does.

It does.

And in Indiana among adults about 12 percent of adults in Indiana have have diabetes and about a third of adults in diabetes in Indiana have pre diabetes, which is a condition that puts you at increased risk of developing diabetes.

>> I have seen some commercials and I don't know why they always use cute farm animals.

I've seen it with hedgehogs and I think with goats it's like a public service announcement where they ask you questions and it's supposed to gauge your risk of diabetes or maybe prediabetes.

>> So you know, I want to ask you about some of those questions and if that's going to give you a good idea and you get to the point where you're at risk, can you still prevent it from happening?

>> Yeah.

So there are sort of risk questionnaires out there and so you can enter and information about yourself, about your family.

It's usually just about five or six questions and based on that they can calculate your risk of having or developing diabetes.

They're also simple blood tests that your doctor can do.

And so if you're concerned about that, make sure to talk with your doctor about what sort of testing would be most appropriate.

So if you take the test and it shows that yeah, you're likely to get it, can you put the brakes on it at that point?

Are there lifestyle changes or medications you can take that would prevent you so so there are there are a number of things in terms of kind of diet exercise that people can do so exercise can be very helpful and even just 30 minutes a day can be very helpful in helping both to prevent and also to help treat diabetes and then diet changes to help promote weight loss decrease the amount of carbohydrates that you're eating can also can also be helpful and so I growing up I don't know if they still refer to Type two as juvenile diabetes.

>> That's what how I you know, because you had mentioned it's primary so type one diabetes used to be known as juvenile start yet.

>> But we we do know that there are a fair number of adults who are also diagnosed with type one diabetes so it can occur at different times and there's not really lifestyle changes will not help prevent type one.

>> I saw you wrote this and it's technically an autoimmune disease at that point but I had thought with type two and I-guet of it as something that you know, it doesn't necessarily have to happen.

It's usually associated with people who are overweight, maybe smoke, have some you know, high blood pressure or things like that.

>> So it sounded like that was definitely more preventable than some of the other.

>> Yeah.

So lifestyle changes definitely can influence your risk of developing diabetes.

>> There's a certain amount of kind of genetic component and so some folks are at increased risk even if they're trying to follow those lifestyle changes.

So I want to remind everybody that we are talking about diabetes.

We have Dr. Emily Shrader here is our guest and she is an endocrinologist.

She has a wealth of information to share with you.

So we're going to continue our discussion but please feel free to interrupt us at any time.

That's why we keep the phone number up throughout the program at the bottom of the screen it's (969) 27 two zero if you're outside of Fort Wayne it is still a toll free college has put an 866- in front of there and again, I don't want to scare anybody off because some people are shy.

So when you call you're not just thrown on the air right away you'll talk to a very nice call screener and she will either ask you do you want to ask you a questio live or she can take the question for you and then they'll relay it to us out here we can get it answered i you call live it's nice because you can interact with Dr. Shrader and get some more information.

Maybe she has questions to ask you that would better help her.& >> So I just wanna let you know you have those two options with type two diabetes once you're diagnosed, can you I mean if you made some big changes and really improved your health , is it possible to be rid of it at some point or do you always have it?

>> So we definitely see people who through weight loss increasing exercise is changing their diet are able to really control their blood sugars and get them back in the normal range without medication.

>> So it's definitely possible especially kind of early in the course of the course of the disease.

I mean it's an unpleasant disease.

I mean there are a lot I mean I run into people all the time who are diabetic and though, you know, they'll have to say, oh, I've got to check my blood sugars.

I don't know if the finger hoaxer is coming out of most people have pumps.

>> Is that more of a combo?

They're both kind of the traditional way of checking blood sugars would you your finger and you drop a blood there on the test strips.

There also are these continuous glucose meters which more and more people are using and so those have a little flexible kind of cannula that goes under the skin and people wear them for 10 to 14 days and they measure those blood sugars every five minutes or so and a lot of them you can see the blood sugars on your phone kind of oh wow.

It's really high tech now everything's gone high tech.

What what about in terms of medicaton?

Are there different medications that you give to somebody who is type one versus type two or even gestational?

>> Yeah, so there are different medications so usually well always in type one would be treating with insulin with type two they're different medication options and there are a lot of new medications out there that have been very helpful both in helping to control blood sugars and also decrease risk of other complications that go along with diabetes.

So some of these medications can help decrease risk of heart disease in the future or help decrease risk of kidney disease in the future.

So they can be very helpful both in terms of treating the blood sugars but also decreasing some of those other risks of those other health problems.

>> And I don't know if you want to even mention some of the other health issues that once you are diagnosed things that you maybe have to think about that you didn't have to think about before I it obviously it impacts what what you should be eating I guess.

>> Yeah.

So you know so those higher blood sugars can lead to damage to heart vessels can lead to cardiovascular disease, can lead to increased risk of congestive heart failure also stroke kidney problems, nerve problem so people with diabetes can be more prone to ulcers or foot infections and then also eye problems.

So part of taking care of diabetes is making sure you're getting the screening that you need.

>> So folks should be getting annual foot exams, annual eye exams and then blood and blood tests through their primary care doctor or endocrinologist.

>> Yeah, I was going to ask you what what kind of care are you looking at once you're diagnosed because I don't know if you can do a lot through your primary care doctor or how often a patient would have to see an endocrinologist who specializes in that.

>> Yeah, so often it takes a team a lot of people with diabetes are able to get their care from their family doctor.

They they do a great job but often like including diabetes educator sometimes people need to see an endocrinologist if things are getting more complicated in terms of their their diabetes.

>> But then also the diabetes educators or dieticians can be really helpful because a lot of the diabetes as we've kind of alluded to has to do with managing kind of how you're living your life at home and hopefully you're spending most of your time at home and that the doctor's office.

So it's really helpful to build up those skills so that you know how to manage things on your own.

>> So you mentioned there is there could be a genetic component to it.

So I don't know how how great of a role or not that plays or if you can give it even like a percentage like what if one of your parents had it or you know, like you said type type one and type two like does that vary as far as how much genetics play a role?

>> So for type two is really thought to be multi genetics.

So there hasn't been one gene where you know, if you have that you would definitely have diabetes but kind of probably a number of genes that each contribute a little bit.

So we definitely know people whose parents or siblings have diabetes.

>> They're at increased risk.

And as far as gestational diabetes, is that something that would run in the family maybe if your mom or sisters experienced it does that so the risk factors for gestational diabetes are similar to those for Type two diabetes.

>> So you just are kind of loading on some extra insulin resistance during the pregnancy and kind of can reveal that you might be at increased risk for Type two diabetes in the future.

All right.

That's tough to know what we have received some call so I'mpl but she wanted me to ask the question for her.

So she's asking what can I do to lower my sugar levels if I have pre diabetes?

>> Yeah.

So just sort of review what we were talking about earlier pre diabetes is a condition in which your blood sugars are a little bit high but not high enough that we would consider it to be diabetes.

So if you have pre diabetes you're at increased risk of developing diabetes but there's a number of things you can do to help decrease that risk.

So some of that would be increasing the amount of exercise you're getting if you're able to do that safely.

Making some diet changes often kind of decreasing the amount of processed foods and carbohydrates that you're eating, especially carbohydrates you're drinking pop and so forth can be helpful to decrease that and then there can be some medications that-can discuss with with your family doctor.

>> There also are programs both online and in person.

The diabetes prevention program is one that's very helpful also for people who find it helpful to kind of work through things in a group and get that group support that can be very helpful as well.

>> Yeah, I know there are some social service organizations where they'll have like diabetes cooking classes and things and I know I've I've never been to one but I've known people have gone to them and they said it's great and even you know, they share ideas and things whatever you do to kind of help other people out so well thank you, Sarah.

That was a great question.

We have somebody else who wanted me to ask for them.

So this was Fred.

Fred wants to know what glucose levels are considered concerning and when should I go to my doctor about these concerns?

>> Yeah, so that's a great question.

>> So there's some glucose levels that we would consider to be high enough that we would say you have diabetes so fasting blood sugars above one twenty six is kind of where we define diabetes or blood sugars after eating that are above two hundred in terms of ones that are considered concerning that's something you know specific to you and to discuss with your physician and some of that has to do with how long they've been elevated and if you're having any symptoms that go along with that.

So symptoms that would definitely be concerning that might develop from high blood sugar levels or high glucose levels would be if you're really thirsty you're peeing a lot to drink a lot if you're feeling weak or lightheaded or nauseous or throwing up.

So those would be signs that your blood sugars probably are kind of dangerously high and you need to come in right away.

Yeah, no good advice.

So thank you Fred.

That was a great question as well.

So Fred and Sarah called in and it was completely painless.

They just talk to the call screener and we got those questions taken care of for them again, you can do it that way or you can call in live.

We love getting those kinds of questions too.

It's (969) to seven to zero again it's toll free if you put an 866- in front of their I don't know what the correct way to say this is.

You would know but when you have diabetes do you say I'm managing it or getting it under control or what's the correct terminology like when you're when diagnosed?

>> What are what are the goals I guess yeah.

So that's kind of a number of ways to talk about we used to kind of talk about people being diabetic but we've moved towards more kind of person first language so people living with diabetes so it's not really defining characteristic of you which just sort of part of your your health problems if people are able to get their blood sugars to their goal which you can help set with your family doctor, then we usually say that they're have diet controlled diabetes so that it's not that they're not needing medications if they're at goal but on medications we usually say their diabetes is well controlled.

>> So it's typically the terminology yeah, I noticed they never say cure but you know the managing and I control so yeah.

>> All right.

We did get another question Doctor from Valerie and she wanted to know how accurate are some medications at preventing diabetes from progressing.

>> Yeah.

So most of the medications out there have been approved for treating diabetes.

There aren't so many that are approved for treating pre diabetes.

We do have a have one in particular foreman is the one that's kind of been around long enough in terms of preventing pre diabetes and there is a good study out there showing that it does decrease that risk of of developing diabetes.

There are also medications out there and there's some that are relatively new and have recently been FDA approved that are very effective in weight loss and so those can also be very helpful in terms they're not they weren't studied specifically in terms of preventing diabetes and people with diabetes, but they're very effective in terms of weight loss and so those can also be helpful.

Yeah, I it's sad that there are thirty seven million people that have it but I did once hear a physician say in a way though when you have that many people affected there's going to be more research and more progress aid maybe compared to some other diseases.

>> So then it gives patients different options or different things to look at I guess it's one positive of that.

>> So those are all great questions we've had tonight from Fred.

Sarah Vallerie, appreciate you guys calling in again.

Feel free to interrupt us at any time.

We're going to continue our discussion about diabetes but I'm sure somebody out there has a really good question to ask just like our other viewers did tonight.

So feel free to call it any time we keep a phone number up at the bottom of the screen.

I wanted to make sure that we got this in but you said there are the ABCs of managing diabetes and I don't think we went over the last time we had you on the program we did not.

>> So the ABCs have been around for a while sort of a helpful mnemonic to for people to remember some of those goals that they should have if they're living with diabetes so that a is for an agency test which is a way of assessing your blood sugars over the previous three months.

So that's a test a blood test you can do at your physician's office and then B is for blood pressure because it's very important to make sure your blood pressure is well controlled in general but particularly if you have diabetes and then C is So that would be another blood test that you would do at your physician's office because we know especially in diabetes having elevated cholesterol levels can increase your risk of heart disease.

So those are the ABCs agency blood pressure and cholesterol and then a lot of that stuff I mean I hear that most people do a lot of this stuff at home managing you know I mean obviously the blood work you'd have to go to a laboratory but there's so much stuff and even you were mentioning with technology related to your phone and all sorts of monitors, it definitely seems like it's more I guess more easy to deal with it today than maybe it was years ago when I was growing >> But definitely more tools, more medications of course then you can kind of get lost in all the numbers at home.

So yeah, you know, has its pluses and minuses to always keep in touch with your doctor though.

Don't try and look at something online.

That's what my doctor said hates all those online things and people go to them and he said it's better to stick with your doctor so I will well we got another call tonight from Marilyn.

Ah Marilyn sorry.

>> She wanted to know if drinking too much soda can cause diabetes.

Yeah.

So that's another excellent question.

It's always difficult to link one particular thing to causing diabetes so we hate to sort of point a finger at one specific thing but we do know that in general soda or pop or sugar sweetened beverages in general don't aren't very beneficial or don't they a lot of healthy nutrients to folks and they do have a lot of really just carbohydrates and sugar in them.

So we do recommend staying away from pop soda and other sugar sweetened beverages.

>> I've always thought about diet soda though I know it's an artificial sweetener so I don't know what that allows you to cheat a little bit more so sometimes although studies have have shown that some of those sugar substitutes they cause people just to consume sugar at other times of the day so they're not really as satisfying as you might think as you're consuming them.

>> Yeah, and a lot of people feel like they have to have something to eat with a soda.

I mean I don't versus like drinking water.

>> I don't know that it does something to your taste but I think OK, well we have one more caller who wanted to know I guess Jenny said she's been off her medication for a couple of months because it was on back order.

I hear that a lot at the pharmacy I was finally able she said to get it back.

>> But is it safe to start taking it again?

So that would be something to discuss with your physician?

That's an excellent question.

There has been one certain class of medications which are called GLP one receptor agonists.

They're injectable medications but they're not insulin.

I think that's probably Agenus been talking about because there's been a huge shortage and demand for these medications in part because there are often so effective some of those medications we do start at low doses and then titrate up because otherwise it can cause some side effects.

>> So we generally recommend if you are not able to get your medication you really should make sure to reach out to your doctor and see if you should be on a different medication instead while you're waiting for your medication to come in and then once you've gotten it back it'll depend on what the medication, what the doses and how you've been doing on it before whether they want you to start back just at the same dose you're on or kind of do that titration again.

So definitely reach out.

I'm glad you were able to get the medication because that can be difficult and then definitely reach out to your doctor to find out whether to restart just at the dose you were on before.

>> Yeah, I feel I hear that allt medications.

You know they're on back order or a lot of times here in Fort Wayne , you know, there are all these chains of pharmacies.

>> They'll say well our store up north has it.

We can get it, you know, the next day.

But it could be a little frightening especially for diabetes when you times need that stuff every day.

>> Yeah.

So definitely if you're having difficulty getting your medication because of supply issues, your pharmacy doesn't have it or some of these medications can be really expensive.

So if you're having trouble affording the medications, make sure to let your health care provider know because sometimes there can be substitutes it can give you or sometimes their patient assistance programs you might qualify for and but your health care provider won't know unless unless you tell them.

>> Sure.

All right.

We're going to try and squeeze in one more Doctor Schrader.

Let's see, Jean, whether you know how much can an agency get to be considered safe?

I guess so that's that's the blood.

Yeah.

Blood test.

Yeah.

So that's a blood test that sort of reflects your blood sugars over the last three months and that's an excellent question.

We used to try to get everyone to kind of the same number and now we've realized that different agency goals are appropriate for different people depending on how old you are or other health care conditions that you have.

>> But in general again you would want to discuss this with your health care provider but in general we aim for an agency less than seven and that would be considered control.

But in terms of safe, it's hard to kind of give a precise number.

But the lower the closer it is to seven that would be better.

>> Yeah, we hear that.

I hear that and a lot of the commercials are medications.

You know, they'll they'll talk about their they specifically will talk about that agency level so I'm going to try and squeeze in one more question really quickly.

Mary wanted to know is it common to get nodules on adrenal glands?

>> So that's a great chronology question not related to diabetes but it actually is fairly common to have adrenal nodules and lots of times they can be benign and not cause any issues.

>> Sometimes they can secrete different hormones.

So sometimes your doctor will have you do a series of blood or urine tests to make sure they're not causing any problems or have you repeat imaging to make sure that they're not growing.

>> All right, great.

Thank you so much Cash.

We had a flood of calls nobody wanted to call I that hey, I'll take it getting the questions in one way or the other.

>> So we appreciate that.

And just real quickly, if you want to reinforce you're talking about lifestyle changes and I think that scares people sometimes like oh, I don't know if I could do this, you know, walk every day for thirty minutes but I know you've emphasized in the past taking it slow.

So really the key is to start where you are and think what it is that you can add and even little changes can make a big difference.

>> So if currently you're not doing anything if you can just get up and walk for five minutes at a time that'll make a big difference and then we'll make it easier for you to kind of build upon it so you don't have to start with training for a marathon.

You can start with activity that's you can do around the house and is easily accessible and the same thing with diet you can make small changes and then build from there.

>> So yeah, I always laugh because my father unfortunately he's passed away years ago but when he was living that was his biggest thing was the food thing and he didn't want to go see a dietitian because he thought she was going to be mean to him and I'm amazed all the again at these cooking classes they have and things there's they're definitely options.

There are there are a lot of options.

You can still eat food and be happy so.

Well, Dr. Shrader, our time is up.

It's so great to have you back.

Thank you.

I know I learned a lot and hopefully all of you did as well.

Appreciate all the calls tonight.

Take care.

And we have another HealthLine coming up one week from tonight and of course next week's Thanksgiving.

So I won't see you until after that.

Have a great holiday.

>> Take care and we'll see you next week