well hello and welcome to HealthLine on this Tuesday night.

I'm Jennifer Blomquist.

I have the privilege of hosting the program tonight.

This is a live show in case you're new to our program Dr. Emily Schrader who is an endocrinologist and we are live in the studio right now and doctor is going to take your questions you may have tonight we're going to be focusing on diabetes so there's a number at the bottom of the screen (969) 27 two zero.

They keep it up there throughout the program and you can call it any time the show only lasts half an hour and a lot of times if people call they wait until the end of the show and sometimes they get kind of busy with other calls.

So I would call sooner rather than later.

And again, if you have a question about diabetes, please chime in at any time.

We have some things we're going to talk about but feel free to interrupt us at any point everybody Dr. Shrader, everybody is probably somewhat familiar with diabetes or they probably know somebody who has diabetes before we go any further, can you just make sure that people understand that the difference between Type one diabetes and type two so in both Type one and Type two diabetes there's an issue with insulin so mainly which is a hormone made by the pancreas that helps our body use glucose and other food that we eat.

So type one diabetes is an autoimmune condition in which the pancreas is not able to make insulin.

So that's what's often thought of as childhood diabetes but also can develop later in life .

So individuals with Type one diabetes need to take insulin.

Individuals with Type two diabetes is primarily an issue of insulin resistance so the pancreas is able to make insulin but the body for a variety of reasons isn't able to always use it well.

So individuals with Type two diabetes may or may not need to take insulin and that usually develops later in life in adulthood and like you said, type one, I always associated that with juvenile diabetes but that's that really doesn't have anything to do with your lifestyle per say, is that right?

>> It doesn't know.

So it's an autoimmune condition in which the body is making antibodies that kind of destroy that part of the pancreas.

So it's not related to lifestyle or anything like that.

>> So if you have a child who has that I mean when would you know is that something detected when they're an infant or they usually a little bit older so usually older than infancy but it can really develop at any time and often what will happen is kids will they can start losing weight or feeling sick and then kind of the classic sign is kids become very thirsty and they're paying a lot.

And so if something like that happens, we just encourage folks to talk to their pediatrician as soon as possible or their family doctor and they can have testing done.

>> Sure.

Yeah, I know we have a lot of grandparents who watch the show so those are some things to think about and at least one children are really young.

They're going to the doctor a lot.

So that's one good thing is maybe that if the parents are grandparents it's about something maybe the doctor and sometimes and younger kids what you'll see like preschoolers is they've been well trained and then they start wetting the bed at night and sometimes that can be a sign.

All right.

Good to know Type two is the one I think maybe people know more about because we're always getting lectured about right and for a good reason that that is preventable.

>> So about ninety five percent of diabetes in the United States is from type two diabetes and usually that develops later in life and as I said is related to insulin resistance which sometimes can go along with obesity or with lack of physical activity.

But there's also a strong genetic component so it's not always related exactly to people's lifestyle but often there's things you can do in terms of addressing lifestyle issues to try to treat or live better with Type two diabetes.

>> So I've seen some pizzas and like in the past couple of years they use animals in these pizzas to make them interesting.

>> But they they give you a little test to take if you are pre diabetic.

So could you talk about that and I mean is there I mean these are like questions like you know, how would you describe your weight?

>> Are you normal?

A little overweight, very overweight stuff like that?

>> Is that a good indicator?

Yes.

So there's a series of questions that have been developed in the American Diabetes Association has it on their website as well as other places that you can go and ask questions about your age weight ,family history, physical activity to kind of give you a sense of whether you might be at risk for diabetes or have diabetes.

And currently in the US about one in three adults has pre diabetes and about one in ten adults has diabetes.

So it's very common there also blood tests that can be done so often people's family doctors will test them periodically to see if they've developed diabetes.

Is that something if you know if you're going to hopefully people go about once a year to the family doctor, is that something special you should ask for or because I know a lot of times they just do labs and I don't know what exactly they just call me and tell me it's normal thankfully the couple of days later but I wasn't sure what all they normally would check.

>> So it kind of depending on your risk and age it might not be checked every year but it would be something you could talk with your doctor about.

OK, perfect.

>> Before we go any further, I do want to remind everybody that Dr. Schrader's only here till eight o'clock and she is more than happy to answer any questions you may have.

She is an endocrinologist so the focuses heavily on treating diabetic patients and so that's something that like I said it probably if it doesn't impact you yourself I'm sure you know somebody maybe a friend or family member if you have any questions at all, please give give us a call so she can answer your question.

And I want to tell you about another option you have if you're a little shy and maybe don't want to ask it live during the show perfectly understandable.

Jim is on phones tonight and he will talk to you.

He doesn't just throw you on the air but he'll talk to you first.

No matter what.

And if you prefer you can just tell Jim your question and then he'll pass it along to us and we'll ask it for you without you having to go on the air.

So I just want to let you know that's an option (969) 27 to zero is the number to call if you're outside of the Fort Wayne area, it's still a free call if you put in 866- in front there and again phone lines will be open to about eight o'clock with the prediabetes is I have heard that that you can reverse that.

I mean even if you're on the verge of having diabetes, can you talk about three different steps people can do in terms of both lifestyle steps in terms of both treating Type two diabetes and then also treating pre diabetes?

So there is a program called the Diabetes Prevention Program which is a series of classes teaches folks about diet, exercise and lifestyle changes and so sometimes with weight loss and with those other changes people can either reverse or prevent the development of diabetes and it's is definitely easier said than done especially depending on what generation you are, you know, like I always joked about my grandma there wasn't a single recipe she didn't make with a whole stick of butter in there and she didn't think twice about it.

That was just how they ate.

And of course, you know, my grandparents kind suffered from that as they get older and were overweight and had heart issues and things.

But now at least today we know more about maybe making some healthy choices and diabetes can be a complicated and often overwhelm disease.

>> And so one of the keys is really trying to identify ways to fit it into lifestyle and make changes that are sustainable for you so often involves checking blood sugars multiple times a day.

It can involve taking medications multiple times a day, can involve making diet or physical activity changes.

And so the key is really figuring out what how to incorporate those changes into your day to day life in a way that's sustainable so that you really live in your best life and not letting the diabetes control over that.

>> That is one of the I had a friend who had gestational diabetes so she just suffered from it during her pregnancy but oh her fingers I couldn't even look at her fingers because she would have to poke them so many times a day.

But yet I think ah there are other other other things people can do.

>> I've seen some things about like an insulin pump or so there are in terms of checking blood sugars there glucose meters that people often use involves taking a blood and then checking from that.

There also are now continuous glucose monitors and so these are little sensors.

They sit just right above the little cannula that goes under the skin and then a little kind of circle that sits above the skin and then either using your phone or another sort of receiver you can see what your blood sugar trends are throughout the day without doing those finger sticks.

And so a lot of my patients have a lot of success with that really enjoy using it because they're able to see the effects of the medication effects of what they're eating on their blood sugar is kind of in real time.

>> That's what I've seen or just witnessed from talking to a few people that have had Type two diabetes is it's kind of like you got to see how does your body react when you eat this or that.

And so it sounds like it's not really a cookie cutter formula .

It can be a moving target too.

So you know things that affect you a certain way one day might affect you a different way another day and also, you know, if you're sick with something else that can also affect blood sugar.

>> So it's a lot to stay on top of .

So even if you do get diagnosed with diabetes I mean if you work really hard at making some of these lifestyle changes maybe get to a better, healthier weight I mean is are way to I guess get rid of it.

Can you actually we talked about reversing it.

>> Can you do that?

Sometimes people are able to even once they're on medications, sometimes people are able to get off of medications.

It is difficult to do so most people end up treating it with different medications.

But we have a lot of new medications these days that can help protect the heart, help protect the kidneys and at the same time lower lower blood sugars all right.

>> I want to remind everybody that we have I'm looking at the computer screen and all of our phone lines are open and so we're kind of lonely here.

We do appreciate the questions.

If you want to call in, feel free to do so.

It's (969) 27 zero again we're talking with Dr. Emily Schrader who is an endocrinologist and we are talking about diabetes.

Looks like there might be a call coming in.

So I'll get to that question in just a second.

So if you get this diagnosis I mean it's not what you want but and you said it can be overwhelming and confusing.

So what's the first step to you know, with it like you get your diagnosis maybe from your family doctor and then you'd go see chronologies.

>> So you know, as we mentioned, it can affect lots of poor portions of your life and so a lot of it is self-management at home.

Obviously we want people to go in and see their doctors.

But most of your time you're at home or at work, you know, interacting with your friends and family.

So it's really key for folks to understand what's going on and how what they do can affect the blood sugars.

So there are diabetes educators out there.

Sometimes there are classes, sometimes two can meet one on one either with an educator or a dietician really to learn how the medications work, how to monitor blood sugars and so forth.

So that's often the first step as well as working with their family doctor in terms of medications that they may need.

>> Yeah, right.

We've had some registered dietitians on and actually they have some great advice and I know a lot of my grandpa used to like blow off his guy his appointments because he's a well she's going to tell me I can't eat anything I like but actually there's you still have yeah.

>> Most of them like to work with people to figure out what changes and what diet works for them.

So there's lots of different dietary approaches and we encourage folks not to think of kind of good foods and bad foods but moderation.

>> So there are different approaches and there are a great member of the health care team.

>> It doesn't have to be like a prison sentence per say I guess so we did have a call that came in and I don't know if that question is still I don't see it on the computer screen so not oh I guess OK I guess I guess you already answered it.

>> I saw it coming in so I think it was some asking.

They've had diabetes for a long time and they've just been seeing their family dog.

When would it make sense to see an endocrinologist?

And so the majority of people in the United States who have diabetes are seen by their primary care provider or their family doctor for their diabetes management.

It's only when folks get on complicated insulin regimen some more might have some complications from their diabetes then often encourage folks to see endocrinologist.

But most folks with diabetes see their their family doctor for that and we were talking before there are a lot of like you mentioned, you know, dietitians and counselors you can see in the community and some of that stuff's free.

You know, it's from like non-profits in the area.

>> So yeah, there's definitely a lot of help available.

OK, we do have somebody who is brave enough to ask a question like Steve, you're a good man.

>> I think you're on line one.

Can you go ahead with your question, Steve?

>> Yeah.

Thank you for taking my call.

Yes, I am a good man.

Hey, I'm 64 years of age and I've been diabetic for so I'd say five years and any more.

I have absolutely no get up and go but is something I'd like to find out how I can get that drive back help me.

>> So that's that can be a common problem with folks with diabetes and it can be for a number of different reasons.

So sometimes it can be related to blood sugar levels both low and high blood sugar levels can lead to lack of energy but also folks who have very normal blood sugars they're well treated with the diabetes can still have issues with energy and sometimes that can reflect whether or not they're getting enough physical activity sometimes they can reflect other issues so sometimes folks can have heart issues or other things like that and then sometimes there can be issues with other hormones such as thyroid hormones.

Sometimes there's not really a clear diagnosis and then working with your family doctor in terms of ways to gradually increase activity, we also see commonly in folks with diabetes obstructive sleep apnea.

So if folks aren't sleeping well or have obstructive sleep apnea that definitely can lead to lack of energy and issues with that.

So there's a variety of different reasons.

So I don't have a clear answer for you, Steve, but it's very common among people with diabetes.

>> Steve, did you want to ask Dr. Schrader anything else?

No, I'm just would like to have some help some way to get up and go.

I sleep Dolev twelve o'clock every day and I'm retired.

That's not how I envisioned retirement.

I envisioned retirement getting out and doing stuff I mean when would be a good candidate instead of maybe just I don't know if you're just working with your family doctor but maybe to bump that up to that is something you could potentially talk with your family doctor about, you know, about whether it makes sense to see an endocrinologist to talk through that.

>> All right.

Well, Steve, we wish you the best because I know that yeah.

You know, you look forward to your retirement and so we hope that finds a way to get to enjoy it and gets more energy there for him.

We have another gentleman named Dave with a question about sugar limits.

>> Go ahead, Dave.

Yes, I'm 78 years old, been on insulin about twenty five years and my blood sugar in the morning seems to jump between ninety eight hundred and thirty four and we're should it be or should I be trying to shoot four.

>> So that's a great question Dave.

There are kind of different blood sugar recommendations for different people depending on other things that are going on in general blood sugars in the morning between 80 and one hundred and thirty or great.

So I would say where you are is pretty is is probably right where you want to be.

You do want to make sure that you're not having low blood sugars other times of day but as long as you're not having low blood sugars kind of between 80 and one one 30 but it does differ for different people depending on their specific targets.

>> All right, Dave, did you want to ask Dr. Shrader anything else before we go here ?

>> No, no, I'm just trying to control it.

What's the I take fifty five years of insulin every day so in the last forty pounds so I'm trying to keep up the good work.

>> I think another interesting tidbit for our viewers is that this year marks the 100th anniversary of insulin.

So it was first discovered in nineteen ninety nineteen twenty one and then the first insulin was given clinically to patients the next year nineteen twenty two so it's a big year.

>> It's been around the community.

I think people also the longest has been around maybe they have a little more faith in it you see long term outcomes and so forth so all right thank you to Steve and Dave for their questions and we have another Steve on the line who'd like to ask a question.

Go ahead, Steve.

>> No to OK, my name is Steve and I would like to ask the doctor to talk about I love the fact that you mentioned it's an individual situation for most everybody and I've discovered that having infected teas can raise my numbers.

I've just had several calls.

Could she speak to other things that can raise your numbers like I have type two mostly controlled but what are the things that can raise your numbers and stress, raise your numbers but to have an answer to that?

>> Yeah.

So that is a great question.

So your first comment about oral health and infections is definitely something that's been reached has it has had more attention in recent years?

I think often we separate medical health from dental health just because people go to different places, have different kinds of insurance for those.

But we do know that infections even if it's not like a big infection, even just gingivitis so inflammation of the gums can raise blood sugars just because of the inflammation.

So it's important to see your dentist regularly everyone but especially if you have diabetes or other things that can raise blood sugars include stress, other kinds of infection.

Sometimes people receive steroids like prednisone or injection steroid injections for other reasons like joints that can raise blood sugars and then other other kinds of infections.

We see higher blood sugars and folks who have covid-19 for example.

>> So those are all things that can increase your blood sugars I guess wherever you would go be at a dermatology store, podiatrist dentists eye they must know that you have diabetes so they definitely need to make them aware of that.

>> We have gosh, you're very popular so we're getting a lot of calls.

I am appreciative of everybody calling it but this the next gentleman Jeff wanted me to ask the question for him.

So Jeff Zeleny, 60 years old for the last several visits with his family doctor, he's been checking his blood sugar levels.

Are they been checking his blood sugar levels and he's asking why is Dr. doing this?

>> Should he be concerned?

So sometimes if folks have either glucose values or another way to test for diabetes would be something called the hemoglobin A1.

See, so sometimes if it's in the pre diabetes range they'll start checking more often.

So that might be a reason or it could be because family history so it's can be for a variety of reasons.

>> OK, all right.

Well you know I mean most doctors I've ever seen they'll say hey, if you're wondering what I'm doing, you know, ask me because sometimes they get really busy and start doing things and they forget that maybe this is not, you know, something that the patient would be accustomed to.

So it never hurts to ask I guess.

Let's see.

We have another person I wanted to ask a question for them.

Let's see is it Lisa is Lisa or she still coming in?

I will wait.

She I guess she is still asking your question.

>> We're going to ask it for her, you know, but you touched on people who have diabetes may be more susceptible to getting covid-19 or maybe it would end up being a more severe case.

So we've seen that people with diabetes are at increased risk of getting severe disease if they do get cold 19 and then also if people with diabetes do get covid they can have higher blood sugars and other issues.

>> OK, I mean as long as they're vaccinated though would they I mean is there anything after they I assume most of them are going to get vaccinated because of their situation should they feel more confident or are they still kind of high risk even with vaccination?

>> So with vaccination that definitely decreases the risk a lot.

And so I encourage most of my patients to know once they're vaccinated to follow the same guidelines that we recommend for the general population.

>> Also about the booster shot too is that if you're diabetic, talk to your doctor about apparently the CDC's list of people who are immunocompromised in which they should already be getting a third shot does not include folks with diabetes.

>> Oh, OK. All right.

Well, just so more to come I was going to say I think that's changing.

>> I don't know what they're up to find you Alpha with these variants I can't keep track of them all so but just want to remind you I have a few more minutes left of the show and we have plenty of time to take more questions so feel free to give us a call.

We're here just about eight o'clock.

Here's the question that was coming in before that wasn't done.

So I'm not going to get this correct.

Elizabeth has tried is it metformin?

OK, metformin she's had several side effects that made her hesitant to try other medications.

Is it common to try other meds before finally when it works?

>> So metformin is a medication that we often use as first line .

>> So a lot of people with diabetes that's with type two diabetes that's the first medication they would try it can some times cause GI issues so diarrhea and other issues sometimes there's some tricks in terms of starting with lower doses or trying different formulations that can work but some people just aren't able to tolerate metformin so you know, we have had a plethora of new diabetes medications come out in the last ten or fifteen years.

So there's a lot more options for people to try.

And so I would just encourage Elizabeth hope to work with her um her primary care team to to see if there are other medications that might help for her and I tend to have different side effect profiles.

So just because you've had reaction to one doesn't there are lots of others that you can try and some might work better.

>> That's good to know you have options.

I guess that's one good thing if you're a diabetic there's there seems to be a ton of research going on and a lot of things that are available to them.

So good or bad of it all we just have maybe a couple minutes left and I wanted to go over a few things with you about, you know, the food.

I mean I know that's a big factor and you have mentioned in the notes you sent to me that you know, I'm not trying to label foods as good or bad and maybe even getting other family members involved in cooking and preparing food know if you want to.

>> Yeah.

So I think you know, whatever people living with diabetes can do to as I said, sort of make those habits to sustainable for them in their day to day life so for in terms of kind of diet and food, to the extent that you can sort of make it a family affair instead of like cooking one meal for yourself and one meal for everyone else sort of you know, help the you whole family work together.

And similarly with physical activity, it can be hard for some people to get to the gym for an hour multiple times a week.

So whatever you can do to incorporate that into your day to day life parking further away, that's a good as going for walks with your family.

Some people will have a treadmill or exercise bike at home so every little bit helps and it really we had multiple callers tonight.

I've had diabetes for ten twenty years so think of it not just for the next week but how can I sort of incorporate this in a way that will be sustainable for me long term?

>> I mean your advice was everything in moderation.

So I mean just because you know when it comes to holiday time and stuff, you know not to get down but I mean I guess they're probably safe ways to enjoy the food to eat.

>> Yeah.

And often, you know, mental health can be an issue for diabetes just because it can be such a complicated and overwhelming condition and so trying to frame things in a in a way that doesn't get you down to not viewing your blood sugars is good or bad but just as tools to help you understand better what's going on and how to treat things well thank you so much, Dr. Shrader.

>> I feel that our time is up but great information.

Thank you so much so I'm sure your patients are very blessed to have somebody like you and so gentle and great approach.

>> So yeah, take all of her advice to heart and keep in touch with your doctor for sure if you're in a dire situation we have diabetes.

>> I'm Jennifer Bloomquist.

Thanks so much for tuning in.

Have a good night.

Be safe and we'll see you back here next Tuesday