IT’S BEEN CALLED A HIDDEN EPIDEMIC.

MORE THAN 100,000 ADULTS IN HAWAII HAVE DIABETES, WITH ANOTHER 400,000 ON VERGE OF BEING DIAGNOSED.

DIABETIC PATIENTS ARE ALSO AT A HIGHER RISK FOR INFECTIONS, SO THIS IS AN ESPECIALLY VULNERABLE TIME DURING THE COVID‑19 PANDEMIC.

FROM MANAGING BLOOD SUGER LEVELS TO MEDICAL TREATMENTS AND PREVENTION, OUR PANEL OF EXPERTS WILL BREAK DOWN THIS HEALTH CRISIS.

TONIGHT’S LIVE BROADCAST AND LIVE STREAM OF INSIGHTS ON PBS HAWAI?I START NOW.

¶¶ ¶¶ ALOHA AND WELCOME TO INSIGHTS ON PBS HAWAII...I'M DARYL HUFF.

DIABETES IS A CHRONIC DISEASE THAT OCCURS WHEN THE PANCREAS DOES NOT PRODUCE ENOUGH INSULIN OR WHEN THE BODY CANNOT EFFECTIVELY USE THE INSULIN IT PRODUCES.

THIS CAUSES SUGARS TO BUILD UP IN YOUR BLOOD.

IT’S ESTIMATED THAT 119,000 PEOPLE IN HAWAII HAVE BEEN DIAGNOSED WITH DIABETES, 410,000 ARE PRE‑DIABETIC AND ANOTHER 39,000 DO NOT KNOW THEY HAVE THE DISEASE.

OUR PANEL TONIGHT WILL TAKE ON ALL ASPECTS OF THIS SIGNIFICANT HEALTH CRISIS…FROM WHO’S AT THE MOST RISK AND WHAT WE AS A COMMUNITY AND INDIVIDUALS CAN DO ABOUT IT.

WE LOOK FORWARD TO YOUR PARTICIPATION IN TONIGHT'S SHOW.

YOU CAN EMAIL, CALL OR TWEET YOUR QUESTIONS.

AND YOU’LL FIND A LIVE STREAM OF THIS PROGRAM AT PBSHAWAII.ORG AND THE PBS HAWAII FACEBOOK PAGE.

NOW, TO OUR GUESTS.

DR. LAURIE TOM IS AN ENDOCRINOLOGY, DIABETES AND METABOLISM SPECIALIST.

SHE GRADUATED FROM THE JOHN A. BURNS SCHOOL OF MEDICINE AND IS THE PAST PRESIDENT FOR THE HAWAII CHAPTER OF THE AMERICAN DIABETES ASSOCIATION.

DR. MARJORIE MAU IS A PROFESSOR IN THE NATIVE HAWAIIAN HEALTH DEPARTMENT AT THE JOHN A. BURNS SCHOOL OF MEDICINE.

SHE WAS THE FIRST WOMAN FROM HAWAII TO BE RECOGNIZED AS A MASTER PHYSICIAN BY THE AMERICAN COLLEGE OF PHYSICIANS.

SHE’S ALSO A PRINCIPAL INVESTIGATOR AND DIRECTOR OF THE CENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH.

DR. MARIANA GERSCHENSON IS THE DIRECTOR FOR THE DIABETES RESEARCH CENTER AT THE UNIVERSITY OF HAWAII.

SHE IS ALSO THE ASSOCIATE DEAN FOR RESEARCH AND A PROFESSOR AT THE JOHN A. BURNS SCHOOL OF MEDICINE.

FOR THE PAST 30 YEARS, SHE’S BEEN AN INTERNATIONAL LEADER IN THE FIELD OF STUDYING PEDIATRIC AND ADULT CARDIOVASCULAR AND METABOLIC COMPLICATIONS.

AND TONI LEE IS A DIABETES PATIENT.

SHE WAS DIAGNOSED WITH ADULT ON‑SET DIABETES IN 2004 BUT THROUGH DIET AND EXERCISE WAS ABLE TO GET OFF INSULIN IN THREE YEARS.

MAHALO TO YOU FOR JOINING US.

LET ME START WITH YOU.

WHAT WAS THE FIRST THING THAT TOLD YOU MIGHT HAVE A PROBLEM WITH DIABETES?

HOW DID YOU FIND OUT THAT YOU HAD IT?

>> WELL, MY HUSBAND HAD DIABETES.

AND PASSED AWAY AT THE AGE 47 YEARS OLD.

SO I KNEW WHAT SYMPTOMS WERE LIKE.

BUT HE WAS DIAGNOSED AT THE AGE OF 20.

SO MOST OF OUR LIFE TOGETHER, HE WAS DIABETIC AND ON INSULIN.

>> SO WHILE WORKING, I NOTICED THAT I WAS DRINKING MORE, WATER, FEELING OKAY, BUT WONDERING IF GOING TO THE BATHROOM MORE, WONDERING IF, ARE THESE SYMPTOMS OF BEING A DIABETIC OF THE DIDN'T WORRY TOO MUCH ABOUT IT BECAUSE NO ONE IN MY FAMILY HAD DIABETES WHILE WAY WAS GROWING UP.

I THOUGHT IT HAD ESCAPED US UNTIL MY KID BROTHER BECAME A DIABETIC BEFORE ME.

I WAS SHOCKED, THEN EDUCATED BY DR. WONG, NATHAN WONG, SAYING TO ME SOMETIMES IT SKIPS A GENERATION.

IT MIGHT HAVE BEEN IN YOUR FAMILY BUT YOU JUST DIDN'T KNOW ABOUT IT.

HE DIED VERY YOUNG.

MY BROTHER DID.

>> AND HE WAS VERY FIT, TALL, LEAN, NOT OVERWEIGHT.

VERY ‑‑ RIGHT THING.

>>Daryl: LET ME GO TO DR. TOM NOW.

KIND OF THE STORY YOU SEE ALL THE TIME?

IT SEEMS LIKE IT'S NOT OBVIOUS TO PEOPLE RIGHT AWAY, THAT THEY MAY BE GETTING IT, AND THEY'RE LOOKING FOR CLUES.

FAIRLY TYPICAL STORY?

>> KNOW WHAT THE RISK FACTORS FOR DIABETES MAY BE.

INCLUDES FAMILY HISTORY.

RISK FACTORS.

ETHNIC MINORITY, GETTING OLDER.

IF ONE IS OVERWEIGHT, OBESE, ONCE HAD DIABETES IN THEIR PREGNANCY, WE KNOW THOSE ARE RISK FACTORS.

ONCE PATIENT STARTS TO HAVE SYMPTOM, AGAIN, INCREASED THIRST, URINATING FREQUENTLY.

LOSING WEIGHT.

EVEN THOUGH YOU'RE EATING.

BLURRY VISION.

CUTS THAT DON'T HEAL WELL.

PHYSICAL SIGNS THAT CLUE YOU IN.

>>Daryl: WHAT TONY LEE WAS SAYING, IT SOUNDS LIKE IT CAN SHORTEN YOUR LIFE.

IF YOU, I MEAN, SOUNDS LIKE THEY KNEW THAT HER HUSBAND HAD IT FOR A FAIRLY LONG TIME.

BUT STILL, '47, HER BROTHER, DO YOU SEE PEOPLE DYING FROM THIS DISEASE OFTEN, EARLY IN LIFE, AND HOW FRUSTRATING THAT MUST BE TO YOU.

GENERATION LATE, WE KNOW MORE ABOUT DIABETES.

HOW TO MANAGED CONTROL T OUR MESSAGING IS IF WE TAKE CARE OF DIABETES, PREVENT COMPLICATION OF DIABETES.

PATIENTS CAN LOVE A LONG, HEALTHY AND PRODUCTATIVE LIFE.

THAT'S REALLY THE GOAL.

>>Daryl: WE TALK ABOUT THE ETHIC BACKGROUND.

I KNOW THAT IS SORT OF YOUR FIELD.

ETHNIC BACKGROUND.

WHAT MAKES ONE ETHNIC GROUP PARTICULARLY NATIVE HAWAIIANS MORE SUSCEPTIBLE TO THIS?

IS IT ACTUAL GENETICS OF BEING NATIVE HAWAIIAN OR OTHER FACTORS IN LIFESTYLE AND SO ON?

>> RIGHT, SO THANKS FOR THE QUESTION.

I THINK WE'RE LEARNING MORE ABOUT THE ORIGINS AND UNDERLYING CAUSES OF WHY PEOPLE ARE MORE SUSCEPTIBLE TO DIABETES.

AND THERE IS SOME RECENT RESEARCH THAT HAS BEEN DONE, LOOKING AT GENETIC PREDISPOSITION HERE IN HAWAII'S DIVERSE ETHNIC POPULATION.

BUT WHAT TONY STARTED WAS REALLY IMPORTANT IS THAT, IT'S NOT KNOWN FOR DIABETES TO GET IT FROM ANOTHER SPOUSE.

UNRELATED INDIVIDUAL.

BUT WHAT IT DOES SAY IS THAT PEOPLE WHO LIVE TOGETHER OFTEN LIVE IN THE SAME LIFESTYLE.

SAME ENVIRONMENT.

SAME KINDS OF FOOD.

SO EVEN IF YOU HAVE A GENT I CAN PREPOSITION, THE ENVIRONMENT IS INCREDIBLY IMPORTANT IN TERMS OF WHETHER YOU'RE ACTUALLY DEVELOP DIABETES.

BOTH GOOD AND ON THE NEGATIVE SIDE AS WELL.

MOST PEOPLE DON'T DIE OF DIABETES ITSELF.

THEY USUALLY SUCCUMB TO SOME COMPLICATION.

HEART DISEASE.

FOR EXAMPLE.

KIDNEY FAILURE.

SOMETHING LIKE THAT.

BUT MY SUSPICION IS THAT HOW WE LIVE OUR LIVES TOGETHER, IN OUR FAMILIES, IN OUR COMMUNITY, HAS INCREDIBLE IMPACT ON HOW OUR LIVES ARE.

AND LIKE LORI, DR. TOM SAID, IS THAT WE HAVE DEVELOPED MORE THERAPIES, WE UNDERSTAND MORE ABOUT THE CORRECT COMBINATION OF MEDICINES.

IF YOU NEED MORE THAN ONE.

AND WE HAVE MORE MEDICINES THAT ARE NOT INSULIN, BUT INJECTABLE, THAT ARE VERY THERAPEUTIC BRINGING SUGARS DOWN.

>>Daryl: DOCTOR, I NOTICE YOU HAVE A LOT OF EXPERTISE IN PEDIATRIC DIABETES.

SO ON.

WHAT IS THE DIFFERENCE BETWEEN, WE HEAR ABOUT DIABETES ONE.

DIABETES 2.

IS THERE A DIFFERENT BETWEEN CHILDREN WHO GET DIABETES AND ADULTS WHO GET DIABETES?

>> THERE IS A DIFFERENCE IN WHAT WE I THINK OF CLASSICALLY.

SORT OF LIKE WHAT I THINK OF AS OLD SCHOOL.

TYPE 1 VERSUS TYPE 2 DIABETES.

TYPE 1 IS TYPICALLY, CHILDREN.

AND WHAT HAPPENS IS THAT YOUR PANCREAS DOESN'T MAKE INSULIN.

IMMUNE SYSTEM ATTACKS THE PANCREATIC BETA CELLS.

>> YOU DON'T HAVE THE ABILITY TO MAKE INSULIN.

VERY DIFFERENT THAN A TYPE 2, WHERE THERE'S A DECREASE IN THE INSULIN PRODUCTION.

THAT IS DUE TO AGING, DUE TO A LOT OF DIFFERENT REASONS.

BUT NOW, FOR INSTANCE, WHAT WE'RE SAYING ONE OF OUR PHYSICIAN, WAIANAE COAST, ESPECIALLY WITH COVID, THAT KIDS ARE SITTING AT HOME AND ON THE SCREEN AND THEY'RE EATING.

NOW SEEING INCREASE IN TYPE 2 DIABETES IN CHILDREN.

AND THERE'S ACTUALLY A WHOLE FIELD OF RESEARCH, MULTISITE STUDIES LOOKING AT CHILDREN TO SEE HOW WELL THEY DO ON THE MEDICATIONS THAT ADULTS TAKE.

UNFORTUNATELY CHILDREN TYPE 2 DIABETES DON'T, THEY CAN'T TAKE THE SAME MEDICATIONS AS ADULTS DO.

VERY SCARY SEEING INCREASE IN WEIGHT IN CHILDREN.

>>Daryl: HAVE YOU SEEN THAT?

MORE PRACTICE COMING IN.

YOU WORK WITH PATIENTS.

ARE YOU SAYING MORE KIDS COMING?

USUALLY OBESITY BRINGS THEM IN?

>> WELL, I AM ADULT MEDICINE PRACTICE.

I'M NOT SEEING THEM, BUT OF COURSE, I'M AWARE THAT THE TYPE 2 DIABETES IN CHILDREN IS INCREASING MORE THAN ACTUALLY THE DIAGNOSIS OF TYPE 1 DIABETES IN CHILDREN.

I DID WANT TO SAY THAT AS CHILDREN, ARE GETTING MORE TYPE 2 DIABETES, YOU CAN GET TYPE 1 DIABETES IN ADULTHOOD.

>> SO WE CALL THAT LATENT AUTOIMMUNE DIABETES IN THE ELDERLY.

BUT YEAH, THE RATES OF DIABETES IN CHILDREN ARE INCREASING AND AGAIN, HIGH RISK ETHNIC GROUPS ARE THOSE AFFECTED MOST.

>>Daryl: NATIVE HAWAIIAN YOURSELF, HOW THINK, WHY DO YOU THINK YOU GOT IT?

YOU MENTIONED GENETIC, SKIPPING GENERATION.

DO YOU THINK THAT LOOKING BACK, PERHAPS YOUR LIFESTYLE OR DIET HAD SOMETHING TO DO WITH IT?

>> SURE.

I WORKED MY WHOLE LIFE.

AND AS I GOT OLDER, I GAINED WEIGHT.

SEEMED TO HAVE HAPPENED IN MY WHOLE FAMILY GENETICS.

ON THE WOMEN, THAT WE WERE VERY THIN WHEN WE WERE YOUNG, AND THEN FROM AGE 40 TO NOW, AND I'M 79.

THAT WE'RE ON THE HEAVYSET.

WEIGHT STARTED TO DECLINE.

SO I'M SURE WEIGHT HAD SOMETHING DO WITH IT.

AND EVERYBODY, WORKING LONG HOURS, I ALWAYS WORKED OVER 13, 14 HOUR DAYS.

FOR THE MILITARY.

AND NOT REALLY TAKING CARE OF YOURSELF.

>>Daryl: YOU LOOK GREAT.

WE'RE GLAD TO HAVE YOU WITH US.

YOU LOOK TERRIFIC.

LET ME ASK THE QUESTION FROM A VIEWER.

ARE THERE ANY FOODS OR DIETS THAT CAN LEAD TO DIABETES?

ANY PARTICULAR THING THAT YOU WOULD LIKE TO POINT OUT AS A FACTOR?

COMES TO DIET?

>> WELL, MAYBE LET ME TURN, LET ME FLIP THAT AROUND A LITTLE BIT.

WE KNOW THAT DIET AND EXERCISE LIFESTYLE IF YOU WILL, IS THE FIRST LINE MEDICINE FOR PREVENTING ONSET OF DIABETES.

AND THAT IS WHAT THE DIABETES PREVENTION PROGRAM SHOWED BACK IN 2003.

YOU, NOW THERE'S A LOT OF DIET PROGRAM AND LIFESTYLE PROGRAMS OUT THERE THAT ARE BASED ON THAT SCIENTIFIC STUDY.

SO DEFINITELY, NUTRITION AND DIETARY INPARTICULAR IS IMPORTANT.

BUT THERE'S NO SUCH THING AS A DIABETIC DIET.

NO SUCH THING AS A DIABETIC DIET.

EVERYONE WHO IS LIVING WITH DIABETES OR PREDIABETES SHOULD EAT WELL ROUNDED, HEALTHY DIET, WATCHING OUT FOR FATS, TOTAL NUMBER OF CALORIES, SO ON AND SO FORTH.

LIKE I ALWAYS LIKE TO SAY, THE IT WAS AMAZING BECAUSE STUDIED SHOW, WHAT WE CAN DO IS INDIVIDUALS LIVING OUR LIFESTYLE, IS MORE POWERFUL THAN A PILL.

WHICH WAS THE OTHER TREATMENT THAT WAS TESTED IN THE DPP.

SO WE MAY GO TO DOCTORS LIKE DR. TOM OR MYSELF, AND SAY, OKAY, GIVE ME SOMETHING THAT IS GOING TO MAKE THIS GO AWAY.

BUT ACTUALLY, WHAT YOU DO IN YOUR OWN LIFE, DAY‑TO‑DAY, IS MORE POWERFUL AT LEAST IN STUDY, MORE POWERFUL THAN A PILL.

TO PREVENT THE ONSET OF NEW DIABETES.

>>Daryl: LET ME ASK YOU.

IN THE RESEARCH, WHY IS IT THAT EXERCISE HELPS?

WHAT IS IT WHEN YOU EXERCISE THAT WOULD HELP YOU PREVENT SOMETHING LIKE DIABETES FROM COMING ON?

>> ONE OF THE THINGS WE KNOW IN THE PREDIABETES STATE, IS THAT THERE'S INCREASED INFLAMMATION.

INCREASED FREE FATTY ACIDS.

WHEN YOU'RE LOSING WEIGHT, DECREASING AMOUNT OF FAT.

DECREASING AMOUNT OF FAT THAT IS ALSO, THAT IS BEING STORED IN YOUR SKELETAL MUSCLE OR IN YOUR MUSCLES OR BEING STORED IN YOUR LIVER.

THAT'S NOT GOOD.

WHEN YOU'RE LOSING WEIGHT, THAT IS WHAT IS HELPING.

IT'S NOT A LOT.

I MEAN, WE YOU KNOW, CLINICIANS WILL TELL YOU, THAT FIVE, TEN, POUNDS THAT HELPS.

AND IT IS POSSIBLER AS YOU'RE HEAR, FROM TONY, THAT YOU CAN LOSE WEIGHT AND GET OFF INSULIN.

I MEAN, I'VE SEN IT MORE THAN ONCE.

AND I KNOW THAT HE LOSING WEIGHT IS HARD.

I MEAN, THAT PART, EXERCISING, YOU KNOW, IS HARD.

BUT THAT REALLY IS THE PREVENTION AND THE CURE.

NOW, AS YOU HEARD, DR. TOM SAY, WE DO, AND YOU HEAR DR. MAU, WE HAVE GREAT MEDICATIONS.

I MEAN, THINGS HAVE CHANGED SO MUCH.

IN THE LAST 20 YEARS.

IN THE LAST TEN YEARS, I MEAN, WE HAVE GREAT DRUGS.

AND TO GIVE ONE LAST THING, WE NOW DO HAVE ONE DRUG CLASS CALLED LUKAGON PEPTIDES APPROVED BY THE FDA, THEY HELP WITH DIABETES.

WITH INCREASING, EATING INSULIN FROM THE PANCREAS.

OTHER THING IT DOES, IS THAT THE FDA HAS APPROVED IT AS A WEIGHT LOSS DRUG IN 2019.

SO YOU KNOW, THERE ARE OPTIONS.

FOR LOSE WEIGHT, TYPICALLY, IF YOU'RE THE FOR GOING TO EXERCISE AND DIET, IF YOU'RE QUITE ILL, CHOICES ARE BARE @I CAN SURGERY, DECREASING STOMACH OR NOW, THERE IS, MEDICATION.

AND I KNOW THAT ENDOCRINOLOGISTS CONSIDERING USE OF THAT.

ALSO, VERY EXPENSIVE.

>>Daryl: HOW DID YOU MANAGE DO IT?

WHAT WAS IT LIKE, YOU KNOW, PSYCHOLOGICALLY, EMOTIONALLY, TO HAVE DIABETES BE ON INSULIN, AND THEN WORK UP THE WILL TO ACTUALLY CHANGE.

WHAT DID YOU HAVE TO CHANGE?

WHAT DID YOU HAVE TO?

>> FIRST THING, LET ME SAY THAT FOR ME, AS A DIABETIC, HORRIFYING THING THAT I WORRY ABOUT IS NUMBER ONE, BECOMING A PATIENT ON DIALYSIS.

SECOND THING, BEING AMPUTEE.

THOSE THINGS TO ME, ARE REALLY FRIGHTENING.

I WAS VERY THANKFUL THAT MY HUSBAND DIDN'T HAVE TO GO THROUGH THAT.

EVEN BEING AS LONG DIABETIC AS HE WAS.

SO WHEN I WAS TOLD, BY THE WAY, I WAS DIAGNOSED ON A SHIP, ON A CONVENTION, FOR THE HAWAIIAN CIVIC CLUBS.

HAWAIIAN CIVIC CLUBS STARTED, MY HUSBAND, AND DR. GEORGE MILLS, STARTED A PROGRAM WITH THE HAWAIIAN CIVIC CLUBS TO HELP HAWAIIANS TO GO THROUGH A HEALTH SCREENING PROGRAM.

SO THAT MANY HAWAIIANS DON'T HAVE MEDICALS.

AND SO THIS WAY, THEY COULD GET THEIR BLOOD TESTED AND ALL OF THAT AND ALL OF THOSE THINGS THAT THEY DID.

WERE GIVEN TO THEM THIS TAKE TO THEIR DOCTOR.

WELL, AS I CONVENTION START, AS LEADER, I WAS RUNNING FOR PRESIDENT THAT YEAR, I WENT, YOU KNOW, TO ENTICE PEOPLE GO AS A LEADER, YOU GOT TO GO SO THEY FOLLOW YOU.

RIGHT?

SO I WENT RIGHT UP AND TOOK MY STATS.

AND DR. BRADY, WHO WAS OUR DOCTOR ON BOARD, SAID, DID ANYBODY EVER TELL YOU THAT YOU ARE DIABETIC?

I WAS LIKE, WHAT?

AS I TOLD YOU, I KIND OF HAD THOUGHTS BUT YOU KNOW HOW YOU PUSH IT OFF TO THE SIDE, AND SAY, MAYBE NOT, HE SAID, WHEN YOU GET OFF THIS SHIP, GO STRAIGHT TO YOUR DOCTOR AND GUEST TESTED RIGHT AWAY.

I'LL TELL YOU, WE END ON A SUNDAY.

I WAS IN EMERGENCY WITHIN ABOUT AN HOUR.

WENT AND GOT TESTED.

THEY SAID, YOU'RE DEFINITELY ONE AND WE'RE GOING TO PUT YOU ON INSULIN THREE TIMES A DAY.

I WAS LIKE, HORRIFIED.

HORRIFIED.

>>Daryl: I'M GOING TO STOP YOU THERE.

WE'RE GOING TO PICK UP THIS STORY.

LITTLE BIT LATER ON.

I WANT TO TALK TO DR. TOM A LITTLE BIT.

HOW SUCCESSFUL ARE PEOPLE IN BEATING DIABETES THESE DAYS IN WE TALK ABOUT DRUGS.

WE TALK ABOUT LIFESTYLE.

I MEAN, YOU KNOW, WITH THE ADULTS THAT YOU'RE DEALING WITH, HOW OFTEN DO THEY HAVE A SUCCESS STORY LIKE TONY'S?

>> I THINK PART OF TONY'S STORY MAYBE THAT AT THE TIME, SHE WAS DIAGNOSED, HER SUGARS WERE REALLY HIGH.

SO THE MOST EFFECTIVE TREATMENT AT THAT TIME WOULD HAVE BEEN INSULIN.

AND SO AS YOU'RE EDUCATED, COMPLAINING YOUR DIET, AND THE BLOOD SUGAR COMES DOWN, YOU'RE ABLE TO GET OFF OF INSULIN.

AND I WANTED TO SAY, EARLIER, ABOUT EXERCISE.

ASIDE FROM THE WEIGHT LOSS, EXERCISE HELPS THE BODY BE MORE SENSITIVE TO INSULIN.

BECAUSE ONE OF THE PROBLEMS IN TYPE 2 DIABETES IS INSULIN RESISTANCE.

SO EXERCISE HELPS INSULIN SENSITIVITY EVEN IF YOU DON'T LOSE WEIGHT.

SO EXERCISE IS A GOOD THING FOR MANY MANY OTHER REASONS AS WELL.

I THINK NOWADAYS, ACTUALLY, MANY MEDICATIONS WE CAN CHOOSE.

ACTUALLY, BEFORE HAVING TO USE INSULIN.

THAT IS KIND OF THE CURRENT TREND.

DIABETES DOES TEND TO BE A CONDITION WHERE YOU, WE DO USE A LOT OF MEDICATIONS IN CONJUNCTION WITH DIET AND LIFESTYLE.

>>Daryl: SO BACK TO MY ORIGINAL QUESTION.

DO MOST PEOPLE END UP HAVING TO MAINTAIN A CERTAIN LEVEL OF HEALTH WITH ALL OF THESE MEDICATIONS FOR THE REST OF THEIR LIVES OR DO MANY OF THEM ACTUALLY MANAGE TO GET TO THE PLACE WHERE THEY DON'T NEED THAT MUCH INTERVENTION?

>> SO EARLY ON, YOU'RE ABLE TO, MANY PEOPLE ARE ABLE TO MANAGE WITH DIET AND LIFESTYLE.

BUT DIABETES IS A PROGRESSIVE CONDITION.

SO MOST PEOPLE WILL END UP NEEDING MEDICATIONS.

AND MAY BE AS MANY AS 50% AFTER DECADE OF DIABETES MAY ACTUALLY END UP NEEDING TO TAKE SOME INSULIN BECAUSE PART OF THE DISEASE PANCREAS DOES NOT MAKE ENOUGH INSULIN.

REPLACING NATURAL HORMONE OF INSULIN IS PART OF TREATMENT.

>>Daryl: LET ME ASK YOU DR. MAU.

FEW YEARS AGO, THERE WAS SO MUCH TALK ABOUT DIABETES.

EPIDEMIC.

GOT TO DO SOMETHING.

ACTUALLY JUST HAD A YEAR LONG PANDEMIC.

STILL GOING.

SO YOU KNOW, OBVIOUSLY, EVERYTHING ELSE HAS BEEN PUSHED OUT OF THE PUBLIC MIND.

KIND OF PROBABLY GOOD.

DOING A SHOW LIKE THIS.

TO REMIND PEOPLE THAT THERE IS OTHER THINGS THAT THEY NEED TO PAY ATTENTION TO.

HOW MUCH HAVE WE HAD ANY SUCCESS IN FIGHTING EPIDEMIC OR IS IT STILL GROWING IN HAWAII?

>> ARE YOU TALKING ABOUT DIABETES OR COVID?

DIABETES.

>> OKAY.

WE HAD TWO THINGS GOING ON.

ACTUALLY, THEY INTERSECT AS YOU ALL KNOW.

INDIVIDUALS WHO ARE LIVING DIABETES ARE SUSCEPTIBLE TO SOME OF THE MOST SERIOUS COMPLICATIONS OF COVID‑19.

BUT WELL, LORI, YOU KNOW, RIGHT.

FOR YEARS, AND YEARS, I FLEW TO MOLOKAI AND TOOK CARE OF THE MANY OF THE INDIVIDUALS AFFLICTED WITH DIABETES ON MOLOKAI AND I SPENT MOST OF MY TIME IT NOW WORKING WITH FOLKS LIKE MARIANA TO UNDERSTAND WHAT'S CAUSING DIABETES IN INDIVIDUALS AND ESPECIALLY OUR NATIVE HAWAIIANS BIG ISLANDER.

INDIVIDUALS, BIG ISLANDER COMMUNITIES TURNING MOST OF MY TO PREVENTION.

DESPITE ALL THE GREAT THERAPIES WE'RE DOING, DIABETES PREVENTION HAS TO BE WHERE WE START.

AND IT SHOULD START IN OUR YOUNG PEOPLE BECAUSE ONCE YOU HAVE DIABETES, IT'S NOT A LOST CAUSE, BUT IT IS COMPLICATED AND IT DOES AFFECT EVERY PART OF YOUR LIFE.

AND WE'RE UNDERSTANDING MORE ABOUT DIABETES PREVENTION AND LIFESTYLE AND HOW EXERCISE WORKS AND THINGS OF THAT NATURE.

BUT FOR ME YOU KNOW IF WE CAN PREVENT ONE CASE OF TYPE 2 DIABETES.

WE ARE ACTUALLY AFFECTING A GENERATION OF PEOPLE.

BECAUSE FOR WOMEN, YOU KNOW, THAT RISK FOR TYPE 2 DIABETES CARRIES ON INTO PREGNANCY THEN THE BABIES ARE THEN AT HIGHER RISK AND IT GOES ON AND ON AND ON.

SO THE GOOD NEWS ABOUT DIABETES IS PREVENTION IS THAT WE'RE ACTUALLY MAKING A DIFFERENCE.

THE RATES OF NEW CASES OF DIABETES IN HAWAII AND IN THE U.S., ARE GOING DOWN.

THERE ARE LESS NEW CASES OF DIABETES OCCURRING SINCE 2012 ACTUALLY.

THAT TRAJECTORY IS STILL GOING DOWN.

IT'S GOING DOWN SLOWER IN OTHER POPULATIONS THAT ARE NOT WHITE.

BUT THE FACT OF THE MATTER IS WE ARE MAKING HEADWAY.

DOESN'T MEAN THAT DIABETES GONE.

BECAUSE MANY OF US WHO ARE LIVING WITH DIABETES ARE STILL HERE.

SO IT'S STILL IN OUR COMMUNITIES.

WE STILL NEED TO CARE FOR THAT.

BUT THE NUMBER OF NEW CASES ARE GOING DOWN.

>> THAT'S GOOD NEWS.

THAT'S REALLY GOOD NEWS.

>>Daryl: DOCTOR, WHAT WOULD YOU ATTRIBUTE THAT TO?

IS IT OVERALL, POPULATIONS HEALTH IS IMPROVING?

OR SPECIFICALLY PEOPLE ARE DOING THINGS TO AVOID DIABETES?

>> WELL, I MEAN, I THINK THE NUMBERS HAVE STABILIZED.

LIKE DR. MAU SAID.

NOW AT AROUND 10%.

10.5.

WHAT'S CONCERNING IS THE HEALTH DISPARITIES.

>> BECAUSE WE'RE STILL SEEING ISSUE THAT NATIVE HAWAIIAN PACIFIC ISLANDERS FILIPINO, THEY HAVE, THEY'RE AT 12%.

13%.

AS FAR AS THEIR RATE.

AS LEAST FROM MOST RECENT 2020 CDC NUMBERS.

SO WE STILL HAVE CHALLENGES AND YOU KNOW, I MEAN, THIS HASN'T REALLY BEEN BROUGHT UP.

ONE.

I WAS GO TO SAY, SAY IT OVER AND OVER AGAIN, IS THE SO EASY TO GET TESTED NOWADAYS.

YOU DON'T EVEN HAVE TO FAST.

CAN YOU GO TO CVS OR LONG'S GET A GLYSOPHATE OSCILLATE HEMOGLOBIN TEST.

MEASURES AMOUNT OF SUGAR BOUND TO HEMOGLOBIN AND IT'S EASY TO DO.

YOU DON'T HAVE TO GO TO THE ‑‑ IF YOU DON'T HAVE A DOCTOR, YOU CAN GET TESTED.

SO IF NOTHING ELSE, GO TO THE DEPARTMENT OF HEALTH SITE.

TAKE THEIR EASY DIABETES.

TEST OR AMERICAN DIABETES ASSOCIATION.

FIGURE OUT WHETHER YOU SHOULD GET TESTED.

USUALLY, IF YOU'RE YOUNGER IT'S NOT THE SAME AS IF YOU'RE OVER 45.

BUT STILL, IT'S SO EASY TO GET TESTED.

SO I REALLY RECOMMEND THAT.

>>Daryl: WHAT ARE YOU SEEING AMONG YOUR PATIENTS?

I KNOW, A LOT OF TIMES, WHEN YOU'RE SPECIALIST IN SOMETHING, YOU SEE PEOPLE WHEN THEY'RE ALREADY SICK.

AS OPPOSED TO BEFORE THEY'RE SICK.

>> WITH A CONDITION.

DO YOU HAVE SUCCESS IN GETTING THEM TO TURN THEIR LIFESTYLES AROUND AND ALSO WONDERING, ARE YOU SEEING A DIFFERENCE IN YOUR PATIENT, PEOPLE COME TO YOU, WITH A CONDITION?

>> SO, WHEN THEY COME TO ME, THEY MIGHT NOT NECESSARILY HAVE COMPLICATION.

OR AS YOU SAID, REALLY REALLY SICK.

BUT THEY MIGHT NEED A LITTLE TWEAKING OF THEIR MEDICATION, A LITTLE BIT MORE EXPERT USING NEWER MEDICATIONS.

YOU KNOW, AGAIN, TOGETHER, I'M A BIG ADVOCATE OF DIABETES EDUCATION.

I SEND THEM OUT TO CLASSES.

A LOT OF RESOURCES.

LOCAL CLASSES.

AND NO SHORTAGE OF INFORMATION ON WEBSITES.

SO WHEN THEY DO GET EDUCATED, THAT INSPIRES THEM, MOTIVATED THEM, EMPOWERS THEM TO MAKE HEALTHIER LIFESTYLE CHANGES, HEALTHIER DIET CHANGES.

AND I WANTED TO COMMENTEN ABOUT THE DECREASED RATES OF DIABETES.

THAT DR. MAU MENTIONED.

WHEN THAT DPP STUDY WAS PUBLISHED, AND IT PROVED THAT WE COULD PREVENT DIABETES, THE MESSAGING THAT WENT OUT WITH THAT, AS WE SCREEN MORE FOR PATIENTS WITH DIABETES, PICKING UP MORE PREDIABETES.

AT THAT STATE, IS WHERE WE CAN TAKE ACTION.

BECAUSE AT PREDIABETES, COULD YOU MAYBE REVERSE IT.

AND PREVENT PEOPLE FROMPROGRESSING TO DIABETES.

BEST CURE FOR DIABETES IS TO PREVENT.

>>Daryl: COUPLE OF QUESTIONS FROM PEOPLE WHO ARE CHALLENGED BY DIABETES.

ONE VERY OPTIMISTIC, A PREDIABETIC REVERSING AND CHANGING MY LIFESTYLE TWO MONTHS NOW.

WITH HELP OF MY DIABETES DIETICIAN.

CONGRATULATIONS.

D FROM FACEBOOK.

KIND OF TECHNICAL QUESTION.

MAYBE EITHER DR. MAU OR TOM, CAN HELP ME WITH THIS.

I NEED TO N WILL I BE FREE FROM PREDIABETES IF I CONTINUE TO REVERSE MY NUMBERS, I AM 5.7AC1 SINCE 2016.

>> TWO MONTHS INTO THIS DIET MOVING MORE, EATING HEALTHY, SLEEPING WELL AND STRESS FREE.

DRINKING A LOT OF WATER.

SCARED OF TYPE 2.

CAN YOU H.E.L.P.

TRANSLATE THAT FOR ME?

I DON'T KNOW MUCH ABOUT DIABETES.

MYSELF.

AND WHAT WOULD YOU SAY ABOUT THIS PERSON'S EFFORTS?

SO I THINK THE HOPEFUL ANSWER WOULD BE YES.

PREDIABETES, BLOOD SUGAR MAY BE HIGH OUT OF NORMAL RANGE.

NOT HIGH ENOUGH TO BE DIABETES RANGE.

SO WHEN YOU'RE PREDIABETES, YOU CAN EITHER STAY AT A PREDIABETES STATE.

YOU CAN PRECONGRESS TO DIABETES OR YOU CAN‑PROGRESS TO DIABETES OR HOPEFULLY WITH THIS ONE, YOU CAN GO BACK TO NORMAL GLUCOSE, NORMAL HEMOGLOBIN A1C.

>>Daryl: YOU WENT TO THE DOCTOR, YOU WERE HORRIFIED, WHAT HAPPENED?

>> SAT DOWN, MY LIFE CHANGED IT.

I WAS WON TO EAT THREE BALANCED MEALS.

NEVER ATE BREAKFAST.

SO I DID.

I SAID, OKAY, I'M GOING TO CHANGE HOW I EAT.

AND ATE BALANCED MEALS.

FAITHFULLY.

DID A LITTLE BIT MORE OF EXERCISING.

REALLY NOT AN EXERCISE TYPE PERSON.

BUT TRIED TO DO, SHORT WALKS.

COUPLE OF TIMES A DAY.

AND THINGS.

AND DROPPED MY WEIGHT.

WATCHED WHAT I ATE.

DROPPED 35‑POUND.

SO THE FIRST YEAR, WAS DOWN TO, FIRST YEAR, 3 SHOTS A DAY.

SECOND YEAR, TWO SHOTS.

THIRD YEAR, I WAS DOWN TO 1.

>> AFTER THAT, I WAS COMPLETELY OFF IT.

ONLY FOR MITT.

>>Daryl: AWESOME.

SO FAR, STAYED THE SAME.

>> SO I'M ALWAYS HORRIFIED WHEN I GO.

TO MAKE SURE IT'S NOT CHANGED.

>>Daryl: SO YOU SAY YOU'RE 79 NOW.

YOU WERE DIAGNOSED IN 2004.

SO THAT WAS 17 YEARS AGO.

OR SO.

WERE YOU IN YOUR EARLY SIXTIES.

HOW HARD WAS IT FOR YOU TO CHANGE THE WAY YOU WERE LIVING WHEN YOU WHY IN YOUR EARLY SIXTIES?

>> NOT AT ALL.

BECAUSE LINING SAID EARLIER, I WAS DEFINITELY AFRAID OF THE OUTCOME IF IT DIDN'T GET MY ATTENTION.

>>Daryl: SEEN THE WORE EA WORSE.

>> RIGHT.

>>Daryl: YOU'VE EVEN HORRIBLE THINGS HAPPEN WITH THINGS PEOPLE WHO HAD DIABETES AT THAT TIME.

I EVERYBODY, WE ALL KNOW THAT BEING A KIDNEY DIALYSIS PATIENT, DOESN'T MEAN THAT EVERY DIABETIC IS.

BUT THE POINT IS TRY NOT TO BE BECOME ONE.

RIGHT?

>>Daryl: EXACTLY.

>> MODERATION.

>>Daryl: DR. MAU, OF TERMS OF THE YOU SAID, THERE'S NO DIABETES DIET.

BUT THERE'S ALSO A BIG EMPHASIS RIGHT NOW ON REDUCING SUGARY DRINKS.

IS THAT SOMETHING THAT TENDS TO BE PART OF THE RISK GROUPS LIFESTYLE, I MEAN, IS THERE A LIFESTYLE PIECE THAT YOU'RE PARTICULARLY CONCERNED ABOUT, THAT TENDS TO BE ASSOCIATED WITH THE HIGHER RISK GROUPS?

>> RIGHT.

I LEARNED, I'M NOT A DIETITIAN.

BUT WHAT I HAVE LEARNED, IS THAT THE GOOD WE HAVE DIETICIANS.

BECAUSE LEARNING HOW TO EAT HEALTHY, NO SET DIABETIC DIET, MEANS WE HAVE TO EDUCATE OURSELVES ON HOW TO UNDERSTAND WHAT WE'RE PUTTING IN OUR MOUTHS.

AND SO YOU HAVE TO LEARN HOW TO READ THE LABELS.

YOU HAVE TO UNDERSTAND WHAT THESE THINGS ARE.

I MEAN, HALF OF THEM, YOU CAN'T PRONOUNCE.

AND TURNS OUT IN THE OLD DAYS, WHEN I FIRST STARTED, YOU KNOW, DOING MY ENDOCRINE FELLOWSHIP AND MEDICINE RESIDENCY.

IDEA THAT ALL FATS WERE BAD.

THAT'S NOT TRUE ANY MORE.

WE NOW UNDERSTAND THE ROLE THAT FATS, DIFFERENT KIND OF FAT, MONOUNSATURATED FATS, HEALTHY FATS, AND UNHEALTHY FAT.

AND SO WE HAVE TO TEACH OURSELVES, HAVE TO EDUCATE OURSELVES, NOT JUST BECAUSE YOU HAVE DIABETES, BUT BECAUSE OF A LOT OF HEALTH CONDITIONS.

>> CARDIOVASCULAR DISEASE, AFFECTED BY DIET IN BIG WAYS.

I THINK THE MESSAGE THAT I WOULD LIKE TO HAVE FOLKS REMEMBER IS THAT'S INCUMBENT UPON US TO UNDERSTAND WHAT WE'RE PUTTING IN OUR MOUTH.

THE MORE THAT YOU KNOW, WE UNDERSTAND THAT, AND COOK OUR OWN FOOD ACTUALLY, PANDEMIC, WE'VE ALL HAD TO STAY HOME, NOT GO RESTAURANTS AND THE PRETTY SOON YOU FIGURE OUT, I'VE COOKED SO MANY OF MY MOTHERS RECIPES PAST YEAR THAN I HAVE IN A LONG TIME AND THEY'RE REALLY HEALTHY.

AND I THINK IT'S JUST, WE HAVE TO EDUCATE OURSELVES AND I AM AREALLY INTERESTED MYSELF IN TERMS OF WHAT I EAT AND DRINK.

I DRINK MORE WATER THAN I EVER HAVE BEFORE.

AND IT'S REALLY A GOOD THING.

>>Daryl: QUESTION FROM A VIEWER.

HAVE THEY EVER STUDIED THE RADICAL INCREASE IN DIABETES SINCE THE 1980S, WE HAVE TALKED A LITTLE BIT ABOUT THINGS MAYBE LITTLE BIT MORE.

UNDER CONTROL.

OR MORE EDUCATION OUT THERE.

WHAT CAUSED THE EXPLOSION IN DIABETES THAT WE DID SEE?

>> OH, BOY.

LOOK AT THE GROUND.

>>Daryl: 30 SECOND.

JUST KIDDING.

>> NO, I MEAN, YOU KNOW, I THINK BACK TO, GREW UP IN SOUTHERN CALIFORNIA.

WE USED TO EXERCISE DURING, THEN FUNDING CHANGED.

THERE WAS LESS EXERCISE.

WE DIDN'T SIT IN FRONT OF TVS.

WE PLAYED OUTSIDE.

WE CHANGED OUR WHOLE, THE WAY WE LIVE.

>> I MEAN, EVERYBODY HAS AN IPAD.

EVERYBODY CONNECTED UP TO THEIR PHONE.

I MEAN, IT'S A COMPLETE REALLY CHANGED.

EVEN OUR DIET.

THIS IS TRUE REGARDLESS YOU KNOW, YOU LOOK AT DIFFERENT ETHNIC GROUP.

WHAT PEOPLE EAT AND THE AMOUNT THEY EAT.

THE SIZE OF PORTIONS.

I MEAN, GO TO A CHEESECAKE FACTORY.

IT'S LIKE, THAT'S ENOUGH FOR FOUR PEOPLE.

PORTION IS AT SIZE OF A DECK OF CARDS.

IF YOU'RE EATING MORE THAN THAT, AND I LOVE WHAT TONY SAID, EXACTLY WHAT MY MOTHER TOLD ME.

EVERYTHING IN MODERATION.

SO I AGREE.

THAT IS WHAT IS CONTRIBUTED TO THE INCREASE.

BUT IT'S NOT, I DO WANT TO MAKE SOMETHING CLEAR.

IT'S NOT, BEING OVERWEIGHT AND OBESE IS A RISK FACTOR.

BUT IT'S NOT THE ONLY THING.

WE JUST HAD A STUDY PUBLISHED LAST MONTH, BY THE MULTIETHNIC CODE.

I KNOW AS NEW AGE NEWS, TODAY, SHOWING THAT FOR INSTANCE, AMOUNT OF SUBCUTANEOUS FAT VERSUS VISCERAL FAT THAT YOU HAVE, SO SUBCUTANEOUS FAT WHAT YOU HAVE UNDER YOUR SKIN.

VISCERAL FAT IN YOUR ORGANS, BELLY FAT, AROUND YOUR ORGANS.

THAT STUDY SHOWED THAT IN JAPANESE INDIVIDUALS, THAT RATIO, IF YOU HAVE MORE VISCERAL, THAT'S ASSOCIATED WITH INCREASE RISK OF DIABETES.

SO IT'S MORE, YOU DON'T THINK OF SOMEONE WHO IS SMALL OR SOMEONE, DIABETES GOES ACROSS.

THEN DR. MAU MENTIONED, KEEP TALKING ABOUT NATIVE HAWAIIAN PACIFIC ISLANDERS, I'M HISPANIC HAVE 40% CHANCE OF DIABETES.

INCREASES RISK TO 50% FOR TYPE 2.

>>Daryl: WONDERING DO YOU SOMETIMES HAVE PATIENTS WHO COME TO YOU AND SAY, I DIDN'T THINK I COULD GET DIABETES.

I'M NOT, FILL IN THE BLANK.

ONE OF THIS GROUP.

ONE OF THAT GROUP.

DON'T REALLY REALIZE THAT THEY WERE COULD BE AT RISK.

IF THEY WEREN'T, JUST KIND OF ASKING WHETHER THERE IS ENOUGH MISUNDERSTANDING OUT THERE THAT PEOPLE DON'T THINK THEY CAN GET DIABETES.

>> SURE.

THERE ARE PATIENTS THAT COME IN.

NO FAMILY HISTORY.

AND THEY'RE FIRST ONE IN THE FAMILY TO HAVE DIABETES.

BUT JUST GETTING OLDER EX‑IS THERE'S A RISK TEST THAT THE AMERICAN DIABETES ASSOCIATION HAS AND AS WE COME UPON THE END OF MARCH, WE SOUND THE ALERT AND TRY TO GET PEOPLE TO TAKE THE RISK TEST.

WRITTEN TEST.

WHEN YOU CAN DETERMINE WHAT YOUR RISK FOR DIABETES IS.

YOU GET ONE POINT FOR JUST BEING PAST AGE OF 60.

SO AS WE GET OLDER, YOU GET ONE POINT FOR THAT.

AS WE GET OLDER WE MIGHT BE MORE SEDENTARY.

AT RISK FOR DIABETES.

WE CAN'T PREVENT GETTING OLD.

CAN'T PREVENT, WE CAN DO SOMETHING ABOUT BEING SEDENTARY.

>>Daryl: OKAY.

LET ME ASK A QUESTION.

THAT I WOULD TRY OFF OF TONY LEE FIRST.

WHY ARE THERE SO FEW SELF‑HELP SUPPORT GROUPS FOR DIABETES IN HAWAII?

I KNOW THAT PEOPLE WHEN THEY GET ILLNESS OFTEN WHEN THEY TELL OTHER PEOPLE THEY HAVE A ILLNESS.

THREE PEOPLE TELL YOU, MY UNCLE, MY BROTHER, YOU KNOW, HAVE THAT KIND OF SOCIAL SUPPORT AROUND YOU.

YOU.

BUT WHAT DID YOU DO AND WHAT DO YOU DO AS A DIABETIC TO HELP OTHER PEOPLE?

WHAT MESSAGES DO YOU SHARE MOST OFTEN THAT PEOPLE MAY BE DON'T EXPECT TO HEAR WHEN THEY IT HAVE BEEN DIAGNOSED OR HAVE FAMILY MEMBERS DIAGNOSED.

>> BEING A MEMBER AND VERY ACTIVE, WITH THE HAWAIIAN CIVIC CLUBS, WHEN WE KNEW EARLY ON ABOUT DANGER AND HOW HAWAIIANS WERE HIGHLY TESTED.

AND POSSIBILITY OF DIABETES WAS VERY PREVALENT.

AND SO WE, I MAKE A CONSCIENTIOUS EFFORT TO MAKE SURE MY CLUB MEMBERS ALL GET TESTED.

WHEN THEY GO CONVENTION.

WE ALSO EAT AND MEET, WHEN WE EAT AND MEET, WE WATCH THOSE DIETS THAT COME, COMING ON THE TABLE.

BECAUSE WE WANT TO MAKE SURE THAT OUR PEOPLE ARE EATING HEALTHY.

YOU KNOW, THE FRIGHTENING THING ALSO, ONCE I GOT OFF OF INSULIN, AND EVERYTHING, MY DOCTOR SAT ME DOWN AND SAID, IT'S REALLY GOOD.

HOW FAST YOU DID THIS.

BUT I'M WORRIED ABOUT YOU.

YOU I SAID YEAH.

HE SAID TO ME, BECAUSE I DON'T KNOW THAT YOU UNDERSTAND THAT THIS IS FOR THE REST OF YOUR LIFE.

NOT JUST NOW.

AND THE FACT THAT YOU LICKED IT AND GOT CONTROL OF YOURSELF AND YOUR LIFE AND DIETS, DON'T THINK THAT YOU'RE HOME FREE.

THIS IS FOR THE REST OF YOUR LIFE.

THAT WAS KIND OF SCARY AS WELL.

SO I TRY TO SHARE MY STORY WITH WHOEVER WITH LISTEN.

AND YOU KNOW, IT'S ALWAYS BEST IN THE LUNCHROOM.

RIGHT?

I'M STILL WORKING.

I'M A TEACHER.

AND KUPUNA IN THE PROGRAM.

THAT'S THE BEST PLACE TO TALK ABOUT IT AND WE ALWAYS HAVE, YOU KNOW, GOOD CONVERSATIONS ABOUT IT.

AND AGAIN, YOU KNOW, I WAS ONE OF THOSE.

DR. TOM SAID, I THOUGHT IT WAS INEVITABLE NEVER GOING TO BE TO BECAUSE NOBODY IN MY FAMILY WAS A DIABETIC.

NOW I WAS FULL‑FLEDGED DIABETES.

MOST PEOPLE START AT ONE PART, INSULIN SHOT A DAY.

I HAD TO START WITH THREE.

>>Daryl: ON THAT QUESTION ABOUT THE SELF‑HELP AND SUPPORT GROUPS, I KNOW THAT THERE HAVE BEEN SOME DIABETES PROGRAMS DID INVOLVE SOCIAL INTERVENTION, HAVE HEALTHY FUTURES.

HOW IMPORTANT IS IT TALK ABOUT THIS, COMMUNICATE, ONE TO ONE TO HELP EDUCATE PEOPLE?

>> DR. MAU?

>> SORRY.

I THOUGHT IT WAS DR. TOM.

LORI CAN ANSWER THAT TOO.

YEAH.

WELL, I WAS JUST THINKING, IN TERMS OF OUR NEW APPROACHES TO HELP CARE FOR INDIVIDUALS LIVING WITH DIABETES.

THERE'S THIS THING CALLED SOCIAL DETERMINANCE OF HEALTH NOW.

AND IT PART OF THE WAY THAT POSITIONS ARE BEING TRAINED TO UNDER THE COMPLEXITIES OF WHAT IS LIKE TO LIVE WITH DIABETES BECAUSE IT IS UNFORTUNATELY THERE IS NO CURE YET.

AND IT IS A LIFESTYLE ISSUE.

LIFELONG LIFESTYLE ISSUE.

AS TONY WAS MENTIONING.

SO I DO BELIEVE THAT BECAUSE IT'S A LIFELONG CONDITION, HAVING OTHERS WHO CAN SUPPORT YOUR EFFORTS TO BE HEALTHY AND WELL, NOT JUST HEALTHY ABSENCE OF DISEASE, BUT WELL, WELL‑BEING, THRIVING, YOU KNOW, THAT IS JUST BECAUSE YOU HAVE DIABETES DOESN'T MEAN YOU HAVE TO LIMIT EVERYTHING YOU DO.

THERE SOME, LIKE I SAID, EDUCATION GOES A LONG WAY.

AND HAVING SUPPORTIVE ENVIRONMENT, HAVING CHOICES IN YOUR SUPERMARKET, THAT ARE HEALTHY, HAVING THE ABILITY SAFE PLACE TO WALK, OR LIGHTS ON A TENNIS COURT, TO PLAY TENNIS, THINGS THAT ARE IN THE PLACES WHERE WE LIVE.

WORK AND PLAY.

THAT ACTUALLY MAKE A DIFFERENCE.

AND SO, I WOULD SAY SOCIAL SUPPORT IS PART OF THAT.

WHETHER IT'S COWORKERS OR FAMILY.

OR FRIEND.

>> OR NEIGHBORS.

AND I THINK PEOPLE, WHEN YOU SAY YOU HAVE DIABETES, I THINK YOU KNOW, PEOPLE TRY TO FEEL LIKE IT'S A STIGMA.

BUT IN THE NATIVE HAWAIIAN COMMUNITY, WHAT I LEARNED IS IF YOU JUST TALK WITH PEOPLE, THERE ARE A LOT OF INDIVIDUALS WHO ARE LIVING WITH THE DISEASE AND THEY'RE MAKING DUE.

BECAUSE YOU KNOW, HAWAIIANS ARE RESILIENT.

WE MUST GO ON.

>> YOU KNOW.

AND BUT I WOULD SAY, THAT SO.

RESEARCH THAT BEING DONE IN DOCTOR'S DIABETES RESEARCH CENTERPIECE TRYING TO HELP US UNDERSTAND HOW, YOU KNOW, SOME OF THE UNDERLYING HE MECHANISMS SO WE CAN MAKE SOME ADVANCEMENTS IN UNDERSTANDING HOW TO PREVENT THE DISEASE.

AND HOW IT BETTER PREVENT END STAGE KIDNEY DISEASE FOR EXAMPLE.

OR END STAGE COMPLICATIONS.

SO SOCIAL SUPPORT.

WE CAN NEVER DISCOUNT THAT.

SO IMPORTANT.

IN MY OPINION.

INTO DR. TOM, DO YOU FIND IN YOUR AMONG YOUR PATIENTS, IS THERE INDEED A LACK OF SUPPORT GROUPS OR IS IT MORE FAMILY SUPPORT THAT THEY TEND TO TURN TO?

>> DEFINITELY IS NOT ENOUGH SUPPORT GROUPS.

CERTAINLY, THE FAMILY CAN BE A SUPPORT.

TO SOMEONE WITH DIABETES.

SOMETIMES, THEY'RE ACTUALLY BARRIER TO MAYBE HEALTHY EATING AND HEALTHY LIFESTYLE.

I WANTED TO SAY THAT AMERICAN DIABETES ASSOCIATION DOES HAVE ADULT SUPPORT GROUP.

THAT MEETS REGULARLY.

AND THEY BRING IN SPECIAL SPEAKERS WHETHER THEY BE DIETICIANS, PHARMACISTS AND SO FORTH.

SO I WOULD USE LOCAL AMERICAN DIABETES ASSOCIATION.

ACE RESOURCE.

FOR WHAT OTHER PROGRAMS THAT WE HAVE OUT THERE.

THERE'S A CAMP FOR CHILDREN.

WITH DIABETES, AND YOU KNOW, WE HAD A LOT MORE GOING IN THE OLD DAYS.

PRECOVID.

AND COVID KIND OF SHUTDOWN.

A LOT OF PROGRAMS.

AND ACTUALLY, TONY REMEMBERS WE WERE ABOUT TO HAVE OUR ANNUAL WALK.

AND THAT WEEK.

SHOULD WE DO IT, SHOULD WE NOT, DO IT, SHOULD WE NOT.

IN THE FINAL HOURS, THAT LIVE WALK KAPIOLANI PARK TURNED VIRTUAL.

INTO TONY LEE, WHAT DID YOU DO, TO INSPIRE YOURSELF TO, I KNOW YOU TALK ABOUT THE FEAR OF ADVANCING WITH DIABETES.

WHICH IS CERTAINLY UNDERSTANDABLE.

BUT ALSO, HOW DID YOU MANAGE TO GET MORE ACTIVE?

I KNOW YOU SAID WEREN'T EXERCISING PERSON.

WHAT KIND OF THINGS DID YOU DO, I WAS THINKING ABOUT PEOPLE THAT I'VE KNOWN, OLDER PEOPLE, WHO'S LIFESTYLE IS VERY SEDENTARY.

PUTTER AROUND THEIR HOUSE.

DON'T REALLY GET OUT MUCH.

WHAT DID YOU TO INSPIRE YOURSELF TO GET MOVING?

>> WELL, YOU KNOW, AS A VERY ACTIVE PERSON, IN THE COMMUNITY, HAWAIIANS AND BEING A HAWAIIAN, WE HAVE A LOT OF KULEANA.

RESPONSIBILITY.

AND MY MOTIVATION IS TO STAY ALIVE AS LONG AS I CAN AND BE HEALTHY BECAUSE I WANT TO HELP HAWAIIANS TO BECOME BETTER PEOPLE.

BETTER CITIZENS.

BE EDUCATED.

BE HEALTHIER.

AND DO THAT, I HAVE TO MOTIVATE MYSELF TO BETTER MYSELF AND DO SOMETHING ABOUT IT.

I DON'T HAVE TIME TO PUTTER AROUND MY HOUSE.

I WISH I DID.

>> THERE IS NO TIME TO DO THAT.

AS I TELL MY CHILDREN, THE WORD RETIREMENT DOESN'T EXIST.

SO GET OVER T BUT THERE'S A LOT OF WORK TO DO TO BETTER MAKE HAWAII A BETTER PLACE.

AND THAT IS MY GOAL.

>>Daryl: WE DID GET ANOTHER QUESTION HERE ABOUT THE RELATIONSHIP BETWEEN DIABETICS AND COVID.

CAN DIABETICS GET THE COVID VACCINE.

I KNOW TODAY, HEALTH DEPARTMENT DID OPEN UP CHRONIC CONDITIONS AS ONE.

ELIGIBILITY FACTORS FOR GETTING A VACCINE.

THEY DIDN'T SAY DIABETICS COULD BREAK OUT OF THE AGE FACTOR BUT PEOPLE WHO ARE ON DIALYSIS COULD.

THE QUESTION IS, CAN DIABETIC GET THE COVID VACCINE I THINK THE ANSWER IS DIABETICS AREN'T HIGHER IN THE LINE THAN OTHER PEOPLE WITH CHRONIC ILLNESS.

CAN YOU TALK ABOUT THE RELATIONSHIP BETWEEN DIABETES AND COVID?

>> OKAY.

THAT'S A LITTLE COMPLICATED.

FIRST OF ALL,.

>>Daryl: YOU HAVE 30 SECONDS NO.

JUST KIDDING.

>> BRIEFLY.

YOU HAVE TO REALIZE IN THE LAST YEAR, MEDICAL SCHOOL, OUR PHYSICIANS TAKING CARE OF PATIENT.

WE'RE STILL OPEN.

WE'VE BEEN ESSENTIAL SO WE'RE STILL TEACHING MEDICAL STUDENTS.

BECAUSE WE NEED PHYSICIANS.

I MEAN, THOSE ARE TWO THINGS WE DIDN'T SORT OF TALK ABOUT.

ONE OF THE THINGS DIABETICS YOU NEED ACCESS TO GOOD FOOD AND ACCESS TO MEDICAL CARE.

THAT AFFECTS THAT ALSO AFFECTS DIABETES.

BACK TO COVID, THERE IS A COUPLE OF ISSUES.

I MEAN, ISSUE WITH COVID IS FIRST OF ALL, THE MOST, BIGGEST ASSOCIATION HAS BEEN WITH OBESITY AND OVERWEIGHT WITH AGING.

DIABETES SORT OF GOES ALONG PARALLEL WITH THAT.

ISSUE WITH DIABETES IS THAT THERE'S A COUPLE OF DIFFERENT THOUGHTS.

>> ONE IS YOU HAVE TO SIDE STORM.

EVERYONE HEARD OF THAT?

>> DIABETIC, EVEN PREDIABETICS HAVE INCREASED INFLAMMATION.

THAT INCREASED INFLAMMATION, INCREASED ABILITY TO COAGULATE, IN OTHER WORDS, TO CLOT THEIR BLOOD, WHAT END UP HAPPENING, NOW YOU THROW COVID INTO THE MIX AND IT MAKES IT MORE DIFFICULT TO FIGHT IT OFF.

SO IT'S A TOXIC COMBINATION.

NOW, PEOPLE ARE TRYING TO UNDERSTAND WHAT IS GOING ON WITH DIABETES.

ONE OF THE THINGS THAT BEING LOOKED AT ADD WHETHER OR NOT COVID IS ATTACKING BETA CELLS IN THE PANCREAS THAT MAKE INSULIN.

AGAIN, THERE'S A LOT OF THAT WE DON'T KNOW YET BECAUSE WE SPENT SO MUCH TIME NOW BUILDING UP TESTING.

SO MEDICAL SCHOOL, WE SET UP A LAB TO HELP TESTING IN THE STATE.

WE'RE TESTING OUT AT THE WAIANAE COAST.

TESTING ON THE ISLANDS.

SO ALL OF OUR ENERGY HAS BEEN PUT ON TESTING.

NOW, WE'RE ALL OF OUR ENERGY AT THE MEDICAL SCHOOL ARE BEING PUT INTO VACCINATIONS.

SO AND THEN FUNDING FOR THE RESEARCH, SO RIGHT NOW WE HAVE ONE GRANT FROM THE HAWAII COMMUNITY FOUNDATION TO LOOK AT IMMUNE SYSTEM.

PRE AND POST VACCINE.

BUT THAT'S IN MICE.

WE HAVE A BUNCH OF GRANT APPLICATIONS THAT ARE ALL OUT.

WE ARE ALL WRITING APPLICATIONS.

TO GET FUNDING FOR THE FEDERAL GOVERNMENT.

BUT IT TAKES THE FEDERAL GOVERNMENT ANYWHERE FROM SIX MONTH TO TWO YEARS.

TO FUND.

GRANTS.

AND SO WE'RE SORT OF BEHIND IN THE LITERATURE.

AS FAR AS WHERE THINGS ARE MOVING.

OVERALL.

>>Daryl: OKAY.

THANK YOU.

DR. TOM, ANOTHER QUESTION FROM BEVERLY IN HONOLULU.

>> AGAIN, HER A 1C IS 5.7, AS HIGH AS 6.

DOCTOR SAYS ONCE YOU ARE DIAGNOSED PREDIABETIC.

YOU ARE FOR LIFE.

IS THAT TRUE OR CAN YOU REVERSE THAT?

TONY SAID HER DOCTOR SAID YOU'VE GOT THIS FOR LIFE.

IS THAT, I MEAN, IS THAT EXACTLY TRUE?

THAT IF YOU ARE PREDIABETIC, YOU'RE GOING TO SORT OF BE PREDIABETIC FOR THE REST OF YOUR LIFE, YOU WILL ALWAYS HAVE THAT DANGER OF FALLING INTO DIABETES OR IS IT SOMETHING THAT YOU CAN MAKE GO AWAY?

>> OKAY.

I'M GOING IT SAY.

QUARTER PEOPLE CAN MAKE IT GO AWAY.

HALF THE PEOPLE WILL STAY PREDIABETIC.

OTHER QUARTER MAY PROGRESS TO DIABETES.

AS SIMPLE NUMBER.

TELL BEVERLY SHE HAS A CHANCE OF MAKING IT GO AWAY.

AND GETTING HER NUMBERS DOWN.

AND BUT AGAIN, ONGOING, IS THE NEED TO HAVE A HEALTHY DIET AND LIFESTYLE.

WHATEVER SHE DID TO MAKE IT GO AWAY, TO CONTINUE WHAT SHE'S DOING.

>>Daryl: DR. MAU, MAYBE YOU COULD HELP ME WITH THIS.

LITTLE BIT LOST ON THIS ONE POINT.

DIABETES COMES FROM EITHER NOT RESPONDING WELL TO INSULIN ISN'T WORK THANK YOU HAVE, OR NOT PRODUCING INSULIN.

BUT THOSE SOUND TO ME LIKE SOMETHING THAT IS PERMANENT.

MAYBE I'M MISUNDERSTANDING HOW THAT MECHANISM WORKS.

YOU HAVE INSULIN RESISTANCE AND THEN YOU HAVE A BETA CELL PROBLEM MEANING YOUR OWN, YOU HAVE DIFFICULTIES SEE CREATING OUT ENOUGH INSULIN TO BRING SUGARS TO NORMAL.

WHEN THAT HAPPENS, YOU GET DIABETES.

TWO THINGS METABOLIC THINGS HAPPEN BEFORE YOU DIAGNOSED WITH DIABETES.

PREVENTION PROGRAM, FOLLOWING INDIVIDUALS, 7 OR SO PART OF THE MULTINATIONAL, MULTISITE STUDY, WE'VE BEEN GOING ON NOW FOR ABOUT 27 YEARS.

OR SO.

SO MOST OF THE DPP INDIVIDUALS, WE'RE JUST FOLLOWING THEM NOW, BECAUSE WE ALREADY KNOW THAT YOU CAN PREVENT THE ONSET OF DIABETES WITH HEALTHY LIFESTYLE AND MODEST WEIGHT LOSS OF 5 TO 10%.

SO IF YOU CAN MAINTAIN THAT 5 TO 10% WEIGHT LOSS OVER A LIFETIME.

YOU'RE AMAZING.

YOU'RE AMAZING.

BECAUSE IN THE LINE OF WORK THAT THAT I DO, IT'S REALLY NOT THAT HARD, RELATIVELY SPEAKING, TO LOSE INITIAL WEIGHT.

IT'S TRYING TO KEEP THE WEIGHT OFF.

THAT IS REALLY THE CHALLENGE.

MOST PEOPLE AFTER ONE YEAR, THE MOST EFFECTIVE WEIGHT LOSS PROGRAM, THEY'RE BACK TO WHERE THEY WERE.

SO KEEPING THAT 5 TO 10% OFF, YOU HAVE A VERY GOOD CHANCE OF ALWAYS BEING AT RISK, BUT NOT DIABETIC.

IN THE DPP SAYS WE'VE BEEN FOLLOWING THESE PEOPLE NOW FOR OVER 20 YEARS, THE MAJORITY OF INDIVIDUALS ACTUALLY HAVE DEVELOPED DIABETES.

SO THERE ARE A MINORITY OF PEOPLE IN THE DPP RIGHT NOW, OUT COMES STUDY, JUST FOLLOWING THEM.

WHO HAVE MAINTAINED PREDIABETES.

THEY'VE BEEN PREDIABETIC FOR OVER 20 YEARS.

>>Daryl: LET ME UNDERSTAND.

WE'RE KIND OF RUNNING OUT TIME.

JUST NEED A QUICK ANSWER TO THE QUESTION.

ONCE YOUR INSULIN IS NOT WORKING THAT WELL, WHAT ARE THE REASONS, YOU CAN'T MAKE MORE INSULIN EXCEPT BY GIVING YOURSELF MORE INSULIN.

RIGHT?

>> ‑‑ MAKE MORE INSULIN.

>>Daryl: WHAT'S THAT?

>> YOU CAN TAKE DRUGS.

>>Daryl: TO MAKE MORE.

I SEE.

OKAY.

>> TO MAKE MORE INSULIN.

THERE ARE DRUGS AVAILABLE.

NOW.

>>Daryl: I UNDERSTAND.

>> THAT WILL STIMULATE YOUR PANCREAS TO MAKE INSULIN.

>>Daryl: OKAY.

YOU HAVE TO BE ON MEDICATION.

WE'VE GOT ABOUT A MINUTE LEFT.

FINISH WITH TONY LEE AND TONY.

I REALLY APPRECIATE YOUR TELLING US YOUR STORY.

WHAT DO WANT TO PEOPLE TO KNOW ABOUT DIABETES AND PARTICULARLY NATIVE HAWAIIAN COMMUNITY, WHAT DO YOU WANT PEOPLE TO KNOW ABOUT IT THAT YOU THINK WILL HELP THEM DEAL WITH IT OR AVOID IT?

>> WELL, YOU KNOW, I ALWAYS KIND OF ATTRIBUTE IT TO LIKE BORN WITH THE WRONG DECK OF CARDS.

IT'S IN THE GENES.

AND YOU CAN'T AVOID IT.

BUT YOU CAN DELAY IT PROBABLY.

I GUESS THAT IS THE PROPER WAY TO, IT'S INEVITABLE.

IT'S GOING TO GET THERE.

BUT THE THING IS TO DELAY IT AND TAKE CARE OF YOURSELF.

NOBODY TAUGHT US THAT AS WE WERE YOUNGSTERS.

EVEN AS A GUY DIABETIC NOW, GO TO THE DOCTOR FOR YEARLY CHECKUP, LOST MAYBE TEN POUND, DOCTOR IS CONCERNED.

WHY ARE YOU CONCERNED?

YOU'VE BEEN AFTER ME TO LOSE WEIGHT.

OH, ABOUT YOU THAT TOO MUCH.

>>Daryl: I GOT TO, TONY, THANK YOU SO MUCH.

YOU GOT YOUR POINT ACROSS.

I REALLY APPRECIATE IT.

>> I WANT TO THANK ALL OF OUR GUESTS TONIGHT.

MAHALO TO YOU FOR JOINING US TONIGHT – AND WE THANK OUR PANEL OF DIABETES EXPERTS TONIGHT... DR. LAURIE TOM, DR. MARJORIE MAU, DR. MARIANA GERSCHENSON, AND DIABETES PATIENT TONI LEE.

NEXT WEEK ON INSIGHTS, THE COVID‑19 PANDEMIC HAS MADE IT HARDER TO ESCAPE DOMESTIC VIOLENCE.

WE’LL DISCUSS WHAT HELP IS OUT THERE FOR VICTIMS AND WHAT DISTURBING TRENDS ARE ON THE RISE.

PLEASE JOIN US THEN.

I’M DARYL HUFF FOR INSIGHTS ON PBS HAWAI`I, ALOHA!