Good evening.

Thank you so much for watching Healthline on PBS.

Fort Wayne.

I'm your host, Mark Evans, celebrating 17 years as your host on this show.

My as time flown by and it's been a pure pleasure.

Hopefully we'll have at least 17 more years to go.

Thank you for watching.

Tonight, a very important subject.

The topic is diabetes.

That's becoming more and more prevalent these days.

More and more patients are being diagnosed with it.

And there are several types of diabetes, some a little bit more serious than others.

But we want to talk about that this evening.

And the telephone number on the screen is 8669692720.

Please call that at any time during the show.

You don't necessarily have to be on the air live.

If you'd like to have your question transcribed, that's fine.

I'll just read it off the teleprompter.

So this show is all about you and the ones you love and all your friends, because we just want to be able to supply information to you and then you decide whether or not you should seek help from another source, like a physician speaking, a physician doctor Emily Schrader is with us.

And you've been on the show a couple of times for us.

And we've always generated a lot of phone calls because it is a very important topic and you're an endocrinologist.

What exactly does an endocrinologist specialize in?

So endocrinologists specialize in different hormone disorders that can occur.

So probably the most common one we see is diabetes, but we also treat thyroid disease, adrenal problems, pituitary problems, and sometimes osteoporosis or bone issues.

So anything that involves the hormones.

All right.

We're we're glad you're here because November is national, diabetes is.

And I think it's just so perfect that you are here for that.

Let's begin with some stats about diabetes.

How many Americans have been diagnosed?

So about 38 million Americans are currently living with diabetes.

That's about over 10% of adults currently have diabetes in the United States.

And that number has been going up over time.

Is that also include youth?

It does.

So in youth.

We can see folks with type one diabetes and then increasing numbers being diagnosed with type two diabetes at a young age.

Okay.

So what's what's the ratio, would you say, in that 38 million, the adults versus the children?

And I hate to throw that curve.

So so in adults, probably about 95% of people living with diabetes have type two diabetes in young childhood before puberty, it's almost all type one diabetes.

And then after puberty, there's some development of type two diabetes as well.

Okay.

Well, if after puberty there's sometimes a type one go go away or no, you can see teenagers diagnosed with type one and even adults can be diagnosed with type one diabetes.

Okay.

And we're going to get more into that as we're going to break those different types of diabetes down in just a moment.

So let's talk about the risk factors.

But before I go into the risk factors, let's talk about what diabetes actually is.

So diabetes is a condition in which the there's an increased amount of blood sugar in the in the sugar, in the blood.

And in fact, diabetes maladies, its name means sweet urine.

And so when the blood sugar gets high enough, some of it gets excreted in the urine.

And so back before we could measure things, people recognized kind of the increased sweetness of the urine.

And that's where the name Diabetes mellitus in the world where they know that the urine tastes sweet.

I cannot speak to that.

We use other methods today.

Thankfully.

Thankfully.

All right.

So the risk factors, I was going to go into that.

Yeah.

So there's different risk factors for type one diabetes and type two diabetes.

So primarily the issue in type two diabetes is the body makes the pancreas makes insulin, which is an important hormone for regulating blood sugars, but the cells in the body don't respond as well to it.

So you develop insulin resistance in type one diabetes.

It's an autoimmune condition in which the body makes antibodies that destroy the part of the pancreas that makes insulin.

So there's different risk factors for those too.

So it's just not involving in the pancreas.

A diabetes can actually cause damage to the body and its vital organs.

Yes.

So those high blood sugars can impact throughout the body, so they can impact the eyes causing retinopathy or eye problems.

They can cause nerve problems, heart disease.

So a wide range of things.

Yeah.

And I know a lot of relatives who have had it, and I'm being watched at the moment.

I'm just not too far from being pre-diabetic.

And I think some of our regular viewers could probably tell that I probably taken some weight off in the last few years, especially since doing these shows and then, of course, seeing a doctor on a regular basis.

But my mother had what type two diabetes, and we're trying to prevent that.

So let's break it down.

There are several types of diabetes, but there are like what, three main types?

There's three main types.

So we've talked about type one, Type two, and then the third type would be gestational diabetes.

So that's high blood sugar that develops during pregnancy.

And then often after the woman delivers the baby, the blood sugars will go back to normal, but that woman will still be at increased risk of developing diabetes and type two diabetes in the future.

Now, you might have mentioned this before, but what is the most common or the main type?

So type two would be the most common type two, and that would be not necessarily adult onset.

Most commonly it's adult onset, but we do see some teenagers also being diagnosed with type two diabetes.

All right.

And can diabetes be inherited?

Is it genetic?

So there is a genetic predisposition both for type one and for type two.

So if your parents have had have diabetes, that you would be at increased risk.

Okay, very good.

We've got a question coming in.

And they're fact in fact, they're typing it.

Pardon me typing it right now on the screen.

So we'll wait until that's done.

So what are the the symptoms?

I mean, do you know you have to I mean, can you.

Yep.

So sometimes there can be no symptoms at all, especially in the early parts of type two diabetes.

And then as the blood sugars get higher, people can develop where they're very thirsty, they're peeing and drinking a lot because of that extra sugar in the urine.

So that's often what what people will notice.

But that's one of the reasons why it's important to see your health care team regularly know whether you're at risk for diabetes, whether you have pre-diabetes and get regular blood testing.

Okay.

And we're going to talk about some of those checkups and things like that a little later on in the show.

And James has called in asking to get an answer on this question.

If you're diagnosed as a pre-diabetic.

What lifestyle changes should I do to prevent diabetes?

So that's an excellent question.

And that kind of gets back to what you were asking about for risk factors for type two diabetes.

So prediabetes, your blood sugars have started to increase a little bit, but you're not in that diabetes range for those blood sugars yet.

So there's a number of lifestyle changes that people can take.

So one is trying to achieve or maintain a healthy weight and studies have shown even a weight loss of 5 to 7% if you have pre-diabetes, can decrease that risk of developing diabetes.

The other thing would be to try to eat a healthy diet, decrease the amount of carbohydrates and processed foods that you're eating and then be active.

So increasing physical activity as well, we know will decrease that risk.

When you say a healthy diet, is that same diet for everybody or is that a diet that needs to be altered just for you by a dietitian and your physician?

How does that work?

So it depends on what other medical conditions you have.

And if you are looking to lose weight as well.

So there's could be a wide range of diet.

So that's the best to discuss with your health care team.

What would work best for you, especially in the Type two diabetes?

Are most of those patients technically obese?

So the majority either are overweight or, you know, have excess body weight.

And so losing that can can often help.

Okay, Very good.

We're going to talk about some of the possibilities of reversing diabetes a little later in the show as well.

But we have a thing called diabetes.

ABC, and it has to do with the blood pressure and cholesterol levels.

Can you break that down for us?

Yeah.

So if you have diabetes or really just for many people, even without diabetes, it's important to keep your blood sugar, cholesterol and blood pressure under control.

So the A and ABC stands for A-1 C, which is a test that can be done in your doctor's office, looks at sort of your average blood sugars over the last three months.

They even have songs on TV about these Do they do B is for blood pressure.

So knowing what your blood pressure goal is and taking medications, if you need to help with that.

And then C is cholesterol.

So knowing what your cholesterol goal is and taking medications or changing your diet if you need to.

Well, it seems to me, as I mentioned, we've got a couple of these songs on commercial TV and they roll out the people dancing and so forth.

But I really and I've done this show for as as I mentioned at the top of the show for nearly 20 years.

I never really heard about A-one C until probably the last few years was all you hear about was the insulin level and the blood sugar level and so forth.

So he wants to explain what that is.

Yeah.

So it's really looking at a variety of different aspects of health.

And we know that in diabetes people are at increased risk for cardiovascular disease and also other complications.

And so in addition to managing your blood sugars, it's also important to keep your blood pressure and cholesterol under control.

If you go and have your A-1 science done through blood testing and you are at a certain level, even if you're trying to if you go to and you're making a concerted effort to diet and lose weight, but it goes up a notch, is that something really to worry about or should we investigate and find out why?

So you would want to investigate and find out why.

And it sort of depends where you're starting at and kind of how high up it's increased.

Okay.

Would in fact, somebody asked me to ask this.

A family member is very concerned about it, but alcohol intake, would that have a possibility of raising your agency?

So there's been sort of a lot of studies, pro and con, you know, a healthy alcohol use.

Alcohol does have a lot of kind of empty calories without a lot of nutrition.

So often it can lead to weight gain and also can change blood sugars as well.

Okay.

All right.

So we're going to hear so in moderation.

In moderation.

Moderation is the key, I've always heard.

That's for sure.

All right.

So how should we approach healthy habits and what are the most important habits to practice?

So we live in a society that promotes a lot of being sedentary, sitting around looking at computers all day, eating more processed foods.

And so a lot of this kind of contributes to a variety of different diseases in addition to diabetes.

But it can be hard to change habits and change, you know, your lifestyle.

So it's important to kind of set reasonable goals and make small steps towards what you're trying to achieve.

So that could include making sure you're walking some every day.

That could include making some small changes to your diet.

And then eventually those small changes will build up.

So you want something that's sustainable and that you can see some success and then build upon that success.

In the green room, we discussed something I do want to bring up.

Diabetes has become much more prevalent and you agreed in the last couple of decades.

Yeah.

And we discussed possibly the fast food ism.

Mm hmm.

That going on and being sedentary.

Because, you know, when I was a kid being raised, somebody's having diabetes.

And in fact, my stepdad had it.

He had type one.

But it was very rare, at least from my perspective, to hear anybody who had diabetes.

And unfortunately, if you had diabetes, oh, my gosh, you know, it was almost kind of considered as a death sentence.

I mean, you and he was insulin dependent and so forth.

And if he didn't take his insulin, he would end up in the hospital and all that.

So but any more, you hear more and more people are being died but diagnosed with the disease.

And it's just amazing to me how society changes in the last couple of decades have contributed to that.

Mm hmm.

And is that a proactive stance on people like you and what you do?

And in research?

Are we looking at ways to curtail that?

Yeah.

So, I mean, there's a lot of research into what we kind of call the built environment, which is the environment that you live in.

And what sort of lifestyle and activity that promotes.

And so there have been, you know, look into, you know, how can we revitalize downtown Fort Wayne with there's been a lot of work towards that to make it a place where people want to go out and walk around and walking trails that, you know, great bike system that we have here.

So how can we make it easier for people to exercise?

How can we make it easier for people to be active and access, you know, healthy and convenient foods in the grocery store and one of the contributing factors, as I just mentioned, is the fast food.

I mean, you're placing a lot of blame on fast food.

What's fast food are going to have to do to help turn that around?

Like the fast food restaurant.

Yes.

Well, fast food industry.

Yeah, that's a tough one.

I mean, there are we do see restaurants that are more health conscious, supporting more salads, less food with a lot of, you know, saturated fats.

Is it the processed foods that are a key contributor?

Yeah.

And what is processed food for the viewers who don't know.

So, you know, ideally, people should be getting a lot of their their food and calorie from Whole Foods.

So foods that haven't been processed a lot.

Fruits, vegetables, things like that.

When you buy packaged food, a lot of things have been added to it and a lot of the nutrients have kind of been removed.

So it still adds calories, carbohydrates, fats, but doesn't have as many of those nutrients.

And I know preservatives are a big factor in that, too.

Very concerning.

We have Niles Online five and actually it looks like he wants to stay off the air with his voice.

So we're going to read his question as well.

We love it when you call in and we can hear your voice, but we also love your questions.

And thank you so much for watching and participating.

Can you reverse Diebold this?

But one of the questions I was going to ask.

Can you reverse diabetes if you make certain lifestyle changes?

So some people can.

Some people cannot.

So like I said, there's been shown, you know, if people are able to lose some of their excess body weight, change their diet, sometimes that can help reverse the insulin resistance and type two diabetes and get those blood sugars back to normal.

So I definitely had patients who've had success with that.

Some people it's just not possible.

And in that case, we recommend medications and other things to help.

I will say that for type one diabetes, that is not reversible.

So since that's an autoimmune process that involves destruction of the part of the pancreas that makes insulin.

Currently, we don't have technologies to to reverse that, although people have looked into islet cell transplants or, you know, pancreas transplants, that would be the only setting in which you'd be able to reverse type one.

Now, you mentioned gestational diabetes earlier, and I wanted to elaborate on that a little bit more.

Have you do that is on the mother's side and it doesn't have anything to do with the baby, Correct.

Although we do know that if women have gestational diabetes, the babies tend to be larger and they also tend to have increased risk of developing diabetes when they are adults.

Oh, I see.

And that would be type one.

Type two, Type two.

Okay.

Let's get into the medications and I know when people think diabetes immediately they're thinking they're going to have to do the insulin shots.

And I've known several people who've had to do those.

A lot of people didn't want to do them and end up becoming very, very ill.

So what are the alternatives and what are the offerings these days?

So for type two diabetes, there's a number of different medication options.

Some of them we've had for a while and some of them are newer.

Some of them, I'm sure you've seen commercials on commercial TV for some some of them.

So they include medications that help your body use insulin better.

They include medications that help you pick out extra glucose in your urine to help decrease your blood sugars.

They include medications that work through some of the hormones in the GI tract, in the intestines.

Again, to help kind of slow how food is processed by the body, help it use insulin better, and some of them medications even do something in the brain to decrease those hunger sensation.

So that people tend to eat less.

So for type two diabetes, we have a number of options, although of course, some people do need to take insulin for type two diabetes.

Okay.

And how important is it to stay on track with your medications?

It's very, very important.

And it can be tough with diabetes is a chronic disease.

It can be sometimes people are in a lot of different medications for their blood sugars, their blood pressure, their cholesterol.

And it can be hard and stressful to stay on top of that.

It also can be expensive.

So if you're having trouble taking your medications as prescribed, it's important to talk with your health care team.

They can either help support you, find some ways to help or choose medications that are less expensive for you, or figure out what would be a regimen that you would be able to take.

And that's certainly something you really need to discuss with your physician.

All right.

Kim is on line six.

She's asking to stay off the air.

So I'll read her a question as well.

How should I take care of my diabetes when I travel?

So that is an excellent question.

Part of it depends on what sort of medications you're on.

But one of the difficulties with traveling is that people tend not to follow their usual routines.

And so either the level of activity is changing, the food they're eating is changing.

When they're eating is changing.

And so all of that is something you can discuss with your health care team before before you go on your trip to see sort of what would be good ways to to adapt to that.

Often you might need to take extra supplies with you.

So a glucometer or whatever you're using to check your blood sugars, you want to make sure you have that with you.

Some medications.

So insulin and some of the other medications that can't be exposed to extreme of temperature.

So you need to make sure you're not leaving them in hot or very cold cars.

And if you're flying, you want to make sure to take all your medications.

And also that your supplies with you as a carry on and not check them in the plane.

Oh, okay.

Take them with you and have them on person just in case a glucometer is that's the thing that you stick.

It is so that works by you get a little bit of blood from the capillary and then the machine reads what your blood sugar is.

Then we have more and more patients moving to continuous glucose monitors, which are those little circles on the arms that you might see.

Okay.

Or sort of oval shaped things and what you use your phone.

So people some people use their phones and people have a separate reader that they use with them.

And those have a little like filament or cannula that stays under the skin and measures your blood sugar every 1 to 5 minutes or so without having to do the finger.

Wow.

They've come a long way.

They have.

Of course, there's been a need for it, too.

So I'm sure that they have accelerated the research.

Yes.

The number of people who are actually getting diabetes.

Let's talk about now.

We talked about the weight and why it's so important.

Why is weight so important in this game?

So there's a lot of factors.

Excess body weight promotes inflammation and also insulin resistance.

So both of those factors then can lead to higher blood sugars.

Oh, I see.

Okay.

Diet that a patient should follow.

We're talking about staying away from sugars, mentioned Whole Foods, stay away from the processed foods.

But would you say that most of the time a doctor would recommend having a healthy, balanced meal each meal?

Yes.

Okay.

And what about carbohydrates?

Is that is that a concern?

So carbohydrates, your body needs insulin to help process those carbohydrates.

So often decreasing the carbohydrates can help people control their blood sugars.

All right.

We have another call coming in.

And in fact, they're finishing it up right now.

So I'll wait until they get that typed in.

Let me ask you about this.

What what exactly?

Pre-diabetes.

Okay.

It's kind of common sense is before diabetes.

But what what delineates the pre-diabetes and then all of a sudden, bam, you're into the diet.

So it's straight, so it's continuous.

So both prediabetes and diabetes are determined or defined based on either your blood sugar or that A1 c that we talked about looking at average of your kind of blood sugars over the last three months.

So people have kind of set a couple different sort of lines in the sand that we say on this side is going to be that diabetes on this side, pre diabetes, but it's a little bit of an arbitrary cut point.

So risk kind of goes up as your blood sugars go up.

Okay.

And then how do they know or how does a physician say, okay, you now have diabetes?

Yeah.

So there's certain numbers that they look for.

So for an A1 C, it would be 6.5 or higher.

I see.

Very good.

Fran is called in.

He's asking if your grandparent had diabetes, but your parents did not.

What are the chances of getting diabetes?

So that is a tough question.

Part of that probably depends on the age of your grandparents and your parents.

So whether or not your parents have reached the age your grandparents did when they developed diabetes, we know for type two diabetes, there's not just one gene that you inherit.

That means you're going to have diabetes.

So it's a number of different genes that probably each have a small contribution to your risk of developing diabetes.

But then it also goes along with kind of the lifestyle and other sort of environmental factors, I assume.

We have a few minutes left and I think I still have a couple of very important questions.

We're going to talk about mental health, Right.

Okay.

So what is the importance of taking care of your mental health in the treatment of death?

Yeah.

So as I mentioned before, you know, living with a chronic disease such as diabetes can be very stressful.

Diabetes in particular can require a lot of monitoring and self-care at home.

Self management at home.

And so it's important if you're, you know, feeling increased stress, depression either due to the diabetes or because of other factors that you talk to your health care team about that sometimes are medications or, you know, other things that can help with that.

But in addition to learning stress management techniques, some people enjoy things like meditation or yoga.

So kind of learning techniques at home that you can use to help manage your stress.

And then if you're continuing to have difficulty, is making sure to talk with your health care team about that.

And you should do that on a regular basis.

And it's so important to communicate and help support your health care team and let them be very truthful and just, yeah, I had a candy bar out in the parking lot.

Oh, yeah.

You know, if you did that, you've got to tell them because they have to be able to help you.

Yeah, and often both, I mean both your health care team in the office, but also, like diabetes educators can help a lot with that too, both kind of those lifestyle changes.

And then talking through with you how to kind of manage that stress.

You mentioned earlier and I wanted to bring this up while we have I think about a minute left, diabetes can actually affect your eyes.

How does that work?

Yeah.

So the increased levels of glucose in the blood vessels in the eye can be damaging to the eyes.

And so people can develop retinopathy.

They're also at increased risk for for cataracts.

So there are a number of treatments that are possible for those.

So in addition to working on controlling your glucose loss, your blood pressure, it's important to make sure you're getting regular eye exams if you have diabetes so that if there's any damage, it can be caught early.

When something can be done to help treat that.

All right.

I always like to in the shows, having the physician maybe take a moment to provide some take home notes about the particular subject they're talking about.

So what would you tell our audience as a wrap up tonight?

Yes, you know, I know a lot of you folks watching or living with diabetes or have loved ones who are living with diabetes.

And so just to encourage you to work with your health care team to help make sure you're doing everything you can, both in terms of medications or things you're doing at home to help manage those blood sugars, blood pressure, cholesterol to help avoid those complications.

And the first person to see it would be your family physician.

Start with your family physician.

And then if they feel the need, they will refer them to a endocrinologist like you.

Yeah.

All right.

Dr. Emily Schrader, thank you so much for being here tonight.

Hope to have you back again at another time.

And hopefully when you come back, we're going to see a decrease in diabetes.

Thanks to you.

Thanks for having me.

Absolutely.

Thank you for watching.

We'll be back next Tuesday with another show.

Until then, we appreciate the phone calls.

Your viewership.

Good night and good health.