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SARA LOMAX-REESE: Right now I want to welcome Dr. Donee Patterson, who is Einstein's internal medicine physician and Dr. Nissa Blocher, who is an endocrinologist at Einstein Healthcare Network. Welcome.
DONEE PATTERSON, MD: Welcome.
NISA BOLCHER, MD: Thank you for having us.
LOMAX-REESE: Thank you for being here. So this is diabetes and it is a huge issue, particularly in the African American community. If we look at the stats, there are about 25.8 million people a year in the US who have diabetes. Approximately 7 million people have diabetes but are not aware of it and another 79 million people have early or pre-diabetes. So if you add all of that up, that is a huge, huge number. Over 100 million people in some way, shape or form affected by diabetes, whether they know it or not. In the African American community we are 1.6 times more likely to have diabetes than Caucasians. So this is really, really critical and as we get ready to celebrate Thanksgiving, it's really important. It is kind of sobering but this is an opportunity for us to redouble our efforts to claim wellness and try to understand what the outcomes, what the consequences are of not being mindful. So let me start with you Dr. Donee. This is a really important topic. Talk to us about the impact of diabetes in the patient population that you see in the African American community. What are you seeing around diabetes?
PATTERSON: It is a very big problem in our community and as you said, African Americans are 1.6 times more likely to have it. I see lots of people with diabetes. I see lots of people who have some of the symptoms but didn't think to come in to get them checked, so they may be new patients and they may have had blurry vision or frequent urination or excessive thirst and they have had it for months and months but didn't think to come in and have them checked. Immediately, when they tell me this, I get concerned and I want them to update their lab work and their urine studies. So it is very common and as we were talking before we started today, it sounds like a very negative topic, the complications of diabetes, but we really want listeners to know that there are some things you can do to help hasten some of these complications and in some cases prevent some of the complications. The more well controlled your sugars are the better outcomes you will often have and there are so many things that can be affected. Actually, any organ system can be affected by diabetes so we want people to be aware of this, we want them to know their numbers and we want them to try to lessen these complications.
LOMAX-REESE: Dr. Blocher, you are an endocrinologist. Explain exactly the connection between an endocrinologist and diabetes.
BOLCHER: An endocrinologist means someone who studies glands and the pancreas is one of the glands of the body and the pancreas makes insulin. We also study other glands, we don't just see diabetic patients; we see patients with thyroid problems and other hormonal problems, but diabetes makes up about half of the patients that we see.
LOMAX-REESE: What are some of the things, I mean there are a myriad, as Dr. Donee just mentioned. It can affect all of the systems in the body but what are the most common complications associated with diabetes.
BOLCHER: The most common complications that we don't think about are actually heart attack and stroke. Those things are much more common in patients with diabetes. Some that we are more familiar with is kidney disease, so people who have to be on dialysis. Also diseases of the feet; people have to lose toes or part of their legs because of diabetes. Those are fairly common ones.
LOMAX-REESE: I know that some of the things that I thought was really interesting that I don't think a lot of people connect with diabetes is periodontal disease. A lot of times we think our teeth are separate from our bodies in some weird kind of way so there is not even an understanding that either if you are diagnosed with periodontal disease it could mean that you have diabetes or vis versa; Dr. Donee?
PATTERSON: What is going on is it's an infection. Wherever in our body that blood flows, which is everywhere can be affected by diabetes. If the gums are infected, it causes this low lying infection throughout the body often and we swallow it and it goes throughout our system and so often peoples' sugars are out of control. There are some studies that actually show when we improve periodontal disease and we clean up that infection that peoples' sugars actually come back to normal. I just want people to have this visual that inside their blood vessel, if there is too much sugar inside of our blood vessels, that sugar is toxic to that vessel so it literally tears up the lining of the vessel. Again, wherever there is blood, our eyes, our kidneys, our heart, a man's penis, our feet, wherever there is blood it can be damaged. That is why diabetes is so serious and that is why we thought it was important to talk about the complications because the lower you have your sugar the less damage occurs.
LOMAX-REESE: Let's talk about the causes of diabetes and then we will go back to the complications. We know that obesity and overweight are a significant contributor to diabetes and that it used to be called adult onset diabetes and now we know that with so much childhood obesity that is no longer. Younger and younger populations are being diabetes with diabetes and as we move into this food feast of Thursday, of Thanksgiving, we just want to present this as food for thought so to speak that this connection and obesity and diabetes is a real one. Dr. Blocher, can you talk about what it is about being overweight or obese that makes you at risk for diabetes?
BOLCHER: The human body makes insulin to process sugar. It helps to store away sugar; store away our food for later. The body was designed for when there wasn't food out there in our refrigerators; it was harder to get than that. What happens is a lot of things can cause our bodies to be more resistant to insulin or to need more insulin. I like to describe diabetes as running a small air conditioner in a very big room. T he pancreas is like the air conditioner and it is trying to make insulin and make the body work right and keep the blood sugars down, but if the room is too big it is going to work at maximum capacity and eventually it won't be able to keep the room cool anymore. That is the point that your blood sugar start to rise; your pancreas just can't make anymore insulin. Then I try to tell patients you need to make the room smaller. You can say literally you have to make your body smaller; if you eat right that will help. If you exercise and move around that will help. Reducing stress will even help.
LOMAX-REESE: Dr. Donee?
PATTERSON: When we exercise, a lot of people think well I'm not going to exercise because I'm not going to lose weight and they get discouraged. Even when you exercise, you make the insulin that you have and the receptors, the little doors inside our organs, you make them work better. So you can make the insulin you have work better just by even moderate exercise daily. Even just modest amount of weight, I know it is a little overwhelming to think about 50 and 60 pound weight loss, but even modest amount of weight, 5, 8 pounds can even make a big difference in how well your sugars are controlled.
LOMAX-REESE: Yes, Dr. Blocher?
BOLCHER: I just want to say on the exercise, even if you re not losing weight from the exercise, it is still good for you by itself.
PATTERSON: Exactly.
LOMAX-REESE: In terms of diabetic prevention or management?
BOLCHER: Yes, absolutely.
LOMAX-REESE: OK, well that is refreshing. There were a number of articles that I read last year about how exercise is not really going to help you lose weight by itself. A lot of times people will exercise and then they binge on a whole bunch of food because they feel like they are rewarding themselves for exercising and it actually counteracts the benefit of the exercise. They focus so much on diet and eating less as a way to lose weight but it is great to hear that exercise is a benefit in and of itself, whether you are actually losing weight or not.
PATTERSON: Not just in diabetes, it really, really does help our diabetics to bring their sugars down but also, exercise has been proven to decrease the risk of heart disease and Alzheimer's as well. Exercise definitely has its benefits; keep exercising, don't get discouraged.
LOMAX-REESE: We are talking with Dr. Donee Patterson and Dr. Nissa Blocher today. We are talking about diabetes and the complications associated with diabetes. If you have a question or a comment, you can give us a call 215-634-8065 or toll free 866-361-0900. One of the things I thought was interesting in looking at the research is that, especially as we enter the colder months and the cold and flue season, that respiratory infections are actually increased or inflamed if you have diabetes. Can you talk a little bit about why you would be more predisposed to pneumonia or infection?
PATTERSON: Again, the excessive sugar damages blood vessels and it can damage our immune system. Often, diabetics are known to have lower immune systems. Sometimes people will have very high sugars and we won't even let them have surgery because they won't heal as well. Also, the very high sugar can damage the inside of blood vessels that are in the lungs and it makes the lungs be more susceptible to getting infections. People with diabetes often get more frequent respiratory infections and then the infections that they do get last longer; they are harder to heal up. We highly recommend people prevent getting those infections in the first place. We highly recommend people get the flu shot which I understand is controversial, but it really does save lives and to get their pneumonia shot. A pneumonia shot you only have to get every ten years but the flu shot you have to get once a year and it really does save lives and in a person who already has a lower immune system, it really is very important.
LOMAX-REESE: Let's go back to the basics. How do you know if you are out of balance so to speak? What are the numbers that we should know in terms of whether your blood sugar is way too high? I don't know why it was very successful to publicize blood pressure. Pretty much everybody knows, at least, I think it changed by now, but 120 over 80 used to be the standard and I don't know why that is a much more commonly known stat. What are the numbers for blood sugar in terms of normal versus out of range? Dr. Blocher.
BOLCHER: One thing that I have heard quite a bit and some people have heard this out in the news is that the hemoglobin A1C number is 7 and below is the way to go and don't get confused that it says hemoglobin, it is a measurement using your blood which is why it is called that, but it is the A1C. It has to do with the blood cells in your body that have been labeled by sugar, however high your sugar is, it sticks to blood cells so we can measure. That number tells you what your average blood sugars have been over the last three months. We can even use this number to diagnose diabetes; we can use the number to tell if your diabetes is under good control or not. Definitely below 7 is where we try to get everyone, if we can safely. There are some people we let them stay at other numbers but that is between you and your doctor. Even below 6.5 or below 6 for some people is their target. The lowest we can make it without having too many low blood sugars.
LOMAX-REESE: Are there any complications associated with low blood sugar?
BOLCHER: Sure. Blood sugars that are acutely low, low fast, you feel it, you get clammy, sweaty, shaky. People who take insulin shots or pills for diabetes are often familiar with this type of feeling and we try to minimize that; we don’t' want you to have too many of those. They can be dangerous if they get very, very low.
PATTERSON: I think one of the reasons why people know the blood pressure number is because it is a set number, 120 over 80 or lower, but with diabetes, there are different ranges because usually we will say somewhere between 80 and 110. We would love people's sugars to be in that range, but some people when they get 80, they start feeling clammy, they start feeling nauseous, they start feeling sick, so we have to raise that range for them. It is one of those things you have to base on your symptoms; everyone is an individual. Talk to your doctor and find out what your range is. That is what we want to encourage people. Please know your range; it's not just OK to just say oh I am just going to have my blood sugars be between 160 - 180. Talk to your doctor about the perfect range for you and where your A1C should be because everyone is an individual.
LOMAX-REESE: So those are two different measurements I'm assuming, the A1C and whatever the 160 over….
PATTERSON: Right. The A1C is a number that we check every three to four months. The other is a random sugar. You may prick your finger that day and know your sugar. We encourage diabetics to check their sugars at home and to log them and to let us know what ranges their sugars are in and if they are very high, please call us so that we can adjust your medicine and if they are very low, we need to know that as well so that you don't have the symptoms of it being too low. We have to find the right range for you. If a person doesn't do them at home, then they will wait 3, 4 months before they come to see us and all that damage can be happening in the meantime.
LOMAX-REESE: Let's talk a little bit about prevention. I know that diet and exercise is always one of the lifestyle suggestions, but what are some of the other things that people can know and again we know that there are already a lot of people who either have diabetes or prediabetic but there are still a whole host of people who are either young or have children who don't necessarily have to go down this path. What are the prevention strategies? Dr. Donee?
PATTERSON: We definitely want people to watch what they are eating. Things that can turn into sugar in our bodies are the carbohydrates, so watch your carbohydrates and watch the concentrated sweets, the candy and the extra syrup and the extra high glucose. We also want people to stop smoking, that is something very, very important because smoking also damages the inside of a person's blood vessel. If you already have sugar that is damaging the inside of a blood vessel and now you have tobacco damaging the inside of a blood vessel, you really do increase your risk of heart disease and other things. There is a correlation between diabetes and cancer as well, so we really encourage people to stop smoking, and again, know your blood pressure and know your cholesterol because high blood pressure, again, damages the inside of the blood vessel and so does high cholesterol. All these things contribute to higher risk of heart disease, heart attacks and stroke.
LOMAX-REESE: We are going to take a quick break. We are talking with Dr. Donee Patterson and Dr. Nissa Blocher from Einstein and we are talking about diabetes. When we come back I want to ask about that connection between all of those things; high blood pressure, high cholesterol, diabetes. It seems like if you have one of them it's likely that there is going to be this ripple effect. We are going to take a quick break and when we come back we will continue our conversation, don't go away.
LOMAX-REESE: And we are back. You are listening to Health Quest Live on 900 AM WURD and we are talking about the complications associated with diabetes. This is a great time; we are all going to be gathering with our family and friends on Thursday for Thanksgiving and so this is a good time to take stock of your health and well being and recognize that we all have a role to play for ourselves and our families to be proactive, to support each other, to educate each other so hopefully there is some information that you are getting together that you will be able to share maybe with a cousin or an aunt or friend on Thursday about diabetes. Let's go to Joe from West Philly; welcome to the show Joe.
JOE: Good afternoon.
LOMAX-REESE: Good afternoon.
JOE: Excellent topic today.
LOMAX-REESE: Thank you.
JOE: One of the questions seems to be a ripple effect if you have one you end up with all three of them. The other question I wanted to ask is when the doctor states you are on the borderline should you conform that you already have diabetes at that time to try to prevent having it?
LOMAX-REESE: Those are great questions; I am going to give that to Dr. Nissa Blocher to talk about borderline and just the connection between all of these other disorders.
BOLCHER: Joe thank you for bringing up borderline diabetes. Diabetes is a continuum, it's not like one day you have it and the next day you don't have it. If your body doesn't process sugar correctly, we just call it borderline diabetes because that's a level where you get some of the complications and not others. It is the best time to learn that you have diabetes is when you only have borderline because you can take small steps to improve that. Like Dr. Patterson said, lose a few pounds, exercise a little bit more and there are even medications that can slow down the progression towards diabetes, so talk to your doctor and come up with a plan on how not to get diabetes or to get it later.
LOMAX-REESE: In terms of the connection, I know that is a huge issue. If you can kind of quickly talk about the connection between high cholesterol, high blood pressure and diabetes.
PATTERSON: There is a connection and that connection is that a lot of times all those diseases separately have independent risk factors that are similar to diabetes. Being obese and smoking and not exercising at all and eating a high animal fat diet and eating a high sugar diet. All of those have risk factors for someone developing high cholesterol; all those are risk factors for someone developing high blood pressure; all those are risk factors for diabetes, so they all go together because they have common risk factors. As I said before, they all damage the inside of a blood vessel so it is common for someone to have one to get the others for those reasons.
LOMAX-REESE: So let's talk about, before we run out of time, let's talk about the eye exam and the foot exam because we know that the eyes and the feet are two areas of the body that can really be damaged by diabetes and we need to take special precautions with those particular parts of the body. Dr. Blocher, can you talk about the eye exam, the foot exam, things like that?
BOLCHER: Diabetics are encouraged to see an eye specialist every year. I don't mean to go and see if you need glasses or not, they need to go where they put the drops in your eyes and make your eyes very large. They look in the back at the retina; they can see the blood vessels that Dr. Patterson is talking about and they can see if they are damaged or not. Some people say that they can't afford an eye exam; the eye exam where they check you for glasses is often a different bill and charged differently to you than the medical diabetic eye exam. If you make this clear when you go see your eye specialist, they can do the part you need even if you don't need to get glasses at that time. As far as the foot exam, every diabetic should look at their feet. The problem is early on you can lose some sensation. You could step on a nail and not realize it or have a sore that you don't know about. Look at your feet; if you can't see your feet easily have someone in your family look at your feet and have a professional, a podiatrist, your doctor, someone, look at your feet at least every year, maybe twice a year. If they don't ask, take off your shoes and say hey I'm a diabetic, can you look at my feet today and they will be more than happy I am sure.
LOMAX-REESE: Go ahead Dr. Donee.
PATTERSON: With that said, there is a whole checklist that we've put on our Einstein website and we want people to make sure that they go to our website and download this checklist. They can print it out and make copies and take a copy to every visit. They can print out 4,5,6 copies so they have one for every visit. You want to ask your doctor, are you a candidate for taking aspirin. You want to ask your doctor, should you be taking a medicine called an ACE inhibitor, or an ARB, because those medicines help protect your kidneys from diabetes. We have seen that in many studies for many decades. Ask your doctor where should your blood pressure range be; where should your cholesterol be. Again, know your numbers. Where is your A1C. We want to make sure you have your feet checked at least once or twice a year and that you have your eyes checked, not just as Dr. Blocher said, not just a glass check but to have it dilated so someone can look back and see the health of your eye, all the way in the back. Download the check list, look at it, fill it out, bring it in and just know more about yourself and be a self advocate. That is on our website at www.einstein.edu.
LOMAX-REESE: I think the eye exam issue is really profound because a lot of times you don't know how healthy your eyes are. You might have terrible vision, but very healthy eyes, or very crystal clear vision and not so healthy eyes so that is why I think the ophthalmologist route is really important. Before we close out, I know you have a gift to offer the listening audience, I want to ask both of you, what are you guys going to do personally on Thanksgiving, to kind of honor and celebrate your commitment to health and commitment to yourself.
PATTERSON: Because childhood obesity is huge in our community, the children in my family aren't necessarily obese, but I just want to encourage them to get up and move so I am going to bring all of them together and we are either going to play WII Fit or go for a walk but I just want to let all the kids know that this is an important part of being healthy. We have to stay limber; we have to stay fit and just talk to them about being healthy.
LOMAX-REESE: Dr. Blocher, what are you going to do?
BOLCHER: Sara, I am so glad you brought this up. With Thanksgiving and the traditions coming up, this is the best thing any diabetic can do is to pass on healthier habits to their children because children will learn from you. Personally, everyone wants to make potatoes and corn, so I am making the green vegetables.
LOMAX-REESE: All right. I think it is really important for us to really begin to create new traditions and to really look at these opportunities, these holiday gatherings and celebrations to celebrate ourselves and to celebrate our families. What am I going to do? I was going to talk about that later, but I am definitely going to do yoga and I am going to try to make my children do yoga with me as a way to reduce stress.
PATTERSON: On nice, nice.
LOMAX-REESE: Yes. So Dr. Donee, do you have something for our listening audience?
PATTERSON: Last week was very successful; we had people come to our website, no our Facebook page, at Einstein Health and 1300 people went within 24 hours to answer this question and get the free $25 gift card, which will come in handy this holiday. If you go to our Facebook page, there will be three very simple questions. If you listen to us at all today, I'm sure you can answer those questions. The first person who answers will win the ShopRite gift card so we encourage people to go to our Facebook page and answer those questions right away. If you need an endocrinologist, a diabetic doctor or you need a primary care doctor, you can go to einstein.edu or you can call 1-800-EINSTEIN. If you want free health tips, you can follow me on twitter at that's @DrDonee.
LOMAX-REESE: All right, we want to thank you both of you, Dr. Donee and Dr. Blocher for being here and sharing such good information with us today. Happy Thanksgiving to you both.