well hello and welcome to HealthLine this Tuesday evening .

I'm Jennifer Blomquist.

I have the privilege of hosting this program.

I love this show.

I've been doing it for 18 years and I've learned so much over those many years and I know many of you out there viewers you've been with us all these years and I run into your grocery stores and gas stations and all different kinds of places and I'm always so grateful if we if I'm ever out and about and you see me please come up.

I love to to talk to you about topics that you like for the show, maybe things that you'd like us to do in the future.

So thank you so much.

But we have another wonderful program again tonight.

We have a returning physician.

He's an endocrinologist and we're going to focus on diabetes tonight, something that a lot of people face or maybe somebody you know or care about faces it.

So again, that's why we have the phone lines open so that you can call and ask a question.

>> The phone number is (969) 27 two zero.

It's still a toll free call if you're outside of Fort Wayne, just put an 866- in front.

There are two options when you call in you can either ask a question live which is great because you can have a conversation with the doctor or you could just relay it to the call screener and they can let me know your question and we'll get it answered that way.

And of course this past winter we started a texting option which is also really nice.

So that's a little different.

No (969) 27 three zero.

I want to assure you that we keep your phone no private nobody will see your your phone number if you feel comfortable just putting maybe your first name and where you're texting from and shoot us a question that way.

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

As I said, he's been on before and I'm so grateful that you came back Dr.

Hamza Quadri, an endocrinologist.

>> My pleasure, Jennifer.

Thank you.

And there's so much that we can talk about with diabetes and like I said in the show opening everybody out there knows somebody who's got diabetes or is may be at risk of it.

So we wanted to start out talking about different kinds of diabetes because I think people get the terminology mixed up sometimes.

>> Yes.

Yes, for sure.

And as you mentioned, yes, it is a huge public health issue in the United States because nearly 40 million people have diabetes which almost thirty eight million people have type two diabetes and almost two million people have type one diabetes.

And when we talk about diabetes there are three broad ranges basically type one type two and gestational diabetes.

Oh yeah, yeah.

And Type one diabetes basically it's mainly autoimmune in which your pancreatic cells are damaged which produce the insulins or your body does not make enough insulin and that's type one and type two there's a resistance to insulin which your body is making insulin but it doesn't function well so there's a resistance to it and third is gestational diabetes which happens during pregnancy and after childbirth and labor .

>> It does go where it's going now the type one I want to make sure I've got this right I always thought that was the same as juvenile diabetes like like a child could be diagnosed with it and it's it's it's different.

>> It's not because your lifestyle is, as you said, an autoimmune.

Yes, exactly.

Most of the times it's diagnosed in early childhood and it is because nothing that you did wrong it's just the antibodies attacking your pancreas.

>> So the type to the resistance to insulin that I've always understood as that's more of a lifestyle there's a way to avoid it.

>> Yes, it helps people.

It has a genetic component to it as well.

There is family history linked to it as well.

>> But yes, lifestyle, your diet, physical activity, all those factors play a big role in contributing to type two diabetes.

>> Now for type two I've met people who have a lot of times there are people who are very overweight or they smoke have high blood pressure and when they make some pretty major changes, you know, and they stick to it, they get better.

>> I don't know if they don't and you can't really be cured of diabetes but is it correct to say like you would be under control, you can be under control, you can switch from diabetes to being like a pre diabetic and see basically if we talk about a see when you go to your doctor's office I always talk about A1 and you should know the numbers, you know something and basically five point seven to six point four percent is the pre diabetes range and anything more than six point five is diabetes.

This is for your agency and basically yes, there are some factors such as even if you lose weight, even if you bring down ten pounds yeah.

It makes a drastic change in your agency.

So bringing down the weight helps a lot with insulin resistance and it helps with your diabetes a lot.

That is the number one factor managing your weight and diet and physical activity at least like 150 minutes of physical activity in a week and that way you can control your diabetes but definitely once you cross the six point five percent agency range we do recommend medical you you need medications on top of lifestyle intervention but if you're in the pre diabetic range you can still help with lifestyle interventions.

>> You can help bring it down and that agency that's always run through blood work blood work agency basically tells us an average three month blood sugar control.

So that's a good thing.

It's not like that at times patient go oh we want to do the test today because had a heavy meal last night.

>> You know, like now it usually tells an average of three you can tell your blood sugar control.

>> So it's a good indicator of the past three months and how your blood sugar is OK so you can't really quote unquote cheat.

>> Oh no not anymore.

Yeah OK.

And you know and I did work with a man years ago whose wife had gestational diabetes and that that was kind of alarming.

>> Yes.

And the baby was very big but it was like a pound baby.

>> Yes.

That's that's the risk with gestational diabetes, you know that you developed insulin resistance due to all the hormonal changes in the pregnancy, especially few hormone secreted by the placenta and when insulin is like a growth hormone so when you have high insulin in your body, when there's insulin resistance, the baby actually grows bigger and there could be complications during childbirth .

That's where they're always a little concerned about controlling the blood sugar during pregnancies.

>> Now does that leave the child predisposed to health issues or not having my juvenile diabetes?

>> No, no it does not in most cases does not.

But usually when the child is born he his body is so used to the high blood sugar.

So as soon as he is born always a risk of hypoglycemia which is low blood sugar.

That's one of the things that needs to be looked out for .

>> I feel like they always send those babies to the neck.

Yes, because we were in the nick you and they they every every time we have two sets of twins and so we we were like we were like frequent fliers it's OK.

>> But every time we were the nick you yeah.

There was a baby that you know our babies were like four pounds and then this baby looked huge.

Yes.

And they said oh he'll be OK but you know they just have to kind of monitor it so you OK?

>> Well we did get a text message actually I was just telling Dr.

Quadri a lot of a lot of you do like to text you which is great.

So this is from Wessely from Fort Wayne and he wanted to know the difference between pre diabetes and diabetes.

So his mom's agency is mildly elevated.

>> So is she pre diabetic or is she ah, she's kind of in between or depending of the agency is less than six point six point four or less.

>> She's prediabetic if it's six point five or more than she is diabetic and prediabetic as we mentioned is something that we still have time and lifestyle interventions can help but once you're diabetic, you know, lifestyle interventions of course do help but that is the time that you need to be on some medications to control your diabetes as well.

And I always tell my patients a lot of times when they come in for diabetes they're feeling fine, OK?

>> A lot of times you know you're walking around, you're talking you're going to work, you're doing fine but your blood sugars are so high and a lot of times patients procrastinate treatment because of that because we're feeling fine.

>> You know, of course when your blood sugars are high you can have symptoms.

I'm feeling more thirsty, peeing more than usual, being lethargic and tired.

You can have all those symptoms.

But I always tell my patients the reason to control Diaby is so that you don't have the long term complications today you're feeling OK even though your blood sugar is in three hundred you might be feeling OK but when you have so much of sugar in your blood you're Whitelaw you do not get enough oxygen and down the line the organ starts getting damaged.

>> So our goal is to control the blood sugars right now.

So from ten to fifteen years from now you do not develop any complications of diabetes which are extremely challenging once you get those so you wouldn't do any kind of medical or or introduce a biologic to somebody pre diet.

>> We can yes we can definitely .

>> Well first the first will try with lifestyle interventions OK if those aren't happening if the weight reduction is not happening of the dietary habits are you know we tried to work on the diet and weight if that's not happening physical activity if that's not happening then we can consider some medications to keep you in the prediabetic range and prevent from going into the diabetes region.

>> OK, all right.

Well good.

Thank you so much, Leslie.

That was a great question and I'm sure there are some of you out there who have questions so please don't be shy.

You could do what Wesley did which is a really that's like a no contact type of thing.

I just say your name and where you're texting from I would get your question answered that way or feel free to call our live telephone line that's (969) 27 to zero.

The texting is (969) 27 three zero.

Feel free to call in at any time.

So so we were talking about screening.

We wanted to talk about that if you know if your find is it kind of like a colonoscopy or they'll say oh you don't need to worry about it for a few years or is it if it comes back OK or is it something you should have done every year no matter what especially after the age of thirty five years for guidelines?

Yes.

After the age of thirty five screening should be started with a one C at least once a year and but if you have any family any risk factors like family history BMI more than twenty five smoking cigarets or you know family history PCOS is a big one.

If you have any of these risk factors then definitely you should be screened earlier.

>> OK that's good to know and do you have to specifically ask for the agency to be checked or is it not a part of a normal blood panel?

>> You know if you're going to be like a physical I tell my patients make sure you get your annual physical exams year at least get that done because if you get your annual physical exam once a year then they're definitely going to screen you for OK, that's not something you have to do special.

>> OK, all right.

Included it's a package deal.

Yes.

OK, all right.

Well we did get a call from somebody he wanted me to ask the question for him.

Dr.

Quadri.

So Tom is asking if elevated uric acid would have anything to do with diabetes or metabolic syndrome not and a bigger picture uric acid would be a different aspect in metabolic syndrome.

Basically it's linked with more diabetes, insulin resistance and high cholesterol levels.

So no uric acid would be a different entity and that would have not much link with diabetes high blood sugars.

>> OK, is that something that if you've got an elevated level of that, is that concerning or is that usually something I'm not linked to diabetes?

>> No.

OK, not be linked to diabetes.

All right.

Good to know.

All right.

Thank you, Tom.

Thank you, Wesley.

Come on.

Let's add you to the list.

Why don't you call in or text in a question for Dr.

Quadri.

We only have him at a little before eight o'clock so call sooner rather than later or text so so you get the screening done depending on what the results are, you probably have some options.

>> Yes, I think some people you know, if they find out they have diabetes is just kind of scary and it's I've always found it to be kind of a confusing disease because there's so much to it.

You know, when I was growing up my mom would say, oh, you know, grandpa has to wear special socks, you know, or he can't trim his toenails.

And I thought why?

>> You know, it just sounded crazy but it was just a lot there's just a lot to it for sure.

>> So it's not a death sentence?

Not at all.

Not at all.

Yeah.

I tell my patients that we're lucky we're in this day and age and thanks to all the scientific inventions that we have excellent new medications for diabetes.

>> Yes, it all started almost hundred years ago with the invention of insulin which is lifesaving.

>> Yes, 1920.

Yes.

It all started with the invention of insulin.

Then after that gradually more medications came in and now we have excellent medications for diabetes.

We have medications which are like once a week injections.

So basically yep.

And for type two diabetes we have a lot of options now for type one of course it's limited.

It's still insulin is the requirement because their body needs the insulin.

But for type 2s we have different medications like JLP one therapies for example.

Those are excellent for diabetes.

A lot of people consider them to be weight loss medications but they actually were started as for type diabetes medications when patients saw that they're losing weight then they became the weight loss area.

But GLP one medications meant for we have some medications by then as VLT two inhibitors these not only prevent and treat diabete but they also prevent other like heart conditions and diabetes are good for your heart.

They're good for your kidneys.

They have other so many benefits as well.

So in this day and age no diabetes is not a death sentence.

>> We have excellent medications that we can help with.

All right.

It's very fascinating.

I want to talk more about that but I don't want to miss this text message too.

So I apologize.

The person's name is MFH so I'll just say Ma but I apologize if that's not correct from Fort Wayne wants to know if medicine can be taken to control diabetes during pregnancy for sure it is yes.

>> Definitely need to at times depending on how the blood sugars are it is managed by endocrinology and maternal fetal medicine MFM both of us can help you with that and it's basically depending on what your blood sugars are if they are in range we have certain goals set for pregnancy.

>> The blood sugar goals are different.

We try to manage it with diet and lifestyle intervention.

If that does not happen we can use medications like insulin and metformin.

>> Those are recommended to control blood sugars.

So I remember during my pregnancies everyone all ladies we hate the the diabetes test, you know, to drink something that's not really that great.

Yeah, And stay at the doctor's office for like three hours keep poking you into intermittently throughout the three hours.

>> So that was to find gestational diabetes.

Yes but can you find it would there be symptoms because I was close to my late second trimester early third trimester so but can you find it sooner like with somebody if they have gestational diabetes, are there going to be symptoms that show up before?

>> Yes.

Yes.

Symptoms early.

Yes, you can catch it earlier but usually gestational diabetes is it usually doesn't come with a lot of performance and signs and symptoms.

>> So usually it's caught up during screening but it can be discovered earlier as well on routine blood work if you have random blood sugars are high or if you have symptoms of diabetes like drinking more than usual, peeing more than usual all those symptoms then it can be hot earlier.

>> OK, somebody has to find a better drink diet required for that then we wouldn't have to drive it.

I picked like lemon lime flavor they all are terrible.

>> Had the orange cherry here.

Not yet.

OK we've got another question from somebody who called in wanted me to ask for them so this is and wanted to know if there's an age.

Oh yeah.

Where is there an age where you should stop testing agency levels basically if you are diabetic then of course it has to be checked every three months no matter no matter but if you are a non diabetic it's just for screening.

>> Yes.

After a certain point like seventy five we can stop screening.

Yeah yeah that's interesting.

Yeah we've had that I've noticed that with a lot of we were doing a lung cancer program last week and they were saying and once you get past 80 you know there's there are some tests that it's just not worth it.

>> Yes they want to look at the long term.

>> Yeah.

Risk for that.

Yes.

Yeah.

All right.

Great questions.

Keep them coming.

We've got probably about seven to eight minutes left so we've plenty of time to take more questions.

I wanted to ask you we were talking about, you know, different ways to treat the diabetes.

>> I know years ago that insulin pump came out and that is actually implanted.

Is that correct?

They're still doing they still do it that way.

>> Exactly.

So now we have so many treatment options as I mentioned even for type one and pumps are also for type two .

You know what happens and that is basically it's a pump.

You know you have insulin stored in it for two to three days depending on how much you need and you constantly get some insulin in your body.

>> OK, and the pumps now I say are pretty smart.

>> I was wondering I'm assuming they hook them up to your phone.

Yes, I hope and they're pretty smart.

>> They can read your blood sugar and they can see a trend if it's going the blood sugar is going up or going down depending on that they maintain their rate insulin secretion but still they're not that smart.

>> You still have to tell them when you're eating you still have to announce your meals.

>> So whenever you eating depending on how many carbohydrates you're eating, you still have to announce it.

>> It's a lot of times people also think if we go on the pump we're fine, we don't need anything else but I tell them I'm going on a pump is a little cumbersome.

>> There's a lot of work involved in it.

>> There's a lot of technology involved to it.

There's a lot of math involved to it.

But once you're used to the pump and once you're on it, the agency control is phenomenal.

OK and especially type one diabetics, they need insulin for this survival because if they're out of insulin for more than 24 hours they can go to life threatening condition called diabetic ketoacidosis.

>> For those people pumps are a game changer.

>> So pumps is an excellent advancement and diabetes technology for type one and type 2s both if you're in very high dosages of insulin because in this day and age I tell my patients it's torture if you're poking yourself three to four times a day, you know it's a lot you know, at restaurants or at work and then you have to it's too much you know, it's a torture.

>> So going on a pump is a good idea.

>> You can eliminate having to poke yourself so many times and you know, the pump manages your diabetes really well.

>> Of course there's a learning curve to it once you start it but once you're on it then it helps a lot and we have a lot of studies and data out there that the agency is controlled.

>> I'd call once you're on the pump.

That sounds like a lifesaver.

I can't I do sympathize with people used to always poke their finger.

>> They just look terrible and it looks painful.

Oh, you're a popular mandate requiring lots of calls and questions and somebody else wanted to another and called and she wanted to know if eating more simple carbs puts you at higher risk for diabetes if you're in your eighties.

>> So basic yes.

At any age if you're having simple carbs that does put you at risk of diabetes you always want to have foods which are low in carbohydrates and simple carbs are more like simple sugars know.

>> So yes, definitely try avoiding simple sugars and simple carbohydrates as always better to have complex carbohydrates or high protein or vegetable died and minimizing the need of carbohydrates and that's what I usually tell my patients.

You know when you're prediabetic diabetic I don't expect miracles overnight for you to change your lifestyle.

So I just tell them, you know, try to reduce the quantity of whatever you're doing.

If you're having a bowl of carbohydrates, do a half and then gradually taper it down, eat as much as protein and fiber and vegetables you want you know but carbohydrates the day you start reading the label on what you're eating the day is when you start making a change.

>> Yes, I did.

I used to have a little posted on my desk that said I never been a carbohydrate I didn't like because that's the thing is taste good so it's tempting.

>> So you're all right.

Wow, this is great.

All the questions coming.

You've got another text message.

This is from Dave from Chair Basco.

He is asking if he's been prediabetic for many years.

He's not overweight, very physically active, watching his diet closely.

So what meds are recommended for pre diabetes and then what is available other than I can't read that form is it OK sorry metformin that doesn't carry all the side effects.

>> All right.

Well thank you Dave.

It's a long question.

Sorry.

So for diabetes if we look the guidelines metformin is still recommended.

>> Metformin is the first line for prediabetes.

OK, because it works well on the insulin resistance level there is another medication called a Capo's that's also used in pre diabetes but that can also have some GI side effects.

>> And now as I was mentioning the JLP one therapy.

>> Yeah, you know it can be considered you know, if the insurance is covering it or if it's cost effective then definitely GLP one therapy can be used at that part as well because it helps with the pre diabetes as well.

>> OK, yeah and we wanted to at least talk about those GLP one drugs.

We were saying you cannot watch anything on television.

I don't care what if is a live stream or a local channel there are you've been bombarded with commercials about those drugs and see I years ago I thought they were being introduced as a weight loss drug and my husband corrected me and said no, that's common for you know, for diabetic patients.

>> Yes.

Basic so that's how they came to be.

>> Yes.

This started for diabetes and then patients started losing weight and then there were marketing for weight loss.

>> And I would like to bring to everyone's attention right now as well that GLP one therapy is excellent for diabetes controls the agency extremely well.

>> OK, but of course every medication has some side effects.

>> You know, especially in my senior population I'm a little careful with GOP therapy because it can cost sarcopenia which is basically muscle loss .

OK, so when you are in GLP one therapy just make sure you have some kind of weight resistance exercise in your lifestyle and you're having enough protein because you tend to lose weight but you can lose your muscle as well.

>> So we don't want that to happen.

You know, and there's a lot of talk right out right nowadays going on about GLP one is causing blindness.

>> He said that it was an FDA.

Yeah.

Did it communicate yesterday only on November 9th yesterday about blindness associated with GLP one therapy?

There have been some cases reported of yes, there's a condition called non arthritic ischemic optic neuropathy basically in which the blood supply to the optic nerve is affected.

>> It can cause sudden onset of blindness in one eye and it can it is irreversible but the rates are pretty low.

It's six point four chances out of one hundred thousand.

OK, so still the benefits are more than the risk, OK because they control the diabetes so well and then not only control diabetes, they're actually good for your heart, your kidneys and when the weight comes down it helps with the arthritis pains.

So it's used for multiple things, you know so definitely you know I would say the risk is still less, the benefits are more but yes, there is an association of this side effect that we've seen with this medication and if somebody has baseline retinopathy, which is a complication of diabetes in which your retina gets affected, you're still at risk of retinopathy getting worse as well.

So please make sure you follow up with your endocrinologist or ophthalmologist if you have retinopathy and if on GOP one therapy.

>> Great to know.

I'm so sorry the show is over.

Dr.

Reid, I appreciate everything tonight so you have to come back with so much more.

>> We can talk for sure.

We have a lot to catch up on.

Thank you so much.

Have a great take care.

>> We'll see you next Tuesday.

Bye bye.