More than 37 million adults in the U.S. have diabetes. In this episode, Dr. Bjorn Mercer talks to APU’s Dr. Stacey Malinowski, who has spent more than 20 years as a nurse, about the common signs of diabetes, why high sugar levels are so dangerous for the body, and the many factors that people don’t realize put them at a higher risk for getting diabetes.
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Dr. Bjorn Mercer: Hello, my name is Dr. Bjorn Mercer, and today we’re talking to Dr. Stacey Malinowski, associate Dean in the School of Health Sciences. And today, we’re talking about Diabetes Awareness Month. Welcome, Stacey.
Dr. Stacey Malinowski: Hi, Bjorn. Thanks for having me today.
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Dr. Bjorn Mercer: Excellent. And so, important month. Diabetes is a problem that is, I don’t want to say common, but it’s out there, and it should be addressed by many people, and hopefully prevented by all of us. And so, the first question is: November is Diabetes Awareness Month. As a nurse, what is it that people need to know about diabetes?
Dr. Stacey Malinowski: That’s a great question, and there’s really so much that people need to know. But the three most important things I think are: we need to know what diabetes is, the long-term outcomes, and how many people it affects. Because like you said, you feel like a lot of people have this, and you’re right. Diabetes affects more than 37 million adults. That’s just in the United States.
Let’s start with the different types of diabetes. Most people may not realize there’s more than one type. The two main types is Type 1 diabetes. A lot of people may have heard of this as juvenile diabetes, as something that just impacts children, but, in this state, your pancreas and your body just doesn’t make any insulin, or make such a little bit amount of insulin that it can’t control your blood sugar.
But what we’re seeing now is, while it was typically thought of as just a juvenile disease, people can actually develop Type 1 diabetes later in life. It could be a result of a viral infection that attacks your immune system, that you are no longer producing insulin. So, this one typically has a genetic component, and it’s not as common. It’s about 5-10% of your diabetes cases.
The one everybody’s really familiar with is Type 2 diabetes. Some people call it sugar diabetes. Your pancreas is still able to make insulin, but your body isn’t using it efficiently enough to control your blood-sugar levels.
And now, we have a thing called prediabetes. 96 million Americans are actually prediabetic, which can then set them up to move into diabetes. Also, heart disease and potentially strokes. In prediabetes, it’s a state where your blood sugar level is higher than normal, but you’re not yet really considered within that diabetic range.
The main issues with diabetes is there’s just too much sugar that’s freely circulating around your body, and this causes problems in every one of your body systems. It causes inflammation in your arteries and all of your other blood vessels that lead to all those vital organs. So, it can lead to vision changes, long-term kidney damage, problems with circulation to your legs and your feet. There really isn’t any body system that isn’t impacted negatively by having too much sugar floating around.
Dr. Bjorn Mercer: Those numbers are shockingly high, especially, you said 37 million that have diabetes. And so, this actually goes straight into the second question is, the rates of diabetes sound really high. Why is that, and what makes this disease so prevalent in our country, in the U.S.?
Dr. Stacey Malinowski: The rate really is high. Like we said, 37 million Americans. 20% of those people don’t even realize they have it. And it’s actually the seventh-leading cause of death in the United States. So, that’s a lot of people that have it.
I think the first issue is, there’s a general lack of knowledge about some of the risk factors that are out there. Some we can control and we are pretty aware of. I think most people realize there’s a correlation between being overweight and being inactive and developing diabetes. But there’s also a lot of factors that people don’t really know contribute to diabetes that might put them at a higher risk.
The first is genetics. The next is age. Being over 45 can put us all at a risk for prediabetes. People may not realize they may have had other disorders that can contribute to leading to full-blown diabetes, such as gestational diabetes, or there’s a condition called polycystic ovary syndrome that some females have that can put them at a higher risk of diabetes. And I don’t think a lot of people realize that people are also at increased risk based on their race. We know that African Americans, Hispanics, Latinos, American Indians, Native Alaskans, are much more of a higher risk.
So, if we can start by letting people know that they may be at an increased risk, they can start communicating now with their healthcare provider to ensure that they’re keeping an eye on their overall health and wellness. And I think too, a lack of knowledge of prediabetes and not addressing the modifiable and the non-modifiable risk factors is what’s really driving more Americans towards a full diabetic state.
Dr. Bjorn Mercer: With the prediabetes, now, I’m non-medical, so please correct me if what I say is wrong. With a third of all Americans being prediabetic, did they change the requirements for prediabetic, like the number for it? Or is our diet so poor for human norms that literally the food is slowly killing us?
Dr. Stacey Malinowski: Well, I think there are probably a couple different ways we could look at it. I think with more access to healthcare and more monitoring and more knowledge, I think we are now realizing that prediabetes is a thing, where we may not have realized it before.
We are seeing so many diseases now caused by chronic inflammation, and, as we know, diet is getting a lot more press in that area, the foods we eat contributing to inflammatory states in our body. So, I think with what we’re eating, chronic inflammation, inflammation in the vessels of our body, we’re starting to not be able to utilize that sugar and have the hormones and sugars going in and out of the cells they need to. So, yeah, we’re damaging our blood vessels, sugars are going high, and we’re now at increased risks for all these long-term complications of this disease.
Dr. Bjorn Mercer: It’s such a sad state, and that’s not the right term, where back in the olden days, 100, 200 years ago, wherever you were, you were limited to whatever food you had in your locality. But even then, the bread that typically was found there was some sort of whole grain. The meat was not as much. And so, even though people, say, didn’t live as long, sugar was virtually nonexistent, besides honey, and versus sugar is found in pretty much everything today. This leads us to the third question. With so many risk factors out there that are beyond our control, how can we identify and combat the disease early on?
Dr. Stacey Malinowski: That’s a good question. Before I get into that, so much new research is always emerging. You typically hear, oh, the carbs, the sugar will lead to diabetes, right? But there’s new science emerging, new schools of thought that it’s not just the sugar and the carbs that you ate. It’s the other unhealthy foods, the other additives and chemicals that are going into foods, that are causing this inflammation and causing destruction in your blood vessels, in your other organs.
So, what may have normally been an okay sugar level for you to eat before, now your body can’t process it because you have this inflammation that may have been caused by high-fat animal meats, proteins, that you’ve been eating. So, they’re starting to really look at the correlation with animal proteins as well, with causing these changes within your body.
But as far as identifying it and combating this early, the key is early recognition. Because one of the most important things to remember is, if you are diagnosed with diabetes or prediabetes, there are steps that we can take to help reverse the disease, where many people may temporarily need to take medication, but with lifestyle and exercise, they can reverse some of it. But again, there’s those other risk factors that we cannot modify, But recognizing the signs and symptoms early.
Some of the most common ones. Frequently urinating, especially at night. Excessive, excessive thirst, just always thirsty. Increased hunger, but yet you’re losing weight, not really trying. You may feel fatigued, blurry vision, numbness and tingling of your feet and extremities. And one of the sayings that I always remember from nursing school was, “Hot and dry, sugar high.” So, if you’re always really thirsty and just feeling parched, and just hot and overheated, maybe it’s your blood sugar.
Annual physical exams are really important of identifying diabetes and prediabetes. Your healthcare provider can check your fasting sugar levels. That’s where they check it first thing in the morning, when you haven’t eaten, to make sure that they’re in a normal range. And if you develop any of those symptoms, or just really aren’t feeling well, it might be a good time to check in with your doctor to see what’s going on.
Because it’s important to realize that now we know there are risk factors besides diet and exercise, the ones that we can’t control that still might be putting us down this pathway. So, even if you’re like, “I eat well and I exercise, I don’t have to worry about diabetes,” your genetics might argue otherwise, so it’s always good to get checked out.
We have tests now that your healthcare provider can order. It’s a lab called a hemoglobin A1C test, where a fasting sugar we check and that tells us, “Wow, okay, at 8:00 AM my blood sugar is this.” The hemoglobin A1C test can show what your blood sugars have been over the last two to three months, so it’s a much more diagnostic test to know the whole picture. So, it gives us a good overview of your health, how your body’s using insulin and sugar.
But like I said, there is a positive side. If you can catch it early and work with your healthcare provider, medications, diet changes, lifestyle may be able to prevent you from going into full-blown diabetes, or from suffering from some of the long-term organ damage that we see.
Dr. Bjorn Mercer: Absolutely wonderful information about diabetes. And so, this really makes me think of, you said risk factors being 45 or above, and with the average American living to 77, 78, 79, 80, and, of course, above, but that’s the average, half of your life, you could be living during a time where your risk factor is greater.
So, should Americans, like you said about the healthy lifestyle, change their diet, exercise more, not work as much, not drive as—there’s all these things that we could do, but they’re hard to do, because they could directly impact our jobs, and honestly, how our lives are.
Dr. Stacey Malinowski: That’s a good point. It’s funny what they consider old now, putting you at a higher risk for some of these diseases, where you’re right, we are still living half our lives now as “old.” And as an old person now, I don’t like to think of it that way, but that’s very true. So, it’s never too early to start living that healthier lifestyle. And that might look differently for different people, but you can really never go wrong with your fruits and vegetables, getting those whole grains, and always getting that activity.
Physical exercise is so good for people on so many levels, just from the stress reduction aspect, to weight management, better sleep. I mean, just overall, we really need to be looking at not only diabetes, but any chronic health condition from a holistic approach and attacking it from all sides, and it starts with knowledge, prevention, healthy diet, and an active lifestyle.
And it’s hard because we’re busy. We don’t have times, we’re “old,” but we’re still shuttling our children around everywhere. It’s hard to have time to stop and cook and fit in that exercise, but it also needs to be a priority, because what we’re seeing now in children is, we’re seeing children at younger ages with high cholesterol and other signs of inflammation in their bodies. And we’re worrying about now 45, now, lifestyles have changed so that we’re exposing our younger children to unhealthy lifestyles.
Pre-diabetes is, before you know it, they’re going to say, “At the age of 25 you’re considered old and need to start looking for signs of prediabetes.” So, we definitely need to start incorporating these healthier habits, not only for ourselves, but for the future generations to come.
Dr. Bjorn Mercer: And as somebody who is closer to 50 than 40, I am also in that category, so it is, it’s difficult, because people work, couples work. They have kids, just like you said, shuttling kids around. When people have jobs, they have to pick something up, and when you pick something up, it’s not always the healthiest or most nutritious food. And so, it’s difficult to always have those whole grains, those high-nutrient rich foods. But that type of diet, and with the physical activity, and with a lifestyle that’s not too stressful, each of those things will help you have a healthier lifestyle and hopefully avoid diabetes. So, from a nursing perspective, should you do all those changes before you go onto any medication?
Dr. Stacey Malinowski: I think everybody should be making those lifestyle changes anyway, but I do think it needs to be a conversation with your healthcare provider, because there will be certain people that would benefit from having their condition managed medically. If their sugars need to be brought down to reduce the risk of any long-term damage. If it turns out they’re really a Type 1 diabetic who did get that strange viral infection that knocked them into diabetes later in life.
I think it should always be a discussion with the healthcare provider, and making sure that once you’re in touch with your healthcare provider, they can get you in touch with a registered dietician, too, because once you have prediabetes, diabetes, there is such a delicate balance of what is a healthy diet, and it looks a little bit different, and the counting of carbohydrates, and it’s very technical, and a registered dietician would certainly be an amazing person to be on your healthcare team to help you navigate through those lifestyle changes.
Dr. Bjorn Mercer: I completely agree. I wish everybody had a dietician. I wish those were courses we took in high school and in college, so by the time we become adults, we understand what the food we eat, what it does to our bodies, and what are the ideal foods for our bodies, and even how our body is unique. Like you said, each body is going to be slightly different, where some will process sugars differently, and poorly, honestly. And so, where some people might look healthy and have healthy lifestyles and still be prediabetic. And when that person is like that, then they would have to have medication to manage it because a lot of their diet and activity attempts have not helped, per se. They have helped, but not to get rid of it completely.
Dr. Stacey Malinowski: I agree. You cannot outrun or out-eat your genetics. We can try, and it certainly will help, but just looking at each person as an individual, and all of their unique risk factors, and everything that contributes to their makeup, will just help us come up with a best plan for that individual.
Dr. Bjorn Mercer: Excellent. I completely agree. And so, absolutely wonderful conversation today, Stacey. Any final words?
Dr. Stacey Malinowski: Yeah, I appreciate you having me, and just, if I could leave any final words, it would be to get your checkups, communicate with your primary care providers, and know your numbers.
Dr. Bjorn Mercer: I completely agree. Know your numbers. And today, we’re speaking with Dr. Stacey Malinowski about Diabetes Awareness Month. My name is Dr. Bjorn Mercer, and thank you for listening.