Diabetology (BLOOD SUGAR) Part 1 with Dr. Mike Natter, MD
Oh Hey it's your friend who looks at listings of houses. She has no intention of buying alley. Ward back with another episode of the allergies. So this this is a real sweet one. It's got everything everything that you crave. There's a personal connection to the allergy very surprising backstory. My copious BS sweating. There's human cyborgs anthrax reasons to drink p but first a quick. Thank you to everyone. WHO's supporting Patriot? Who tells friends and co-workers and Fam This week olives was number three on science charts up there with the NPR giants so thanks to everyone who listens and subscribes rates. And of course reviews old Edward Von podcast. Read them all and because talking into a microphone in your closet toward a pile of laundry can be kind of a weird kind of lonesome your review as always keep me going so i. I read a new one each week this week. This from dermal dental. Who says kept my adhd attention? I thought podcast might just not be for me. But I'm so glad I gave allergies. Listen and thanks for making everything from my college commute to shoveling a crap ton of snow off the driveway a little joyful. I hope to listen to these as an apologist one day well thank you dermal tentacle for. We're spending time in the freezing cold with me speaking of logistics. Let's meet this week's dire tallest which as I say often surreal frigging word. But what does it. What does diastolic Cataldi First off it is not diabetes policy. As I thought so I was wrong. Whoops Diabetes Policy is the science of Diabetes Diagnosis and its treatment? So it's a term used in medicine but just not super formally so it might refer to doctor who has an interest or special skills with diabetic patients. Which is Allah just very certainly does he has been studying the disease for over twenty five years? And he's only in his mid thirties so so we became Internet pals in twenty thirteen. He makes these really great science drawings and I have watched his journey from MED STUDENT TO MD.. You and I have never met a doctor. So passionate about his work or his patients or the cause of diabetes he has a vested deep and Glue be interest in the hormones that regulate our blood sugar which I am so excited to talk about He was in L. A.. From New York City over the summer and so we sat down in my living room. We had a GAB. Even though he was blazing hot and his Friday afternoon lift across town had him arriving an hour late he was so stressed out. He didn't realized that in LA showing up. Our late is pretty punctual. So we cleaved this episode in two in this first one you're gonNA learn of his staggering. Very heartwarming worming journey to being a doc wet. Blood sugar does how it affects your mood and energy in every cell in your body. Kito Diet versus veganism. How many people Oh have diabetes? What could cause it and why I fall asleep in pants a lot? Also how to handle the emotional aspects of a busted pancreas so it's at whereabout to spill some unsweetened tea on the topic of your blood. Sugar with wonderful person and diastolic. Dr Mike Natter Am Dean Gene Dr Mike Matter Dr Ali Award Doctor You are Dr Natter. You're a doctor I am. You have been a doctor for Helen three years. Let's see so I started. I finished med school in twenty seventeen. Seventeen so. I've been a doctor almost three years him. Well let's talk about your shitty pancreas. I have a shitty pancreas. Let's talk about his busted. You've you've been a diabetic Longer than you've been a diabetes tallest true so Dr Nassar is in his final year of internal medicine residency and he will soon be a board certified internist internist which then leads to to your endocrinology fellowship. But he sees and treats patients with diabetes and again has been studying diabetes for decades. At at. What point did you realize that you're not only the president? You're also a customer. At what point did you realize. I am baby Mike madder sadder. And I've got a busted shitty pancreas. I will point that. I realized I was diabetic. The origin story. We're going to dig in. Yeah we're GONNA digging because I've as long as I've known. Yeah I've known your your diabetic type. One we've known each other for five years. No Dr Ward. We go back. I know I've known your pancreas. This long still our I told you piece of shit terrible. I can hear you so okay. Let's see so I was. This was two weeks after my ninth birthday and I remember very well it was pretty traumatic. Unfortunately I was super lethargic as really tired and I would wake up at night. Three four or five times to urinate but also to choke water was like the parched beyond belief you chug and then you'd need to chuck more you. Would you would be thirsty. Like you wouldn't believe nothing that satiated and then he'd be peeing constantly so those were kind of the symptoms initially Liam this one on for maybe a week or two and then h Scott to the point where I was losing weight. It looked very ill. And there was one day when In in mid September number when I started to get ill vomiting and couldn't couldn't move and I just looked awful and my dad scooped me up. I'll never forget. It actually scooped me up in his arms and carried me to The ER at Mount Sinai in New York City. I was kind of in and out and ended up kind of falling into a coma. Yeah it was very traumatic but I had the from what they tell me at the time. The highest blood sugar history in Mount Sinai at the time so the ninety four. Yeah what were we talking. It was up there so if to normal range of Glucose is Lakes Blood Glucose yours right now is probably like a hundred. You know you run in that range. A High Glucose is typically two hundred three hundred four hundred my glucose sixteen sixteen hundred. Yeah it was really bad. That's so bad it was good. It was not good. How long yeah had type one diabetes before you were diagnosed probably few months okay? It's I would have probably died if it was more than that. I don't think anyone can live with type one undiagnosed for more than a few months. No probably probably Probably less maybe like a month. Yeah and let's dig straight into to what is diabetes. Yeah let's do it okay. So so diabetes. So there's there's flavors of diabetes so we're talking about diabetes melodies you and I okay if we look at the the ideology and the at demolished. I'll let you dig into that. But my understanding is I think it translates diabetes itself translates into Siphon van and the ideas that it's a siphon because you're ingesting so much fluid and you're peeing out and so back in the day. The doctors who are observing serving this. We're like Oh. They're like a siphon they're just fluid going in fluid coming out melodist translates to something like sweet honey coated or something like that so back in the day hey physicians would actually kind of do a little bit take a little little taste test. That's how you could tell it was your sugar in the urine and so- Siphon of fluid fluid coming in and going out and it's sweet sweet urine diabetes melodies sugar colander. Call her that's right. PS If you. I haven't heard the melody episode. It's about bees and honey also if your name is Melissa and you have a bad pancreas your name means be which which is sweet like. Maybe you're P is it hygienic. To drink urine no. It's not a good thing. Yeah I wouldn't recommend it although if there's no infection affection technically I guess sterile. But we'RE NOT GONNA. Yeah okay. Yeah not that's not good another disclaimer on this whole deal I have an md.. There's no medical advice being you can get on this show drink. Up Don't drink. I'm sure there's so many people out there right now just toasting glasses of their own room temperature yours so many people right now. Oh my God with the healthcare industry what it is what else are you gonNA do. Cheers cheers okay. Quick side note. Why not on P. Drinking King? As long as we're here do people do this. I mean I did draw the line the other day. Apparently there's an ancient Ira Veta- practice where you drink your own urine With Potter doses and though it has roots in ancient medicine according to one published study I read titled. The Golden Fountain is year in the miracle. Recall drug. No one told you about they say as a big no no scientific benefit even the army is like if your inner survival switch snot worth it. The army also so says not to drink booze seawater or blood just no matter how parched you are. It's got a lot of salt and though it sterile when it leaves your kidneys that is true. It can pick up up to eighty five different kinds of bacteria on its merry way out of your body tubes and I want you to know as I was researching this. I was sipping a really large speaker of lukewarm green. Tea Big mistake big huge. So what is diabetes. I know that there's the two flavors there's there's probably more So is that. Just the name for when your pancreas stops working. No so there's so there's more than two flavors neighbors actually. There's a handful. There's something called. Lada or latent autoimmune diabetes of adults at sometimes called one point five which is strange. There's just stationl channel diabetes. So there's different flavors of the sugar diabetes that there's also something called diabetes insipid which also kind of has that Siphon quality where your body for either central reasons meeting from the brain on the Or nefer genyk reasons meeting from the kidney itself you're unable to concentrate urine and so it's really an issue with water and sodium. That's a whole other can of worms. It's not really at all related to type. One type. Two or just diabetes okay. This is the foundation of what diabetes is so I'm GonNa reiterate it because it's complicated and important. We're going to go through that once again so we feel that we really know what's up. Okay so once again type. One autoimmune autoimmune issue causes your pancreas to stop making insulin and your pancreas by the by for like what is that. It's a large dom shaped organ. That's hiding behind kind kind of like your liver and stomach area and most medical illustrators seemed to draw it kind of like if a corn on the COB had matching cards or lumpy lumpy butter sack. Once again I'm not a doctor okay. Type two according to the American Diabetes Association is the most common form of diabetes. So type two means that your body doesn't use insulin properly. And Ninety to ninety five percent of diagnosed cases of diabetes type two now between the two. There's a type one point five and we are not clowning. This is a real thing. It's called latent autoimmune diabetes in adults or Lotta and it shares characteristics of both type one and type two diabetes. Okay Dr Not not are also mentioned justice diabetes that happens in about ten percent of pregnancies in otherwise non diabetic folks. And it's caused by hormones in the Placenta Messing passing with how your body responds to Insulin. So justice diabetes. It's usually diagnosed about the twenty four th week of pregnancy and it can lead to pre ECLAMPSIA which is high blood pressure depression or having a large baby as I like to call them real LONCAR's which is a fishing term. I just applied to your big baby. Okay there are also Oh. A few rare types like mono genyk diabetes. That's caused by just a single gene there. CYSTIC fibrosis caused diabetes. There's brittle diabetes and something called Wolfram Wolfram Syndrome. which sounds kind of like the back story of the Harry Superhero and finally there's diabetes and Simitis which Dr Natter mentioned? It is a hormonal issue. You that makes you unable to make concentrated P so you're just thirsty and you pick up to twenty liters a day and insipid us by the way means bland hand or lacking flavor. So you're a siphon with flavourless P which is sick. Burn and how. Huge health issue is diabetes. So the city says it's a seventh seventh leading cause of death in the US and in the last twenty years cases have doubled almost ten percent of Americans. More than thirty million people have AB diabetes and one in four of them does not know they have it. So if you are listening to this on the subway or at a rave or like a crowded gym Kim there is a good chance someone near you has the beat us and may or may not even know it. You can tell them about this episode if you want you don't have to. When did you decide that you weren't just going to be a patient that you were going to be a doctor? That's a really good question so I grew up as art kit so I used to draw my whole life and I still still do but there was no medicine in my family. I never really thought that I was smart. I know so I. I didn't excel academically my whole life so I was really bad in math and science. I did pretty well in like history and English and art obviously and so I never really thought that it a career in medicine or anything that that you know people considered intelligent people would go into something in the cards for me. Obviously I am appalled by this when I I was diagnosed with diabetes. I gained this kind of appreciation of this. Aw of our physiology because if you think about it like the panthers is doing so many things and it would do it automatically. It was autonomously regulating homeo- stasis of blood sugar and now at nine years old this crazy responsibilities thrust esta shoulders and it gave me this appreciation for holy crap. This is really cool really intense really beautiful and so I said it'd be really interesting to be a doctor but I never never thought of it seriously. It was almost like if a kid was like saw an astronaut and there would be A. Wow that'd be cool to be an astronaut but they never really could actually become an astronaut. That's what I thought about as being a doctor. Yeah here you are. Yeah it was crazy. Thank you well. When at what point did you decide that you were going to pursue medicine like did you have a moment where you said I can be an artist and deductor? What did you do? Yeah so I went to Undergrad. I started studying studio art and then in my end of my junior year ahead been taking some classes in neuroscience because they found neuroscience interesting but I was doing kind of like as an aside and to my surprise is I did well. I was getting really good grades neuroscience and so this was the first time you know twenty years old in my life that had good grades in a science based Class So I thought Oh. I have some academic confidence and I had this epiphany of I need to go to medical school. This is what I need to do. So Dr graduated with an art degree degree without taking organic chemistry or Calculus. Because he was afraid he wouldn't be good at it so he moved back to New York City and got up the courage to go back to school and tackle. Those pre recs had moved back home to New York. And I DID A POST BAC PRE MED program. Where you kind of do all those pre recs and I struggled? I didn't do so hot. I did very mediocre. I mean I did well for myself but to get into medical school. It's very competitive so I did decent and then you take the cat hat. which is the entrance exam and I did also very very mediocre not so fantastic and I got essentially rejected from almost every school? I applied to accept one one and that one offered me an interview solely based on the fact that at the time I had created and was making a comic book about Data Diabetic Superhero Very nerdy. Super Nerdy I love so based on that they said Oh you clearly early you have a passionate of a background like let this guy in. Let's see what we can do. I think that was part of that. I think the the admissions Dean said your numbers are a touch low but they're not Horrible but you seem to have something that sets you apart. Let's give you an interview and I was very very fortunate. You know but it also did stoke. A lot of the impostor author syndrome like kind of got in through this back door. I remember sitting in my interview day. You know there's this big board table. Everyone's in their suit. I've already swept through my shirt. And my at this point and everyone goes around around to say what mets. What undergrad there from? And you know. I'm sitting next to some kid from Harvard. Princeton and Yale and they ask what they did the summer before they you know they came there and a lot of them would say. Oh you know I was carrying AIDS in Africa and I was curing cancer in this lab created a comic book. It was like what am I doing here. You need hashing drive in order to get through medical school you do you do what I found is that you don't have to be crazy. Brilliant you have to be very motivated. It'd because it just takes time. The volume of information is very vast but the depth of the the intellectual difficulty is not like the rigors not that bad. It's it's just taking the time to kind of comprehend the concepts and I found that using art actually helped me to do so right because I have found you because you have all these medical illustration three. You're drawing comics to remember. Certain medical concepts are those being used as study guides for a lot of people. So that's the hope I mean so I put a lot of that stuff on social media and I and initially it was very didactic. Nature be stuff to kind of help me remember medical concepts for tests and exams and so on and that seems to help a lot of other medical students but as I've is kind of evolved into being a resident and a lot of the emotional struggles I've kind of utilized in kind of poke fun at with some humor so kind of all those things I think hopefully are offering some solace and some help for other people going through the journey so his instagram handle by the by is Mike Dot net and he has all kinds of illustrations and comics based on his life. As has a doctor. It's Hellas we'd okay. Speaking of which yes that was sugar related. So let's talk a little bit about blood. Sugar I have a very overactive pancreas. overachiever workaholic. Pancreas so I have reactive hyperinsulinemia post-prandial Jio look at you at the big word. I know I've read them off of a lab reports and then I've ignored the advice that doctors have given me. I have a bad system going on but explain kind of wet. Wet Blood. Sugar is and what the pancreas does and why that's important absolutely okay. So let's start with the increase. The pancreas is freaking awesome. Okay it is is the coolest okay so clearly a little biased. But when you can. It wears two hats in general. Okay wears an execution hat. I an endocrine hat okay. The bulk of the pancreas is made up more or less like ninety percent of the cells or like acid ourselves. They Make Execution Enzymes to help Abi Digest foods things like trips in and stuff and helps you break down fats and carbs and all this stuff. So that's kind of one hat. And that's the bulk of what it does then. A handful of cells in these little islands called the islands of Langres hands. And there's Alpha cells and Beta cells and Delta cells all these cells and they make hormones and the the Beta cells in particular making insulin. Okay so put that on the shelf alley. What did you have for lunch today? y'All okay here's here's the deal. I have great days where feed microbiome a literal shitload of veggies. And then sometimes I'm just the worst and I'm traveling and I'll just have like hotel. How coffee for breakfast and some airport cheetos and then I'll try to consume a packet of peanut butter with a Q.? Tip as spoon. I'm not proud of this. I know that I have reactive hypoglycemia. I find that I will get to bed with my contacts out lights out When I have a low carb diet and I tend not to do it because I just don't want to seem Fussy uh-huh cookies? A horrible reason to get diabetes. Oh on a normal day. It's a I'm a dumpster fire on a normal day. I would have like an almond milk law. That probably had sugar for in the milk. And then I got a little bit more more sugar Derbyshire at because I liked her crotch and then and then I would probably eat like some sort breath pastry one. PM for breakfast. Love it. Okay so that pastry which sounds delicious is made up primarily of carbohydrate injury so that carbohydrate initially starts bringing down in your mouth. It's mechanical digestion with your teeth but there's also a little bit of chemical with salary Emily's or it's your breaking this carbohydrate which is a complex macromolecules down it eventually goes down. The food tube into the stomach and into the small intestine more and more of that digestion is taking place once wants those enzymes really breakdown at carb. It finally gets small enough into a form called Glucose the glucose can then get in through these little tingling projections that are absorbing all of that goodness from your food into your bloodstream. Bloodstream is kind of like the subway system. It just like transport all the shit to to all the things that needs to go talk about. So where does it need to go. Essentially is it needs to go to the trillions of cells that make up your body and once glucose can get into those trillions of cells cells can embrace that glucose down into ATP and energy and do what those cells need to do whatever that may be the problem problem or not the problem from my problem but years is not a problem but the problem is that the cells particularly the adipose tissue which is the fat and the skeletal muscle have locks on the doors of their cells and so for that sugar or glucose to get into the cell. Something needs to unlock that. And that's insulin insulin's kind of like a key. This is very over-simplified metaphor but I think it works well for people who don't necessarily have a backyard and scientists or in medicine and so this is the way in which your pancreas says. I'm going to dip my toe into that stream of blood tasted so it's a little bit. Sweet let's pump out some some insulin. In the right proportion to allow that glucose to get into the cells you WanNa maintain some glucose in the blood at all times for whatever reason Dr Ward once again. Not a doctor. Your pancreas gets very excited and so when you eat something with carb and if you don't have anything with fiber fat and protein protein to kind of help that carb to help that kind of slowly digested then you're paying a sees that sugar and it's a spike and it goes. Oh my God and it just. This is out all of this insulin into the blood. It's such an asshole. It just kind of like a sponge leases it in there and then Dan postprandial really which means like maybe two to four hours after you eat. You'll notice that there's still insulin hanging around so that too much of that sugar gets out of your bloodstream into yourselves and what does that feel like. What do you feel like when you have? I feel like it makes mono seem like I've had a red ball. I feel so so tired. My my limbs feel like lead and it just feels like the energy that would be needed to take out. My contacts is massive. That did I just have to fall asleep. Sometimes wearing shoes I have fallen asleep with my car in the driveway. I fall asleep on the bathroom floor. Brushes this is dangerous. I know so. That's that's like that's one way that someone might experience focus also known as low blood sugar and and it's miserable. Okay quite well researching this. I came across a two thousand sixteen paper called generalized anxiety disorder and hypoglycemia Symptoms improved with Diet modifications. One passage read quote increasing odds of depression and anxiety have been associated with the consumption of foods that have a progressively aggressively higher glycemic index are more sugary and spike. Your blood sugar faster. So doctors and lay folks alike no too much. Sugar can lead to like excessiveness and irritability and mood swings so much so that after the assassination of Harvey Milk the defense attorneys cited his murderers murderer's love of coke and hostess. And this is now known. As the twinkie defense. It did not work but perhaps we need a neuro psycho biology episode anyone. Yes also at this point in the interview a fluffy enor- raccoon interrupted and my dog. Grammy was a great way to deflect from my bad pancreas and hypoglycemia that were low blood sugar to his over there. She brought me a trait. My blood sugars fine right now. She's like shelby drink. Your Jews did you ever see Julia Roberts and dresser that ever happened to you. has anyone been shelby. Drink your juice shelby shelby shelby. You need some juice. You need some juice doc. Rate the juice. Excuse me should I call the doctor something. No she's a dumping. Thank Insulin that saw which is get a little more. I mean when I have hypoglycemia which unfortunately happens here here. And they're so. My symptoms are a little bit different than yours. I don't get the exhaustion as much as I get. This kind of cold sweats weak in the knees. Like Oh man I'm going to pass the hell out. kind of tunnel vision just feeling like just true death and then you get these weird cravings like anything and everything looks delicious shovel into NGO mouth like I would. I imagine being pregnant feels like like peanut butter and ice cream and pizza all at once and then the immediately feel ill afterward but yeah that's essentially. That's my hypoglycemia CUMIA. And so now a type. One diabetic has to monitor their blood glucose and then inject or have a pump for insulin. Because your pancreas checked out right. That's exactly right. So you're you're worried about high blood sugar. Which means you don't have enough insulin? You're also worried about low blood sugar which means maybe took too much. Insulin or blitzer can also be lowered by exercise. There's a lot of factors let's be elevated by times of stress and so stressed stressed out. How is how does that happen to good question? So the thought is that there are a lot of stress hormones particularly things like cortisol and epinephrine friend that when secreted into your bloodstream are good one gluconeogenesis. Oh let's say it again Glucose Neo Genetic German Burke Down Glucose sugar neo like like like the beginning of in Genesis the beginning of his wall. So like you're basically making making new sugar and and breaking things down of storage so things in the liver or bodies are super smart little store things into forms of glycogen glycogen storage orm of sugar mostly in the liver and so it'll kind of basically poop out all that extra sugar because your body's Oh fighter flight we we need this energy immediately. Let's get this out there. So that type of diabetes Dr Nassar has is the more rare form type one which is typically but not always diagnosed in childhood and Mike found out that he he had it one late September day in nineteen ninety four and also weird type one may be related to colder weather so it tends to be more prevalent in chillier climates and it's diagnosed more often during winter months which is just a whole man that is kind of type one. Does that happen with an auto immune problems as your immune system. Attack your pancreas exactly right so I mean that's the theory. Most of the time it's thought to be auto immune related and auto meaning means auto meaning self and immune meaning your immune mean system and I think of the immune system kind of little army of dudes and they have these little Like Spears and at the end of spears little y slow prong and at the end of those prongs are very specific shapes so armee systems kind of dumb like you you have like all. These pre made antibodies. which is what these spears? These are and they're like every as many combinations as they can in case they encounter an invader that looks like one of them so they can clip it and so on but then you also have memory of that and so you can pump out more so the theory is something called Molecular Mimicry. And it's very clever theory and it basically states that You have both a genetic and environmental kind of dual trigger so you have a genetic propensity to having some sort of autoimmune disease. It's not won't understood but you have some predilection for autumn unity. And then in the environment you come into contact with some common virus so I think Coxsackie B virus is thought to be one of the leading molecular mimicry. Theories for type one diabetes kind of a virus that you got and that is what triggered. Yeah so that's on your pancreas. That's the thought. And if the idea is that the EPA Topa like this small piece of virus that gets kind of clicked into your antibody. He looks similar to that of the cells of the pancreas. That's the theory. And then you have all these. Antibodies that are going ham and chop down them pancreatic tissues Cock Doc coxsackie pardon Yes this is a group of viruses named for the Hudson Bay hamlet of Coxsackie New York. And if you've ever had hand foot mouth disease he's congrats. You've been a bearer of one type of Coxsackie and also coxsackie is just. It's a small town it's about a hundred miles upstate for Manhattan and its name in. coxsackie means Al Hoot and you can buy a three bedroom log cabin there for just over a hundred grant and then tell your houseguests. Yes this is where some viruses were first is isolated in nineteen forty eight via fecal samples. Let's move on from number two type two shall we. Well what happens with type two diabetes. And why don't they just call call it. A different name is type two enough of a distinction or do you think that confuses people. It's a really good point so if you look at the numbers the over like by by a huge amount type two is much more prevalent type. One makes up a very small amount John. I think it's something like three hundred thousand in the United States. Something like that. Something tiny a type two is significantly more than if you count pre diabetics who are pre type two but it's also just like a mammoth amount. It's it's a massive problem in our country. Yeah well let's suppose backup so so type to a really good point like is there a big it. Should it be different name. And it used to be called adult onset and type one used to be called juvenile but they had to change that because for many reasons. One you're starting to see people who are for adults with type one getting diagnosed as an adult and then you're starting to see younger people including kids with type two which is a problem. So unlike doc being able to use tick tock or wearing only polo shirts type two is not an age thing but Dr Nassar says the end result dissimilar they both result in high blood sugar hyperglycemia but for very very different reasons and for very different mechanisms type one is never ever an issue issue of someone having a lifestyle choice that might have predisposes them. It's never that type. Chu Is often secondary a to some lifestyle choices that being said. There's genetic components to both and I wanted to also preface that they tell us a med school. That fifty percent of what you learned in Med school after you graduate is proven in wrong and different side. Note I check this out and yes type. Two has a stronger connection to a family history than type one so much so that they have crunched the numbers on twins and found that yet twins are more likely to share underpants and had all of their birthday parties ever and also a diabetes diagnosis. So why does type to happen may have changed but my understanding is that there's actually the higher genetic component to type two type one. Oh Wow and does that happen. Where you kind of exhaust your pancreas and so it? It has put out so much insulin over so much time that it just one day is like fuck all out for. I think there's a component of that. It's actually a really exciting time in research very very recently most people think. Oh you ate too much crap you a too much carbs and sugar. But what we're finding more more is that it's actually the animal products in the fact that we're eating is specifically the long chain fatty acids and the saturated fats and what's happening is there's fat. Deposition of fat is kind of accumulating and things like deliver your skeletal muscle on the pancreas and that is spawning a storm of like pro inflammatory cytokines. So you're getting a lot of inflammation nation that inflammation is really detrimental. You're getting free radicals and oxidation and that's really gunk and up. The works of the insulin receptors. So initially actually. It's an in an issue of insulin. Insensitivity the Baloch is broken. The key is there and so very early on type. Do you actually see a hyper insulin state because your pancreases saying Oh shit. My Insulin secreting. Doing anything goes pump out extra. It's falling on deaf ears and so for that reason. Eventually you'll have some of that. And like you said the pancreas pooping out. But then there's also some thought that this is also secondary to the fat deposition and inflame inflammation in the pancreas as well if you're silently analyzing your diets right. Now you are are not allowed my friend. The question of should eat Paleo Kito Cherie plant-based plant-based have evidence that suggests that they help treat and prevent certain disease processes like type two diabetes. And I do think that that is a very healthy way to go. There's good data for other dieter out there. But I the only one that I know that I've seen with empirical data behind it. That seems very good. Is the plant based Diet. Yeah a low plants really fascinating and so if you are say pre diabetic nick. What exactly does that mean? And what can you do. Can you turn this boat around if you have type two diabetes. Can you turn the cruise ship around. Like what are we talking here. You turn start with a huge. Buffet dispatch okay. So yes so. Let's I get into the definition so in in medicine we like objective number two like data so we use something called Hemoglobin A.. One C hemoglobin a one C refers to if you look at your blood blood. Your blood is made up of cells and plasma and some of those cells are red blood cells. They're just kinda hanging out at the charismatic G.. And they get some iron and they're doing their thing sugars sticky and so sure ends up sticking to these suckers and your blood turns over every ninety days every three months. You're marrow's like your some new blood so if I were to take a sample of your blood every three months or every ninety days and I took a look at how much sugar stuck on those red cells going to get a sense of what your average blood. The trigger is over those three months looking at that. So a normal haemoglobin. NC is somewhere between four and five percent. A Pre free diabetic is classified as as anywhere between five point seven and six point four percent. And then if you have six point five or above your classified as diabetic Oh wow And so if someone hears. They're pre diabetic or they'd just diagnosis type. Two what should they do. Like what is like an emergency toolbag back here we go. I mean I think I think the thing that we have to understand species. Medical professionals is that it's such a multipronged multipronged issue and just that physician alone in that ten minute visit saying like you need to lose weight is not going to cut it. There's so much to it. There's there's culture there's access availability there's cost of food and food deserts. There's a lot to talk about part of the reason I want to go into taking care of folks diabetes. Abe's because I get it. It's so difficult. It is a life altering you have to think about it constantly and it's never going away and so for that reason I think having having that connection and that empathy with the patient is first and foremost but usually proto typically type two diabetics and pre diabetics can spare some pounds also. Losing weight is key. Exercise is really important because exercising itself in and of itself even without the weight loss is gonNA help re sensitize to insulin and then losing weight with using things like a plant based Diet and cutting out a lot of the CARBS and a lot of the refined sugars and stuff as well. Staying away from some of those saturated fats is going to help significantly lower. UNC and get people back on track so people with diabetes type one and to come in all shapes and sizes. I know bean-poles and even someone who's a world renowned boxing coach who has diabetes in great shape but doctors agree that higher body fat in some patients can be one aggravated curve. ATER and part of the environmental factors. So why does lowering body fat seemed to help some patients so it's still not really well understood so the more more recent studies like I said are looking at the fat deposition on our organs itself and so the excess fat that we carry around her waist and so on is kind of a external marker of some visceral fat. Interestingly if you carry your fat like in your thighs and your butt. It's considered more healthy than if you were going to carry it in your in your belly. Let spare tires fires particularly bad. But I think there's also this idea of something called liposuction city and so just having that in and of itself is very inflammatory. And having inflammation kind of cascades all of these biomarkers in our body to go haywire kind of gunk up the normal mechanisms and therefore making making you were less sensitive to the insulin. Are we learning more and more about inflammation are we starting to realize like Oh inflammation. You're really awful. We I forgot to look into you before. It's all about balance because inflammation can be good if we get sick. Inflammation is going to bring all of the characters years of our immune system to where it needs to be into a really good job a fever in and of itself is actually potentially good thing but then if the fever continues news after the infections been quarantined. After you're feeling better you're going to cause damage. And so it's all about finding that balance. Do we have maybe more inflammation than we need. These days do do we have more factors that are contributing to increased inflammation absolutely and I think unfortunately a lot of it is diet smoking drinking all of the vices that I wish I could send more sexy and say like you have to stay away from this one thing. Yeah but it's it's everything we already kind of know but we're just learning more and more about how bad some of it really Elliot's and what do you use to manage your diabetes your work. That's correct I I I have so I have an insulin pump. I have something called the. CGM Am I see GM Continuous Glucose Monitor and my insulin. Islam pump basically has a reservoir of insulin that I change out every four to five days and it automatically will pump in. What's called the Basil rate into me through a subcutaneous little Caola Aniela suicide note a subcutaneous? Kenya's just fancy talk for tiny house that goes onto your skin and then every time. I have something to eat as carbohydrates. I have an estimation mation of how many carbs at his I have an insulin. Capriccio plug that guy into my pump and get a Bolles Vincent and hopefully cover that meal and who is a good it candidate for that because that seems way better than poking your finger and and poking yourself with all right no it does. I mean it doesn't it doesn't so it's interesting. A lot of type. Ones prefer her to not have the pump. So you have to be attached to it all the time. It's kind of annoying the main question you get asks like what are you doing. I'm in sex single dangling Mike. Pack or something exactly is like I mean you haven't ever had sex before but when you do those things Ashley Plug for your sexology episode. What does a person with type one diabetes do about having an end right? I mean when I was first diagnosed. A lot of these technology didn't exist so I would use syringes and and so the technology has come to be so that the disease can be very well managed and hopefully kind of fall into the background a little bit and the pump allows a lot more of that. And so now we have this. What's what's called a closed loop system so my continuous glucose monitor which I have on my arm? It sits in the interstitial space. And it's detecting. This kind of flux walks of glucose across cells. Why so meaning is because it's given me a sense of the direction of where my blood sugar's heading before it gets there? So if I'm on my way down or on my way up I can kind of take care curve that before it actually hits and my pump has now the ability to say. Oh you're going up. I'm going to give you a little more incident with having to do anything which is like phenomenal. Yeah it's not a good candidate for a pump so really expensive to it is is. It's crazy expensive so thankfully I have insurance but I think about this often as well as more recently with the you know the Crazy skyrocketing price of insulin. It's ridiculous that what is causing this insulin. Search what's the deal who I oh boy howdy. We're going to get to the cost of insulin in next week's part too but you can start right now just practicing screaming then with rage if you like but at this moment back to the pump. Oh my God so many things so so just real quick with the pomp. So who's a good candidate for the pump. So if you're type one you know you have to demonstrate that you have you still the pump not autopilot. You still need to be cognizant of how to take care of yourself and how how to troubleshoot and it's also a machine which can have its own issues which I've dealt with as well so if you've proven to your your endocrinologist who you're diastolic. Just that you have have a good sense of your disease you know how to handle it and you know what to do in case of emergencies and troubleshoot and you really want to try and find tune then that would be a good thing for you a. c. g. m. on the other hand I think every diabetic should should have priority. GM It kind of feels like you're flying an airplane with a blindfold on you test your blood sugar. And that's one point in time you don't know if that's a one hundred and it's going up we're going down. You have no idea. So the only way to combat that as you test your blood sugar. Twelve Times a day and connect the dots which is a pain in the ass right. Yeah it sucks. Does it hurt too perky finger. No no I mean. I don't think so. I think anything that you do every day for X.. Amount of years like you just kind of adapt to but even when I was diagnosed picking your fingers like Nothi- walk doc in the park. Yeah what advice we give someone who's just been diagnosed. Who took a question? I think it's important to recognize that. It sucks I think oftentimes when like bad stuff happens to people and people who have experienced with it like. Oh it's not that bad or whatever I think it's okay to Kinda Kinda get down on their level and be like this sucks but just because it sucks doesn't mean that your life is over and it doesn't mean that you need to alter everything in your life it means so you can have to make some changes and you're gonNA have to adapt but it's adaptable and it's doable so adaptable and it's doable. especially with all the diabetes and charities working to further outreach and research and for each episode we donate to a cause of the logistics choosing and for part one one diabetes doctrinaire chose an organization called beyond type one and beyond type one is uniting the global diabetes community and providing solutions to improve lives. Today it was founded in two thousand fifteen and they focus on education advocacy and the path to a cure and their site is awesome. It has everything from equipment information to to die at Info to Dad's AKA diabetic alert dogs and it was a great resources. I was researching this episode and it has wonderful links for patients patients in for newly diagnosed folks. So that's beyond type. One with the numeral one dot org so that donation was made possible by sponsors of the show. which you may hear about now? Did you know that there's an engagement season it's true. It's in full swing. It starts on Thanksgiving in its pants through Valentine's Day. It's a things. Love is in the air so if you are newly engaged you may or may not have heard of Zola. They make wedding planning easier. It's less stressful. They have wedding websites. They have a registry. They have invites. They have a guest list manager. It's all at one place. It's actually smart wedding planning. They have free wedding website designs. They have hundreds of templates. It's really easy easy to create your site in just a few minutes. They have the highest rated registry of all time you can register for gifts or experience and honeyman funds. 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You will be delighted. I promise if you've got something going on that is interfering with your happiness or it's preventing you from achieving your goals in having the life you want better help. Online counseling can help so better help service have licensed professional counselors. They're specialized in all kinds of issues like depression and relationships and anxiety and anger anger and family conflicts and LGBTQ matters self esteem grief. It got you covered so you can connect with a professional counselor in a safe and private online environment environment. You could help on your own time at your own pace. Anything you share is confidential and it's really convenient you can book secure video or phone sessions and you can chat. You can text with your therapist. It's really a whole new model and if for any reason you're not happy with your counselor. You can request a new on at any time. No additional charge no drama. I use help I check in with them a few times a week. It's really great to have a point person in one thing I really like about it is. It's more affordable than traditional therapy also our listeners. Get Ten percent off your first month with Discount Code Allergies. Why not get started today? You can go to better help dot com slash allergies. Fill out a questionnaire they will assess your needs and match issue with a counselor that your love. So that is better help dot com slash allergies. You deserve okay. So where were we. Yes okay we were talking about Cyborg pancreases do you think we're GONNA get pink like Robo internal pancreases or is it too many moving parts. I think that there's two flavors of cure are there. Is I think if we can get stem cells the conservative if it was an autoimmune process that killed off your own cells than putting your own selves back and we'll also so have the same issue so I think if we could somehow like hermetically seal them in like a Trojan horse and then we can implant them in the them or deliver. Those Beta cells will then kind of act as their own. Free roaming. Endocrine pancreas and I think that would be a potential cure. The other way would be a mechanical cure. Which I think we're very close to doing and you have kind of mechanical pancreas has just external? That's exactly right and I think that the mechanical cure will be an external want. But the thing that we didn't really dive into too much is that there's a gas pedal. There's a break the gas pedals. Insulin Insulin is going to drop your blood sugar down. But I don't have a break in the break that our body has physiologically something called Guca. Gone Oh aw so. I mentioned that there is the Beta cells for insulin. But the Alpha Cells Nick Luca gone so it's another hormone and that hormone just put very simply basically goes over deliver knocks on doors. Hey liver ever. Let's get. Some sugar breaks glycogen. Pours out some sugar kind of is the Yin to the Yang kind of deal so a pump. That has a dual chamber with some Guca gone anthem. Insulin and the closed loop system with the C. G. M. would essentially be that system and remember. CGM stands for Continuous Glucose Monitor. I got you and it can A. C. G. M. B. A. C. G. G. M. Like Glucose go Anglican Monitor. It be like a candidate monitor. Both on an and Glucose so glucose would be the piece that you want to measure because both both Luca gone and insulin. Or what's GonNa Be Affecting Glucose gotta Oh so then it would be more the pump that had two nozzles that not. That's exactly right. Hey you double nozzle God wait a minute muzzles. Are there any good movies or TV. Shows about diabetes. Who are there albinger creatures? I'm trying to think of other. Oh there was so my sister. WHO's a bit older than it? Used to be a big babysitters fan club. uh-huh my God Claudia Claudia. Of course I looked this up and the baby sitters club character with type. One diabetes was named great for this Stacey McGill. So congratulations if you've been in your car alone screaming states that was onward it Stacey. Yes sorry there was an episode that my sister made me watch with her because there was a diabetic and she was like a Christmas episode. nullum cookies and then she goes goes into such a good segue then she goes into something called. Okay should we. Should we dive dive something. Kito acidosis boom crushing it with the I mean. We're talking about diabetic. PEDO acidosis brilliant. So you are a doctor Dr Ward at pretty much. All I need is a lab coat and a really good insurance policies. The best practice and I read it. You're golden so what is diabetic. Keto acid So this is what I was in when I was diagnosed and often this is what happens with type ones. If you have type one diabetes. You have no insulin in your system with no insolently system like we spoke about before all that Sugar Glucose can't get out of your bloodstream and it can't get into your cells. How's your cells are dying in a see plenty like Yo? Where's all that delicious? Sweet sweet sugar now and it's all around them. It's all around them. That sucks. So what does that do earlier tissue so your tissues like we get some energy now so they go to alternate forms of energy. And that's breaking down your adipose fat tissue and and sometimes your muscle as well when you breakdown fat tissue. It's called Beta oxidation. And you can get some energy from that you actually get things called Ketones which can be used as sources of energy and the major key tones you get or things like Beta hydroxybutyrate in a CD acetate Acetone and so your brain can actually use is like neurons can and your heart can use tons for energy and so on but the problem with key tones? Is that if there's absolutely no insulin around then these key tone bodies buildup in the blood and super acidic in your blood is super finicky. And he wants to remain very very very neutral like seven point three seven point four. GPA starts to drop precipitously precipitously and you become acedemic an asset dodig and then you get very sick coma brain swelling death kind of deal. That's decay yeah. Why does that not not happen on the Kito Diet so on the Kito Diet you go into something called Kito Service? So you're getting more key tones and you kind of shunting that as your fuel source but you still have insulin around in your body. And so those kitone bodies don't build up to the point where they're dropping your blood ph okay so on Akito Diet can can you survive without look in your blood and glycogen and your lover and your muscles. You need some glucose. But you're getting some glucose like I think it's almost impossible awesome to eat a diet that has zero zero because like plants and stuff have a little bit of glucose. You can't your your body is able to kind of two different sources. And so on but I. I really don't think it's the best way to go. I think it does help with epilepsy to some degree the mechanism. I don't think it's that wonderful but it has to do with the idea of neurons. Utilizing key key tones is instead of glucose as their source. So it does something with the Excitability of the cells. And so if you don't have insulin deficiencies Kito Diet won't throw are you indicated acidosis like it would someone with diabetes and in terms of using the key Diet to control blood sugar. Some folks with type to say it's allowed them to manage their glucose levels and useless. Insulin of course do not use this episode to diagnose or treated disease. Consult your doctor before making any changes do not see us. How do think we can change our culture at large to avoid so many people? Getting type two diabetes the. Obviously there's a lot of things. A person can do individually to take responsibility for it and try to look out for themselves but in terms of an epidemic. What what should people be doing a higher level? I think that's a really good question. It's a really important question because it's really turning into such an issue I think. SP multipronged approach. I think we have to change is culture which is a very difficult thing to do and I think the idea of changing culture is really centered around food. I think food is is is a huge driving source. I think we need to make healthy food options more accessible. I think you know if you if you think about you know a single mom raising four kids. It's probably really easy and affordable to McDonald's And feed everyone we also in our culture American culture. You know if you eat dinner. It's expected that your dinner is going to be you know filled with a lot uh of meat and carbs and sugars and our portion sizes are crazy and so I think that's huge. I think having access to healthcare is important. I think those do things would make a huge difference and then outside of that. I think we need to be more active. I think we need to exercise. How does a person stay active when they are doing doing something really hard like raising a lot of kids going to medical school or asking people about Lizard? Dick's assuming hours. How do we prioritize? Yeah I know I can fit it in my schedule. I know I can touch her. Sit In there and I'm so bad at it lately. It's hard I mean I'm going to be a hypocrite because is like I. I'm a resident and like my schedule is is awful. I mean. I wish I could talk about Lizard. Dick's lizards and here. I I think the idea is being active in exercising. Doesn't mean you have to like carbon an hour and go to the gym you can take the stairs instead of the elevator. You can park your car a little farther in the parking lot you know. Now you can take to stares at a time one step. Even I mean if you get fifteen twenty minutes a day of doing something like that that counts and that makes a difference it adds up. Do you ever advise patients to get fit or get a step tracker and just try to hit a goal. Yes usually what happens. Is they'll get it and they're very excited up front. And then it kind of peters out towards the end but it is nice to have objective data and then try and do is. I'll bring them back so say instead of Siemian six months come back in a month. Let's see how many steps you did. Let's see many pounds lost and then you kind of work with them and you kind of keep them honest helpful. How do you Dr Approach something like you know physical fitness and things like that without making it into like an emotionally shaming issue? You know what I mean because it's so hard to feel good about your body in a a culture that celebrates like emaciated instagram model. That's correct and so we're fed these two different messages about. We should be stick thin and and also you should feel good about your body at any size. It's a little confusing is difficult. You're absolutely right and I think from from a clinical research serve physician point of view when someone has disease or they're developing disease that it should be the motivating factor. It's not about you. Don't look good it's about. I want you to lose weight. Because I'm worried about your diabetes and your Metabolic Syndrome in your you know your blood pressure and losing weight doesn't necessarily mean that you're GonNa you know I don't want not necessarily like look different. I want them to feel better. And so I think if you package it like that and say it's about your health and it's not necessarily about the physique that's important. How do you doctor? And also a patient motivate yourself to do. The things you know are good for you. I struggle I really do the things that I can control control so I try really hard to be careful about what I eat but I also think it's important that I believe in moderation. I think it's important that if you like ice cream if you like French fries you shouldn't deprive yourself of them all the time. I think it's okay being a diabetic or being hypertensive or overweight or two once in a while indulge Dole yourself and I think that's that's that's you know that's the balance right. That's I've like for instance. I try not to eat any red meat but all have red meat. Maybe once a month once every two months and that's not evidence based I don't I just made it up. I just said well you know what I do is win at the restaurant where I'm out with my friends or whatever and you know everyone's ordering stakes I think back okay. When was the last time? When was the last time I had red meat if it was recently? Like you know what I'm going to go for the salad but I try to eat in the morning. I try and eat eggs some like avocados. Oh something with like a lot of protein fat to kind of keep me going. Maybe we'll have like a Greek yogurt. Some berries berries tend to be okay. In terms of seem it conducts for diabetics other. The fruits are a little bit more tricky and then in a coffee. Lots of coffee. Numerous amounts of copious coffee and then for lunch. I'll have a salad. Usually if possible and then maybe some fruit like maybe an apple or something for a snack a handful of almonds something like that. Another two or three coffees. So what do we okay. Oh my upper dinner. What are you for dinner? So like I come out of Sushi. Sometimes some grilled chicken salad or a keen gene Wa. Sweet potato kind of stuff. Yeah I try. Have you ever done like a straight up diet like a whole thirty or south beach. Sure have you ever now no. I don't think diets like those types of days. I don't think that they work because I don't think they're sustainable. And I think the best kind of diet is the Diet that allows some moderation. So Diet doesn't work but But it looks like a diet in that like you know generally what you want to stay away from him what you WanNa have and then recognize that there's some room for moderation in moderation means both serving size and frequency of how often you have it and Can I ask you some Patriot questions at me. Let's do it okay. We're going to inject you with patron questions. So so ask Nice doctor stupid questions and stay tuned for next week's episode. which has more of your questions about staying healthy and affording insulin and supporting people people you love? Who have diabetes? How to avoid getting diabetes yourself so to follow doctor's later in the meantime he's Mike Dot on Instagram or Mike underscore natter on twitter? We are allergies at both. And I'm Allie Ward with one L. on instagram twitter links to beyond type one and the sponsors of the show are in the show notes and and at four dot com slash apologies. Such Dia Batali allergies. merch is available at allergies MERCH DOT COM or up at Allie worn dot com. Thank you two sisters Shannon and felt isn't Bonnie Dutch they are hilarious and they run all that merge and they host a podcast called you are not which is so funny. Thank you to Erin Hannah who have admin the facebook group since the start. Emily white organizers all the transcripts and we are catching up fast their links to bleeped episodes and transcripts in the show notes dirt sleeper of the mental health. PODCAST my good bad brain brain does assistant editing. And thanks of course to he who is sweet and not insipid Steven Rayle Morris for putting all the parts of the episode together and getting it out of time Nick Thorburn Burn wrote and performed theme music. He's band called islands. Listen to them. And if you stick around until the end of the episode you know I tell you a secret who this week. I'm going to share. We'll hot tip for my fellow folks who have sleep procrastination or fall asleep in their clothes a lot so apm. This is a new habit. I make myself get ready ready for bed even if I have no intention of sleeping for like ours that way at like eleven thirty when I'm super tired I don't have to splash cold water on my face and have a bit run down my sleeves and essentially look possum. WHO's been attacked by Garden House? So baby steps kids get ready for bed hours early. It helps with asleep procrastination. Okay okay so next week we get emotional. We have more living tips on how to avoid or afford the Beatles so meet me back here for by Pack Dermatology Chami. Does zoology meteorology there. There are so many new ways for you to treat your diabetes few like what was that online counseling. It was better help so whatever struggles. You're facing from depression anxiety. Trauma Grief Better help connects you with a professional counselor in a safe and private online environment. It's very convenient so convenient I do it. You can schedule secure video or phone sessions you can chat. You can text with your therapist. Anything you share is totally confidential. And it's a truly really affordable option and Allah jets. You'll get ten percent off your first month. There's discount code and it's just all Geez so why not get started. You deserve it. Go to better so help dot com slash allergies. You can fill out a questionnaire and they will match you with a counselor that you'll love today okay. Provide for real.