Welcome to Wonderfully Made
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Our topic today:
Pre-diabetes and Diabetes.
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Hello!
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My name is Dr. Christine Salter
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I'm board certified
in family medicine and
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now I'm the medical director of
Vibrant Health Family Medicine
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St. Louis, Missouri
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Our topic today,
Diabetes and Pre-diabetes
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is very important.
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We really want you
to pay close attention.
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First of all,
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How many people are
affected by Diabetes?
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Well, the US ranks only
third behind India and China
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for Diabetes prevalence.
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There are 300
million people worldwide,
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affected by Diabetes.
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In the US alone there are
18 million people with Diabetes
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and that's slated to
increase to 30 million by 2030
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Before we
discuss the risk factors,
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and how to treat Diabetes,
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let's just talk
about the complications,
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so we can really
get a perspective here.
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Diabetes affects the brain, via
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It's action on atherosclerosis
increasing the risk of stroke,
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it affects the eyes,
being one of the leading causes
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of blindness,
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It affects the heart as
considered a coronary equivalent
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that is if you have Diabetes
you're considered to have
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heart disease.
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It affects the kidneys.
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It's the No. 1 cause
of dialysis in the US
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for renal failure,
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also increases the risk
for renal cell carcinoma,
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a malignancy of the kidney.
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It also affects the nerves.
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Peripheral neuropathy,
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a very disabling
and painful condition
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that diabetics may develop
with uncontrolled Diabetes.
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Pain in the toes,
pain in the fingers.
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It's very difficult to treat.
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The best way to avoid that is
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to avoid Diabetes
in the first place
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or to adequately
control Diabetes.
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And what other
systems are affected?
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The immune system.
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Poor healing when
there's an infection.
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Increased risk for
deep seated infections
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So, Diabetes
clearly is a problem,
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and we want to
avoid it at all cost.
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That is why we are
discussing Pre-diabetes.
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And what is pre-diabetes?
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We have to
consider it as a continuum.
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We have euglycemia,
which is normal glycemia
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or normal blood glucose,
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and then we have pre-diabetes
or impaired fasting glucose
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or impaired glucose tolerance
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2 different situations,
but both pre-diabetic,
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and then we have hyperglycemia
and then after that
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we have disability and death
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we've already listed
what some of those are.
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In addition to what
we've rightly mentioned
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erectile dysfunction
is another problem of the
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uncontrolled
diabetes as is amputation.
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And so, between euglycemia
and pre-diabetes, that is
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reversible. and that is where we
want to diagnose and find people
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to prevent them going
on to the hyperglycemia
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and the on to diabetes, and
then on to disability and death.
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So, let's talk about
impaired fasting glucose.
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If you go to see your doctor
and you'd not even breakfast,
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and did not eat after midnight
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and your doctor checks
the fasting blood sugar,
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your sugar should
easily be less than 19 mg/dl.
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If your blood glucose is
100 or above, but less than 126,
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we say that you have
impaired fasting glucose.
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On the other hand. If you had
a meal or a carbohydrate load
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and we checked your
blood sugar 2 hours later
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and it is greater
than 140 but less than 199
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we say, you have
impaired glucose tolerance.
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So, that's the problem
with elevated blood sugar after
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eating Both of these
states are pre-diabetic,
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and we can reverse this
state, an that's the good news.
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A large trial was done recently.
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And that trial showed that
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physical
activity and proper diet
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was superior to drugs for
reversing the pre-diabetic state
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to the normal glycemic state.
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Normal diet or a good
diet and physical activity,
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2 lifestyle factors
that can cause a reversal
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of the pre-diabetic state
into the normal diabetic state
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what are those dietary factors?
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First of all, we want you to
limit the high glycemic foods.
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what are those
"high glycemic" foods?
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Those foods cause a
spike in the blood sugar,
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causing the
insulin to go to high,
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and than that coupled
with insulin resistance,
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you may have heard of that term,
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insulin resistance,
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when the insulin is released
in response to a glucose load,
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the glucose needs to go
to the peripheral tissues
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like the muscles, the liver.
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If there's insulin resistance.
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there's a problem with the
receptors at the periphery.
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It's like a lock
and key mechanism.
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somehow the key comes
in, but the lock is blocked.
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and so the insulin unable to
do it's job to get the glucose
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into those cells.
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Consequently we have
this elevated blood sugar.
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and that's a problem.
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Glucose is very good
when it's used for energy
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in the right place, but
when it's in the wrong place
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it causes problems, such as
end of field dysfunction and
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contributing to atherosclerosis.
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And so, when you eat and insulin
is released there needs to be
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a mechanism to get the glucose
into the peripheral cells.
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And exercise is
one of those mechanisms
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But let's talk about
the high glycemics again.
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So, what are those
high glycemic foods,
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that causes spiking insulin
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and just too much glucose
too quickly into the bloodstream
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Unrefined carbohydrates,
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and what we want to
have, refined carbohydrates,
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are high glycemics.
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White bread, white rice, white
flour, products made with these,
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white pasta, juices, alcohol,
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cakes, pastries, pretzels,
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sounds familiar?
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These are the common
foods if you go to a restaurant,
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or to a party gathering,
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what do you find?
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juice,
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chips,
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pastries,
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cakes,
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these are high glycemics.
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These cause a spike
in the level of insulin,
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and just too much
glucose in the bloodstream.
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So we want you to limit
those high glycemic foods.
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but we also
want you to exercise,
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because that is the
other half of the puzzle.
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Eating properly
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and exercising.
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When we exercise
the large muscles,
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the large muscles work and
they will bring in the glucose
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under the influence of insulin.
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But, if you go to a
party, or after dinner,
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and you eat cakes,
pretzels, drink a glass of juice
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and then go and sit
down in front of the TV.
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That is a recipe
for insulin resistance
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and high blood sugar,
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and the damaging
effects that it causes.
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So, you can understand
why in this large trial,
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that proper eating and exercise
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decreased the risk for diabetes
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by reverting from
the pre- diabetic state
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to the normal glycemic state.
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from the pre-diabetic state
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to the normal glycemic state.
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with proper diet and exercise.
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But the diet isn't
about what you shouldn't eat,
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the high glycemics,
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it's also about
what you should eat.
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Foods that are high in fiber.
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These help to
stabilize the blood sugar.
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So, those high glycemic
foods as the white bread
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replace that with
whole grain bread.
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The white pasta, replace
that with whole grain pasta.
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The white flour
products, replace that with
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whole wheat
flour or oatmeal flour,
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the complex carbohydrates
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We are not advocating a high
protein, low carbohydrate diet,
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what we are
advocating is that you avoid
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the refined carbohydrates
and you replace them
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with the complex carbohydrates.
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What else is important?
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Phytonutrients, that we
find in fruits and vegetables.
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These phytonutrients
help regenerate and protect
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the vessels of the eyes,
of the brain, of the heart,
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of the kidneys, of the nerves.
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It's important that
you eat these foods.
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So, whole grains,
fruits and vegetables, legumes,
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seeds and nuts.
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What are in
these seeds and nuts?
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Well, the brazil nut
for instance is very high
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in the mineral selenium,
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and selenium is rather important
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as it is a powerful antioxidant.
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Why do we want you to
have antioxidants in your blood
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steam? Because oxidation
is a normal fact of life.
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If you exercise,
you're going to get oxidation.
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If you breathe, you're
going to get oxidation.
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If you have pre-diabetes,
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you're going to have
a lot more oxidation.
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So, we need to have those
antioxidants in the blood stream
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to mop up all the
oxidants to prevent the damage.
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Oxidants prevent damage,
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antioxidants mop the up.
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and improve the lining,
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so, oxidants cause damage,
antioxidants prevent damage.
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And so, fruits,
vegetables, whole grains
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coupled with seeds and
nuts, and regular exercise,
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is going to be protective,
and will reverse the process
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of pre-diabetes,
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back to a normal glycemic state.
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But, if you do not
follow these things,
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then we will have a problem.
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How can you tell,
that you're at risk
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for being pre-diabetic?
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Well, there's
certain body habitus factors,
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that can let us know this.
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First of all,
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are you obese or
are you overweight?
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You can tell that by
simply getting' on the scale,
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and checking your height.
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If your Body Mass
Index is greater than 25
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than you are overweight,
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and if it's greater
than 30, than you are obese.
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Obesity is
increasing in an alarming rate.
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Not only in the US, but also
in other developed countries
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and this is all linked
with the increase in diabetes.
00:14:20.47\00:14:25.04
What is the
problem with obesity?
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Let's talk about
that for a second.
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We are concerned
about abdominal obesity.
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or the "apple" shaped body.
00:14:39.61\00:14:43.60
Abdominal obesity.
00:14:44.62\00:14:50.01
is very active,
metabolically, and is producing
00:14:50.36\00:14:54.86
all kinds of what we
call inflammatory cytokines.
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that are damaging
the blood vessels.
00:14:59.95\00:15:02.15
We are not as concerned
about obesity around hip area,
00:15:04.04\00:15:08.70
but we're very concerned
about abdominal obesity.
00:15:09.27\00:15:13.69
So, in a man: if
your waist circumference
00:15:13.91\00:15:17.25
is greater than 40 inches
00:15:17.28\00:15:20.23
that's a problem,
00:15:20.91\00:15:22.01
that's abdominal obesity.
00:15:22.43\00:15:24.09
and in a woman, greater than
35, that's abdominal obesity.
00:15:24.23\00:15:29.29
So, when you go
to your physician,
00:15:29.62\00:15:32.09
we want to know what
your body mass index is,
00:15:32.75\00:15:34.76
we want to know what
your waist circumference is.
00:15:34.79\00:15:38.37
Because these are risk
factors for insulin resistance
00:15:38.81\00:15:44.09
and pre-diabetes.
00:15:44.47\00:15:46.20
We also want to know
00:15:46.62\00:15:47.85
about your
lifestyle, are you sedentary?
00:15:48.95\00:15:51.66
Family history is important.
00:15:52.81\00:15:54.52
If your mother, father,
brother, or sister have diabetes
00:15:54.55\00:15:57.21
you are the
significant risk for diabetes.
00:15:57.27\00:16:00.30
What are the organs that
are affected with diabetes?
00:16:02.79\00:16:09.45
Well, we've talked
about the major organs,
00:16:10.06\00:16:13.87
but the pancreas is the
organ that produces the insulin.
00:16:14.26\00:16:19.22
The beta cells of the pancreas.
00:16:19.63\00:16:21.55
Now, it is thought that in some
individual they are targeted
00:16:22.49\00:16:28.33
or genetically predisposed
for those beta cells to fail.
00:16:28.53\00:16:33.20
What I mean by that?
00:16:33.23\00:16:34.32
Those beta cells
produce the insulin.
00:16:35.53\00:16:40.22
so, the insulin
helps to deal with glucose.
00:16:41.39\00:16:45.49
The large muscles help
to get rid of the glucose
00:16:46.30\00:16:51.28
If we have a situation
where those cells are failing,
00:16:51.91\00:16:56.38
so they are not
producing the insulin
00:16:56.60\00:16:59.34
to deal with the
glucose that's coming in,
00:16:59.41\00:17:01.61
from all those
high glycemic foods,
00:17:01.65\00:17:03.76
and then there is no exercise
or minimal exercise to...
00:17:04.35\00:17:09.80
the glucose into those cells,
00:17:09.83\00:17:11.58
then we have a situation
of hyperglycemia and diabetes.
00:17:11.62\00:17:15.94
What are the numbers for
the diagnose of diabetes?
00:17:16.53\00:17:20.38
If on two occasions you have
a fasting blood glucose of 126,
00:17:20.62\00:17:26.09
that is a diagnosis of diabetes.
00:17:26.35\00:17:29.10
On the other hand,
00:17:29.79\00:17:31.11
if I just did a
random blood sugar
00:17:31.21\00:17:33.63
and this is greater than 200,
00:17:34.48\00:17:36.43
that is the diagnose
of diabetes right there.
00:17:36.68\00:17:39.50
I do recall a
case of a gentleman,
00:17:40.45\00:17:43.39
who was complaint
of erectile dysfunction
00:17:43.42\00:17:45.69
and as I mentioned earlier
00:17:46.29\00:17:47.86
that is one of the
areas affected by diabetes.
00:17:48.03\00:17:51.20
so right away I new that I
needed to check him diabetes
00:17:51.27\00:17:55.44
as well as for his cholesterol
and for his high blood pressure.
00:17:55.48\00:17:58.89
He assured me that
diabetes was not in the family,
00:17:59.24\00:18:02.90
and that he did not
have a problem with that.
00:18:03.11\00:18:05.57
However I went ahead and
I checked a random glucose
00:18:06.23\00:18:11.64
and that was greater
than 200, closer to 250.
00:18:12.01\00:18:17.17
That is a diagnosis of diabetes.
00:18:18.13\00:18:21.65
And so with that diagnosis,
he is taken to a higher category
00:18:22.56\00:18:28.49
as far as risk assessment
for coronary artery disease.
00:18:28.66\00:18:32.31
and not only for
coronary artery disease,
00:18:32.88\00:18:34.83
but all the other
conditions, we mentioned.
00:18:34.87\00:18:36.79
The kidneys, the brain,
the eyes, the feet, the nerves.
00:18:37.44\00:18:42.76
That is the reason
why we are so concerned
00:18:43.81\00:18:45.91
about diabetes
in the first place.
00:18:45.94\00:18:48.27
Now,
00:18:49.67\00:18:50.64
the foods we eat,
the fiber content,
00:18:51.64\00:18:54.79
the exercise, are the mainstay
of the treatment of diabetes.
00:18:55.03\00:19:00.01
We can use medications,
00:19:00.50\00:19:02.74
and there are some
reasonable medications out there
00:19:02.77\00:19:05.70
that can help in diabetes,
00:19:06.45\00:19:08.20
but they do have
their side effects too.
00:19:08.23\00:19:10.43
So, the ideal situation is
to use the diet and lifestyle,
00:19:10.65\00:19:15.81
the same diet and
lifestyle that causes reversal
00:19:16.08\00:19:19.23
of the pre-diabetic state
to the normal glycemic state,
00:19:19.48\00:19:23.29
will also treat
the diabetic state
00:19:23.45\00:19:26.46
to prevent further progression
to disability and death.
00:19:26.56\00:19:33.52
Some of those drugs are
Metformin or Glucophage,
00:19:35.04\00:19:38.91
again can be useful
00:19:40.17\00:19:41.45
But in a certain individuals
that medicine is contraindicated
00:19:41.80\00:19:46.61
If you have
severe renal disease,
00:19:47.49\00:19:50.78
if you have
congestive heart failure,
00:19:52.00\00:19:54.61
than you're not a candidate
for Glucophage or Metformin.
00:19:55.32\00:20:00.29
So, please don't
ever go and take that drug
00:20:00.43\00:20:02.98
that belonged to your mother,
or your brother, or your sister
00:20:03.37\00:20:06.74
without first being checked
up by a physician to make sure,
00:20:06.77\00:20:09.85
that you are a
candidate for that medicine.
00:20:10.03\00:20:12.51
Again.
00:20:12.97\00:20:13.94
Medications are
secondary to lifestyle.
00:20:13.98\00:20:19.71
Diet and exercise.
00:20:20.44\00:20:22.36
Even the standard
American diabetic diet,
00:20:23.15\00:20:25.84
when fruits
00:20:25.97\00:20:27.76
just a few servings of
fruit was added to that diet
00:20:28.64\00:20:31.41
they had a lower level
of blood sugar than before.
00:20:31.78\00:20:36.89
So, we see the importance of
the fiber, the soluble fiber,
00:20:37.58\00:20:42.01
that we find in fruits,
00:20:42.04\00:20:43.57
the soluble fiber
that we find in oats,
00:20:43.87\00:20:46.62
and as well as the fiber,
we find in the whole grains.
00:20:47.35\00:20:50.40
These are important to keep
that blood sugar stabilized.
00:20:50.48\00:20:55.23
The Bible says, there's
nothing new under the Sun,
00:20:56.68\00:20:59.25
the same problems and conditions
and lifestyle facts that cause
00:21:00.04\00:21:04.67
coronary artery disease,
00:21:04.70\00:21:06.03
that contributes to
high blood pressure,
00:21:06.94\00:21:09.29
are also a
problem with diabetes.
00:21:09.67\00:21:12.64
So we could save
ourselves a lot of trouble,
00:21:12.97\00:21:15.82
as far as those
conditions are concerned,
00:21:17.00\00:21:19.36
if we'd eat fruits, vegetables,
whole grains and exercise.
00:21:19.67\00:21:24.64
but in addition, it is important
00:21:24.78\00:21:27.76
to drink an
adequate amount of water.
00:21:27.92\00:21:30.29
A large study was
done on over 70.000 women,
00:21:30.61\00:21:36.38
and they looked
at the water intake,
00:21:36.97\00:21:39.91
and they found that drinking
at least 5, 8-ounce glasses
00:21:40.01\00:21:43.96
of water,
00:21:44.06\00:21:45.03
significantly cut the
coronary vascular disease risk.
00:21:45.16\00:21:50.14
Why is that?
00:21:50.24\00:21:51.45
When we are properly
hydrated, the blood is thin.
00:21:52.00\00:21:58.50
and it can flow
through the vessels nicely.
00:21:58.78\00:22:02.25
With diabetes, the blood
flow is slow and sluggish.
00:22:02.88\00:22:08.33
You've seen syrup.
00:22:09.16\00:22:10.44
If you pour syrup,
it's very slow and sticky.
00:22:10.50\00:22:14.89
Just imagine, what your
blood stream looks like,
00:22:15.56\00:22:18.87
if you've got all
this glucose in it.
00:22:18.91\00:22:21.85
It is thick and sticky.
00:22:22.22\00:22:24.98
If you have diabetes, make sure
that you're not drinking sodas,
00:22:25.47\00:22:30.13
caffeinated beverages,
for your fluid intake.
00:22:30.74\00:22:34.79
Make sure that your main
fluid intake is pure water,
00:22:35.06\00:22:39.02
to keep your blood nice and
hydrated and flowing freely.
00:22:39.28\00:22:45.76
So, as you drink your
water, eat a plant based diet
00:22:46.22\00:22:50.59
with fruits,
vegetables, whole grains.
00:22:50.64\00:22:53.80
Exercising for
at least 30 minutes,
00:22:54.27\00:22:56.88
on most days of the week.
00:22:57.03\00:22:58.80
If you have pre-diabetes,
00:22:59.58\00:23:01.41
you will revert
to normal glycemia,
00:23:01.54\00:23:06.25
if you have diabetes,
you'll prevent the progression
00:23:06.85\00:23:10.66
on to more serious
conditions involving the brain,
00:23:11.13\00:23:15.99
the heart, the
kidneys, the nerves,
00:23:16.45\00:23:21.96
the feet, preventing amputation.
00:23:22.06\00:23:24.27
This will be a good
thing and it is simple.
00:23:26.29\00:23:29.92
If you are still
not getting control,
00:23:31.49\00:23:34.14
and you want to give
yourself at least 3 months,
00:23:35.08\00:23:39.63
on the lifestyle
diet and exercise,
00:23:39.85\00:23:44.49
then we can add
some of the medications
00:23:45.07\00:23:47.77
to help control the blood sugar.
00:23:48.29\00:23:51.16
I've had the wonderful
opportunity of treating patients
00:23:52.86\00:23:55.59
with diabetes, and
getting them off medicines,
00:23:55.62\00:23:59.29
sometimes using herbs
that will help regenerate
00:24:00.15\00:24:05.51
the pancreatic cells,
00:24:06.22\00:24:07.80
to help with the
insulin production,
00:24:08.30\00:24:11.87
thereby lowering
the blood glucose.
00:24:11.98\00:24:15.43
But we don't want to
use herbs as a band aid.
00:24:16.03\00:24:20.33
In the same way we don't want
to use medicines as a band aid.
00:24:20.41\00:24:23.66
We want to go to the
source, to the cause,
00:24:24.00\00:24:27.69
we want to treat the root cause.
00:24:28.02\00:24:30.54
And if the root
cause is poor diet,
00:24:30.92\00:24:33.26
inadequate physical activity,
00:24:35.40\00:24:37.79
than that is
where we need to begin.
00:24:37.85\00:24:41.55
So, as you plan to exercise,
00:24:42.51\00:24:45.95
just think to yourself.
00:24:46.12\00:24:47.93
This exercise is like medicine.
00:24:48.37\00:24:51.90
This exercise is like medicine.
00:24:53.01\00:24:55.58
It is decreasing
the ... of blood stream.
00:24:56.27\00:24:59.60
It is improving the
circulation to all the vessels,
00:25:00.08\00:25:02.62
it is improving
insulin resistance.
00:25:02.65\00:25:06.34
We want to share with you
some additional parameters
00:25:09.19\00:25:13.11
to look for,
00:25:13.14\00:25:14.61
regarding insulin resistance.
00:25:15.26\00:25:17.47
When you get your
fasten glucose profile done
00:25:17.54\00:25:20.08
and we hope that
you will do that,
00:25:20.11\00:25:22.29
we want make sure to look
at your triglyceride levels,
00:25:23.02\00:25:26.28
that's the fat
in the blood stream,
00:25:26.48\00:25:28.83
if it's greater than
150, that's a problem.
00:25:28.91\00:25:32.33
We want to look at your
"good" cholesterol level,
00:25:32.74\00:25:35.34
or the HDL,
00:25:35.37\00:25:36.93
we wanted to be greater than 50,
00:25:37.70\00:25:39.29
if it's less than 50 in
women or less than 40 in men,
00:25:39.32\00:25:43.07
that's a problem.
00:25:43.15\00:25:44.56
If your waist circumference
in men is greater than 40,
00:25:45.36\00:25:48.90
or greater than 35 in women,
00:25:49.38\00:25:51.36
that is also a problem.
00:25:52.00\00:25:53.69
If you have
elevated blood pressure,
00:25:54.57\00:25:56.73
that is also a problem.
00:25:57.40\00:25:59.35
And if you have
impaired fasting glucose,
00:26:00.05\00:26:04.48
that is also a problem.
00:26:04.73\00:26:06.22
That consolation, those
5 things I've mentioned,
00:26:06.54\00:26:09.83
constitute the
Metabolic syndrome,
00:26:10.24\00:26:13.55
or the syndrome that's
associated with pre-diabetes,
00:26:14.20\00:26:18.15
is almost a link
into full blown diabetes.
00:26:18.18\00:26:22.28
So, if you see your doctor,
00:26:23.70\00:26:25.45
and your blood
pressure just slightly elevated,
00:26:25.49\00:26:27.75
you have these other
consolation symptoms,
00:26:27.80\00:26:30.12
that is the metabolic syndrome,
00:26:30.30\00:26:32.28
that increase your risk
for coronary events as well as
00:26:32.31\00:26:38.05
diabetes.
00:26:38.40\00:26:40.17
The good news is,
00:26:40.25\00:26:41.59
these things can be reversed.
00:26:42.31\00:26:44.61
Exercise will raise
the good cholesterol.
00:26:45.09\00:26:49.84
Limiting and
avoiding the high glycemics
00:26:50.30\00:26:54.04
will lower the triglycerides.
00:26:54.11\00:26:56.85
As you exercise
and loose weight,
00:26:57.35\00:27:00.80
that will change the
abdominal circumference,
00:27:01.07\00:27:04.47
thereby,
decreasing abdominal obesity.
00:27:05.52\00:27:08.46
And you remember
that abdominal fat
00:27:08.77\00:27:11.20
is highly metabolically active,
00:27:11.23\00:27:13.50
producing
inflammatory cytokines.
00:27:13.64\00:27:16.76
Did you also know that there
is another lifestyle factor,
00:27:17.10\00:27:20.33
that affects diabetes?
00:27:20.60\00:27:21.87
and that is, not
getting enough sleep.
00:27:21.90\00:27:24.79
We want you to
get adequate sleep,
00:27:25.21\00:27:27.33
especially before midnight,
00:27:27.36\00:27:29.05
because that helps
00:27:29.16\00:27:30.19
in the circadian
regulation of the hormones.
00:27:30.22\00:27:33.58
We are truly
fearfully and wonderfully made.
00:27:33.93\00:27:36.69
The Lord made the pancreas
and all the other endocrine
00:27:37.04\00:27:42.14
organs to work together to
maintain normal blood glucose,
00:27:42.17\00:27:46.53
and so if we do this
simple lifestyle factors,
00:27:47.08\00:27:49.89
adequate sleep, proper diet,
high fiber, regular exercise,
00:27:50.08\00:27:55.69
avoiding the
high glycemic foods,
00:27:55.95\00:27:58.92
drinking at least 5, 8
ounce glasses of water,
00:27:59.25\00:28:03.69
you can prevent diabetes,
00:28:03.95\00:28:06.20
reverse pre-diabetes,
00:28:07.09\00:28:09.22
so I wish you above all
things that you'll prosper
00:28:09.94\00:28:11.83
and be in health,
even as your soul prospers.
00:28:11.86\00:28:12.83