The following
program presents principles
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designed to promot good health
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and is not intended
to take the place of
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personalized professional care.
00:00:06.04\00:00:07.78
The opinions and ideas expressed
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are those of the speaker.
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Viewers are
encouraged to draw their own
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conclusion about the
information presented.
00:00:13.77\00:00:15.93
Welcome to Wonderfully Made,
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in today's segment
of Wonderfully Made
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we will look into
the role of preventive
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medicine in diabetes.
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I am Dr. Meshach
Samuel, I currently serve as
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a Family
practitioner and I enjoy doing
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what I do in the
field of primary care.
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I love preventive
medicine and in our study today
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we will try to apply
the principles of preventive
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medicine in diabetes,
why choose the subject
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of diabetes, let
me give you at least
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three good reasons,
firstly it is estimated
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that approximately
17 million individuals
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in the United
States alone have diabetes
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and it is a growing
concern throughout the world.
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Secondly, it is well
known that a significant
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fraction of those
with Type 2 diabetes
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remain undiagnosed.
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You may want to ask
yourself the question,
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could I be one of
those who has the disease
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and is not aware of it?
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And the third reason is that,
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diabetes is a condition
which in its early stages
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presents with
little or no symptoms
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and if left
undiagnosed will eventually lead
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to major
complications, disability and
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premature death. And
remember we will deal
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with this
subject of diabetes today
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with emphasis on
preventive medicine.
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Before going any
further let's cover
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some basic information,
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what is diabetes?
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Diabetes is a condition
in which there is excessive
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amount of sugar in the blood,
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and persistent
excessive sugar in the blood
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adversely affects our
blood vessels and finally
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results in damage
of important organs
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such as the
kidneys, the eyes and
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the nerves and so on.
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Let's now review
briefly the physiology,
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that is the
processes that take place
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in the body
relating to blood sugar.
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The cells in our
body need glucose,
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which is the
simplest form of sugar
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that is broken
down to obtain energy.
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The body tries to
maintain what we call
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normal range of blood sugar
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in a normal healthy individual
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soon after a meal
especially one that
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is reach in carbohydrates,
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glucose from the diet
enters the blood stream
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and as a result
blood sugar levels go up.
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And in response to
the raising levels of
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glucose in the
blood, the pancreas,
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an important organ in the body,
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produces a
substance called insulin.
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Now the most
important function for insulin
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is to lower the
blood glucose levels
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and it does this in two ways.
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Firstly, the most important one,
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insulin enters
into the cells of the
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various tissues
and helps the cell
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use up the glucose
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and secondly insulin
also triggers the liver
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to take up the
excess glucose in the blood
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so that it can be
stored and later released
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when there is a need.
00:04:05.10\00:04:06.15
Now, there are other organs,
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enzymes and
hormones that play a role
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in processing and altering
the blood glucose levels
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but all these factors
work together to maintain
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a normal range of
blood sugar in our body.
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Unfortunately we live
in a world where things
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do go wrong and
this applies to the
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way our body functions.
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It could happen as
a result of something
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we have brought up on ourselves
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or sometimes due to
factors beyond our control.
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In type 1 diabetes the
particular cells of the
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pancreas which
produce insulin are damaged
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or destroyed and as a result
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there is no insulin production,
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this often happens in the early
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part of our lives.
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There are several explanations
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of how this happens,
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however when a
significant number
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of cells in the
pancreas that produces
00:05:09.66\00:05:12.13
the insulin are destroyed
type 1 diabetes occurs.
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Now, let us see what
happen in individuals
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with type 2
diabetes which is what
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we're going to be
talking about mostly today.
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We have seen earlier
that glucose and insulin
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from the blood has
to get into the cells
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where the glucose is broken down
00:05:32.36\00:05:34.13
and used up to obtain energy.
00:05:34.26\00:05:36.28
Normally, insulin
enters into the cells
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whenever there is
a need for glucose
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to be broken down
but in type 2 diabetes,
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there is a gradual
build up of some form of
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resistance making it
difficult for insulin
00:05:51.12\00:05:54.15
to get into the cells.
00:05:54.16\00:05:55.45
So, we see that
individuals prone to
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type 2 diabetes tend to
develop what is known as
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insulin resistance. When
insulin cannot be utilized
00:06:02.75\00:06:07.28
due to resistance build up,
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blood sugar levels remain high.
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And the pancreas is
now constantly stimulated
00:06:12.89\00:06:16.16
due to the persistently
elevated blood sugar
00:06:16.54\00:06:18.85
levels and the
over stimulated pancreas
00:06:18.86\00:06:22.51
now produces more
and more insulin because
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it appears that a
larger amount of insulin
00:06:26.17\00:06:29.42
is needed to
overcome the resistance.
00:06:29.43\00:06:31.76
And in the early
stages of type 2 diabetes
00:06:33.83\00:06:36.09
this seems to work
but as the resistance
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continues to increase
the pancreas at some point
00:06:39.92\00:06:44.26
is unable to meet the demands
00:06:44.61\00:06:46.79
and appears to give up.
00:06:46.96\00:06:48.22
So, we end up with two problems
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in type 2
diabetes, one the gradual
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progressive development
of insulin resistance
00:06:54.65\00:06:57.27
and two the
gradual decrease in insulin
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production by the
pancreas due to the
00:07:01.69\00:07:04.96
excessive demands placed on it.
00:07:04.97\00:07:06.95
The end result is that glucose
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is not broken
down and blood glucose
00:07:11.27\00:07:13.62
levels begin to rise,
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leading to type 2 diabetes.
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The risk of
developing this form of diabetes
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is greater in those
with a family history
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of type 2 diabetes,
suggesting a stronger
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genetic component
than in type 1 diabetes.
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We have looked
into what diabetes is,
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and what happens in the body
00:07:34.94\00:07:36.97
when one has diabetes.
00:07:37.09\00:07:39.59
Now, let us take
a little look about
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how the disease progresses in an
00:07:44.81\00:07:47.80
individual, from its
onset to its termination,
00:07:47.81\00:07:52.82
either as a cure or
disability or even death.
00:07:52.83\00:07:56.61
Now, we call
this the study of the
00:07:57.22\00:08:00.27
natural history of diabetes.
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Let us see if we can illustrate
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this with a diagram.
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The horizontal line
that you see on your screen
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represents a time line
a period in one's life.
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And the small
vertical line that intersects
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it represents the
point of onset of the disease
00:08:18.08\00:08:20.76
in that particular individual.
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Now, we have the time
line divided into two,
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the line before the
point of onset represents
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the diabetes free stage
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that is there is no diabetes,
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and the period
beyond the point of onset
00:08:36.97\00:08:39.82
of the disease
represents the diabetes stage.
00:08:39.83\00:08:43.84
Now, let us take a closer
00:08:45.33\00:08:46.76
look at the diabetic stage.
00:08:46.77\00:08:48.84
You will recall
that when we talked about
00:08:50.42\00:08:52.79
the prevalence of
diabetes we learned
00:08:52.80\00:08:55.54
that a significant
number of those with
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type 2 diabetes do
not know that they have
00:08:58.16\00:09:01.48
that type of
disease. And this is because
00:09:01.49\00:09:05.04
although the
disease process has started,
00:09:05.28\00:09:07.75
they have not
developed any symptoms of the
00:09:07.94\00:09:11.22
disease and therefore
they remain unaware of it.
00:09:11.23\00:09:14.15
Evidently, in
type 2 diabetes after
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the onset of
the disease process,
00:09:19.73\00:09:21.53
there is a period of
time when the patient
00:09:21.68\00:09:25.31
is free of symptoms.
If the disease process
00:09:25.32\00:09:29.41
is allowed to proceed
unchecked at some point
00:09:29.42\00:09:33.85
symptoms will begin to show up.
00:09:33.86\00:09:35.67
So, we now see
that diabetes stage
00:09:37.46\00:09:40.72
or the disease stage
can really be divided
00:09:40.73\00:09:44.30
again into two
stages, one the early stage
00:09:44.31\00:09:47.17
in which the
disease process has started
00:09:47.40\00:09:49.91
but there are no
symptoms and this period
00:09:49.92\00:09:53.60
we refer to as
the pre-diabetic stage
00:09:53.61\00:09:56.59
and then we have the late stage,
00:09:57.85\00:09:59.48
which is the
true diabetic stage.
00:09:59.49\00:10:01.36
Let us review
the natural history
00:10:03.64\00:10:05.21
of diabetes again.
From the natural history
00:10:05.22\00:10:08.55
of diabetes we see at least
00:10:08.56\00:10:10.04
three different stages.
00:10:10.05\00:10:11.96
One could be in the
period before the onset
00:10:13.46\00:10:16.59
of the disease
representing disease
00:10:16.60\00:10:19.46
free or diabetic free state,
00:10:19.47\00:10:22.05
or one could be in
the period immediately
00:10:23.26\00:10:26.59
after the onset of
the disease representing
00:10:26.60\00:10:29.33
the early stages
of diabetes without
00:10:29.34\00:10:32.22
any symptoms and
this we refer to as the
00:10:32.23\00:10:35.48
pre-diabetic state or
we could find ourselves
00:10:35.49\00:10:39.95
in the latter part
of the time line namely
00:10:40.22\00:10:42.63
the diabetic state. If
we should extend this line,
00:10:42.64\00:10:47.64
the time line and
leave this diabetic state
00:10:48.19\00:10:51.83
unchecked it will
lead to disability
00:10:51.84\00:10:55.03
and eventually premature death.
00:10:55.32\00:10:57.07
So, the first step in
dealing with the question
00:10:58.52\00:11:01.05
of diabetes is to
know where you stand
00:11:01.06\00:11:04.14
in the natural
history of diabetes.
00:11:04.36\00:11:06.38
In other words,
are you in the diabetes
00:11:06.70\00:11:09.81
free state or are you
in the pre-diabetic state
00:11:09.82\00:11:14.68
or are you in
the diabetic state?
00:11:15.08\00:11:17.74
I believe that God
desires for all of us
00:11:19.38\00:11:21.96
to be in the
diabetes free state,
00:11:22.38\00:11:25.33
but how do we
find out where we stand
00:11:26.77\00:11:28.58
in the line of
natural history of disease?
00:11:29.00\00:11:31.21
One way to guess
is to see if you have
00:11:33.10\00:11:37.17
any symptoms, what are some
00:11:37.18\00:11:39.86
of the symptoms of diabetes?
00:11:39.87\00:11:41.44
Fatigue, excessive
thirst, excessive urination,
00:11:43.22\00:11:47.33
unexplained
weight loss and sometimes
00:11:47.79\00:11:50.94
blurred vision. Now,
there are two problems
00:11:51.12\00:11:55.04
if you decide to
guess and go by symptoms,
00:11:55.05\00:11:58.10
the first one is that
most of these symptoms
00:11:58.51\00:12:01.62
are non-specific for diabetes,
00:12:01.63\00:12:03.94
so we really can't go
by that and the second
00:12:04.63\00:12:07.58
one which is a more
important one is that
00:12:07.59\00:12:10.42
most individuals
with undiagnosed diabetes
00:12:10.43\00:12:13.68
remain asymptomatic.
00:12:14.00\00:12:16.04
So, we see a very disturbing
00:12:18.38\00:12:20.14
picture here, you
could be in the diabetes
00:12:20.15\00:12:23.18
free state or in
the pre-diabetic state
00:12:23.19\00:12:27.25
or in the late
diabetic state and yet have
00:12:28.05\00:12:31.45
no symptoms at all.
00:12:31.46\00:12:32.90
So the single best
way to find out where
00:12:34.94\00:12:37.82
we stand in regard
to diabetes is to do a
00:12:37.83\00:12:41.14
blood test and see what
the blood sugar levels are.
00:12:41.15\00:12:43.69
We call this process screening.
00:12:44.96\00:12:47.31
Screening is a
process where we search for
00:12:49.24\00:12:51.79
unrecognized disease or defect.
00:12:51.80\00:12:54.79
The term screening is
not new to many of us.
00:12:56.62\00:12:59.21
You may have
heard about screening
00:13:00.05\00:13:01.57
for breast cancer, screening for
00:13:01.58\00:13:03.83
colon cancer or
prostate cancer and so on.
00:13:03.84\00:13:06.29
But someone would like to ask,
00:13:06.89\00:13:09.47
is it really important
to be screened for diabetes?
00:13:11.30\00:13:14.92
The answer is yes.
Undiagnosed diabetes
00:13:16.16\00:13:20.04
is very common,
current estimates suggest
00:13:20.05\00:13:23.35
that up to one third
of adults with diabetes
00:13:23.36\00:13:26.97
in the United
States remain undiagnosed
00:13:26.98\00:13:30.31
and it has also
being found that upto
00:13:32.87\00:13:35.91
50 percent of those
with diabetes were diagnosed
00:13:35.92\00:13:40.04
after complications
of diabetes developed
00:13:40.36\00:13:42.98
and here's the
most important reason.
00:13:44.68\00:13:46.24
Screening for
diabetes offers the potential
00:13:47.34\00:13:50.64
to not only
diagnose and intervene at an
00:13:51.54\00:13:54.15
early stage that is
before the complication
00:13:54.16\00:13:57.07
is developed but
also screening offers
00:13:57.08\00:14:01.13
the possibility of
preventing diabetes itself
00:14:01.14\00:14:05.19
We must ask the
question who should be
00:14:07.80\00:14:11.67
screened for type 2 diabetes.
00:14:11.68\00:14:13.77
We need to
remember that by screening
00:14:15.38\00:14:17.77
we are looking for
people with unrecognized
00:14:18.00\00:14:21.12
disease and the
term screening is usually
00:14:21.13\00:14:26.44
applied to a population at risk.
00:14:26.45\00:14:29.00
So, there is no need
for everyone to be screened,
00:14:30.98\00:14:33.21
it is recommended for
the population at risk.
00:14:33.97\00:14:37.34
What do we mean by
population at risk?
00:14:38.68\00:14:40.71
It simply refers to
individuals who have risk
00:14:42.13\00:14:45.86
factors for
developing the disease.
00:14:45.87\00:14:48.49
Now, based on
several studies of the
00:14:49.63\00:14:52.44
many factors that are
associated with diabetes,
00:14:52.45\00:14:55.28
the American Diabetic
Association has come up
00:14:56.09\00:14:59.28
with some
guidelines for screening.
00:14:59.29\00:15:01.99
In other words, they
have identified some important
00:15:03.05\00:15:07.23
risk factors and
based on the presence
00:15:07.24\00:15:10.83
or the absence of
these risk factors
00:15:10.84\00:15:13.74
the commendations are made as to
00:15:13.89\00:15:16.22
who should be screened.
00:15:16.23\00:15:17.21
So, here's what's recommended?
00:15:19.12\00:15:20.40
Number one if you
are of 45 years of age
00:15:21.23\00:15:25.23
or more you
should be screened for
00:15:25.24\00:15:28.19
type 2 diabetes and
if the result is normal
00:15:28.20\00:15:30.88
it should be repeated
at three year intervals.
00:15:31.33\00:15:34.37
And number two,
testing should be considered
00:15:36.29\00:15:39.40
at the younger age
or be carried out more
00:15:39.41\00:15:42.96
frequently if you
are obese or overweight
00:15:42.97\00:15:46.83
and you have one of the
following six risk factors
00:15:48.02\00:15:51.76
that I will shortly mention.
00:15:51.77\00:15:53.55
What are these six
risk factors? Number one,
00:15:54.81\00:15:56.69
if you have a first
degree relative with diabetes.
00:15:58.16\00:16:02.02
Number two, if you
belong to a high risk
00:16:03.49\00:16:06.75
ethnic group
example African-American,
00:16:06.96\00:16:10.93
Pacific
Islander, Native American
00:16:11.46\00:16:14.30
or an Asian
American. And number three,
00:16:14.31\00:16:17.64
if you have hypertension,
00:16:18.76\00:16:20.67
that is high blood pressure.
00:16:20.87\00:16:22.12
And number four,
if you have abnormal
00:16:23.60\00:16:26.54
cholesterol
levels most importantly
00:16:26.55\00:16:29.20
low HDL
Cholesterol or high levels
00:16:29.21\00:16:34.07
of triglycerides. Number five,
00:16:34.08\00:16:36.82
if you are
habitually, physically inactive.
00:16:37.69\00:16:41.36
And the last one number six,
00:16:43.52\00:16:44.84
and this one pertains to women,
00:16:45.00\00:16:46.73
if you are a
mother of an infant with
00:16:47.02\00:16:50.74
a birth rate of
greater than 9 pounds.
00:16:50.75\00:16:53.36
So, if you have any
of these six risk factors
00:16:55.04\00:16:58.02
and you are obese or overweight,
00:16:58.03\00:17:02.02
your chances of
developing diabetes
00:17:02.24\00:17:04.55
is higher than
the normal population
00:17:04.56\00:17:06.96
and it is
recommended that you be screened
00:17:07.59\00:17:10.68
as soon as
possible and not wait till
00:17:10.69\00:17:12.99
your 45 years of age.
00:17:13.00\00:17:14.24
We have seen that
screening is important
00:17:15.33\00:17:17.88
and we have also seen as to
00:17:19.12\00:17:21.19
who should be screened.
00:17:21.20\00:17:22.25
Now, we ask the question,
00:17:23.20\00:17:24.40
how do we screen for diabetes,
00:17:24.71\00:17:26.92
several different
tests can be done,
00:17:28.24\00:17:30.12
but for the purpose of screening
00:17:30.88\00:17:32.40
we always choose
the simplest test,
00:17:32.41\00:17:35.12
a morning fasting
blood sample is tested
00:17:35.89\00:17:39.25
for glucose levels.
If the value obtained
00:17:39.26\00:17:43.28
is less than a 100 mgs,
00:17:43.29\00:17:45.36
it may be considered normal.
00:17:46.00\00:17:47.97
If on testing
we get a value of a
00:17:49.55\00:17:52.57
126 mgs or above, it
is considered abnormal
00:17:52.58\00:17:57.80
and if repeat
tests confirms this value
00:17:59.10\00:18:02.24
the individual
probably has diabetes.
00:18:02.25\00:18:04.57
What about values
between a 126 and a 100 mgs,
00:18:06.03\00:18:10.66
this is considered impaired,
00:18:11.30\00:18:13.46
so we see three
groups on screening.
00:18:14.31\00:18:17.03
The first one
normal and then we said
00:18:17.85\00:18:20.85
talk about abnormal
and the third one impaired,
00:18:20.86\00:18:24.08
let's review
these numbers once again
00:18:25.56\00:18:27.34
and also see how
they correspond to the
00:18:27.92\00:18:31.83
natural history of diabetes that
00:18:31.84\00:18:34.32
we talked about earlier.
00:18:34.33\00:18:35.38
The fasting blood
sugar value of less than
00:18:37.10\00:18:39.97
a 100 mgs would
be considered normal,
00:18:39.98\00:18:43.05
this will correspond
to the diabetic free state
00:18:43.71\00:18:46.71
of the natural
history of diabetes.
00:18:47.12\00:18:49.24
A value of 126 mgs
or above is considered
00:18:50.00\00:18:55.10
abnormal and
this would correspond
00:18:55.11\00:18:57.77
to the disease phase
or the diabetic state
00:18:58.00\00:19:01.23
of the natural
history of diabetes
00:19:01.99\00:19:03.89
and values between
126 mgs and 100 mgs
00:19:05.07\00:19:10.50
would be considered impaired
00:19:10.76\00:19:12.90
and it would
correspond to the early stages
00:19:13.59\00:19:16.79
of the disease phase
or the pre-diabetic state
00:19:16.80\00:19:20.37
in the natural
history of diabetes.
00:19:20.71\00:19:22.73
We now move on to
the most important part
00:19:24.70\00:19:29.03
of our study on
preventive medicine
00:19:29.04\00:19:31.31
in diabetes and that is
00:19:31.70\00:19:34.35
intervention or treatment.
00:19:34.84\00:19:37.04
Intervention will
obviously depend upon
00:19:38.77\00:19:41.06
where you find
yourself on the time line
00:19:41.07\00:19:43.98
of the natural
history of diabetes.
00:19:43.99\00:19:45.72
Let us say you were
screened for diabetes
00:19:46.29\00:19:49.13
and found the test to be normal,
00:19:49.14\00:19:51.38
that is less than a 100 mgs.
00:19:51.52\00:19:53.35
You may now
consider yourself in the
00:19:54.23\00:19:56.61
diabetes free state.
Is there anything that
00:19:56.62\00:20:01.65
you need to do at this stage?
00:20:01.66\00:20:02.73
The answer is yes.
00:20:03.44\00:20:04.74
The interventions at
this stage are actions
00:20:06.19\00:20:09.17
that would enable
you to preserve that
00:20:09.18\00:20:11.71
state of health, that
is, being free of diabetes
00:20:11.72\00:20:15.54
and also continue with
actions that will promote
00:20:16.08\00:20:19.98
better health and
the way we do this is by
00:20:19.99\00:20:23.89
following the
natural laws of health.
00:20:23.90\00:20:26.07
Eating a well balance diet,
00:20:26.75\00:20:28.31
exercising regularly,
by the proper use of water,
00:20:28.57\00:20:33.72
fresh air, sunshine
and ensuring adequate rest,
00:20:34.06\00:20:38.59
upstaining from things
that we know are harmful
00:20:38.98\00:20:42.15
to the body and
living a life free of worry
00:20:42.16\00:20:45.56
and stress by trusting in God.
00:20:45.57\00:20:48.35
This is how God meant
for us to preserve health
00:20:50.12\00:20:52.94
and promote health
and this is true primary
00:20:52.95\00:20:59.37
prevention in
diabetes after that matter
00:20:59.38\00:21:02.35
with regard to any disease.
00:21:02.64\00:21:03.87
But what if on
screening you find yourself
00:21:05.58\00:21:08.23
in the early stage that
is the pre-diabetic state?
00:21:08.62\00:21:13.32
This is where
screening really pays off,
00:21:15.39\00:21:17.43
in fact
screening is really aimed
00:21:18.78\00:21:21.16
at picking up this group.
00:21:21.17\00:21:22.53
In finding some one
in the pre-diabetic state
00:21:23.98\00:21:26.94
by screening we have
actually made an early
00:21:26.95\00:21:30.38
diagnosis of diabetes,
early diagnosis along with
00:21:30.39\00:21:36.02
appropriate
treatment forms the basis
00:21:36.03\00:21:38.55
for secondary prevention
in preventive medicine.
00:21:38.56\00:21:41.83
So, now lets see
what is the appropriate
00:21:42.69\00:21:45.37
treatment for those in
the pre-diabetic state,
00:21:45.38\00:21:48.57
the American Diabetic
Association recommends
00:21:49.56\00:21:52.32
what is called the
therapeutic lifestyle
00:21:52.33\00:21:54.89
changes and there
are four recommendations
00:21:54.90\00:21:57.49
under the
therapeutic lifestyle changes.
00:21:57.50\00:21:59.70
Number one,
carbohydrate counting,
00:22:00.32\00:22:02.57
because carbohydrates
is, in our diet has the
00:22:03.17\00:22:07.36
largest influence
on glucose. Number two,
00:22:07.37\00:22:11.02
calorie restriction,
this can done effectively
00:22:11.44\00:22:15.10
by cutting down dietary fact.
00:22:15.11\00:22:17.06
Numbe three, weight reduction,
00:22:18.54\00:22:20.59
diabetes is closely
associated with obesity,
00:22:21.92\00:22:24.60
we have noticed
earlier that obesity
00:22:25.24\00:22:28.62
is an important risk
factor, special reference
00:22:29.11\00:22:33.18
is made to central
obesity that is a waist
00:22:33.19\00:22:36.54
circumference
greater than 40 inches in men
00:22:36.55\00:22:39.13
and 35 inches for
women has been found
00:22:40.01\00:22:43.43
to co-relate with
insulin resistance.
00:22:43.44\00:22:46.05
And the fourth
one, exercise, exercise
00:22:48.05\00:22:51.41
enhances or facilitates
muscle intake of insulin
00:22:51.42\00:22:55.68
and reduces insulin resistance.
00:22:55.98\00:22:58.33
A recent study
found that 60 percent
00:22:59.77\00:23:01.89
of Americans do not
engage in any moderate
00:23:01.90\00:23:04.90
level activity
and that 30 percent do
00:23:04.91\00:23:08.18
not exercise at all.
00:23:08.19\00:23:09.44
So, we see that
carbohydrate counting,
00:23:10.62\00:23:13.08
calorie
restriction, weight reduction
00:23:13.38\00:23:16.10
and exercise form
the basis of therapeutic
00:23:16.33\00:23:20.14
lifestyle changes
recommended by the
00:23:20.15\00:23:22.43
American Diabetic Association.
00:23:22.44\00:23:23.87
Now, let me stress
here that these four
00:23:26.46\00:23:28.72
recommendations for
the pre-diabetic state
00:23:28.73\00:23:31.33
is an addition
to the interventions
00:23:31.48\00:23:34.28
we have mentioned for those
00:23:34.29\00:23:36.11
in the diabetic free state,
00:23:36.12\00:23:38.38
that is along with
the therapeutic lifestyle
00:23:38.43\00:23:41.75
changes one must
follow the natural laws
00:23:41.76\00:23:44.82
of health as well.
00:23:44.83\00:23:45.80
Let's move on to the
advanced disease stage
00:23:47.23\00:23:50.34
what if on
screening your results confirm
00:23:50.93\00:23:53.69
blood sugar levels
that are very high.
00:23:53.97\00:23:56.21
One must initiate
aggressive medical
00:23:57.63\00:24:00.86
treatment as soon as possible,
00:24:00.87\00:24:02.91
it is important that
we do not leave elevated
00:24:04.15\00:24:07.30
blood sugar
levels to go unchecked
00:24:07.31\00:24:09.35
for long periods of
time, medications are available
00:24:09.36\00:24:13.55
that lowers insulin
resistance which we have
00:24:13.56\00:24:16.80
learned is one of the
reasons for developing
00:24:16.81\00:24:18.96
type 2 diabetes.
Medications are available
00:24:18.97\00:24:22.68
that stimulate the
pancreas to put out
00:24:22.69\00:24:25.05
more insulin. We
may even have to resort
00:24:25.06\00:24:28.95
to insulin administration
by injections to replace
00:24:28.96\00:24:32.52
the natural insulin
that the body is lacking.
00:24:32.53\00:24:35.56
Again, let me
emphasize that the aggressive
00:24:37.18\00:24:39.56
medical treatment
is to be accompanied
00:24:39.57\00:24:41.80
by the therapeutic
lifestyle changes that
00:24:41.81\00:24:44.30
we talked about
for those in the early
00:24:44.31\00:24:46.74
disease stage and we
also need to the follow
00:24:46.75\00:24:49.70
the natural laws of
health that were mentioned
00:24:49.71\00:24:52.60
for those in the
diabetes free state.
00:24:52.61\00:24:55.69
This where many miss the mark,
00:24:56.44\00:24:58.27
we must realize that
in order for God to bless
00:24:59.18\00:25:02.24
the treatments that we take,
00:25:02.25\00:25:03.98
we must first follow
the natural laws of health.
00:25:04.38\00:25:07.71
No matter what approach
we take in our treatment,
00:25:09.72\00:25:13.06
our goal should be
to move back from the
00:25:14.76\00:25:17.62
late stage of diabetes,
00:25:17.63\00:25:19.21
if you find yourself there,
00:25:19.47\00:25:20.85
to the pre-diabetic state.
00:25:21.39\00:25:23.08
We do that by
starting on aggressive
00:25:24.79\00:25:26.87
medical treatment
and careful monitoring of
00:25:27.01\00:25:30.56
blood sugar levels.
Self monitoring of blood
00:25:30.57\00:25:33.86
sugar has been
made simple and patients
00:25:33.87\00:25:36.78
are able to do
this at their home.
00:25:36.79\00:25:38.14
Patients on medications
are encouraged to check
00:25:39.76\00:25:43.23
their blood sugars frequently
00:25:43.24\00:25:45.44
and when we have
brought the numbers
00:25:46.90\00:25:49.27
to the pre-diabetic state,
00:25:49.61\00:25:51.82
we should then try to
move from there to the
00:25:52.38\00:25:55.37
disease free state
and this could be done
00:25:55.38\00:25:58.30
by following the therapeutic
00:25:58.78\00:26:00.06
lifestyle changes.
00:26:00.07\00:26:01.59
Once we obtain
the desired level of
00:26:02.92\00:26:04.74
blood sugar
control, we can try and wean
00:26:04.75\00:26:08.00
ourselves off the
aggressive medical
00:26:08.01\00:26:10.40
treatments and
continue with therapeutic
00:26:10.41\00:26:14.26
lifestyle changes, which
is carbohydrates counting,
00:26:14.45\00:26:18.14
calorie restriction
weight loss and exercise,
00:26:18.42\00:26:22.81
and of course we
always need to continue
00:26:23.14\00:26:26.06
following the natural
laws of health to preserve
00:26:26.31\00:26:29.58
and promote health.
Which would include a
00:26:29.59\00:26:34.57
well balanced
diet adequate rest,
00:26:34.58\00:26:37.19
proper use of water,
fresh air and sunshine,
00:26:37.57\00:26:40.96
and attempting to
live a life free of stress
00:26:41.23\00:26:44.68
by trusting in God.
So, we need to understand
00:26:44.98\00:26:48.84
three steps in
dealing with diabetes,
00:26:48.85\00:26:51.04
first, know where
you stand in the natural
00:26:51.05\00:26:54.16
history of
diabetes by screening,
00:26:54.17\00:26:56.61
then we make
appropriate interventions.
00:26:57.87\00:27:00.42
When we study and
understand the intricate
00:27:02.62\00:27:05.58
ways in which our body functions
00:27:05.59\00:27:08.01
and the way our body
takes care of its energy
00:27:08.67\00:27:12.86
requirements using
glucose from the diet,
00:27:12.87\00:27:15.21
and how the body
regulates and maintains
00:27:15.52\00:27:19.37
a normal blood sugar
level, we are reminded of
00:27:19.38\00:27:23.23
the verse in the
Bible in the 139th Psalm,
00:27:23.24\00:27:25.70
I will praise
thee; for I am fearfully
00:27:26.03\00:27:29.56
and wonderfully made.
00:27:29.88\00:27:31.25
One of the ways we
could praise God is by
00:27:32.96\00:27:36.22
following the principles
of preventive medicine
00:27:36.23\00:27:39.21
and learning how to
take steps to prevent
00:27:39.77\00:27:43.82
the development
of diabetes and the
00:27:44.28\00:27:47.24
progression of
diabetes or for that matter
00:27:47.25\00:27:49.62
any disease, in
order for us to preserve
00:27:49.91\00:27:54.67
and promote health
that God has given us.
00:27:55.01\00:27:57.51
I hope that this presentation
00:27:59.39\00:28:01.01
has helped you
understand a little more
00:28:01.02\00:28:03.48
clearly as to
what diabetes is and
00:28:03.49\00:28:06.80
how you could
prevent it from onset.
00:28:06.81\00:28:08.96
Thanks for joining
me today in our study
00:28:09.29\00:28:11.79
of preventive
medicine in diabetes.
00:28:11.80\00:28:14.27