S02_E10 - Diabetes. It's on the Rise, so it's Time to Get Wise.

Speaker 1: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:21

Hey everybody, it's Dr. David Hilden, and this is episode 10 of the podcast. And today we are talking about diabetes. What is it? What causes it? What are the symptoms? What can be done about it? Tell me out. I've invited Dr. Laurel LaFave. Dr. LaFave is the director of the division of Endocrinology here at Hennepin Healthcare with me in downtown Minneapolis. We trained together a couple three years ago, or maybe a few more than that, and now she is leading that division. Laura, thanks for being on the show.

Speaker 3: 0:48

Thanks for having me, Dave.

Speaker 2: 0:49

So let's talk about diabetes. If we could. First of all, some definitions. What, what is diabetes?

Speaker 3: 0:56

Diabetes is a state of having too much sugar in your bloodstream. And the reason that that happens is because something is often the balance of the physiology in your body. So carbohydrates or sugar that go into your body through food or from stored places like in your liver, will exit the liver or, or come in through the the gut and the, and get into the bloodstream. And diabetes is the state of not having adequate mobilization of that sugar into the muscles and cells where it belongs to power your body.

Speaker 2: 1:27

Yep. Before I even get into more diabetes mellitus, I think means something along the lines of sweet urine or something like that. Is that true?

Speaker 3: 1:33

Correct. So when you have too much sugar in your bloodstream, one of the ways it tries to get out is through your urine. And so back in the days before, we had adequate ways to test blood sugar. Doctors would actually diagnose it by tasting a patient's urine.

Speaker 2: 1:47

Do you still teach that? We do. Is that

Speaker 3: 1:48

What you do? We do not.

Speaker 2: 1:49

<laugh>, that has a huge oo factor. They really did that. They l and it was if it was sweet, yeah. Diabetes. Correct. Oh my goodness. Okay. Back to some definitions. Type one versus type two. Are they the same thing or are they different?

Speaker 3: 2:03

They're not the same thing, although there tends to be a little bit of overlap. Okay. Type one diabetes is what we used to call juvenile onset diabetes because it's, you get it when you're a kid mostly. And the problem that leads to type one diabetes is really a destruction of the pancreas, which is the organ, the gland kind of right in the middle of your belly that produces insulin. And insulin is the hormone that is essential for getting that sugar into the places it needs to be. So when people have type one diabetes, what happens is that they have a destruction of part of that gland, the pancreas that produces insulin. And so they no longer produce any insulin at all.

Speaker 2: 2:42

And we need insulin for life.

Speaker 3: 2:44

Absolutely.

Speaker 2: 2:45

Even that sounds kind of weird to me. So what you got a little extra sugar in your body? Is it just that you can't store it or something?

Speaker 3: 2:50

Right. So if you have too much sugar in your body, not only do you then your muscles and organs and cells actually get depleted because sugar is basically the fuel for it. So if it's not in the right place, your body, all your body processes get weaker. But also just having too much sugar in the bloodstream and kind of hitting up against blood vessels, kidneys, eyes, nerves, all these parts actually does a lot of damage to those organs and blood vessels. And that causes further health problems that we see when people have diabetes long term or not in a state of control that is helpful for

Speaker 2: 3:28

Them. What about type two?

Speaker 3: 3:30

So type two diabetes is by and large the most common kind of diabetes. So we mentioned type one, and that is something that we see a lot in our endocrine practice, but it's actually the very, very rare kind of diabetes compared to type two. So type two is by and large, when you hear people talk about diabetes, they're usually talking about type two diabetes. Type two diabetes starts with more of a problem where a body becomes less receptive to insulin. So a person with type two diabetes makes insulin, but their body does not recognize or receive it well. And so they typically, not all the time, but typically have a state of what we call insulin resistance. So their pancreas is churning out insulin to try to keep the sugar in the right place, but it just can't keep up with it. So as a person who has an, an underlying insulin resistance as they get maybe older or sometimes heavier or just are on different medicines or things like that, or maybe they're less active, their body in trying to keep up with producing enough insulin to overcome this issue, eventually the pancreas may kind of poop out and not make enough insulin. And that's when the balance tips and the blood sugar goes up despite the fact that the body's still producing a fair amount of insulin.

Speaker 2: 4:44

So a few more definitions. You've used the terms, uh, so far, carbohydrates, glucose, sugar, and, and I use sugars all the time. I talk about patients about their blood sugars. Many people I've been told when, when you say sugar, I think of, you know, the teaspoon of sugar or sugar cube that you put in your coffee. That's sugar. I don't need any sugar. What is, what is sugar versus glucose versus a carbohydrate?

Speaker 3: 5:06

I think it's a confusing point because again, the same thing, sugar is not, does not only come the form of sugar or coke or you know, sodas and things like that. Carbohydrates are a macronutrient. So it's one of the big three things that you get in your food. Carbohydrates, fats, proteins, carbohydrates are basically turned into sugar in your body, different kinds of sugars. And so when we think about sugar intake, it really extends to not just sweet things, but starchy foods. So foods that are high in starch are high in carbohydrate. So that includes for most people, pastas, breads, rice, crackers, chips, potatoes, corn. So lots of foods that are very high and carbohydrates are, they're turned into sugar in your body. I should say. Fruit also has a fair amount of sugar in it, but that form of sugar fructose that it, it becomes, is less harmful to your body

Speaker 2: 5:59

Than the glucose that the others are turned into. Correct. Could you talk about risk factors for developing diabetes Now? It sounds like there might be some genetic predisposition to it, if you could comment on that and also what puts people at risk for developing type two

Speaker 3: 6:14

Diabetes? Yeah, so type two diabetes is just so incredibly common in the US now in I think 2019, the CDC c statistic was at 8.7% of all adult Americans have diabetes. A very, very small percentage of that is type one diabetes. We know that there are some pretty clear risk factors for developing diabetes, and one of them is a family history. So, uh, you know, first degree relatives with, uh, parent or sibling with type two diabetes being from a high risk ethnic group. And so we do know that the, uh, rates of diabetes in Native Americans, black Americans, Latinos, and non-Latino Asians are all higher than in non-Latino white Americans history of having hypertension, having heart disease, having underlying hyperlipidemia, um,

Speaker 2: 7:00

Cholesterol

Speaker 3: 7:01

Problems, cholesterol, exactly. For women having a history of polycystic ovarian syndrome, which is a very, again, a common kind of metabolic syndrome that shows up in women of reproductive age, um, and then physical inactivity and then being overweight or obese has, uh, a higher risk as well.

Speaker 2: 7:18

And these rates are all on the rise, aren't they? That's you, you said about 8%, 9%, that's one in 10 or 11 people have diabetes and there is a connection with obesity and being overweight. Correct. So that, and since those rates are going up, I imagine diabetes is, uh, also becoming a little bit more prevalent. I

Speaker 3: 7:34

Think it's predicted that by 2040 we're gonna be at about 20%

Speaker 2: 7:39

Of American, of the population one in five. Wow. And in my primary care practice, you said it's roughly one in 10 people have diabetes, it's easily one in three of my clinic visits involve a patient who is living with diabetes, even if it's not the main reason they're there. I would say a third of my clinic visits have involve a patient with diabetes. Is this problem mostly in the United States or is this a global phenomenon?

Speaker 3: 8:04

It's a global phenomenon. It's worse than the us but it's a global phenomenon.

Speaker 2: 8:08

Is it worse than the US because of our diet, of our, of our prevalence of being overweight? Or do we know? I

Speaker 3: 8:14

I think it's multifactorial. Mm-hmm.<affirmative>, our, our diet is a big part of it. And I think when you look at people moving from other countries with low rates of diabetes into the us, the rates in those groups skyrockets. So there's definitely something in the diet slash environment slash culture slash something here.

Speaker 2: 8:32

Let's shift gears. Let's talk a little bit about symptoms. When would somebody, um, know they have diabetes or, or maybe another way to say that is, is what are some of the presenting symptoms for someone who has not yet been diagnosed? How do you know if you have diabetes?

Speaker 3: 8:45

So the classic symptoms that diabetes presents with are increased thirst. So feeling thirsty all the time, increased urination, peeing more often, blurry vision, weight loss and fatigue. Other less typical things that we see is just craving sugar craving. People will say they just felt like they couldn't get enough soda or candy because they just had this intense sugar craving. Headaches, again, fatigue or lethargy or just not being able to kind of participate in what you're doing. It affects other hormones in your body. So you know, people won't sleep as well. They will have things like low libido, low interest in things, um, even association with depression. So

Speaker 2: 9:24

That's a, a myriad of symptoms I've seen, uh, more people that I can count over my career that did show up with, I'm urinating more and I'm thirsty and maybe have blurry vision. So those are the folks that have some symptoms that are pretty attributable to diabetes and we'll obviously we'll go test you right away. Uh, I wanna kind of shift into what is the diagnostic plan? Do we screen people and if so when? And talk about that if you

Speaker 3: 9:46

Could. I'm glad you asked that because when people are diagnosed with diabetes, they usually on average have had diabetes for about five years. Mm. As many people as we're diagnosing with diabetes, we're missing a lot

Speaker 2: 9:56

And we're catching'em five years too

Speaker 3: 9:58

Late. Right. And part of the reason is that people probably don't have symptoms for years when they're obviously when they're developing it. And, and that might have a lot to do as well with things like access to care and the likelihood of seeing healthcare providers at that point. As far as screening for diabetes, the general recommendation is to screen adults who have risk. So the risk factors that I mentioned before, if you have one of those risk factors, you should let your healthcare provider know. If you don't have any of those, you should start being screened at age 35.

Speaker 2: 10:30

So how is it diagnosed?

Speaker 3: 10:31

It can be diagnosed three different ways. One way is with a screening test called a hemoglobin a1c. This is a blood test that does not require fasting. It measures a person's average blood sugar over the previous three months. So it's a lab test that we use when we are monitoring a person's diabetes control and we have targets for that, but it can be used for diagnosis. The second way is to get a fasting blood glucose or sugar level that requires an eight to 10 hour fast, which is a good reason to maybe go in fasting when you see your doctor. It's a

Speaker 2: 11:04

Good idea. Get a morning appointment.

Speaker 3: 11:06

Get a morning appointment. That's right<laugh>. And the third way is very inconvenient. We used to do these a lot, which was an oral glucose tolerance test and that's where you come in and you drink 75 grams of glucose, which is basically kind of like slamming two cans of Coca-Cola and then you measure the blood sugar two hours after that.

Speaker 2: 11:22

So those are the diagnosis. We're gonna take a quick break. We've covered a lot of ground here, but when we come back from the break, we're gonna talk more about diabetes including treatments, outcomes, complications, and Dr. LaFave, three tips for all of you. Stay with us. We'll be right back.

Speaker 1: 11:37

You are listening to the Healthy Matters podcast with Dr. David Hedon. You got a question or comment for the doc? Email us at healthy matters hc m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 12:00

And we're back talking about diabetes with Dr. Laura Lafe. So Laura, people living with diabetes are so used to sticking their finger and having glucometers and keeping checking their blood sugars. Could you comment a little bit about, first of all, why do people need to check their blood sugars and what are some of the techniques they can do that, including some of the more advanced techniques?

Speaker 3: 12:21

This is the thing that people with diabetes probably like the least about living with diabetes, right, is having to monitor and know and watch and react to what their blood sugar is all the time. And it's important to do it because how much insulin you take might depend on what your blood sugar is or perhaps you're trying to restrict or reduce your carbohydrates and you need to know whether that's working or not. Uh, perhaps your provider put you on a new medication and you need to see if it's effective. It's working and hopefully the diabetes educator has given you some good goal blood sugars to be looking for. But again, this is an area where we have, it has just changed tremendously in the last five years. There are now pretty broadly available glucose sensors, little devices that you insert in your upper arm and that can be used to scan or directly go to a little meter or a phone. So it has basically aviated the need to stick the finger four or five or six times a day to get blood to do that. It's really becoming a standard of care to use these and to prescribe these. And insurances have kind of come along and have started to cover them much more broadly. And the advantage is removing another one of the barriers to being able to be engaged with diabetes and what your blood sugar is. It just, it just takes away one more barrier.

Speaker 2: 13:40

It's a game changer. I wish all my patients were on these continuous glucose monitoring systems. Wonderful, wonderful development in patients living with diabetes. Dr. Lafe, tell us a little bit about treatments. What is available?

Speaker 3: 13:52

Well, there are certainly a lot more treatments available than when I was training to do this 25 years

Speaker 2: 13:56

Ago. Oh my gosh. You and I trained together roughly 25 years ago,<laugh>. And there was metformin. There were some drugs we barely use anymore called Sulphonylureas and there was insulin and they were not even as good as the insulins we have now. Talk us through

Speaker 3: 14:09

It. That's correct. The story of diabetes treatment is both wonderful and also awful. Um, and the reason I say that is because the ways that we now have to treat diabetes are so much more specifically addressing the underlying problems with diabetes. And they are so much more, the meds are so much more likely to help other body systems, but they are incredibly expensive. Yeah,

Speaker 2: 14:34

I just, I was, I think that's what you were gonna say. I am so frustrated by how expensive these effective drugs

Speaker 3: 14:39

Are. The story locally, state and nationally has been insulin prices, which I think were possibly turned a corner on on that area. But you know, again, 25 years ago there was just a, a very new insulin called glargine insulin, which was just sort of a revolutionary advance in the way that people could administer insulin once a day. Very steady background insulin. It was sort of really was

Speaker 2: 15:03

Revolutionary, I remember when it came out. Yep.

Speaker 3: 15:05

And with time, the prices of that insulin as well as other very good, excellent physiologic insulins, insulins that basically mimic the way a human body makes insulin, those all became so much better. But they also became prohibitively expensive such that people were rationing insulin, they were going without it and being at very high risk of being very severely ill and dying. So now there is a cap on Medicare Part D and now going to be part B that a month prescription of insulin should not, will not exceed$35. And the, the drug companies have sort of followed suit with that. So the three main producers of insulin have gone ahead and limited their prescription costs for some of their kinds of insulin now for privately insured people as well. So returning a big corner on accessibility to very excellent types of insulin

Speaker 2: 15:55

Before you move on from insulin. So type one diabetics, people with type one diabetes require insulin. So that is nothing but good news for people living with type one diabetes. There are a number of other drugs now medications that are highly effective for type two diabetes that are still really cost prohibitive. Do you think the lower cost of insulin will lead us to prescribing more insulin instead of these other new medicines that are so good?

Speaker 3: 16:23

I think that's the reality

Speaker 2: 16:25

Is that reality

Speaker 3: 16:25

Insulin is the absolute essential medication for people with type one diabetes, but it turns out that about 30% of people who have type two diabetes also take insulin. And yeah, I think the big advances that I'm concerned about with the newer medications for diabetes being so, so expensive is that one of the kind of holy grails of, of diabetes treatment is to try to treat the disease but also prevent and treat the complications of the disease because it's really, diabetes is terrible, but it's also the complications of the disease that really tend to make people sick and not feel good and not be able to work and not be able to enjoy their families and things like that. So the development of medications that have been shown to not only treat the diabetes but also protect the kidneys for example, or protect the heart are very potent. And so the idea that we could treat people in a way that gets at all of these things is very promising, but again, at a very high cost. So, and those medications are in general many years away from being generically produced,

Speaker 2: 17:32

Et cetera. Most of, if, if you happen to be a TV watcher, most of the medications that are being advertised on TV and it says ask your doctor if this is right for you. In general, those are all the expensive medications that are so wonderful but are so cost-prohibitive. So, um, that is, is a problem for our policy makers and our healthcare systems. But I think it's the reality for a lot of people living with diabetes. Before I get off treatments, could you just say like the, the basics of what people should be on now? Like for instance, the first thing people should be on metformin,

Speaker 3: 18:03

Correct? It's still metformin. Metformin is our old old medication. It's been around for decades. It's safe, it's very effective. There's an association with actually lower risks of heart disease, of cancer, of all kinds of things. So metformin is still a mainstay of treatment for type two diabetes and that might be the only medicine that many people need to control their diabetes along with lifestyle changes if they have some things to adjust in that area as well. The second realm of treatment used to be, as you mentioned, sulfonylureas, which are also pills. And those are pills that help the body release more insulin on its own. We try to not use those as often because they do tend to cause a lot of weight gain, which doesn't help diabetes and also hypoglycemia or low blood sugars, which is not safe. They're also a little bit limited when people have other issues such as kidney problems or when they're older patients, there are class of medicines that are still, they still work to lower blood sugar. Beyond that, they don't have much benefit. They really don't benefit other organ systems and they put people at a little higher risk. That being said, do we still use sulfonylureas? We do. We do. And this gets into, you know, the idea that with other drugs being very cost-prohibitive, if this is something that somebody can afford, then it's going to work probably to control their blood sugar.

Speaker 2: 19:23

Right. So listeners, if you're on glide or glimepiride or glipizide, they're still okay. They're still okay. What about the new kids on the

Speaker 3: 19:30

Block? Yeah, the new kids on the block one an an oral pill that has become very widely prescribed and is quite good is a, a category of medications called SG l T two inhibitors. Those are pills that get the body to get rid of sugar by through the urine. So again, making the sweet urine even sweeter. Mm-hmm<affirmative> pushing sugar out through the urine. These medicines are well tolerated. They are very effective for protecting the kidneys, which is an issue with a lot of people who have diabetes and also they have now an indication to actually treat people who have heart failure. So this is one of those examples of a medication that has wide-reaching benefits to people is a fairly low risk medicine in terms of its side effects and its serious consequences, not without side effects, right? Because no medication is without

Speaker 2: 20:20

Those, it's easy to take. It's just a pill.

Speaker 3: 20:21

Just a pill. Again, pretty expensive. So still in the realm of, you know, when it's covered with good coverage, it's affordable and when it's not good coverage, it's not, how

Speaker 2: 20:30

About the one everyone's trying to get nowadays cuz it causes weight loss?

Speaker 3: 20:34

So I think you're talking about ozempic.

Speaker 2: 20:35

I am

Speaker 3: 20:36

<laugh>. Um, Ozempic is in a larger class of medications called the GLP one agonist. So this is where we're kind of jumping from oral medicines to injectable medicines. So ozempic and its friends are injected medicines that you inject either once a day or once a week. It's a class of diabetes medicines. That's very interesting because it is also like insulin, it is also a hormone, but it's a different hormone than insulin. So it's, it's mimicking a hormone that comes from your, your gut, your small intestine. And it has some pretty favorable effects on things like causing you to feel full sooner, causing your carbohydrates to be absorbed more slowly and also stimulating your own pancreas to secrete or produce more insulin. So it's got kind of a three-pronged way that it really benefits people's blood sugars but they lose weight with it. So with this class of medicines, it is now crossed over into having some labeling for weight loss as well. So not only for diabetes but for

Speaker 2: 21:34

Weight loss. Same drug, new name,

Speaker 3: 21:36

Same drug, different doses, new name. Yep.

Speaker 2: 21:38

Yeah. Mm-hmm.<affirmative> and I have patients all the time tell me they have to almost pharmacy shop to find it because it, it's really effective. But as you said, expensive. So you talked about all of those carbohydrates and the starches and the sugars in our diet, many people are trying a variety of diets including some low carb, high protein diets, the Mediterranean diet. What is the effect if we see one of the diet you eat on the risk of developing diabetes,

Speaker 3: 22:02

There is very good evidence that if you are able to modify your diet, that you can prevent diabetes. Those studies go back away a couple of decades where showing that pretty significant lifestyle interventions prevent people from developing diabetes or from progressing from what we call pre-diabetes to diabetes. This isn't funny, but I kind of do think we're, we all have pre-diabetes because basically we all have capacity to have diabetes someday. So I think the category of pre-diabetes is sort of a funny one cuz I think, I think it sort of extends to

Speaker 2: 22:33

Everybody. Yeah, I think it, I think you're absolutely right on that. Do also, does that extend to people who are living with type two bi diabetes and are carrying a little extra weight? Does losing weight have an effect on the diabetes you already have?

Speaker 3: 22:46

Absolutely. So we know that control of diabetes improves and sometimes resolves meaning maybe goes into remission or you don't

Speaker 2: 22:55

Use the word cure, but you're get, you're, you're adjacent to the word cure. Yeah. Right,

Speaker 3: 22:58

Right. I'll avoid the, I'll avoid that. The use of the word cure. Uh, but certainly losing five to 10% of body weight in a person who has a higher body weight is definitely shown to improve control and possibly push diabetes into remission. Just to hop back to the low carb approach, there have been many different trendy diets that have come up over the years, kind of going back to like the Atkins diet or the South Beach diet. I think maybe back in the eighties where people really restricted carbohydrates and brought the level or the percent of carbohydrate in their diet very, very low or even to zero. There is not terrific evidence to show that that will keep diabetes at bay forever. My counsel to patients is to make smaller changes that you, you can live with for the rest of your life. And so going to a diet that is completely restrictive of all carbohydrates, I think can lead to certainly some other health issues. And also it's simply in some ways just not a sustainable diet for most people. The diet that has been the most consistently studied and confirmed to be beneficial to a realm of different, uh, issues including diabetes, is the Mediterranean diet, which again includes carbohydrates, it does mm-hmm.<affirmative>. So it just includes healthy carbohydrates.

Speaker 2: 24:15

I wanna shift gears. I wanna talk a little bit about the complications of diabetes. What are the potential problems down the road for people living with it?

Speaker 3: 24:23

Really the big three main complications are those that affect tiny blood vessels. So the tiniest blood vessels in your body are the most susceptible to the harm from excess amounts of sugar. Thinking about that, the tiniest blood vessels are in your eyes, in your retina, the back of your eye in your kidneys where there's just tons and tons of little tiny blood vessels and then in your nerves. So the little blood vessels that affect that serve nerves are also small and susceptible. So, so those are the three microvascular complications or small blood vessels. And for that reason, not only being aggressive about controlling diabetes, because we know from very long time worn studies that keeping diabetes controlled really lowers the risk of those developing those three complications.

Speaker 2: 25:07

And that's blindness and kidney failure and neuropathy.

Speaker 3: 25:11

And with that, having your provider check your kidney function and urine for any problems with your kidneys, seeing an eye doctor once a year and then having a regular once a year foot exam, reviewing signs and symptoms of neuropathy or numbness, tingling pain, things like that is important.

Speaker 2: 25:27

And all of this is controllable. You aren't destined to have all these things, but it takes a team. And so I, I always encourage my patients who are living with diabetes to not only see me, but if need be, go see you and your team in endocrine, but it's not just the doctors tell us. Talk to us about the team-based care in diabetes. I'm specifically thinking about the education team, but I know you have a broad swath of expertise.

Speaker 3: 25:52

Yeah, so for sure here in other places I've worked, I think the, the team-based approach is always the best for sure. And another part of that would be that we have advanced practice providers such as nurse practitioners and physician assistants who also do specialize in diabetes care. So in addition to physicians or MDs, those are also people who will be at the head of your diabetes team. As far as certified diabetes educators, these are usually nurses, sometimes dieticians. And they are really essential because particularly at the time of diagnosis, when somebody is first diagnosed with diabetes, learning about all of these components, all of the things that are involved, I mean diabetes is, it's a 24 hour a day thing. So it's kind of like you wouldn't not wanna get all of the education that you can get to be able to live with and thrive in the, with this thing that that is gonna be with you for 24 hours a day. And the diabetes educators are essential for that. The other thing I would say is that all the ones that I work with in clinic, what do they do at lunch? They go out and walk. So that group is,

Speaker 2: 26:55

They're the ones walking around the campus or around the block.

Speaker 3: 26:58

They're always, they're always walking. I mean they, first, first what they do is they all have lunch together. They all bring salads, so they all mix up salad.

Speaker 2: 27:05

Okay. Do these guys ever like have a pizza?

Speaker 3: 27:07

Yeah, yeah, yeah, yeah. For sure they do<laugh>. But I guess my my point about this is that they are living, they are like walking the walk, talking the talk. And, and, and I say that because I think that their insight and their commitment is really, is really there. Um, and, and they support each other. And that's the other part that I was gonna say is that none of this happens in isolation. You just have to be really in community to be doing this kind of thing. So they bring their salad, they make a big salad together, and then they go and walk for like 40

Speaker 2: 27:33

Minutes.<laugh>. That is just amazing.

Speaker 3: 27:34

It is amazing. Yeah.

Speaker 2: 27:36

That role modeling and support. I love what you just said about supporting each other because people living with diabetes need us, need to have people supported them just like you and your team have that. Um, in your clinic, before I let you go, what one or two things would you like to leave our listeners that they should remember about diabetes?

Speaker 3: 27:53

I think that if there are three things that you can do to try to prevent getting diabetes or improve control of your diabetes, if you have it, the three things I would say is get 150 minutes of physical activity every week. The second thing I would say is do not drink your sugar. And the third thing I would say is be in community. Because we know that when we find a physical activity that we like to do, if it's walking with your friend or if it's playing pickleball,

Speaker 2: 28:18

We're of a certain age, we're at the pickleball. So playing age, but

Speaker 3: 28:20

Young people are playing it now too. Oh gosh. There's lots of evidence that even if you are a solitary exerciser, that just doing things in community with other people is better for our health and that includes diabetes. And I think a lot of that comes with just the support, the acknowledgement that, you know, we're just not in this alone. And plus it's all just more fun, you know, to do things together with people. And so I think those are my three main takeaways. Those

Speaker 2: 28:43

Are great takeaway tips, lots of great information on a complicated and important topic. Thank you for being here, Laura. You're welcome. We've been talking with Dr. Laura Lafa, the director of endocrinology here at Hennepin Healthcare in downtown Minneapolis. And we've been talking about the world of diabetes listeners, I hope you've picked up a thing or two that you didn't know before. On our next episode, we're gonna specifically talk about weight management with Dr. Aisha Galloway Gilliam. It's gonna be a great episode and I hope you'll join us. In the meantime, be healthy and be well.

Speaker 1: 29:13

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. If you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.