SPEAKER_00: 0:01

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_03: 0:18

Hey everybody, welcome to episode 20 of the podcast here in season four. I am David Hilden, your host, and today we're going to tackle a topic that affects literally millions of people, that being diabetes. So today we're going to unpack what diabetes actually is, how it affects your body, who's at risk, and what you can do to manage it. To help us do that, I'm joined by an expert in diabetes, Dr. Allison Estrada. She is an endocrinologist, and I'm maybe going to ask her to tell us what the heck that is. I I kind of know, but it's maybe helpful to find out what that is. And being an endocrinologist, she's an expert on diabetes and other conditions of the body. Allie, welcome to the show.

SPEAKER_02: 0:58

Thank you so much for having me. I'm excited to be here.

SPEAKER_03: 1:00

Can you explain briefly what is an endocrinologist?

SPEAKER_02: 1:03

Sure. We are hormone doctors, and I think a lot of people think hormones and maybe think kind of the sex hormones like estrogen, testosterone. We do deal with that too, but there are a lot of hormones in our body. So we'll talk today a lot about insulin, which is a hormone involved in diabetes. There are hormones that come from the pituitary gland, adrenal gland, all sorts of stuff. Did you know

SPEAKER_03: 1:23

you wanted to be a hormone doctor when you went to med school? I think most people said, I don't even know what that

SPEAKER_02: 1:28

is. No, I did not. But I found it and I loved it. And here I am many years later, practicing as an endocrinologist, a hormone doctor.

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And I see tons of diabetes in my clinic as a primary care doctor. So it is a huge issue in our population. You do it as a specialist. So could you dig back into the most basics of diabetes and explain to us what that is? Yes.

SPEAKER_02: 1:49

Diabetes is a condition in which your sugar level in your blood is elevated. And there are different reasons why this occurs, but it usually has to do with your body not making enough insulin or not being able to use that insulin effectively.

SPEAKER_03: 2:04

So you said sugar. Well, I don't eat sugar. What do you mean by sugar?

SPEAKER_02: 2:08

Another really good question. So to give a little context, I like to talk about carbohydrates and sugars and how our body breaks them down. So anytime we eat something starchy or something sweet, our body breaks it down to the kind of most basic building blocks. The biggest one I'd say is glucose. And that's kind of what we call sugar. Blood sugar is glucose in the blood. And that flows through all our body and it's used as fuel. But in order to get that fuel so we can use it, we need insulin.

SPEAKER_03: 2:39

So that's where insulin comes in. And insulin's the hormone that I think a lot of people have heard about. But insulin isn't sugar. Insulin is your body's response to blood sugars.

SPEAKER_02: 2:48

Exactly. How does it work? Exactly. So I have a nice little analogy that I like to think of. Insulin is a key to a door and really to like a storage unit, I say. So if you think about you're in the hallway, your blood sugar, your sugar that's in the blood, you're in the hallway and you want to get inside the cell. That's where we can use that fuel again. So insulin is like the key that opens up this door and allows the glucose to go inside the cell. And the glucose can then be used as fuel right away. It can burn that glucose and we can get energy out of it. So you've

SPEAKER_03: 3:22

mentioned sugar, glucose, carbohydrates, starch. So you and I might think of all those things as basically sugars. But when people think of a carbohydrate, their spaghetti noodle or their potato, they're not thinking that's sugar.

SPEAKER_02: 3:36

That's right. Are those the same? They essentially break down to the same thing. So when we're thinking about table sugar, for example, that you might sprinkle on something, that is a combination of glucose and sugar. and another version of a sugar called fructose, which in the body, we often just change it to glucose. And things like potatoes or breads or noodles are mostly made up of glucose molecules that just all break down. So all these things look very different on your plate, but our body breaks them down to the same kind of basic thing.

SPEAKER_03: 4:06

So we have to eat these things and your body deals with it by insulin. So let's talk about when that doesn't work. So the normal human body makes insulin so that you can unlock the key to the storage. And I love that. That analogy, by the way. What is diabetes, the disease then?

SPEAKER_02: 4:22

Yeah, so diabetes, again, is that either you don't have the key to unlock the door, you don't produce it, or Or you kind of think of it as like resistance to that insulin. So you need like four keys instead of just one key to open that door. And if you can't open that door, the blood sugar just rises. Those sugar levels go up and up and up in the bloodstream. And that's when we can diagnose diabetes when the blood sugars start to get high.

SPEAKER_03: 4:51

So what? So you got high blood sugars. Is that a problem?

SPEAKER_02: 4:54

It definitely can be a problem in the long run, yes. So high blood sugars and uncontrolled diabetes are associated with a lot of different health problems or bad health outcomes, I would say. The biggest things we think about are our eye health, our kidney health, and our nerve health. So you might have heard about people who develop blindness from diabetes or kidney failure and have to be on dialysis or people who have amputations. Those can all be complications from these high levels of sugar in the blood, really kind of injuring our blood vessels and our different tissues in our body.

SPEAKER_03: 5:30

There's all these types of diabetes, type 1, type 2, type 1 1⁄2, juvenile, adult. There's all insulin dependence. Could you break that down for

SPEAKER_02: 5:40

us? Yes, absolutely. So kind of the simplest way to think about type 1 diabetes is that it is an autoimmune disorder. So your own body is attacking the cells that make insulin. And so people with type 1 diabetes just really can't produce insulin. So they need to use insulin as a medication. People with type 2 diabetes often make quite a bit of insulin. But due to those other factors that I talked about, they have more resistance. They need more of that insulin, more of those keys. And And so their body tries to compensate and compensate by making more and more and more, and they get to a kind of a critical threshold where it just can't keep up anymore, and your blood sugars start rising. And so that has more to do with resistance to the insulin.

SPEAKER_03: 6:21

Insulin resistance. So how common are these, the two of them?

SPEAKER_02: 6:25

Yeah. In the United States, type 2 diabetes is much more common. Actually, about 10% of the population, about 35 million Americans roughly, have type 2 diabetes as of the last kind of big statistical count. When it comes to type 1 diabetes, it's about 1.8 million or 0.5% of the population.

SPEAKER_03: 6:44

So it's 10 times more common or 20 times more common, type 2. Exactly. Why might that be?

SPEAKER_02: 6:50

That's a really good question. So there are a lot of risk factors for type 2 diabetes. Obesity is probably the biggest one. As we as Americans are gaining more weight, it becomes harder for our body to, again, make enough insulin. We become more insulin resistant. Genetics can play a part. It actually, we see that type 2 diabetes is a stronger genetic disease than type 1 diabetes. Age, as we age, we get a higher risk of type 2 diabetes. And then family history. So we talked a but family history, just thinking about if you have a first-degree relative, so that's a mom, dad, brother, sister that has diabetes, you're two to three times more likely than the general population to develop type 2 diabetes.

SPEAKER_03: 7:33

I want to get more into risk factors and what people can do to some of those. You can't actually change, can you? But others, there are things you can do. Before I do that, we talked about type 1, small percentage of people, but you don't make insulin. We talked about type 2, insulin resistance. Two other terms. What is gestational diabetes and what is prediabetes?

SPEAKER_02: 7:52

Yes. So gestational diabetes is a type of diabetes that you can develop during pregnancy. So it really just affects women and it typically occurs in the second or third trimester. And what's happening is that the placenta is making a lot of hormones that make our body more insulin resistant. So it kind of is mimicking this type 2 diabetes, but as soon as the placenta is delivered, then that diabetes typically goes away.

SPEAKER_03: 8:18

Are they at higher risk for getting Type 2 diabetes later?

SPEAKER_02: 8:21

Yes, they are. And it has to do with, again, placentas are going to make a lot of extra hormones in every woman, but not every woman develops gestational diabetes. So it is kind of this marker that down the road there is a higher risk because during the pregnancy they couldn't keep up with that insulin production. So down the road, even outside of pregnancy, they might have that risk as well.

SPEAKER_03: 8:40

So here's a term that we didn't invent, but came into practice pre-diabetes while I've been practicing. When I started out, we called it impaired glucose tolerance. That was 20-some years ago. Somewhere along the lines, we used the word pre-diabetes. And I think it was literally just to maybe raise more awareness that, hey, you're at risk for diabetes. So what is pre-diabetes?

SPEAKER_02: 9:04

I like to think of it all on a spectrum, essentially. And you're right, pre-diabetes is this condition where... It's the same kind of underlying driving causes that bring us to type 2 diabetes, but it's all based on the numbers at which we diagnose diabetes. And people of prediabetes have elevated blood sugars, but just to a milder extent. And it's important because it can help us recognize who's at risk for going on to develop type 2 diabetes. And it can be a better time to intervene with lifestyle measures and really be able to reverse that so you don't go into type 2 diabetes.

SPEAKER_03: 9:42

What do you recommend for people who don't have diabetes to be tested then to see if they might have prediabetes?

SPEAKER_02: 9:50

Yeah, there's a lot of things that can increase your risk of diabetes. And so screening for diabetes is important. We want to test and make sure if they have it, we can start treating early. And so people who are 35 years or older, people who have a family history of diabetes, people who struggle with overweight or obesity, people in certain ethnic backgrounds should be screened earlier because, again, if we can diagnose early, we can hopefully try to reverse it.

SPEAKER_03: 10:17

Just because it's more common in certain groups? Exactly. Who might it be more common in? Yeah,

SPEAKER_02: 10:22

so again, people who struggle with overweight or obesity, when we think about ethnicities, there is a high risk of diabetes, type 2 diabetes in people of Black, Native American, Pacific Islander, and Latino populations. You know, when we're thinking about percentages, you know, white people have about an 8.5% risk of developing diabetes over their lifetime. But when we look at Native Americans, it's more like 16%. So that's nearing double the risk over a lifetime. So it's important to kind of know that and be able to Check into it early.

SPEAKER_03: 10:59

I'm glad you mentioned it. We have to name health disparities so that we can do a better job about that. So I'm glad you named that. Maybe you could talk to us about what are some of the short-term bad things that can happen and then what are some of the long-term complications?

SPEAKER_02: 11:15

So short-term, you can just feel crummy. So when your blood sugars are high, you can have symptoms like tiredness, feeling really thirsty, having to pee a lot. So those are kind of big signs that if you're struggling with that definitely see your doctor. And in the short term, high blood sugars can also cause things like increased risk of infection, increased risk for hospital stays. So we don't want that. And like we talked about earlier, in the long run, when you have blood sugar levels that are high for many years. Again, we get these risks of damaging the small nerves and small arteries in the body that leads to these symptoms like eye problems, kidney problems, and nerve

SPEAKER_03: 11:58

problems. Do we know why that is? I mean, at the nitty gritty level, why does your little nerves in your feet or in your eye, why do they get infected by high blood sugars?

SPEAKER_02: 12:07

It's a good question, but I kind of think of it as like, you know, the most vulnerable things in the body sometimes are the smallest things, right? And in comparison to those small nerves and small arteries, those blood sugar molecules have an easier time kind of affecting the walls of those things, the cells of those things. And the hard part is sometimes once you get the damage, it can't really be reversed. So it's really important to control the blood sugars to prevent those complications from happening.

SPEAKER_03: 12:38

So I want to ask you, how inevitable are those complications for someone living with diabetes? We'll talk about treatments later, but just Give us a teaser. Are those inevitable if you have diabetes?

SPEAKER_02: 12:48

No, they're not. We can definitely avoid those, again, with good blood sugar control. I will say I think there's some people who are more susceptible for reasons that we don't always understand. But again, the more we can control the blood sugars in the long run... the lower your risk of these complications. And that's why we have goals for our blood sugar management. Many of you may have heard of a test called the hemoglobin A1c, often just referred to as an A1c test. And, you know, in many populations, we try to get that under 6.5 if, you know, they're not really complicated or on a lot of medicines because we know the risk of those complications are going to be the very lowest if we can keep that number under 6.5.

SPEAKER_03: 13:31

When we come back from a break, we're going to talk more about that. Who should be getting that test done and then what you can do about it to manage diabetes. We're talking with endocrinologist Dr. Ali Estrada all about diabetes. And when we come back from this short break, we're going to talk about some symptoms, how the disease is diagnosed and treated, as well as how you can potentially avoid type 2 diabetes altogether. So stay with us. We'll be right back.

SPEAKER_01: 13:57

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at hennepinhealthcare.org. Hennepin Healthcare is here for you, and here for life. Thank you so much.

SPEAKER_03: 14:35

Ellie, we're going to talk now about symptoms, diagnosis, and that kind of stuff about diabetes. So what symptoms might someone have that would cause them to think, oh, geez, this might be diabetes?

SPEAKER_02: 14:46

So the symptoms that are the most common for diabetes are actually feeling really thirsty and peeing a lot. And interestingly, it's because when our sugars get high enough, our kidneys have to kind of get rid of the sugar so that we pee it out. And when we pee out sugar, water follows it. So we get diabetes. And then we get thirsty, so we keep drinking. So if that's a symptom that you've been dealing with for a while and you can't really figure out why, it would be definitely a good time. Super

SPEAKER_03: 15:12

thirsty, peeing a lot because there's sugar in your urine. Is it true or is this a myth that that's what diabetes mellitus, that's the whole name of it, diabetes mellitus, means sweet urine?

SPEAKER_02: 15:22

Sure it does, yep.

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Is it also true? Do you know? Did doctors used to, I don't mean in our generation, but did they used to taste the

SPEAKER_02: 15:29

urine? I think they did. Like 100 years ago? That's how they would figure it out. You'd stick your finger in the urine?

SPEAKER_03: 15:35

and taste it, and if it tasted sweet, that was how you diagnosed diabetes. Okay, folks, we don't do that anymore. Yeah, yuck. So how do you diagnose it?

SPEAKER_02: 15:45

Good question. So I'd like to add to that symptom question. Actually, most people who are diagnosed with diabetes don't have any symptoms. So that's not

SPEAKER_03: 15:52

that common that you have the polyuria and polydipsia are the medical terms for

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peeing a lot and

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thirsty. And

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your blood sugars have to be fairly high, often above 180. And I know that's kind of seems arbitrary for a lot of people, but that's higher blood sugars. So to diagnose it, either if you have symptoms, we can start testing then or again like we talked about screening ahead of symptoms developing we can get different tests so the most common we talked about is the hemoglobin a1c

SPEAKER_03: 16:18

does it matter if you're fasting when you get that test done

SPEAKER_02: 16:21

that test does not require fasting again it's looking at how much sugar is stuck to a red blood cell and a red blood cell lives for three months so fasting or not fasting is not going to have a huge effect on that test

SPEAKER_03: 16:32

you guys are going to be great at bar trivia everybody listening to this podcast how long does a red blood cell live in the human body three There you go. You're going to get it right. You're going to impress all your friends. Okay, so that's one way.

SPEAKER_02: 16:43

That's one way. Another way is called a fasting blood sugar test. So that one does require fasting. It's right there in the name. And if your blood sugar is 126 or higher, that's diagnostic of diabetes. The third test is one we don't use a whole lot just because it takes a long time and is not the most fun, but it's called an oral glucose tolerance test, OGTT. And we essentially give you a big drink that has a lot of sugar in it. a standardized amount of sugar. You drink it and we measure your blood sugar at two hours afterwards. And if that blood sugar is over 200, that is diagnostic of diabetes.

SPEAKER_03: 17:18

So I almost never do that anymore. Maybe you in a specialty practice, do you do that very much?

SPEAKER_02: 17:23

I almost never do it. I've just done it a handful of times. Pregnant women sometimes. Pregnant women do need a specialized version of that test. It can be a great test for postpartum women after they deliver if they've had gestational diabetes because it's a sooner way to evaluate their risk of diabetes than waiting three months to do the A1C, but it's just a little bit more cumbersome, so it's not used often.

SPEAKER_03: 17:44

But the other two are simple, fasting blood glucose or an A1C. Exactly. And that's how you're diagnosing. Okay, so you've been diagnosed. You're in with your doctor, your primary care doctor. Hopefully, you're getting to see a diabetes specialist like you. So we're going to talk about treatments now. So I'm going to start out with, I know the answers to these, but I want you to help us out. Is there just a cure for diabetes to make it go away?

SPEAKER_02: 18:07

So if you think of a cure as like a medic you can take one time, kind of like an antibiotic that just cures the situation, makes it go away. No, there's not a cure. But there are a lot of interventions that can reverse diabetes. It can essentially kind of make it go away with time and work. But again, there's not really a magic pill that will just make it go away forever. That

SPEAKER_03: 18:27

was a great way to put it though. But there are these interventions now. So let's talk us through those.

SPEAKER_02: 18:31

So I think the biggest way to start treating diabetes is with lifestyle interventions. There's actually studies that show us that lifestyle interventions, when done, are more effective than some of the medications. So that's huge. We have to remember that we have the power to reverse diabetes. Again, easier if we catch it earlier.

SPEAKER_03: 18:52

So lifestyle modifications. Do I watch more TV? Do I travel more?

SPEAKER_02: 18:58

I wish, no. So changing our diet and our exercise, are the two biggest things. And when it comes to diet, there's no one perfect way, but I think a big thing that people need to focus on is reducing portions, particularly of the carbohydrate-rich foods that we talked about, the starchy foods and the sweet foods. Another huge thing is just trying to cut back on really the processed foods if possible, because those foods have a lot of extra sugar, salt, fat added to them. And if we eat a lot of those or in excess, it can essentially kind of overwhelm our system and make it harder for us to kind of process the more natural or kind of carb foods that we eat.

SPEAKER_03: 19:41

So I think I might know the answer to this, but what is your take on pop? And folks, we originate in Minnesota. The correct term is pop, but some of you might know it as soda or soft drinks. What about those?

SPEAKER_02: 19:55

I love

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Coke.

SPEAKER_02: 19:57

I know. They taste good, don't they? But especially the regular types of sodas or pops like Coca-Cola or Pepsi or Mountain Dew have a ton of sugar. And so something to think about is, you know, one 20-ounce bottle of Coke has about 65 grams of sugar. And I know a lot of people don't necessarily think about grams, but that is like triple the amount of sugar you should have in a day. And you're getting it in that way. So trying to really cut that out is a huge thing. The other thing that might be hard for some people to hear is juice because juice seems like, well, it's made from fruit. It's healthy. But really, it's just the sugar extracted from the fruit. And when you drink it, it can raise those blood sugars really fast. And I say it's so much better to just eat the fruit if you want that, you know, something sweet that's kind of fruitful Yeah, I am

SPEAKER_03: 21:00

never

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one to say people have to cut things out completely. But again, I think a huge thing that people need to learn is portion sizes and kind of what is a healthy portion size of certain foods. And it's hard. It's hard to know that. I think in our society, we normalize really big portions and you see billboards or ads, like you say, just showing these huge meals. And that's really about the amount of food that someone should eat in a whole day, much less a meal. So learning about that's important. And there's a lot of ways to learn about it. I think a really easy trick that people can start with is using what we call the plate method. It's essentially starting with your plate and a filling half of that with non-starchy vegetables or fruit, filling one quarter of that with whole grain carbohydrates or kind of whole foods, potatoes, brown rice, quinoa, those kinds of things, and pasta too. And then a quarter of that being kind of lean meats or proteins. So things like chicken, turkey, fish, or non-meat things like tofu or lentils, legumes, things like that.

SPEAKER_03: 22:25

And that's such easy to visualize advice. You know, half the plate's supposed to be good vegetables and colorful things. And many of us have that plate and you fill it with pasta and then you put like four little... broccoli things in there or a quarter, three spinach leaves. So it's probably not the right proportions.

SPEAKER_02: 22:46

Right. And it's hard. Again, you go to a restaurant and you order pasta and that's what it is. It's a whole mountain of pasta. And that's a lot of pasta. So kind of thinking about trying to keep it to a quarter of the plate. And hey, it's okay if you go out and like those things from time to time. Just save some for the next few meals. I was

SPEAKER_03: 23:02

at Target Field. That's the place where the Minnesota Twins play just last week. And this sounds so judgmental because I was eating all bad stuff too. But people are coming by with a human-sized helmet. Plastic helmet filled with nachos and things. It's like a regular head-sized helmet. And like everybody had one. I thought, oh my goodness, that's probably not your best portion size. Maybe when you go to the ballgame, maybe not every other day.

SPEAKER_02: 23:26

Exactly. And that's just what it's all about. It's about moderation, right?

SPEAKER_03: 23:30

Okay, so you talked about diet. You also mentioned exercise. Does that have something to do with it?

SPEAKER_02: 23:35

Yes, it's huge because over time, our lives have become a lot more sedentary. And so we sit around a lot and are less active. And so just by incorporating a little bit of movement into your day, you really can help reduce your risk of diabetes. I was reviewing a study recently that looked at walking. And so if you walk just at a very calm, slow rate, you can reduce your risk of diabetes by 15%. It goes up to about 25% if you do a little bit more of kind of a natural walk.

SPEAKER_03: 24:05

That's a lot.

SPEAKER_02: 24:05

Yeah. And if you are walking like briskly about like a 15 minute mile, so like four miles per hour, essentially, you can reduce your risk by 40%. That's huge. And so again, moving your body, we kind of have a blanket recommendation for most people trying to move your body 30 minutes a day, cardio, maybe five days a week, strength training, two days a week. But I always tell people to just start where you're at. If you're not exercising it all, jumping into five days a week is going to be really hard. So set some small goals, maybe say two days a week, you're exercising for 15 minutes. And after a couple of weeks, go up to three days a week, 15 minutes, and just slowly increase until your body can do those things without feeling exhausted.

SPEAKER_03: 24:48

Really good advice. Really good advice. I'm going to briefly talk about medications. We're not going to talk about doses and all of that, but there are a number of medications. Just do you prescribe?

SPEAKER_02: 25:04

So like you said, there's a lot of medications now and some of them are pills. So people may be taking pills once or twice a day. A very common one, like you said, is metformin. There's lots of new injection type medications that actually aren't insulin but can help our body better regulate the blood sugars and our own insulin production. So those

SPEAKER_03: 25:24

are for people with type 2?

SPEAKER_02: 25:25

Exactly, yes. And then we have injections that are insulin and those can be for people with type 1 diabetes or type 2 diabetes. Because like we talked about, sometimes people with type 2 diabetes make their own insulin. They just can't make quite enough to control the blood sugars. And so using insulin is sometimes something we have to do. A

SPEAKER_03: 25:44

lot of the ads people might see on TV are for some of these new ones that you're talking about. I don't think they advertise insulin. I've never seen that. But the ones I'm controlling my A1C and I'm carrying my pancreas around in a little purse, those are these newer class of medicines. Could you say a little bit more about those? Because those are on people's minds. Who should be on those?

SPEAKER_02: 26:03

Yeah. So those are called glucagon-like peptide 1 agonists or GLP-1 medications. And they actually mimic another hormone in our body called GLP-1 that does a lot of things to help stabilize blood sugars, helps our body produce a little bit more insulin to control the blood sugars. They're really helpful for people who not only struggle with diabetes, type 2 diabetes, but also obesity because they've been shown to help lose weight over time and do Doing that goes on to further help the diabetes and that insulin resistance. So they're really great medications. They're not for everybody necessarily, but they can be super helpful to manage diabetes.

SPEAKER_03: 26:43

Yeah, I often tell my patients, you know, after you've done medicine for a while, sometimes new medications are just what we call, well, just an addition, a me too one. A new drug company comes up with basically what you already had. And so the newer ones aren't always better. These seem to be pretty good, these GLP-1s. And for listeners, we never on this podcast or in our hospital endorse any specific brands. But I want to use the words because you've maybe heard of them. It's semaglutide and its cousins, but they go under the brand name Ozempic. And for weight loss, we go just so you know what we're talking about here, although we don't endorse any specific brands. So they're expensive and they're not for everybody. When do you go to medications like that in your patients? When do you start talking about maybe you need one of these new non-insulin injectables?

SPEAKER_02: 27:32

Interestingly, it's becoming more and more of like a first or second line medication. It's

SPEAKER_03: 27:36

really moved up the list.

SPEAKER_02: 27:37

It's moved up the list because they're so effective. They really are effective. And people can sometimes be on just this medication or this and one other medication, whereas without it, they might need three or four medications. So it can be really effective. Again, we use it for people who struggle with their diabetes control and weight. Interestingly, a lot of these medications have actually been shown to have heart protection benefit and kidney protection benefit. Newer studies are looking at rates of fatty liver infiltration, and they're showing benefit for that too. So we really do look at a person's whole medical history and try to kind of pick out if a certain medication is really going to help with things beyond just the type 2 diabetes.

SPEAKER_03: 28:19

What about weight loss in and of itself, regardless of whether you did it by eating different exercise? Hopefully both. Or whether you did it by one of these medications that has some weight loss benefits. How does weight loss affect diabetes? I mean, just... Does losing weight help?

SPEAKER_02: 28:35

Yes. When it comes to insulin resistance, losing weight will help, right? So we talked about how in type 2 diabetes, we have more of this resistance. It's often associated with weight. So as our weight goes up, the insulin resistance goes up. So losing weight by any means like you talked about is typically going to help reduce our insulin requirements and therefore is going to help us be more effective at controlling our blood sugars.

SPEAKER_03: 29:00

So there's only so many of you, Ellie. There's only so many endocrinologists in the world. When do you recommend that somebody see a specialist like yourself?

SPEAKER_02: 29:07

I want to say primary care doctors are amazing at managing type 2 diabetes, diagnosing that. So I think for most people who have type 2 diabetes, especially kind of in the earlier stages or maybe requiring one or two medications, it's totally fine to see your primary care doctor. They're going to do a great job. People who have type 1 diabetes, I really do recommend see an endocrinologist. People who have type 2 diabetes who it's just really hard to or they're on lots of medications or particularly insulin. Again, not everybody on insulin needs to see an endocrinologist, but if you're on insulin and still having a really hard time controlling those blood sugars, I'd say at least getting it stabilized with an endocrinologist is a good idea.

SPEAKER_03: 29:49

Well, I have a lot of diabetes patients and many of them are complicated. So I really appreciate having an endocrinology office just down the hallway from me. We are happy to be there. Ellie, before I let you go, what would you leave listeners with? Because I'm actually quite hopeful about diabetes. It's on the rise. There's lots of people with it, but we have a lot more than we did 10 years ago. What message would you leave our listeners?

SPEAKER_02: 30:11

I think that type 2 diabetes in particular is a disease that we can fight with knowledge. The more you know about how to better take care of your body, the more we can prevent it, we can treat it, we can reverse it like we talked about. And again, sometimes it gets to a point where no matter if you're doing all the right things, it's hard to reverse it, but you've got people here to help. We've got great medications there's new stuff coming out all the time it's hard to keep up with it and so you know just getting seen by your primary care doctor early to go through those screening tests to learn I always say please be open to learning because it's like a full-time job learning about diabetes and so be patient with yourself but keep learning because there's always more to learn

SPEAKER_03: 30:55

that's great tips about one of the most massively important medical conditions we'll talk about on this podcast so Ellie thank you for being here

SPEAKER_02: 31:02

thank you for having me

SPEAKER_03: 31:03

we've been talking with Dr. Dr. Allison Estrada, she is an endocrinologist right here at Hennepin Healthcare. And listeners, if you need more information, we could perhaps put some links in the show notes to some resources for you. And I want to thank you for tuning in, and I hope you'll join us in two weeks' time for our next episode. And in the meantime, be healthy and be well.

SPEAKER_00: 31:22

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 healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org or call 612-873-TALK. There's also a link in the show notes. 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.