Can you lower your risk of diabetes-related complications? This week co-hosts Dr. Tamika Perry from WellMed at Redbird Square and Ron Aaron discuss how to prevent or delay diabetes complications and how to improve overall health.
April 6, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award-winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Welcome to the award-winning Docs in a Pod, I'm Ron Aaron, we are delighted to have you with us. We talked today about a really important topic, one that affects literally thousands and thousands of people, wherever you hear this radio show or our podcast. Our guest today is our co-host, Dr. Tamika Perry. Dr. Perry is an associate medical director and a physician at WellMed at Redbird Square in Dallas, Texas. Completed her master's degree in the University of North Texas Health Science Center program in Fort Worth, earned her medical degree at Philadelphia College of Osteopathic Medicine in, oddly enough, Philadelphia, Pennsylvania.
She also earned her master's in public health from the University of North Texas. Dr. Perry's great to have you as a co-host, but this is a topic dealing with the issue of complications of type 2 diabetes, you must deal with almost every day in your patients.
DR. TAMIKA PERRY
Every single day, if not diabetes, pre diabetes and the sequelae or consequences of diabetes.
RON AARON
Well, give us the 411 first on diabetes, both type 1, which used to be juvenile diabetes, that's what it was called, and type 2 diabetes, which ordinarily was older people and now younger and younger people.
DR. TAMIKA PERRY
In terms of type 2 diabetes, do you know that 11.6% of the population has type 2 diabetes? And that's according to the American Diabetic Association as of 2021. There's a tremendous amount of people that affects health, the economy, it affects so many aspects of American life. But if we break down the 2 types of diabetes or 2 major types of diabetes, we have type 1 diabetes and theoretically type 1 diabetes is thought of as an autoimmune disorder. It's just where your pancreas doesn't effectively make insulin because of maybe an attack on it so there's not enough insulin circulation. Typically, we find out when you're a little kid because some sequelae of something has happened, you've passed out profuse sweating and just regular routine testing. What's wrong with my kid’s sugar? So they have type 2 diabetes.
RON AARON
And what does insulin do?
DR. TAMIKA PERRY
That's a great question, and I meant to say type 1. Insulin is the car or the vehicle that drives that sugar from the blood to inside the cells of the body. Without that vehicle, or think of it as a garage door opener, it opens up that cell and allows that sugar to come in.
That sugar just flows aimlessly in the blood and sugar is not supposed to be in the bloodstream. That's where all the habit is reaped. It's supposed to be inside the cells of the body. And once that sugar unit gets inside the nucleus or the brain of the cell, it's inside the center of the cell, it's turned into an energy source called ATP adenosine triphosphate, and that's kind of like our gasoline, right? So, if our gas is not in the engine where it's supposed to be, it's floating in the blood and that's what causes problems. So that sugar in the blood, your kidneys will go. And this is in type 1 or type 2, because remember the problem, the end problem is there's too much sugar in the blood.
So your kidneys sense that and the main function of the kidneys is to filter blood of toxins to make urine, right? So it realizes that, hey, there's too much sugar in the blood, and I need to filter my blood to make urine and to get some of the sugar out and you start overworking your kidneys. And that's why when you have type 1 or type 2 diabetes, you'll start to urinate a lot because your kidneys are working really hard to push that sugar out.
But when you urinate a lot, you also push out all your water so uncontrolled diabetics will feel thirsty and they'll pee a lot. And this is a sequela of too much sugar in the blood. And while you're doing this, you're overworking those kidneys and that can eventually lead to renal failure.
RON AARON
When I was a kid, if you go back many years in elementary school, we'd often get a little questionnaire which asked, are you peeing a lot? And are you drinking a lot of water? As kind of a pre-screening to whether you might have diabetes.
DR. TAMIKA PERRY
Right, and that's why statistically, at least for type 2 diabetes, people have had it a good 5 to 10 years. I think the recent literature says 10 years before they were diagnosed, but some of the symptoms. They just say well, everybody in my family pee’s a lot. Right? Every person in my age group may urinate a lot. Or thirsty? I've been thirsty my whole life. I've drank water like this my entire time.
But really, these are signs your body's telling you like, hey, something is going on. So type 1 diabetes is that insulin production is not there, and theoretically, some theories say it's not there because of immune system destruction of the pancreas.
So type 2 diabetes is a couple mechanisms. One, that insulin production is slowed down and two, there's insulin resistance. Type 2 diabetes has some genetic problems preponderance, but it's a lot of lifestyle changes. You've overworked that pancreas, you've made a whole bunch of insulin because of lifestyle choices: high carbohydrate foods, lack of exercise, made a lot of insulin to try to combat your meals, and your pancreas says, I'm tired. I'm tired. I don't want to make as much as I did before because you have overworked me. And then the cells of the body say, you've exposed it so much to insulin, that's insulin resistance. It goes, yeah, there's insulin, so what? It doesn't open up that garage like it used to.
So that's insulin resistance, right?
RON AARON
Hold that thought, we’ll come right back to you. I want to talk to you about the correlation between obesity and type 2 diabetes. If you just joined us, I want to let you know you're listening to Docs in a Pod, the award-winning podcast and radio show available to you each week.
We talk about a variety of physical-related issues, health-related for both seniors and others. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry. And Tamika, among other things is also experienced and certified in looking at issues involving obesity. Dr. Perry, is there a correlation between type 2 diabetes and obesity?
DR. TAMIKA PERRY
There's a direct correlation, so if we think about how food is how we how food is processed in our body, right? We have these macro and micronutrients, the macronutrients we have fats, carbs and proteins. So, when we eat a carbohydrate: cookies, candies, cake, rice, potatoes, pasta, sweet tea, ect. Part of it is going towards making of that energy source we talked about earlier but a significant part of it is actually stored as an energy source, like the storage of that gasoline that was called glycogen and stored right around your liver area, your abdominal area. So we store that as a source of energy to use later. The problem is most of us never use it later, so we have all the storage in the abdominal area.
And then when we have these hard carbohydrate meals, we make lots of insulin so now we have truncal obesity, we have insulin resistance, and it's all one big, ugly cycle, so there's a direct correlation. In fact, when people have bariatric surgery, up to 75% of people take no diabetic medicine one year from their bariatric surgery and up to 50% of people after that. That's because there's some weight gain in some individuals, but 100% of people take less medicine than they did before a significant amount of people eliminate medicine. I'm talking about medicine for blood sugar for diabetes.
RON AARON
Now, bariatric surgery is where they tie off your stomach?
DR. TAMIKA PERRY
Well, yes, in a very basic sense.
RON AARON
That's a layman's description.
DR. TAMIKA PERRY
That's a layman's description. Bariatric surgery is a rate weight reduction surgery, and it usually involves the manipulation of your anatomy, like your stomach on the inside. If it's the gastric sleeve, then we've taken off a significant we shade off a significant portion of your stomach so it kind of looks like a banana now, as opposed to like a sack before. If it's the ruin wide bypass, we've taken the first very pouch part of your stomach and reconnected it to your small intestines and bypasses a large part of your stomach.
If it's the duodenal switch, we take your esophagus and we tie it to the very, in part of your small intestine. So it's a manipulation of that anatomy on the inside so basically all of it results in a restriction of how many calories you can consume.
RON AARON
Except some people end up bypassing that because they just eat incredible volumes of food?
DR. TAMIKA PERRY
If you were a person who consumed 4,000 to 5,000 calories a day but you did it over two large meals, you can get past that. I mean, it's more difficult with the duodenal switch and the bypass in the sleeve, but a lot of people will just, instead of having two large meals in which they consume 4,000 calories, they will just graze all day because the amount of calories that they get in it is basically the same. That's how they unfortunately get around that. So with any weight loss effort, it really is a lifestyle change, whether you do it medically, surgically, whether you do it just by diet and exercise, the most important piece in that is lifestyle change. You change your habits, you change how you behave physically, as well as how you physically eat.
RON AARON
Now let's talk a little bit about what the end result is to our body can be from type 2 diabetes. What does it do to us? I know, for example, in San Antonio, a tragic statistic; we lead the nation in the number of foot amputations, which can be a result of diabetes, untreated.
DR. TAMIKA PERRY
Absolutely. So if you look at populations, like I was watching a Netflix show one time, and it was about, in India, there's unfortunately, a black market for kidneys because there's a lot of kidney transplants in India. The reason is because there's a lot of diabetes in India.
And you said, well, that population doesn't eat meat. It's not about meat. If they're not eating meat, they have very high carbohydrate meals. There's a large population in India, people need kidney transplants. Unfortunately, they take them from the part of the population that isn't very didn't have a lot of money for lack of a better word. In populations where there's large diabetics like in San Antonio, in Dallas, the United States as a whole. So what happens? What happens is that once again, that sugar has to settle somewhere. If you're not peeing it out, which at this point, you're overworking your kidneys, then it starts to settle like in the nerve endings in the blood vessels of your extremities, and that sugar starts to damage the nerve endings in particular, then you get something called neuropathy. So if you damage your nerves, which allow you to feel and your feeling is impaired, when you're walking on a soft surface, it may feel like you're walking on a hard surface, or you may have lack of sensation or impaired sensation.
So say for example, you cut your foot, you can't feel it, you don't know you got to cut, you get an infection. A lot of times in diabetic extremity infection leads to amputation.
RON AARON
Happened to a friend of mine who had diabetes, knew he had diabetes, but figured he could just manage it by what he ate, he wasn't taking his medication, ended up with neuropathy, ended up with a cut in the foot. He didn't, and this is gross, but didn't know he had a problem until he smelled the gangrene.
DR. TAMIKA PERRY
Yes, and that happens because they don't feel it. They do not feel it. We'll talk about that in blood vessels. I think we have a commercial break coming up.
RON AARON
Well, we can do that right now. You have learned so much about radio, I like that. I'm Ron Aaron, along with our knowledgeable radio and physician co-host, Dr. Tamika Perry, you're listening to the award-winning Docs in a pod.
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RON AARON
We are so pleased you are with us here on the award-winning Docs in a Pod. Our podcasts are available wherever you get your podcasts. We're also on the radio in a number of markets and look forward to talking to you every week about a variety of physical ailments and conditions. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, talking today about complications that flow out of type 2 diabetes. We were talking about the difficulty with peripheral neuropathy. You have no feelings in some of your extremities, you may get cut, you may have an infection, and you may have an amputation. Where else would you like to go with this, Dr. Perry?
DR. TAMIKA PERRY
If we just go back and talk about infection for a second. When a diabetic or when anyone gets infection in the soft tissue, it's at risk of going to the bone, especially if you don't take care of it. And when you get a bone infection, there's a few therapy options.
One therapy option is 42 days of IV antibiotics in the hospital, which fails 50% of the time. And this was like a test question when I was in medical school is why I know this.
RON AARON
42 days? That's more than Noah had to keep the boat out.
DR. TAMIKA PERRY
That's exactly right, and if I had to choose, I probably would choose to stay on the boat with water and a bunch of animals than to be in the hospital for 42 days with a reading flesh infection. The other option is amputation because the bone marrow seeds the rest of the body; we don't need infection there, right? So what else can happen? You can also impair your blood vessels in your lower extremities. The sugar itself impairs the endothelium or tears up the blood vessels in your extremities, which leads to circulation complications.
So now, if you have an infection because you couldn't feel anything, now it's difficult to get fresh oxygenated blood to that infection to help kill the bacteria. so it's like a double whammy. We've learned that diabetes type 1 or type 2 can lead to amputations because it impairs not only your nerves, but also your blood vessels.
Now, that same mechanism can happen in the eyes causing retinopathy or damage to the retina, so diabetes can unfortunately lead to blindness. You can have that same mechanism, especially with the tearing up of the blood vessels in the heart. Diabetes is a huge risk factor for heart disease.
I don't want to make this sound like a sad story so when anyone gets a diagnosis of type 1 or type diabetes, everyone is like, make out my will now, because remember we talked about earlier that macronutrients, right? There's food sources or carbs, proteins and fats, right?
So, if your body has a problem with processing carbohydrates, then, by golly, let's have a low carbohydrate diet.
RON AARON
How would you know you have a problem processing carbohydrates?
DR. TAMIKA PERRY
Then you're either going to be diagnosed with prediabetes, diabetes type 1, or diabetes type 2. And on a side note, there's a few other ones like brittle diabetes, diabetes insipidus and something called MODY, mature onset diabetes of the young. And that just means like younger kids are getting type 2 diabetes because of lifestyle. Ron, when you and I were kiddos, we go outside, we play, we ride our bikes, we play things that people hate like dodgeball, but we were physically active as opposed to kiddos now sit in front of the computer, video games, etc.
RON AARON
Yeah, when I was a kid, my mom would say, all right, out the door, I don't want to see you till the sun goes down. We ran and played and got a lot of incidental exercise, didn't know we were exercising, we were just playing.
DR. TAMIKA PERRY
You're just playing and that's pretty much it. You came back in smelling, like my mom says, like the outside. you took a bath and it was time to go to bed and start all over again, that's pretty much that cycle, and it was wonderful.
Now we have this mature onset diabetes of the young, but nonetheless, your body has a problem with it. Either signs and symptoms will tell you, blood work will tell you, which I always got to throw in the plug for the PCP. It's a great reason for you to see your doctor every year, your primary care physician, they can give you clues such as do I have a sugar issue or not?
RON AARON
And they can tell you?
DR. TAMIKA PERRY
Absolutely. We can use tools like a value card, your hemoglobin A1C, and your hemoglobin A1C, not to be confused with your regular hemoglobin. Your A1C tells you the 3-month average of your blood sugar When your A1C number is greater than 6.5 on more than one occasion that gives you a diagnosis of type 2 diabetes. What does that mean? 6.5 is approximately a blood sugar of 140. The other ways you can diagnose diabetes is that if you have a random blood sugar of greater than 200, whether you've eaten or not, so if you just happen to check your blood sugar with a regular glucometer at home and you're like, why is my blood sugar 202? Because you have diabetes, and you never knew that you had diabetes, you just happened to use your grandma's glucometer. That's probably the reason you've been peeing a lot and thirsty a lot and hungry a lot and had weight changes because you have a diagnosis of type 2 diabetes. Or, if you've been fasting for the last 8 hours or so, and it's greater than 126, then you have a diagnosis of diabetes.
I also do something called 3-hour glucose tolerance test, and that requires you to be in the physician's office for a few hours. We give you a high sugar drink at hours one, two, and three, and then measure your sugars. And from those measurements, we can tell if you have diabetes.
RON AARON
I'll tell you a funny story, and this is how my old PCP got my attention. I went in for my 6-month checkup and I walked in the exam room just kind of looking around. He comes in, we talked for a while and sitting on the exam table was a blood glucose meter, and he finally said to me, do you know what that is?
I said, well, yeah, it's a blood glucose meter. He said, you're going to be living with that if you don't do something about your diet and exercise, because I was at the time borderline diabetic. Man, did that get my attention?
DR. TAMIKA PERRY
Absolutely, and diabetes, if uncontrolled can really change your lifestyle. It will not only hinder your eyesight, you're at risk of amputations. If you're a guy, it can hinder the function of certain happy parts of your body.
RON AARON
So erectile dysfunction?
DR. TAMIKA PERRY
That's right. A lot of times that gets my guys in my practice, it really gets their attention, or lack of a better word there, please let me come back on the show. It really can change your life.
But once again, treatment of diabetes is threefold, it's medication to address it, and if you get it under such control, we may, I'm not saying always be able to eliminate that part, but it's most certainly dietary control and exercise. Most certainly, those are the two essential components of it for controlling diabetes.
RON AARON
For controlling diabetes?
DR. TAMIKA PERRY
Most certainly. Yes, sir, controlling and prevention. Recently, I had a wakeup call because last year or year before last, when I went to my PCP, my A1C was 5.7 and that's the value where pre-diabetes start. So I said, oh, no, Tamika, you have to go back to the gym, you have to take the soda back out of your diet that you had put back in, and that was the wakeup call for me. So when you go to your PCP, really sit down and talk about these values. If they say, you're absolutely not diabetic, well doc, am I pre-diabetic because I want to make sure I'm 100% okay. And what do I need to do from here?
RON AARON
Yeah, you used to be a Coca Cola junkie, right?
DR. TAMIKA PERRY
I say I am in Coca Cola, not Coke, but Coca Cola rehab. Yes, I used to be a Coca Cola junkie. Absolutely. It is refreshing, just like the commercials say. However, it is not good for my A1C profile.
RON AARON
Well, it's all sugar.
DR. TAMIKA PERRY
It's all sugar. It's all sugar and flavor, like most sodas. This is just a quick tidbit for everyone. If you look at a product and you turn it over, you take the total number of carbohydrates per serving and it's listed per serving, you divide it by four. That tells you how many teaspoons of sugar is in that product, approximately. Even if the product's not sweet, you can rationalize in your head, should I consume this product or not?
A can of soda, which is about 12 ounces on average has about 10 teaspoons of sugar. Most of us drink the 20 ounce bottle so we're talking about like 16 teaspoons of sugar. So you can either drink that or just put a whole bunch of little sugar packets, 10 or 12 sugar packets on your tongue.
This is the same thing. Same thing.
RON AARON
Yuck. Well, you wouldn't do that.
DR. TAMIKA PERRY
No, you wouldn't, so you shouldn't drink that either. Water, which for the most part is free, is what your body prefers, and that's what you should be drinking.
RON AARON
I have this discussion with my kids all the time. We've got a cooler in our kitchen. In it we keep mostly water and some juices, which I wish we didn't have in there, but I lost that battle. When they go to reach in there, I will say hey, why don't you try water?
DR. TAMIKA PERRY
Yes, that's what our body loves, that's what our body craves. That's what it prefers, and it is economic, you can't lose with that combination.
RON AARON
Now, before we run out of time, a quick recap. If you are concerned about whether you have diabetes, talk to your PCP, and if you have diabetes, what are the most important things you should consider?
DR. TAMIKA PERRY
Consider dietary changes, and if you are lost at that, ask your PCP for a diabetic education class, and exercise.
Most certainly, 150 minutes a week of cardiovascular exercise.
RON AARON
And eliminate sodas if you're drinking them.
DR. TAMIKA PERRY
Do not. They are not your friend.
RON AARON
Now, before we go, what about the diets that many people are looking at? The Mediterranean diet, yes or no?
DR. TAMIKA PERRY
Yes. Mediterranean diet is actually a great diet. Meat is kind of a garnish, good fats in the diet, leafy green vegetables. We're going to say two thumbs up to that diet.
RON AARON
Thank you, Dr. Tamika Perry, appreciate it. Everything you should know about complications from type 2 diabetes. Thank you for joining us today on the award-winning Docs in a Pod, I'm Ron Aaron, we'll talk to you soon.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net. Be sure to listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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