National Diabetes Month

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
Thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. We come to you every week with a look at a variety of health and wellness issues that effect folks, predominantly seniors, but not always. We look at the kinds of things that you can do to improve your life and ways in which if you are tackling a chronic illness, how you can make your life better. Dr. Tamika Perry is our co-host. She's associate medical director for WellMed. Dr. Perry's goal in that role is to support the providers at a number of WellMed clinics as they deliver quality care and a compassionate patient experience. She's been with WellMed for nearly 11 years and we're delighted to have her with us every week on Docs in a Pod. She earned her undergraduate degree from Prairie View A&M University. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Care Service Corps Scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, where she served as chief resident. She's obviously overtrained. Dr. Perry also is a diplomat of the American Board of Obesity Medicine. She loves to travel, and when she's not playing doctor, she and her daughter, in their free time love to go to the seven continents of the world. Antarctica is on that list. Not yet though, right?

DR. TAMIKA PERRY
Not yet. I haven't been to Antarctica yet, and I haven't been to Australia yet. But of the continents that I've been to, I can say that food is great in all of them, which plays a vital part in what we're going to talk about today.

RON AARON
Have you been to Iceland?

DR. TAMIKA PERRY
No, I haven't been to Iceland yet.

RON AARON
A neighbor of ours has been to Iceland and they're going back. They loved it.

DR. TAMIKA PERRY
I've heard the same, so have added it to my list of places to go.

RON AARON
Cool. LetÕs introduce our special guest, Dr. Kathy Nguyen as we talk about National Diabetes Month celebrated across this country in November. But frankly, every month ought to be diabetes month because the disease is so prevalent. Dr. Nguyen is a board certified internal medicine physician and Optum - Cross Ridge. She earned her medical degree from the Medical College of Wisconsin in Milwaukee. She completed her residency at Saint Francis Medical Center in Peoria, Illinois, home of a whole lot of soybeans, by the way. Dr. Nguyen is certified by the American Board of Internal Medicine and is dedicated to providing compassionate, patient-centered care. Outside of medicine, she enjoys attending soccer games and spending quality time cruising with your family. That sounds like fun. She's at the Optum - Cross Ridge clinic in Clermont, Florida. Dr. Nguyen, it's so good to have you with us.

DR. KATHY NGUYEN
Thank you for having me, Ron. IÕm excited to be here.

RON AARON
I mentioned to you off the air that this topic of diabetes is so important. The city of San Antonio leads the nation, or very close to it, in the number of people with diabetes. I'm sure that's true in Florida as well.

DR. KATHY NGUYEN
Yes. Diabetes, I think many of us know, is a very prevalent condition. I actually was reading up a little bit before our talk and, most recent statistics, almost 40 million Americans have been diagnosed with diabetes. There are two types of diabetes. There's type 1, which makes up a small percentage. Type 2 is the majority of diabetes, and that's what a lot of us primary care physicians take care of on a day-to-day basis. We see a lot of it. We have to be comfortable with it because a lot of Americans do suffer with it. In addition to the 40 million Americans that have diabetes, there's a large number of Americans, over 90 million that have prediabetes. So, if you combine those two numbers, that's a lot of people that have diabetes or are at risk for getting diabetes in the future.

RON AARON
Now, when you say prediabetes, on the surface, I think we understand what that means. But what does it really mean? How close to diabetes would you be? And what's the risk of developing diabetes if you're diagnosed as pre-diabetic?

DR. KATHY NGUYEN
So, prediabetes we will diagnose mainly based on blood work. There's a blood test called A1C that we use that helps us diagnose patients as normal blood sugar, prediabetes or sometimes I'll say borderline or prediabetes and then diabetes. A1Cs is a test that can be done every 90 days. It gives us an average of your blood sugar over those 90 days. So, the higher your blood sugar is in your body, then the higher that A1C number goes. The A1C is a good number for patients to understand what it is because that's something I like to talk to my patients about. Say I'm seeing them for the first time, and they share theyÕre diabetic, I'll ask and well, what was your last A1C? Sometimes patients are like, what is A1C? I think knowledge is power, so patients to know what an A1C is. They should know their personal information. That's your health. When we do an A1C, we get a number. A normal A1C is 5.6% or lower. When you fall between 5.7% to 6.4%, that's what we categorize as the prediabetes borderline blood sugar. Then, once you hit that 6.5% number or higher, that's when we diagnose diabetes.

RON AARON
All right. Hold that thought. I'm going to I'm going to come right back to you. I want to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. We come to you every week with a look at a variety of health and wellness issues that affect folks across this country. WeÕre talking today about diabetes. November is National Diabetes Month. But as I suggested, every month ought to be a diabetes month. I'm Ron Aaron. Dr. Tamika Perry, our co-host is with us. Dr. Nguyen is with us as well at Optum - Cross Ridge in Clermont, Florida. She is leading this discussion. Come back to A1C for a moment, Kathy, because that's a number that folks with or without diabetes ought to know.

DR. KATHY NGUYEN
Yes. A1C is the 90-day average of your blood sugar, and it will tell us where you are on that scale of a normal blood sugar. If you're at risk, we call it prediabetes or borderline blood sugar and then diabetes. Normal A1C is calculated by percentage. 5.6% or lower is. normal If you fall between 5.7% to 6.4%, we were diagnosed with prediabetes. If you're 6.5% or higher, that is diabetes range. Like you said, very important to know that number because a doctor may ask you, well, what was your last A1C? Or, if you go to your specialist, they might want to know, hey, how's your diabetes doing? What was your last A1C? So, yes, a very important number to know.

RON AARON
We're talking about diabetes, and many people have it. What's the downside? What happens to people who don't control their diabetes?

DR. KATHY NGUYEN
Yes. Diabetes is very prevalent, and why it's so important and serious that we see in primary care every day is if the diabetes is not controlling, your blood sugars arenÕt in normal range, it can cause a large list of complications. It's a leading cause of blindness because of what it damages on the back of your eye. That's the retina. It can cause kidney damage. It's a leading cause of dialysis, meaning that we have to find means to clean the blood because your kidneys are no longer able to eliminate waste products on its own. It can cause nerve damage. We call that neuropathy. Other long list of things. It does increase your risk for cardiovascular diseases like heart attacks and stroke. It can affect circulation. We call that PAD, or Peripheral Artery Disease. It affects how well the blood flows into your legs. If you don't have good blood flow, you can lose your toes and feet. It's a leading cause of amputation in our country.

RON AARON
In fact, San Antonio leads the nation in the number of legs amputated as a result of diabetes running rampant. It's nothing to be proud of, but it's a fact.

DR. KATHY NGUYEN
Yes, indeed. Like I mentioned, we see diabetes every day. We have patients that are well controlled, and unfortunately, sometimes have patients that are not well controlled even with their best efforts. So, education is key. When patients know how serious the diabetes is and how important to work with their doctors to come up with a treatment plan to control it, so they don't come down with these complications we discussed.

RON AARON
Dr. Perry, we talked about diabetes as affecting an individual, but it really is a family problem because whether you have it or not, in a family, the person with diabetes often controls what people eat and the way they behave.

DR. TAMIKA PERRY
That's right. Diabetes is intertwined with so many other comorbid conditions like obesity. If we go back to food, and you were talking about eating and behavior, one statistic I'll give you, that if the individual is obese, a grown up, there's a 60% chance that their kids will be obese. ThatÕs one parent. If both parents are obese, there's a 90% chance their kids will be obese, leading to their increased incidence of diabetes. Really, the entire household has to change their habits. Dr. Nguyen was talking about earlier education being key because she is so, so very right. I remember early in my practice, and I remember at that point when this happened to me, that I changed my diabetes speech with each and every patient. I told a young lady that she was diabetic, and when she came back to me, her sugars were still high. She said Dr. Perry, I don't understand. I went from eating white sugar to brown sugar. Why am I my sugar still high? Education is paramount. We as clinicians shouldn't assume patients should know. We shouldn't take it upon ourselves to impart that education on a patient. Just like Dr. Nguyen was telling us about the A1C. The three-month average. What that really means is 5.7% is about 117. 6.4% is about mid-130s. If you go over that range in that three-month average consistently, then we diagnose you've diabetes. Patients will come in and be like, my sugar's only in the 90s but A1C is 12%. This cannot be the case. Let's go ahead and talk about what's really happening. We cannot microwave Snickers and drink them for breakfast. Let's talk about what we need to do.

RON AARON
I want to come back to something you said so people understand. You said you had a patient who said, I went from white sugar to brown sugar. My sugar should go down. Sugar is sugar.

DR. TAMIKA PERRY
Sugar is sugar. Just like bread is bread. Instead of your sugar going up really high with white bread, it may go up not quite as high with wheat bread, but it's still going to go up. ItÕs important that you have a very candid relationship with your PCP who may refer you to a nutritionist. From a lifestyle standpoint, how can we control this? Because thereÕs really the three arms of the triangle. It's diet, medication and exercise. The fourth piece is education. Dr. Nguyen and I control that. We control what we prescribe to you, but it's up to you to say, am I going to follow the recommended exercise guidelines? Am I going to follow the recommended dietary guidelines?

RON AARON
Let me come back to Dr. Nguyen. When you talk about managing diabetes, what are your recommendations to your patients? We'll do that in just a moment. Don't go anywhere. You're listening to the award winning Docs in a Pod. I'm Ron and along with our co-host, Dr. Tamika Perry, and Dr. Kathy Nguyen is with us as well. We're talking about diabetes. This being National Diabetes Month, but every month, we should look at diabetes. Stick with us right here on Docs in a Pod.

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RON AARON
Thank you so much for sticking with us right here on the award winning Docs in a Pod. I'm Ron Aaron. Dr. Tamika Perry, our co-host is with us, and we're talking with Kathy Nguyen. It's National Diabetes Month in November. What can the patient do? What should the patient do, Dr. Nguyen, in trying to manage their diabetes? What are your thoughts?

DR. KATHY NGUYEN
I completely agree with what Dr. Perry had mentioned about diet. I often tell patients, no matter what stage of diabetes they're in, early, more advanced, that the importance of monitoring what you eat never goes away. It's important. No matter if you're on insulin, you're taking pills, you're not taking any medication, diet is important. Medications that you talk about with your primary care physician and then exercising on a regular basis. Exercise can help regulate your blood sugar. Your body can metabolize glucose better. She mentioned the fourth piece, which is the patient. We can have conversations with patients every day about what we recommend that they do, but I often tell patients that once they go home, I'm not there with them at home. I tell the patient, I'm telling you to do this, this and this. I'm not there at home behind your shoulder remind me to do these things. It's on the patient at the end of the day to have the motivation and accountability to say, I'm going to go home and follow these things that I talked about with my primary care physician. So, I think that's very important as well. That's where education is so important because patients really need to understand the severity of what they're dealing with and what they can do to get tools to take home and really take charge of their condition.

RON AARON
If you want an example of what happens when you don't manage your diabetes, I've got a good friend, Barry is his name, who went for several years where he didn't manage his diabetes. He figured, hey, I know what I need to do. I can eat okay. And he went really downhill from there. He cut his foot in the bottom of a pool and had no idea it was cut. He had neuropathy. He couldn't feel the foot. He got infected. He got gangrene. They amputated his leg below the knee. He has gone on since to struggle with kidney issues. He's on dialysis, and he also struggles with vision. He had diabetic retinopathy and lost vision in one eye. The other eye has been touch and go. All of that began because he didn't manage his diabetes. I'm not telling a story out of school. He will tell you about it and he talks to folks about it. I'm trying to reinforce him as an example of what can happen.

DR. TAMIKA PERRY
Exactly. We have to really be mindful of our disease state in what we're eating, because a lot of times the disease states don't affect us into we're a day late and a dollar short. A lot of times the disease state is coming, and we don't recognize it. We don't recognize that we're peeing more than we used to urinate. We don't recognize that instead of, as a lady having, one vaginal yeast infection a year, we've had three this year. But these are all signs that sugar is creeping up. Or why do I have this prolonged toenail infection? It's not on anything robust, but it's coming. And by the time we get to the point where we're not urinating at all and we have to go on dialysis, we're day late and a dollar short. Even little changes in our diet go a long way. For example, a slice of cornbread, which I personally love, has 33g of carbs in it, but a dinner roll has like 13 or 14. So, if I really have to have that carbohydrate with my dinner, then I should choose the dinner roll. Corn tortillas have a little less carbs and flour tortillas. So, these are things that the patient should be mindful of. If you don't know, that's where you seek out your primary care physician so they can lead you in the right direction and refer you to a nutritionist or direct you to the American Diabetes Association website. Dr. Nguyen, are these some of the resources that you use in your practice?

DR. KATHY NGUYEN
You mentioned the American Diabetes Association and, like you, it's one of my favorite, go to websites to give to patients because there's a lot of great information that's patient friendly that for people that want a little bit more advice on how they can manage your diabetes or just want to educate themselves. You mentioned nutritionists. Some patients don't realize that at Optum/WellMed, we have resources under our umbrella to help. We have pharmacy teams and social workers. We have disease management nurses. So, we have a lot of resources to help patients have the tools to manage their diabetes better.

DR. TAMIKA PERRY
A lot of these resources are my favorite price, which is free. Zero is the best number ever when it comes in terms of spending money. For example, on the ADA website, my mom was able to download a book called Soul Food for Diabetics. It was still the traditional food that she likes to cook. However, there were nuances in it where it didn't have such a carbohydrate load. And it was still good.

RON AARON
The other challenge, of course, is salt. Now we are as a nation saltaholics.

DR. TAMIKA PERRY
Right. Salt is good on french fries, but it's not necessarily good for us. It contributes to hypertension. Hypertension and diabetes most certainly are most often married. But it's not a good marriage. In fact, we want them to separate and break up. Dr. Nguyen, what do you see in your practice?

DR. KATHY NGUYEN
Yes. Like you mentioned, a lot of times it's like a triad. You have diabetes. Often these patients also suffer from hypertension, high blood pressure and they often have high cholesterol. Like we discussed earlier, diabetes is a very high risk for heart disease. So, with that being said, controlling blood pressure and lowering cholesterol are key. We know that salt intake can have some effect in your blood pressure. So yeah, definitely all three often go hand in hand and often things we are discussing at one time with the patient.

RON AARON
When you talk about patients who are pre-diabetic, if you are able to get them to modify the way they eat, to increase their exercise, can you then see them move away from pre-diabetic into a healthier A1C number?

DR. KATHY NGUYEN
Most definitely. We know that earlier intervention can help prevent the patient to make that progression towards the actual diagnosis of type two diabetes. We've touched on this a few times already. Little changes can go a long way. So, oftentimes with the pre diabetics, I may give them a goal. Let's try to lose 5% or 7% of your weight. A lot of times that's maybe 10 pounds. Very doable. I give them a short goal to work towards, but it can make a big difference in terms of even seeing lower A1C. I had a patient, a good example, he's lost about 100 pounds over the last three years. He was diabetic. He had started at a maximum A1C in the 9Õs. He is dialed down to a normal A1C of 5.6. ThatÕs just from losing weight. Diet, exercise, he did all those things.

RON AARON
When that happens, do you then change the diagnosis so he's no longer listed as diabetic?

DR. KATHY NGUYEN
I still consider him a diabetic, but he is controlled with diet. He was able to get off medication, but he is still considered diabetic.

RON AARON
You mentioned medications. Before we run out of time, there have been some major improvements in the kind of medication available to people with diabetes. What are some of the medications that you prescribe and what's their effect?

DR. KATHY NGUYEN
There are many treatments for diabetes. Like you mentioned, some newer ones that have gained a lot of popularity that people are probably seen on TV. One pill that's used often is Metformin. It's still number one for many people because of the cost. It's generic, so oftentimes no cost to the patient. It helps the body use insulin more efficiently. We didn't get into some of the science behind diabetes, but type 2 diabetes, which I mentioned are a majority of diabetics, they make insulin, which is a hormone that tells your cells to break down glucose. We have sufficient insulin, but it's not being used efficiently. So, metformin helps to reduce what we call insulin resistance. We have insulin, which is the hormone we make overtime. Type 2 diabetics do not make insulin, so we have to give it to the patients and replace it with insulin injections. A new class that's really gained popularity, like I mentioned, is a class called GLP one agonist. Those come by names like Ozempic, Trulicity, Mounjaro. These have really revolutionized treatment diabetes because they help with weight loss and also a lot of data with its reduction in patients risk of cardiovascular events. So, a lot of patients are getting on those.

RON AARON
The Ozempic-type medications that are so expensive.

DR. KATHY NGUYEN
Correct. That's why I mentioned Metformin. For some patients, that's the best first line treatment because budget. Not everybody can afford to pay $30 or $40 a month for Ozempic. Metformin still has a role in treatment, and it's a good choice for a lot of patients, especially if they're early on in their diagnosis.

RON AARON
Medicare now covers it. Does it not?

DR. TAMIKA PERRY
It does. It depends on the plan and which one, but yeah, it does. Sometimes they show a copay associated with it, and that's what Dr. Nguyen was referencing when she said the $30 or $40. Tier three is like a $47 copay, and sometimes that still poses a barrier. I like to tell people first thing I do is what's in the best interest of your body, then what's in the best interest of your pocketbook? A lot of times we can make them align.

RON AARON
I like that. We've got about a minute left, Dr. Nguyen, as you think about the kinds of issues that people with diabetes face, what are the biggest challenges they have? Someone walks in, you do an A1C, they come back and you diagnose them with diabetes. A shock at first. What then do they do?

DR. KATHY NGUYEN
For a patient, we've been emphasizing the key is just education. As soon as they're diagnosed, just educate themselves, have the doctor educate them. The more information the patient has, like I said, that's power to the patient. They can better control their symptoms and be more aware of what's going on in their body. That's number one. Learn more and get educate.

RON AARON
And don't be afraid.

DR. TAMIKA PERRY
Don't be afraid.

DR. KATHY NGUYEN
Yeah. Don't be afraid. There's a lot of options out there. With the work and help of your doctor, it can definitely get under control with the right tools and treatment in place. So, yes, definitely a lot of people that can live a good, healthy, quality life with diabetes, as long as it's under control.

RON AARON
Well, perfect. Thank you. We really appreciate you coming on, Dr. Kathy Nguyen. You find her at Optum - Cross Ridge in Clermont, Florida. Our co-host, Dr. Tamika Perry, thank you for being with us. It's always been great. I'm Ron Aaron and thank you for listening to the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and 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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