It's time to be well with your health. Welcome to the Adventist HealthCare and You podcast. I'm Shanna.

And I'm Nimeet.

Hi, Nimeet. How are you?

I'm great. How are you doing?

I'm good. Today, we're talking about diabetes. Always a hot topic.

Yes.

I feel like we always get a lot of questions and engagement from our listeners and from the community when we talk about diabetes. And we have a great guest today, Laura Previte.

She is a diabetes nurse educator at Adventist HealthCare. Welcome, Laura. You've been on the podcast before, and we wanted to bring you back because diabetes continues to be a serious concern and a chronic condition in the United States. Can you talk about the different types of diabetes?

Sure. Diabetes is all about the body not using insulin correctly, and that's why insulin's a hormone. That's why it's an endocrine disorder because it deals with hormones. But there's a big difference between type one and type two diabetes. There's a difference between prediabetes and type two diabetes, and then there's also gestational diabetes.

So to kind of reverse back and go back to type one diabetes, type one diabetes is an autoimmune issue. There's usually some kind of a virus or something that has caused the body to destroy the cells that make insulin. And so people that have type one diabetes, they don't make any insulin at all, so they have no way to lower their own blood sugars unless they give themselves insulin injections. That's kinda mandatory.

In type two diabetes and prediabetes, we're dealing with something called insulin resistance is usually the culprit. And that means your body's making insulin, but the cells just are resistant. They're not responding like they're supposed to, and this allows blood sugars or yeah. Blood sugars to stay in the bloodstream for longer than they should, making those blood sugar averages higher. Prediabetes is kind of this, like, I call it the land of golden opportunity because it's when blood sugars are a little higher than normal, but not high enough to be called type two diabetes. So we measure that with that hemoglobin a one c number to get those diagnoses.

The other main one is, gestational diabetes.

And gestational diabetes is when blood sugars are high during pregnancy. So, like, your blood sugars weren't high before you got pregnant, but now you're pregnant and we do this test where we challenge you. You drink this really sugary drink and we see how does your body manage this big, like, tidal wave of sugar. And if your blood sugar is too high after, like, an hour or two hours or three hours, we do different times testing there. Then that's how we diagnose that gestational diabetes. So it's unique to the pregnancy itself.

Okay. Laura, can you, actually talk about what you do at Adventist HealthCare? What is a diabetes nurse educator and why having someone like you around is really important?

Yes. So I am a nurse by trade, and I have couple different roles. I work with our clinically integrated network and our what's called a CTO and work primarily with our primary care offices that are in our network, and they refer patients to me that have prediabetes, type two diabetes. And I do get some type ones every now and then as well. So I provide one on one education and support. It's very individualized.

But I also teach community classes that are open to anyone. So you don't have to just be a patient in one of our doctors' practices, provider practices, anybody. I've even had people from out of state sign up for these classes. So I teach, like, workshops and nutrition classes and things like that just to teach people the basics.

K. So having a coach like you can help get people through those distressful moments. Right? Okay. I don't have to do this by myself. Exactly.

Yeah.

I think there's, like, a whole medical aspect of the people talk about.

You know, you need to take insulin. You need to go to your doctors. You need to watch, you know, diet and exercise, like, you know, do this.

Take all this medicine.

Exactly. But I think the emotional aspect of it is what people don't typically talk about or what peer support they may need. Because to your point, like, you know, it's a it's a day to day. It impacts their day to day life and, like, how do they control it? And for some people, it's a new disease for them if they're if it's not autoimmune.

Initially, you highlighted really well all different diabetes. I've never heard somebody say it so clearly in different aspects of diabetes. So I think, it's so valuable for you to say that. Now with a lot of the upcoming technology, like, how how's that impacted some of the disease management or provide help to our patients?

And treatment. Right? It's treatment technologies. I mean, insulin pumps, you know, the elephant in the room, the new weight loss medications that are also for diabetes. What's going on in the world of diabetes today?

There's a lot, and it's happening pretty quickly. Yeah. Of course, you know, insurance coverage and stuff for a lot of people with some of the stuff is, of course, lagging behind a bit. But, yeah, the continuous glucose monitors are a really big deal.

I love them. I try to get people to use them when they can because they can visualize. They can see what their blood sugars are doing. So if you know anything about blood sugars, people do finger sticks.

Right? That's been our traditional way to check blood sugars for the last couple decades. And so finger stick is like words. Right?

Like, maybe a thousand words. Right? This can tell us, you know, what your blood sugar is at this specific point in time. But with a continuous glucose monitor, we get a blood sugar reading every couple minutes, and so it paints a picture.

Right? It's a story it tells us. So, you know, I love people even if they only use a continuous glucose monitor for a couple of weeks just to get an understanding of how their own body responds to the food state, to stress, to illness, to exercise, to being sedentary. Mhmm.

The continuous glucose monitors are just invaluable tools. I love them because it makes my job so much easier because I can say, hey, look. Look where our opportunities are. What did you eat for breakfast yesterday that made your blood sugar go up high?

Right? We can talk about that and then talk about, you know, weaving in all this education stuff. Right? What are you eating and what did you do?

What could we have done differently kind of thing? Yeah. So that's continuous glucose monitors. And the good news is is for people that it's not covered for with their insurance, they now are selling them over the counter.

So you can order them online. The FDA has approved them and you can get them over the counter.

Oh, that's nice. That's that's that's good access.

Fantastic access. So very excited about that.

The insulin pump, Shanna, you mentioned that the technology there is just growing by leaps and bounds. They have artificial intelligence that's, you know, learning glucose patterns and some of them you don't even have to count carbs. It's just making it so much easier. It's taking a lot of that burden especially off the type one diabetes and the type two patients that are insulin dependent that, you know, just don't make enough insulin anymore that require a lot of insulin, they can also benefit from insulin pumps. Those are probably the two biggest things and you mentioned the these medicines. So the class of medicines, the GLP one Adventist, that's like Ozempic, Menjaro, Zepbound, Wegovy. Mhmm.

You know, some of these have now been approved for weight loss specifically.

Mhmm.

But, you know, initially, yeah, they were designed to help people lower their blood sugars. And it does side effect of slowing down your digestion and curbing your appetite was kind of a side effect. Mhmm. But, you know, what they've also found now with, you know, all the research that's been done over the last couple years is that these medicines also have some cardiac and kidney benefits as well.

So, you know, not and not just to mention, you know, like, all the weight loss as well. Yeah. You know, the benefits that we get from that. But there's another class of medicines called SGLT two inhibitors, and that's things like Jardiance, Farseek.

If you watch TV, I think there's some snappy We might know all the music to them.

Yeah. Exactly.

So those SGLT twos, they also are utilizing the kidneys to help your body get rid of extra sugar.

But what they have found and I remember when these medicines first came out was when I first got into diabetes and everybody was like, why would we use people's kidneys to get rid of sugar? Right? We're trying to protect their kidneys all the time. Why would we do this?

And now we've got over a decade worth of research that says, actually, it's protecting your kidneys by letting those kidneys, release that sugar into your urine where it doesn't normally go. But there's also cardiac benefits for people with, like, heart failure and heart issues, cardiac issues. So they're now approved by the FDA to be used solely for those purposes, not just diabetes. Plus, if you have a history of other issues, now it's like, hey.

If you have a patient with heart failure, you can give them these medicines. If they have kidney issues, you can give them these medicines even if they don't have diabetes.

So and that you mentioned, like, the cardiac benefits.

A lot of times, those that have diabetes also can have, you know, heart disease as well. So they Correct. A lot of times, they go together. So it's kind of helping both ways.

So Yeah.

Seeing good benefits from all of them.

They're just wonderful medications.

Okay.

So it sounds like there's a, you know, combination of technology with, like, continuous glucose monitoring to give, like, patient specific, patient centered care to a specific patient.

Very personalized.

Very personalized. Thank you. Mhmm. And, you know, and in terms of, like, the upcoming drugs that are coming out that we're still finding out more about, and I think there's so much room for, have additional medication for diabetes and other diseases as well. So I think there's a lot of breakthrough that is happening actively, sounds like. Yeah.

Oh, yeah. It's just constantly. I was just at, the American Diabetes Association Clinical Update Conference in January and, yeah. It's just everything is just like leaps and bounds.

What are some common misconceptions that you encounter about diabetes?

Probably one of the biggest ones is especially people that are newly diagnosed with type two diabetes is they're always looking for what did I do wrong. Right? And they feel like it's their fault. It's, oh, it's because when I was twenty and I I drank Coke all the time and I ate candy bars or whatever.

And, you know, I try to let them know that, well, diet, yeah, has an impact on all of that. What you eat has an impact. What is actually making your blood sugars high is stuff that's going on inside your body. Right?

This insulin resistance. Maybe your body not making enough of that insulin and letting them know that this is something that's, like, kinda out of their control. But, again, there are things that you can do to help control it. Right?

So we can watch what we we learn how to eat healthier. We learn to move. We learn to that if we lose weight, we can lower that insulin resistance so that insulin works better and it lowers your blood sugar in a more timely, efficient manner. And all of that, again, giving that power to the patient.

Right? You can do this. I think one of the other things is a lot of people think that people that are overweight and obese, they're the ones that have diabetes. Right?

It's just kind of a stereotype that's out there. And so that's a huge misconception. I work with a lot of patients who are not, like, morbidly obese. Right?

They do not have morbid obesity, and they still have diabetes. I have people that have normal body weights. You know, their BMI is normal, and they have type two diabetes, and they're like, I don't understand it. And so what we do know is that ten percent of people that have type two diabetes are not overweight or obese.

We also know that there's a huge population of people who are overweight and have obesity, and they don't have diabetes. They don't even have prediabetes.

So there is a kind of a genetic component to some of this as well that people have to understand. And sometimes, you know, there's other little culprits lurking around like stress, People that live in a lot of stress or that internalize stress. Stress makes your blood sugars higher. Stress increases insulin resistance.

And it's causing people to do things like stress eating. Right? They get out of their normal behaviors because they get so caught up in all of the stress. So managing stress is also another big part of that as well.

Considering all the complications with diabetes and, like, all these factors you have to consider and you may have diabetes or maybe prediabetes, how important is to have a a relationship with your primary care provider, and what role do they play in this?

Especially since it's somewhat silent too, as she was said earlier. Yeah.

So that's a good point. And, you know, diabetes is complex. You know, we go to the our primary cares, and there's, like, a million things on the plate in addition to diabetes. Yep. Right? And so it's so important there to go to those primary cares because they are, you know, they're like our gatekeepers or our quarterbacks.

Our first line of defense. Exactly.

Right? And they're the ones that are, you know, saying like, hey. Right? You gotta have that eye exam done every year.

Right? We wanna check and make sure your eyes are the only place that we can actually see blood vessels to see what the condition is of, you know, your the health of your blood vessels. You know, we can't look anywhere else in your body unless we cut you open. So, you know, looking at your eyes, getting that good retinal exam, that dilated retinal exam from an ophthalmologist is a really, really important thing to do, and that's where the primary care should be staying on top of that, right, every year telling you to do that, doing foot exams at least once a year and making sure you don't have any kind of sensory deficits.

The other things, you know, is running certain lab tests. Right? We wanna check that cholesterol level as you mentioned earlier. Right?

We know heart disease hand in hand with the diabetes, so we wanna pay attention to those cholesterol levels.

And diabetes is progressive. So seeing your primary care doctor regularly can help you track how you're managing it and if it's out of control or under control.

Exactly. Or do we see start seeing a worsening trend Yes. Right, then we can do those referrals. Maybe you need to go see a kidney specialist or cardiologist or neurologist depending on what the issue is.

Yeah. But they'll provide those referrals, those primary cares. They're gonna keep up to date on those lab work. There a lot of the primary cares are managing type two diabetes, not so much type one, but type two.

So, you know, they're the ones responsible for tweaking your medication.

So I'm making those referrals to people like you.

Right?

You know?

You People forgot about me.

Yeah. Yeah. Me too. Right. Exactly. Yeah.

Alright.

I think that's great because then they finally, like, you know, put the picture together and, like, look at the story from from the whole patient body and, like, all the labs and assessment when they do it to understand how the diabetes itself is playing a role in this and how other risk factors, whether you have cardiac history or whether you have other genes in your body that may impacting this as well, they could put a whole picture and they refer you appropriately.

And, you know, we've said this before, Nimit, but having that relationship with your primary care provider is really important.

But finding the right one exactly.

Can help you and can be another coach for you too, you know, and be your partner.

Yeah. So I agree. I always tell people finding the right doctors is like finding the right pair of shoes.

Some of us have less trouble with that than others.

Every shoe's right.

I think we've covered a lot today. Any final thoughts that you wanna share before we go? I know, Adventist HealthCare, as you mentioned earlier, we offer classes around diabetes. It's open to the community, so take advantage of those. Oh, some of our listeners, if you have a friend or family member, take advantage of those. Tell them about it. If you're curious about diabetes or you're right on that cusp, take advantage of those free classes.

No. I totally agree. I think, you know, anywhere you can get support, whether it's your health care provider team, a diabetes education specialist like myself, family members, friends, you know, I think you gotta look for that support where you can get it, and don't be shy about it. Right?

And don't, you know, just kinda go to the doctor and just, you know, ask questions when you go to the doctor. That's a big thing. Right? If you don't understand something or they prescribe a medicine, you know, a lot of people read those little inserts and they start freaking out.

Right? I'm not telling you not to read the insert, but have a conversation with your doctor before you say, hey, I'm not taking this. Right? Have that conversation.

Talk about the risks and benefits. But, yeah, as far as the classes, you know, I teach, you know, some in person online, offerings you can see on the Adventist Healthcare website.

Come back to them as many times as you want.

I just Come back to them as many times as you want. I just had somebody last week come back for a refresher. She came a year ago and said, you know, I just felt like I needed a refresher on my nutrition concepts, and that's great. You know, I encourage people to do that.

That's really great.

And the research stage is so often right sometimes.

So keeping up with that, it's also good.

Absolutely. Research is available and what the research says today.

Yeah. Alright.

Sometimes there's just not enough time to go over everything.

Right?

Well, I mean, it it is overwhelming too when you get a lot of Right?

Well, I mean, it it is overwhelming too. When you get a lot of information, it's overwhelming. You're like, all of this stuff is great, and you think you're gonna remember it. And then a couple months later, you're like, what was that that I heard? And then so it's, yes, take them again. Like, it's Yep.

It's sort of there for me.

It's remotivating and it's what it's there for. Exactly.

Yeah.

So I call it the drift.

Right? It's so easy to drift. Right? Yeah. You're like, well, I'm doing really good.

But so it's not gonna hurt if I start, you know, a little more of this or a little more of that or if I want this much and Yeah.

Right? And the next thing you know, things start kinda creeping up.

But and that's the beauty of those continuous glucose monitors for people that wear them is that they can keep tabs Nice.

On that. Alright. Well, thank you, Laura. You'll come back again. Right? Like I said, diabetes is a hot topic.

I don't think we're ever done talking about it.

Sure.

Absolutely. I'd love to.

If you are in need of a primary care provider, visit adventisthealthcare.com. Click on find a doctor.

To find upcoming classes and events like what Laura was talking about, we offer, diabetes classes and a bunch of other types of classes as well. So visit adventisthealthcare.com and click on classes and events. For additional diabetes health resources, you can visit adventisthealthcare.com and click on living well. And as always, we'd love to hear from you. You can let us know if you like the podcast by leaving a review, or you can email podcast at adventisthealthcare.com. Let us know what health care topics you want to know more about.

Don't forget to subscribe to the podcast so you can get new episodes. Thank you, and well.