Hi everybody, we'll start in just another moment. Thank you for joining us today.
Okay. I see more and more people are joining. We're going to go ahead and get started.
Good afternoon. Thank you to everyone for joining us today. We'll begin our health chat. I'm Shanna.
I'm your moderator for today. We have a wonderful health chat scheduled for today, Managing Diabetes in the Real World. We've had an excellent response to this health chat and our experts Laura and Doctor Newsome, are really looking forward to providing some meaningful information today.
Before we begin, everyone is muted to limit any background noise.
During today, if you have any questions for experts, can put them in the Q and A down at the bottom or the top of your screen depending on your Zoom setup.
And we'll be sure to get to those as our time allows. We did have, like I said, we had a great response for this Health Chat. Had a lot of people submit questions ahead of time. So we'll be answering those as well today. We ask that you please only submit any general health related questions. For anything very specific to your case, please, you know, reach out to your healthcare provider.
And we're recording today's Health Chat so you can access it in a few days on Adventist HealthCare's blog so that you can always have access to this good information.
So I am pleased to introduce our experts for today, Doctor T Newsome. He is an internal medicine physician with Adventist Medical Group in our White Oak office in Silver Spring. And then Laura Previte, who is a diabetes nurse educator with Adventist HealthCare. And she works specifically with those with diabetes. So thank you both for being here today.
Thank you for having me.
Thank you.
All right. Thank you.
We're going to go ahead and jump right into our first question. I'm actually going to stop sharing my screen so that we can see you all. So first question for today is for Doctor Newsome. Let's start out with something very, just kind of gets everybody thinking about diabetes, but what are the recommended A1C and other blood sugar numbers that, people on our call, on our Zoom today should know?
Yeah, that's a great question. So, we'll start with the A1C number. So, hemoglobin A1C lets us know how well your blood sugar is doing over a span of about two to three months.
And so a non diabetic or non pre diabetic, quote unquote normal A1C is anything less than five point seven. So that five point six or below is ideal for non diabetic or non pre diabetic. Pre diabetes between five point seven and six point four for your hemoglobin A1C, and then anything above six point five or above is considered in the diabetes range. So those are the A1Cs ranges that you should keep in mind.
Blood sugars are a little bit more complex and I won't get into all the minutiae of it, but ideally at least a relatively easier blood sugar to keep in mind if you're non diabetic. Usually if it's fasting, less than one hundred is ideal, anywhere between seventy to one hundred fasting is ideal. Eighty to one hundred twenty for diabetics for fasting, or if you haven't eaten or drank anything in the past eight hours or so, there's a relative range for a diabetic patient.
Those ranges can vary depending on the patient and your age and whatnot, but A1Cs are usually a pretty good thing to hone in on when it comes to those numbers.
Those are some really good numbers to keep track of as people progress.
For sure. Yeah, absolutely.
Okay. And then one other question that came in is, has the range changed over time?
Yeah, really good question.
So the range has changed. I think in the past, like years ago, they used to be a little bit more stringent in terms of A1C ranges, but they were finding that especially older patients who were having a lot more issues with very low blood sugars, which can be pretty dangerous for individuals. So we become a lot more lenient when it comes to A1C, especially for our older patients that have predisposition to having low blood sugars because if they're on insulin or even medications that can drop your blood sugar, it can be very dangerous and even cause death if your blood sugar gets too low. So we have gotten lenient over the years as it pertains to the A1Cs, especially for our older patients.
Okay. So really important to stay in touch with your doctor about what's right for you.
For sure.
All right.
Question for Doctor Newsome again, and Laura, if you have anything to add, please jump in.
You mentioned prediabetes. What is that?
Good question. So prediabetes can be a little bit tricky. So I kind of look at it or think about it in a range of non prediabetic, prediabetes, and then diabetes. So once you become a diabetic, it can be really challenging to, I guess, undo the diabetes if you will but prediabetes is that range where you're starting to teeter on becoming a diabetic and it's really, really important to really follow the instructions of your health care provider and really hone in on your diet and exercise to make sure you don't teeter over into that range of diabetes.
So, with pre diabetes, that's when your body is still making insulin but you're starting to have what's called insulin resistance. So, when the body is making the insulin, it's unable to use it as well as individuals that are non diabetic or non pre diabetic. And so even though you're making insulin, it's hard to get the blood sugar out of your bloodstream into your tissues to utilize it. So it becomes quote unquote resistant.
So the insulin's unable to be used very well. So your blood sugars end up being higher than what everybody else's or what they should be. So that's, it's kind of like a rough detail, a rough explanation of prediabetes. So it increased insulin resistance has occurred for prediabetics.
Thank you. You. I know it's a complicated disease.
It is. It can be very complicated for sure.
Which is why doing things like this is really helpful for people to manage it.
For sure, yeah.
Another question for you, Doctor Newsome, that came in, and then we'll switch over to Laura.
We have a lot of questions come in about insulin and how people should manage their insulin, the highs and lows of blood sugars. What is something you can share about to help sort of guide people around insulin use?
Yeah, it's a really good question. So, my recommendation for insulin use is make sure you have a plan with your health care provider. Whoever is managing your insulin, sometimes it's your primary care provider like myself, sometimes it's your endocrinologist.
Those are the individuals that are gonna should be making formulated plans with you to make sure that you know if you're doing like a sliding scale insulin, how to navigate that sliding scale. If you're on a long acting insulin, which doses you should be taking. When people get into trouble, if they start to try to make too many adjustments on their own, they end up having very low blood sugars or excessively high blood sugars because there is a science that goes behind those type of management skills, which should be done by your medical provider, your physician. So it can be kind of hard to navigate that for in a general aspect.
So I usually will just say, make sure that you talk to your healthcare provider so they can make a plan for you because it can change and based off of what's going on in your life, if you're or if you're fasting because some people, various religious reasons go through fasting periods and whatnot. All those things can change. It's not one size fits all, unfortunately.
Okay, thank you. So again, we emphasize again staying in close contact with your healthcare provider.
Please, please, please.
All right, Laura, a question about, and this is actually a great segue from what you were saying, Doctor Newsome. Everybody's different and and and life, you know, kind of throws you things and and you may have to make adjustments. Eating out. How can someone with diabetes handle eating out?
Because oftentimes there's not any information about the nutritional what they're getting when they're eating out.
Yeah, that's a great question. And it's a challenge a lot of us face, especially, you know, because eating out is fun, right? It's a big social event for all of us. So I would say one of the most important things to do is to look at a menu before you go to the restaurant and get an idea before you go what you're going to eat.
That way you don't get tempted by things on the menu that maybe aren't going to be so good for your blood sugar. You can look up nutrition facts online. You can just search for specific restaurants, especially chains will have all their nutrition information. But even if it's not a chain restaurant, you can certainly look up a specific dish to at least get an idea of how many carbs are in this dish usually.
Other things you can do when you're trying to eat healthy, right? That's what this is all about, being healthier. You know, avoiding fried foods, meals that have rice, pasta, breaded items, cream sauces. Those are things that can really sabotage blood sugars.
If you have an option for your protein, like for some kind of meat or chicken or fish, do grilled or baked or broiled. Don't do fried.
A big tip is that bread. What do they sit down in front of you at every meal? That basket full of bread to keep you busy so you don't realize how long you're waiting for your food.
Ask them to bring that bread with your meal. You don't want to eat that bread first. Ask for a salad first and eat that first. That's not going to raise your blood sugar, but that bread sure will.
Ordering vegetables instead of things like french fries as a side, and taking home leftovers. There's no crying, right? It's actually more economical. Split that meal in half at the beginning of the meal and have it already packed up so that you kind of portion control. So those would probably be some of the best tips for eating at restaurants that I can think of.
I love those. I can see some things I can even do myself with those tips. Thank you. You're welcome. Doctor Newsome actually mentioned, if you're traveling, might mean you have to make some adjustments.
Again, what are some tips for traveling to help you manage your diabetes?
So I can't, some people tell me all the time, I'm getting ready to go on a trip. What do I do?
The most important thing is to make sure you take extra doses of medication, at least seven to ten days, depending on how long you're going to be gone. Make sure you take extra testing supplies if you're wearing a continuous glucose monitor or use an insulin pump, definitely take extra supplies for that. So you never want to get stuck somewhere where your flight gets delayed or something else happens that delays your return. You want to be prepared for that.
Traveling with insulin is always a big concern for people. They do sell you can search these like insulin cooling cases that are really cooled. That's kind of cool, no pun intended.
They're really great. Some of them you just get them wet and it keeps them cool. So you can slip your insulin pens into those. And all you have to do is keep them wet every couple like two or three days. You just get it wet again and it keeps it cool.
Always keep medications with you. That's another big one. Don't put it in your checked luggage if flying.
Make sure you always have control of where your medicine is so you don't lose it. And if you're wearing any kind of technology, let TSA know before you go through the scanners and then you don't have to have one of those body scans. You just let them know ahead of time.
Thank you.
Doctor Newsome, next question for you. And I think this is a great question. We don't talk about this enough.
Sleep. What is the recommended amount of sleep and is it different for someone with diabetes? How can, you know, interrupted sleep affect diabetes? Talk a little bit about the importance of sleep here.
Yeah, that's a really, really good question. We don't talk nearly I know I don't talk enough about my patients, but, my patient recommends six to eight hours of sleep, for most adults.
Sleep or lack of sleep can increase stress levels and stress levels can actually have negative consequences on your diabetes or your blood sugar.
So making sure you're getting the needed amount of sleep is very, very important. Another aspect of interrupted sleep because you said that specifically, when people have interrupted sleep, they often snack, right? So, you know, choosing unhealthy snacks in the middle of the night because you're up now like, you know, I'm I'm a little hungry just because I happen to be up If you're sleeping, you wouldn't eat. So, if you're getting uninterrupted and comfortable sleep, you're more well rested, you're less stressed, you're less likely to snack on bad things in the middle of the night as well that ends up just getting stored as fat most likely. So those would be my recommendation. I usually say six to eight hours of uninterrupted sleep.
All right. Thank you. Yeah. I was thinking about, you know, if you stay up too late too, maybe you'll sleep through, but if you stay up too late, you're going to snack too. So make sure you prioritize that sleep.
Absolutely.
All right. Next question for you, Doctor Newsome. How much physical activity is recommended and how much can exercise or even just little things, physical activity can improve A1C or blood sugar numbers?
Yeah.
Physical activity is really, really important, especially for pre diabetics. I usually will really push them to make sure that they're staying very active and being consistent with their activity because the main goal for pre diabetics is to make sure they don't become diabetics or reach that six point five or above A1Cs. Even our diabetics, I always tell patients that there's a big difference between diet. There's a wide range of diabetics.
There's very well controlled diabetics that are on few medications, if any, what most are on, some type of medication. Then there's uncontrolled diabetics or poorly controlled diabetics that tend to need a lot of medication, especially insulin and things of that nature. So you never want to get onto the latter end where you're uncontrolled. But as it pertains to your question of exercise, exercise can lower A1Cs in a tremendous way, especially if you're consistent with it.
I don't tell patients that they need to run marathons weekly or anything crazy like that, but three to four times a week of strenuous exercises, getting the heart pumping, you'll feel better, you'll be more energetic, your blood sugar levels will stay more constant and consistent. The likelihood of you needing more and more medication to keep your blood sugar under control becomes less and less likely when you're active. So, I usually recommend depending on your age, of course, three to four times a week of some type of strenuous exercise for at least thirty to forty five minutes is is usually a good amount.
Okay, thank you. Laura, along those lines, you know, you work with diabetics every day.
What are some tips for staying motivated when it comes to exercise? You know, busy lives, busy schedules, all of that. How can we stay motivated?
That's hard for a lot of people, right? It's kind of getting into a routine, making it a habit. But I really think honestly, it's understanding the benefits of it should be the biggest motivator because we know that exercising is going to help lower our blood sugar. So that in and of itself is like, yay, right? Things I can do that aren't medication and aren't food restriction. That's the way people feel, I have to restrict my food to lower my blood sugars. But just moving can help lower those blood sugars naturally.
And in addition to that, other motivation is that, right, it's going to strengthen your muscles. It's going to burn your calories. It's going to help you potentially lose weight. It can prevent things like heart disease and cancer.
So there's so many benefits to it. That's kind of my motivation to exercise personally. I know that if I exercise, I'm going to take care of the vessel that I live in, right, my body. And I'm going to have a much better quality of life because of that.
Thank you. Thank you. Well, those were some of the initial user submitted questions that we have, and I have a few more to go into. But if anybody does have a question as our experts are talking you feel free to drop those into the Q and A there and we'll be sure to get to those if time allows. So let's continue on.
Doctor Newsome, you mentioned we've talked about a couple things for managing lowering A1C exercise.
What are some other ways to lower your A1C and control that number, maintain that number.
Yeah.
Diet and exercise are probably like the base ones. We talked about exercise but definitely diet. So, Laura had kind of mentioned this before, avoiding the breads, the pastas, the rice.
I try not to implement avoid at all costs type of behavior. I just don't think it's always the most sustainable. I tell patients that, you know, it's it's it's helpful if you just treat yourself. You know, you had a little treat on Monday.
You maybe had a little bit extra pasta than you normally do, then, try not to do that again before Friday, right? You know, give a give a span of at least four or five days in between so that way you're spreading out those carbs and you're also not miserable, right? Like, you you give one life to live and you know, you deserve to to treat yourself especially for good behavior. You exercise four or five days that week, you know, and you're you're it's a birthday or something.
Your your family wants to go out for ice cream. You're like, oh, I got diabetes. I don't want to eat. I, you know, and and you shouldn't every day but you can treat yourself.
So, the long story or the short is, you know, diet is definitely really, really helpful at decreasing your A1C or at least maintaining it and just being very mindful what you're putting into your body of wind, right? So, you you have the choice when you go to the restaurant, you don't have to buy the Sprite or purchase Sprite. You can get the water instead, right? So those things can really make a big difference over time when you're A1C for sure.
Okay, thank you. Going back to prediabetes a little bit, Laura, if someone is prediabetic and they want to become more educated, not reach that type two diabetes status, what recommendations do you have for resources and tips when you're in that stage? And Doctor Newsome, if you have anything to add, tack on as well.
Yeah, so I think we've touched on a lot of this already, right, is that eating healthy, eating a lot of those vegetables, lots of vegetables, lots of whole fruits. And when I say whole fruits, not the ones that have been pureed or turned into jelly, things like that. And eating healthy sources of protein. So kind of a nice balanced out diet.
I'd highly recommend anybody that has prediabetes and to finding some kind of diabetes education resources. There are prediabetes programs out there that are run by the CDC oversees a program called the Diabetes Prevention Program. But there are also local. I mean, even here at Adventist HealthCare, I actually teach some nutrition classes.
So, you know, it's really we focus on lifestyle and diet and losing weight. Those are kind of the big three modifications that people can work on to help prevent that prediabetes from turning into type two diabetes.
Okay, thank you.
Staying with Laura for a minute, we've talked a little bit about diet and a couple from a couple different of the questions.
What are your thoughts around lower carb diets?
You know, is there any recommendations around carbs and, you know, specific diets or specific tips for type two diabetes when it comes to, having a healthy diet?
Yeah, so that's a good question. I get asked that a lot, right? Can you just give me a diet, right? Tell me what to eat.
And I wish it was that simple, but it really is just, you know, I don't like the word diet to begin with because it sounds temporary, right? It sounds like a means to an end. It also makes people not feel good about themselves most of the time. I'm going to go on a diet, right?
But my question is always to people, if you're going to pick a way to eat like a ketogenic diet or a very low carb diet, something like that, the question is, can you see yourself doing this in a year, in five years, for the rest of your life? And if the answer is no, then don't do it. So what I try to get people to focus on is more of that healthy eating pattern that I just mentioned. The lean, healthy proteins, healthy fats, healthy vegetables and fruits and whole grains, lots of things like beans and lentils, avoiding those processed foods and the red meats and dark skin meat, like dark skinned chicken, skin on the chicken, foods that have added sugars, those less processed foods.
And increase that activity level along with that diet, and you're going to create this energy imbalance that can help people kind of if they're trying to lose some weight too, it's a nice complement is increasing that activity level along with the diet modifications.
Wonderful. Thank you. Some good tips in there. Doctor Newsome, let's switch back to you for the next question or two.
Can you talk about managing type two diabetes with possibly someone who has another condition like chronic kidney disease, for example? What are some tips or ways to manage those together?
Yeah, that's a really good question.
A lot of people don't realize that diabetes or elevated blood sugar can actually cause damage to your kidneys. So if you do have chronic kidney disease, it's very, very important that you're mindful of what you're doing that might be harming your kidneys in the process. Chronic kidney disease also has a very wide spectrum in terms of the severity of the chronic kidney disease but ultimately, if you have chronic kidney disease plus heaven forbid, poorly controlled diabetes, you can tip over into what we call end stage kidney disease which can be dialysis bound if you will and which nobody necessarily or shouldn't want.
But overall, you know, things like ibuprofen, Advil, Aleve cause more harm to the kidneys, elevated blood sugars in general. So, if your A1Cs are not well controlled or if your doctor is using the term poorly controlled diabetes often at your doctor's business, that probably means you're causing more and more damage to your kidneys. So, making sure that you're well aware of what type of medications, what type of foods is a little bit tricky for chronic kidney disease, not to say they don't necessarily matter but they're not quite as significant but things like high blood pressure, right? We
don't talk about that as well enough but that can cause more damage to your kidneys too. So, if you're individual that has normal blood pressure and then all of a sudden, you're eating lots of things with salt for whatever reason and your blood pressure gets too high. That for patient with chronic kidney disease and diabetes is going to cause insult to injury to your kidney, your kidneys overall. But I think the biggest thing is listening to your healthcare provider, doing exactly what they tell you to do as it pertains to follow ups, managing your blood sugar, as well as making sure you're monitoring your chronic kidney disease.
There's various tests that need to be done over time to make sure that your kidneys are staying the way they need to be.
Okay, thank you. We've touched on medication a little bit during this talk, talked a little bit about insulin. A question came in around metformin and how does metformin work when it comes to diabetes?
Doctor
Meeks, that one's for For sure, yeah. So metformin is a, it's an older medication and pretty complex in terms of how it works, but nonetheless, that's a really good question. The easy way to describe how metformin works is it helps your body. We talked about pre diabetes and insulin resistance.
It helps the body utilize insulin a little bit more readily in the body. It helps your body actually, the liver to function in terms of glucose production. It helps decrease the production of sugar from the liver because your liver actually produces sugar for the body. That's one aspect that metformin helps with.
Decreasing sugar that's created by the liver. Obviously, high sugar levels would be bad for patients with diabetes. That helps decrease that. It also decreases intestinal absorption of sugar.
When you consume sugar, your body obviously has to absorb it from your gut into your actual bloodstream. Metformin will actually decrease how much that's actually absorbed, decreasing the amount of sugar in your bloodstream overall. It does, we talked about insulin sensitivity or increase the sensitivity so that insulin resistance that occurs, especially for pre diabetics or even diabetics, it helps to improve that or make insulin more sensitive in the body. Those are some of the biggest ways that metformin works in the body. Then it also can help you lose weight, not in a severe way, but definitely somewhat. It can definitely have some effects on weight loss in positive way.
Okay, thank you. Let's switch over a little bit to Laura for a second. You've mentioned this a few times, Laura, continuous glucose monitoring, monitors. Are they accurate? What are some of the pros and cons of using, a continuous glucose monitor?
So I'm a little probably, I don't know what the word is. I'm a little, I don't want to say prejudiced, but I can't think of the word and I apologize. I'm biased. There we go. I knew there was a good word for that. I'm a little biased because I love continuous glucose monitors because they make my job so much easier when I'm working with somebody that has one because I get to see what their blood sugars are doing And I get to show people what their blood sugars are doing and we can actually see it. There's no guessing.
With that said, if we're going to compare it to a blood sugar, like a finger test, like from a glucose monitor, picture that finger stick when you do it. It's like a snapshot. It's a moment in time of what your blood sugar is. It gives us no past or future information. Continuous glucose monitoring, because they check your blood sugars every couple minutes, it creates a story. Instead of being that snapshot, that one moment in time, we get to see the past, the present, the future. We get to learn trends and patterns, the effects of foods and exercise.
From an accuracy standpoint, there's been tons of research that's been done on this. And of course, the FDA does their review of all of these devices as well. And these devices are what we call they have a MARD. And MARD is this way that they determine the difference between what the person's actual blood sugar is from a lab draw, right, where we actually draw all the blood out and measure the sugar, and what the sensors, the continuous glucose monitor sensors, what that reading is.
And these under ten percent is considered acceptable. So like a ten percent difference between the finger stick or a blood draw and the sensor reading. And most of these sensors now are around eight percent. So pretty accurate.
They are technology. I will give you that. That is probably the downside is that it is technology, right? Things like sleeping on them, or sometimes they fall off or sometimes they just malfunction or your phone has a fit, you know, stuff like that.
But if you can get over kind of all the technology that we deal with these days, know, you can kind of set that aside. They are really an excellent tool to help people learn about their blood sugars, whether they have prediabetes or type two diabetes.
Wonderful. Thank you. Along those lines, Laura, glucose testing strips.
Any tips on how to use those, when to use those, when to talk with your doctor?
Yeah. So if somebody's doing finger like blood sugar testing, and they're testing every morning, right? Fasting before they eat anything. And they're like, why am I doing this? Right? What am I doing with this number?
And I usually agree with people. I'm like, yeah, I don't know why. So I usually tell people I call it I don't know if there is an official name, but my official name is called strategic blood sugar testing is to test your blood sugar before you eat. Our goal is to be less than one hundred thirty according to the American Diabetes Association.
And then check your blood sugar again two hours after the beginning of your meal. So if I ate breakfast at eight am, at ten am, set an alarm, check your blood sugar, and it should be less than one hundred and eighty. It gives you a little bit more information than just doing that once a day, finger stick, first thing in the morning. But it can also help you make some decisions about, hey, what was in that food that I ate because two hours after my blood sugar is two fifty.
So now it gives me an opportunity to go back and relook at what I ate.
So there are ways to use blood sugar testing to help you get some really good information.
But again, it's not as good as a CGM. I sound like a commercial, but I'm just telling you.
I love CGMs.
You. Question that came in in the Q and A about testing strips, actually, so I figured I'll tack this on here is, have you heard about the over the counter A1C testing strips? Are those available? Any tips on those?
Yeah, I've seen those.
And I think they're pretty accurate.
So I mean, if somebody wants to know what their A1C is, in between doctor's visits or something like that, you can certainly purchase those. I think Amazon even sells them. I do believe they're pretty accurate. Make sure it has been approved by the FDA as a device before you use it.
The only thing I would point out to somebody is that an A1C is your average it's a reflection of your average blood sugar over the last three months. So if you're going to check your A1C every day, you are not going to see a huge difference because we're looking at long term retrospective stuff from the past, the last three months. So checking it that's why the doctor usually only orders it every three months to six months is because it's not going to change significantly if you check it every week or every four weeks. So just kind of keep that in mind is that it's not going to change significantly.
It's not like a finger stick. Not a great question for your visit with the doctor.
Absolutely correct.
All right.
Along those lines, another question that came in into the Q and A that, while we're just we'll stay on this topic for a little bit.
The best way any recommendations or tips for drawing, blood with less pain with the finger sticks or do you always have to use your finger?
Laura?
Yep. That's a good question, right? Like, yep. So the side of your fingers is always better.
So don't do it like directly on the pad right here. There's more nerves here.
So go a little bit off to the sides.
The other suggestion is you have a lancing device that has the needle in it that pokes your finger.
So you may try adjusting that. Usually they have dials on them. So try turning it down a notch at a time until you get to a point. It shouldn't hurt that bad. And if you're getting a huge drop of blood, that's another sign that you probably don't need to be pricking your finger that hard. That would probably be the two things I would recommend.
Perfect. Thank you. All right. Quick time check. It's about twelve thirty three. We have a couple more questions to get to, but we're making good time.
So if anybody listening in has, some additional questions, feel free to put those in the Q and A. Doctor Newsome, if someone's, A1C goes down, does that mean medication can be adjusted?
That's a good question that I get asked often from patients and not always would be how I would answer that because A1Cs can fluctuate, right? You know, some people have good, I'll call them quarters of the year, you know, where they're exercising, they're active, they're doing all those things. They're outside, outdoors, not less sedentary and they have not so good quarters of the year, you know, where it's another three months where they're doing the exact opposite, eating things, you know, life happens as well where, you know, you're not in your best of moods that those particular two to three months, you know, you're making less healthy decisions on your diet.
I use a rule of thumb. I try to tell patients if you are consistently in a certain range of lower A1Cs and that range can kind of vary depending on the patient, then we can discuss maybe decreasing medications. One A1C in a low range does not always qualify for medication adjustments at that time. It's usually more of a trend.
You're consistently in this lower range or you repeatedly get these lower A1Cs. Of course, if having consistent or repeated low blood sugars, that's a different conversation as it pertains to adjustments to medication.
But if we're going strictly off of A1Cs and know if history of low blood sugar is subjective or objective low blood sugars, I. E. You feel it or you're testing, that I usually will wait until we get repeated A1Cs, at least two in the lower range before we make some adjustments.
Okay, thank you. I'm seeing one of the best questions that I saw that we got in the user submitted questions near the end, Doctor Newsome, so I'm going have a follow-up question for you in a few minutes.
We're going to move on to Laura and talk a little bit more about diet. We've had a couple of questions come into the Q and A. We had some actually submit some questions about some diet specific or eating specific questions. So we'll spend just a few minutes on that real quick.
Laura, is there a recommendation around brown rice versus white rice for diabetes?
Yep, I get asked that question a lot as well. So yes, so brown rice is not as processed. So I think anybody remembers what I said a couple of minutes ago about staying away from processed foods. So believe it or not, white rice is processed.
It was taken from a field and they removed all the outer layers of that grain of rice and took away all the natural nutrients and all the fiber out of it and left behind just the sugar part, the carbohydrate in the center of it. So white rice has a pretty high what we call glycemic index. So on a scale of zero to one hundred, usually in the seventy to eighty range. Brown rice, because it has a layer of the wheat still left on the outside that's got some fiber in it, it actually helps that effect on the blood sugar and it lowers that glycemic index down into like the 50s and 60s.
With that said, that's still going to have impact on blood sugar.
So, you know, the way you cook it can change the way that it breaks down.
What I usually recommend if you're a rice eater and you want to continue to eat rice is to cook your rice, refrigerate it overnight, reheat it the next day. And that kind of locks in some of the starches or the carbs or the sugars that are in that rice. It locks them up so that they can't be absorbed into your bloodstream. It again reduces the effect on blood sugar, but doesn't make it a freebie by any mean. And that's called resistant starch is what that's called. So cook it, refrigerate it, reheat it. It's going to have better impact on your blood sugar, but you still got to watch how much of it you eat.
Gotcha. Thank you. Mentioned fiber. Particular tips around fiber or in particular with older adults as well?
Yes. So fiber is our friend. I brainwash everybody that comes to any of the classes that I teach about. Fiber is your friend.
Fiber digests really slowly. It is a carbohydrate, but it's very fibrous. So it takes a long time for it to digest and it usually doesn't have any impact on our blood sugar because of that.
The trick is to increase if you're not eating a lot of fiber and you're thinking, Oh, hey, right, fiber is my friend. I want to start eating more. Don't go out and start eating tons of fiber because your body kind of has to get used to it.
If you eat too much of it too fast, you're going to end up with like gas, bloating, nausea. You're not going to feel so good. You also have to make sure that you drink plenty of water because if you don't, that fiber is just going to kind of I always picture clods of grass out in the yard and on a hot summer day, right? It's all like caked together.
It's kind of what happens to fiber if you don't drink enough water. It's going to clog things up. So you want to drink plenty of water. But I recommend just adding a few grams of fiber to every meal through the day and gradually increase that total fiber.
The recommendations currently from the American Diabetes and the Heart Association are between twenty five to thirty eight grams of fiber total throughout the course of the day. The average American is only eating, I think, fifteen or sixteen grams a day because of all the processed foods that we eat, all that processing removing that fiber. But one more thing about fiber is not only does it help your blood sugars, but it helps them be more stable. It's going to keep them from spiking up.
If you eat high fiber foods, it's going to keep that blood sugar from spiking. But it can lower your cholesterol, can decrease the risk of colon cancer and other heart related illnesses and diseases. So lots of good reasons, kind of like exercise, right? Lots of reasons to exercise, lots of reason to eat lots of fiber.
All right. Thank you. One last question around diet.
You been asked this before, but can you provide any information about cinnamon and any other sort of natural things that may help balance out blood sugar?
Yes, cinnamon. And I don't know, Doctor Newsome, if you have any thoughts on cinnamon, but I will tell you the research is very mixed on this.
The American Diabetes Association does not recommend cinnamon as any kind of a treatment. But, you know, if it's the cinnamon out of the shaker, right, or out of the container, you're adding it into your food, it's not going to harm you.
You've to watch with some of the supplements. I do believe that I read some of them can be contaminated with lead. So you definitely want to make sure for any supplement that you always talk to your health care provider first, right, Doctor Newsom?
And that you want to make sure that you buy supplements that have a verification or a certification on them from the US Pharmacopeia. USP or NSF are the two big ones. You want to make sure any supplement that you use is certified because the FDA does not regulate supplements. Berberine is another one I get asked a lot about, and there is some evidence that it can potentially have some blood sugar lowering effect.
Again, if you're going to start something like that, you definitely want to talk with your healthcare provider that's prescribing your diabetes medications because there could be interactions.
Yeah, definitely agree with what Loris mentioned. But one thing that I noticed with patients, a mistake that gets made is they feel like because they do this supplement, let's say cinnamon for instance, they don't need to take their medicine. And that's a big no no. I usually encourage patients.
If you feel strongly about the supplement, as long as you're following the guidelines that Laura just mentioned, and it's not harming you and you feel like it can be a good additive, you know, it's worth, it's worth a shot at something like cinnamon is usually not very harmful in my in my understanding of cinnamon. And so, you know, if it gives you a little bit of a boost or a drop in your A1C, why not? But, but definitely you want to keep, keep the regimen that your provider, your physician, your endocrinologist, your primary care is recommending for you. Don't think that it's going to be a direct substitute because people make that mistake often.
Okay, thank you.
Okay, last two questions, I believe. Doctor Newsome, these last two are for you.
Someone dropped into the chat about, could you speak a little on, and I believe this is another medication, JanuMet, for example, is that a different kind of medication than metformin Anything you can add on that question?
Yeah. So, JanuMet is the name of the medication. It's actually a combination pill. It's Januvia mixed with metformin, one pill that has two medications in it. Metformin, we kind of talked about its mechanism of action and how that works.
Januvia is a slightly different medication that Oh, let me take you back to Mexico. In terms of Januvia, it ultimately can help lower your A1C in different ways than metformin specifically. It's a pill that you would take.
This particular Januvia is not one of the stronger diabetes medications. It's more a little bit more of a milder medication. We kind of put them on a scale. So, metformin is probably one of the weaker ones.
It's an older medication. Januvia is stronger than metformin but not quite as strong as like a GLP one that everybody talks about like Ozempic or Mounjaro and stuff like that. It's kind of right in the middle. So, it can give you a little bit of a, I say boost, but it can help decrease your A1C.
It's pretty well tolerated for patients. It can be a little bit pricier depending on your insurance, but it's an effective medication. I like using it if your insurance allows for combination medications like that, but I like JANUVIA. It's a bump up from metformin, I would say.
Okay, thank you.
I thought this was a great question, Doctor Newsome. For someone newly diagnosed, what are the top five, maybe top three since we're getting closer to our end time, but what are the top to five, two to five questions I should ask my doctor?
Good question, yeah. I often go over this with patients that are newly diagnosed. I think the way I look at new diagnosis of diabetes, I think it can be a little overwhelming. People who hear diabetes, I think they think insulin.
Oh my gosh, I'm going be an insulin for the rest of my life. And that's not the case. Thankfully, science has come such a long way since decades ago when our, I guess my parents or grandparents were diagnosed with diabetes. But nonetheless, the quick questions to ask are I And I get asked this often, if I have diabetes today or if I'm diagnosed today, does it mean I'll have it for the rest of my life?
The answer to that is, yeah, typically. It's really hard to get away from a diagnosis of diabetes once you've been diagnosed, especially depending on what your A1C is at the time. I like to navigate patients into changing their mindset, not from diabetes or not diabetes, once they're diagnosed, more into a mindset of, am I well controlled or am I uncontrolled? So those are the big two spectrums, if you will, or sides of the spectrum you should start thinking about if you're diagnosed with diabetes.
The next question is, how should I be changing my diet and exercise? Kind of what we talked about earlier, because now I have diabetes. The things that individuals that have diabetes can and cannot do or should or should not be doing can be somewhat different than individuals that are not diagnosed with diabetes. You have to be mindful of how many carbs you're consuming, your exercise, if your blood sugar is getting low especially if you're on various medications that can cause low blood sugars.
If you're out in the sun too long or get overheated or dehydrated, that can cause a lot of very negative effects on patients with diabetes, especially when you're on medication versus somebody that's not.
That's a really good question I think patients should ask. What other parts of my body get affected when I have diabetes? Really big We talked about kidney function. That's a big one and we kind of touched on that already.
Your eyes are a big component that get affected by diabetes. Diabetics should be getting at least yearly eye exams to make sure their diabetes is not negatively affecting their eyes and last but certainly not least, your heart health takes a major hit once you become a diabetic, so risk for heart attacks and or cardiovascular disease, I should say. So heart attacks and strokes increase, especially as you get older. So those are the three really big concepts, if you will, I would say you should definitely ask, but it's, you know, just because you have diabetes does not mean you're you need to be on insulin and it also doesn't mean you need to check your blood sugar, right?
So, a lot of people think that, oh, I have to check my my finger sticks and all that stuff. It doesn't always necessarily mean that. It really just depends and I think that that's a hard commitment, you know, to do that, you know, you have, it's painful, it's uncomfortable, it's costly. If your provider, your physician thinks that you do need to, you can, but it doesn't always necessarily mean that.
I have patients that actually beg me to check their blood sugar. Sometimes, I'm like, no, this is this is already a deep endeavor. You don't necessarily need to do that at this particular point. This is what we're going to start you on.
So, that was a roundabout way of answering that question but those are some of the things I think are really good questions when you first diagnose diabetes. I always encourage patients go out, look online, talk to their friends and family, then come back and we can discuss because everything's not factual or accurate, especially from family and friends, unfortunately. But it is important. Knowledge is power, like I think Laura might've mentioned earlier.
And so, the more knowledge you have, more questions you have, bring to your provider, and then we can kind of dispel some of those things so that way you feel more confident about it.
I love that. I love that, ask questions. And you mentioned earlier everybody's different. So talking and learning and then coming back to the provider to find out what's right for you is great advice.
For sure.
We have two last questions in our Q and A here that we can get to.
Doctor Newsome, at the beginning of our webinar here, you talked a little bit about A1C levels and what's considered pre diabetic and diabetic. Is there any special considerations for older adults when it comes to A1C?
I recall if you mentioned that or not. I want to make sure we answered that.
Yeah, that's a really good question. Older patients, like I did kind of mention this before, we don't want to have quite a strict A1C levels because it enhances the likelihood of low blood And what I've mentioned before is they can be very dangerous, especially for older individuals. Their ability to compensate for low blood sugars is not quite as readily available, if you will, as your younger diabetics. So we give a lot more, a little bit more lenience when it comes to A1Cs. If you look online, the first number you'll see is A1Cs less than seven, but for older patients, and really depending on the patient, how their diabetes is, a lot of times we'll give more lenience to more of like a seven point five. And sometimes depending on the patient even maybe even eight but that's that's very specific for a certain patient population but overall, it's more lenient for older patients because we're fearful of significantly lower severely low blood sugars.
Okay, thank you. Laura, a question for you. You talked a little bit about fiber and digestion, but can you just, to any latecomers to our webinar today, any suggestions around fiber and digestion just to kind of help that a little bit?
Yeah, so I had mentioned, right, fiber is great for so many different things. Now, some people, depending on like if you have a GI issue, perhaps you may have to, you know, certain things like Crohn's disease.
You may need a low fiber diet. But for the most part, a higher fiber diet is going to be beneficial to pretty much anyone.
It's going to help kind of regulate or stabilize the rate of digestion and also the digestion of those carbohydrates that turn into sugar and raise our blood sugars.
So as I said, too much fiber can be a problem, especially if you do it quick. If you increase the amount you're eating rapidly and you don't drink water, you are definitely going to get a big bloated belly and a big old bellyache along with it. So do that gradually. If you kind of think about twenty five to thirty eight grams of fiber and you eat three meals a day, you're looking at somewhere between like eight and twelve grams of fiber in a meal. If you're having some snacks in there, can add some fiber into those as well. So spreading it out through the course of the day can actually help digestion. But yeah, I would say if you're saying too much fiber, yeah, that can actually cause some problems, especially if you're not drinking enough water.
Okay. One other question from the chat. Maybe Laura, do you you may be familiar with this, are there is there anything, to add or talk about the is the Libra three patch, is that a type of glucose stick or?
It's the continuous glucose monitor. Yes. Yep. So the Libre three plus is the current one. Yep. And so that's a fifteen day wear patch.
Like I mentioned earlier, you get great information, but it is technology.
And so sometimes people will get a I will call them a bad batch where they're like, Oh my gosh, these are all malfunctioning. But the companies are pretty good, right? You call and say, hey, I've got this sensor that's not working properly or it fell off or whatever. They're usually pretty good about replacing that unless you start calling them every other day, then they're going to have a little problem with that.
But I all of the I shouldn't say all of them, but the two main ones that are out there are the Libre three and the Dexcom G7. Those are the most popular ones that we're seeing right now. And I do like both of them. They both have kind of like their strengths and their weaknesses, but for the most part, they do what they're supposed to do and they give us the information that we need.
Okay. One last question from the chat and then we'll close it out.
I actually had to look this up myself, Laura. This might be for you, but the pistachio effect, have you heard of that? Is that related to anything you've heard of?
Well, know they're like, yeah, yeah. Mean, pistachios are these like little superfoods, right? You've got a little bit of carb, but you've got some fiber to offset it.
You've got no added sugar, obviously. We've got protein. We've got lots of healthy unsaturated fats in those.
And so they can be a great supplement.
I usually recommend pistachios, walnuts, almonds, as if you need to add some protein into your diet somewhere with a snack.
But I'm not exactly sure. I honestly would have to look up something specifically called Pistachio Effect because I haven't heard of that one, but I will be looking that up.
Okay, thank you.
Yeah, sorry, I couldn't answer that.
No, that's okay.
I'm no help with that one either, sorry. I was going to quickly try to Google it.
That is okay. It sounded like though pistachios just in general can be a helpful helpful part of someone's diet so we'll leave it at that. All right I am going to share my screen one more time. We have some final tips from our experts today So let me get to that screen real quick.
I'm going to hit share there. We're going to go here and share. All right.
All right. Hopefully everybody can see my screen there. Doctor Newsome, you had three tips to end our call today.
Doctor. Yes, I did. Thank you.
Really important, having diabetes does not mean you need or should be missing meals. A lot of people think, Oh, I gotta skip breakfast or skip lunch, or I'm only eating two meals now to help reduce my A1C or get my blood sugar under control. Especially for diabetics, that can actually be pretty dangerous depending on what medication you're on. It can drop your blood sugar too low, and it can actually make it really challenging for your physician to or your provider to be able to regulate your blood sugar especially if you're having too frequent low blood sugar.
So, it does not necessarily mean that. Three meals a day is what I usually recommend and then, if you're going to snack just healthy snacks in between, is that actually a better option than that? Next tip that I recommend is everyone's diabetes is not the same. So people often say, Oh, well, my aunt did this or my cousin does this, or they have this or take that.
I want to take that too. That doesn't always correlate to your diabetes. A1Cs can be drastically different responses to medication, side effects to medications from person to person can vary even if you're in the same family, shockingly enough.
So, what works for one person may not work as well for the next person. So, that would be my second tip and then, last but not least, with diabetes, it is very important to keep all of your scheduled appointments with your health care providers and follow their instructions as much as possible to help prevent future complications associated with your diabetes. Time and time again, I have patients that I try to work with and say, hey, you know, I I needed to come back to the office for, you know, so we could see each other. They missed their appointments and guess what happens?
A one Cs go through the roof. They start having complications. Heaven forbid even end up hospitalized because their blood sugars are just not well controlled. They start having various complications with their vision and eyesight and and their kidneys as well depending on how severe it is.
So, if you keep your appointments, we can navigate it together or even with your provider specifically and help prevent some of those later aspects of the disease from occurring or at least put it off until much later in life if it does occur.
Wonderful. Thank you for that. And Laura, you had three quick tips as well.
Yep. So this is a pet peeve of mine, right? Don't use social media for health advice unless it's a reputable source. So like our podcast or not podcast, but our webinar, our health chat here today. Right? This would be a reputable source and our podcast too. That's right.
So, you know, I hear all the time from people, right? TikTok. Oh, I saw on TikTok. I saw Oprah said this, or Doctor.
Oz, right? If it sounds too good to be true, it most likely is. And so go looking for those answers. If you found that on TikTok or YouTube, you obviously know how to use a computer.
So go look for good information that's coming from a reputable source. My second tip is to give yourself grace. It is okay to be a human. Diabetes is a twenty four seven job.
You have to think about what you're doing, what you're eating every time you turn around, right? So we don't expect you to be perfect.
And my last tip is: Knowledge is power. Ask questions.
You know, educate yourself. Make informed decisions.
You know, go to diabetes classes or, you know, some kind of, you know, sign up for webinars. Anything like that. Listen to reputable podcasts, Arm yourself with the information.
All right. Those are some excellent tips. Well, thank you to everyone for joining our Health Chat today. I hope you found this information really helpful for you, and beneficial.
If you would like to, look into other wellness classes, future health tests, please check out our website, AdventistHealthcare.com, click on Classes and Events for all the latest information. Laura does offer diabetes related workshops and classes you can find there. You can also learn more about Doctor. Newsome by visiting our website, AdventistHealthCare.com.
Search Find a Doctor and you can find Doctor Newsome.
He's an excellent physician over in the White Oak area.
And we'll send some follow-up. We'll send a follow-up email to our attendees tomorrow with any links that we talked about for today. Thank you to for all of these questions. These were excellent tips. I learned a lot. I had some tips that I'm going to take away too.
So thank you for being here and taking time out of your day.
Thank you for having us.
Yeah, thank you. Our pleasure. Be well everyone.
Thank you. Peace.
Thank you. Bye bye everybody.
