Loading summary
Transcript102 lines
- [00:00]
A
Foreign.
- [00:24]
B
Well, if you've just been diagnosed with type 2 diabetes, you may be feeling overwhelmed or even blaming yourself. But here's the truth. Type 2 diabetes is largely a hereditary metabolic condition, not a personal failure. In this episode, we talk through the most important things to understand in the first days and weeks after diagnosis and why small, consistent changes, not extreme short term makeovers or efforts, are the real key to improving your health in our top 10 tips for people newly diagnosed with type 2 diabetes on this edition of the Taking control of your diabetes podcast. You've never done it with me. That really threw me off. I can't decide if I like that or not.
- [01:04]
A
Well, it was a long pause, so I thought you were waiting for me.
- [01:08]
B
No, I was going to. At a moment I was like, I want to extend this pause, but you jumped in. Anyways, if you're just tuning in, Steve and I are endocrinologists, both seeing patients with type 1 and type 2 doing research work here at TCOID that Steve founded 30 years ago. Thanks for tuning in, Steve. This is top 10 tips for for newly diagnosed type 2. Why is this an important topic?
- [01:29]
A
Yeah, it's such an important topic, Jeremy, because there are 6,000 people diagnosed with type 2 diabetes every day and many of those folks probably have had diabetes for years, just didn't know it. And it can be overwhelming, like you said. And I would add on that a lot of times they are blamed for, quote, unquote, eating themselves into getting diabetes. Cause their relatives will say that because central obesity is associated with type 2 as part of the metabolic problems.
- [01:59]
B
Or blame themselves.
- [02:00]
A
Or blame themselves, you're right. Or blame themselves. So it's such an important issue to address. And that's why my number one, well,
- [02:09]
B
let me say too off the top, is that I think this can be reframed, especially with all the new medications. And like getting a diagnosis of type 2 diabetes can be a life changing positive event. Medications, interventions, things to like, not only just improve your health, but your overall life. So I know that this can be overwhelming, but I think our top 10 list will hopefully show that it can be a real game changer, literally.
- [02:37]
A
You know what, Jeremy, I remember doing a video before you were born, but it was about getting type 2 diabetes and living longer because you were. And we'll talk about that. But getting diagnosed with type 2 could save your life because you're going around life because most people with type 2 are a little bit older and it's associated with meth metabolic syndrome, which we'll talk about high blood Pressure, cholesterol problems, heart disease, these are all silent conditions until they're not. And when you get diagnosed with type 2, any doctor that's worth his or her grain of salt would say, okay, great, let's get your blood sugars under control, but let's check your cholesterol level, your blood pressure, and let me help you work on the weight. And we now have good tools for that. And if they were not diagnosed, they be just going along with those conditions untreated because they're silent. So getting type 2 could save your life.
- [03:31]
B
Well, I love it, Steve. And as way of background, this is one of two podcasts. I kind of ran the type 1 version where I came up with 10 tips for newly diagnosed type 1. Now, you've done that for type 2s. I haven't looked at this list. So I'm really excited to see what you have. In no particular order, but I did make you nail down your numbering system because it gets really loosey goosey, which is an actual point or not. So what is number one again, in no particular order.
- [03:56]
A
Okay, and you do the recap, but no particular order. But I feel that understanding what type 2 diabetes is, is important. Knowledge is power, and that could lead the way to so many lifelong history of living with type 2 successfully. So I'll start off and then you could add on because, you know, when I was your age, there was nothing for type one and everything was type two. But type two is a disease of a condition, I should say of insulin resistance. And what happens is the tissues of the body are resistant to the glucose lowering effects of insulin. So people with type one, we don't make any insulin. Type two, there's insulin, it just doesn't work well. And the other thing I want to mention, it is a progressive glucose condition. You know, in the beginning, your pancreas is working hard to make up for insulin resistance, and sometimes it does. But then over time, we have pancreatic exhaustion. So that's why the therapies that you might be on may increase in the number of pills or the amount of insulin over time. And that's important to know because a lot of people, even if they're doing everything right, following the dietary and exercise regimen, their blood sugars are good and their caregiver may say, hey, I think we're going to have to add on another medication because your A1C is slipping upwards. And remember, the other thing I want to say is that.
- [05:25]
B
Can I just comment on that point because I think that's a really Important one, yes. That it's set up for people to feel like they're failing. I used to be okay. And now I can control it with diabetes, sorry with exercise and diet. But now I need one pill now, two pills now I need an injection now I need insulin. And that is actually the way it typically goes, that after about 10 years or so, at least half of people with diabetes or type 2 diabetes are usually on insulin. So that's kind of the natural progression that has nothing to do with effort or personal failure or anything like that. And people are not used to that. If you have a UTI or pneumonia and you take an antibiotic and it doesn't work, you switch to a different one. Here we're saying, okay, that pill, that's not cutting it, it's still helping, we gotta add something to it. And please keep that other one. And we're going to continue to kind of add to it is a little bit different than other things in medicine.
- [06:25]
A
Yeah. And we add medications we don't subtract. And I would say with the newer GLP1s, which we'll get into, that has improved that paradigm. And just the fact that you have to go on a natural hormone that your body doesn't secrete enough of doesn't mean you failed. And remember that the earlier you control your diabetes, the better. And the other thing I want to mention, and you talked about it in the beginning, it's not your fault. But type 2 diabetes is super hereditary and it's passed along from generation to generation. And so I say it's your parents fault.
- [07:03]
B
It is, it really is.
- [07:05]
A
And early action matters.
- [07:07]
B
So this is all, this is where I got to nail you down. Number one is education and educating yourself on all these things that it's not your fault it runs in families, that the natural progression is you might need more medications, but jumping on it early is super important. So is that all still number one?
- [07:24]
A
That was all knowing what type 2 diabetes.
- [07:26]
B
Okay, got it.
- [07:27]
A
Yeah. And you know, I added on to your opening paragraph. Okay.
- [07:30]
B
So that doesn't count.
- [07:31]
A
Okay, you ready for number two?
- [07:32]
B
Yeah.
- [07:33]
A
Okay, two is don't panic. Type 2 diabetes is totally manageable and actually reversible the earlier you jump on your type 2 diabetes. What does reversible mean? It doesn't mean it's cured. It means it's under total control. And you can live a long and healthy life with type 2 diabetes, as we mentioned. And there's no reason why you can do anything you wanted to do in life with type 2 diabetes, it's a different era now. So, you know, I think, you know, you can say to yourself, gosh, I got type two, I'm gonna improve my overall health because of it. No reason to panic. But it's easier for me to say because I don't have type two.
- [08:13]
B
Well, and I totally agree with that. I would say that don't panic, but take action. You don't want to get in a situation of apathy where I'll deal with this in six months, whatever. The longer you wait, the more difficult it is to control and more medications you might need, et cetera. So it's very correctable. But do something about it.
- [08:32]
A
Yeah, I think you said it perfectly in the opening. And if I could repeat that, small, consistent changes, not extreme short term efforts. It's the real key. So thank you for reading my opening book that I wrote for you.
- [08:49]
B
But you're right, sometimes panic will lead to these extreme things. Okay, I'm not going to eat for a week or I'm going to lose £20 this month. And that's not sustainable. And so you want to have an appropriate amount of panic or like, this is a watershed event. This is a life changing diagnosis. I'm not going to die tomorrow, but this is a time that I need to do something about it and I can fix it. But knowing that it is fixable, I think helps people take action. Because a lot of times there can be apathy. Well, my parents had it. They both died at a young age. It's just in the cards for me.
- [09:20]
A
You're right.
- [09:20]
B
That is just completely not true.
- [09:23]
A
If you look at certain ethnic groups that have a high rate of type 2, like Native American Indians, Latinos, African Americans, Asian Indians, sometimes if they don't have access to good healthcare, they think it's their destiny to get type 2 and to pass away in their 50s, you know, and 60s. So you're right. It's like the Starling curve, you know, a little bit of panic. As long as it drives you to do something too much. If you're frozen into inaction, that's not good. Okay, you ready for number three?
- [09:52]
B
I am.
- [09:53]
A
Okay. One of the big things with. Well, I'll just say it up front so you don't give me any grief. Focus on your weight. Now, Jeremy and I know, easier said than done, but it's important to know that 90% of people with type 2 have weight problems. And it's a certain type of weight problems. We call it central adiposity. It's a certain area of Your stomach, inside intra abdominal area, the beer belly
- [10:20]
B
kind of for men. And, you know, we always say the apple shape for men and the pear shape for women when they get in their hips.
- [10:26]
A
But it's different than subcutaneous fat that you can pinch. It's in the abdominal area. And that has a lot of complicated implications around your organs.
- [10:37]
B
Yeah, yeah. Sorry. Am I allowed to talk? I feel like I'm throwing you off.
- [10:42]
A
You need to raise your hand first. No, no, you're allowed to talk. So I was just going to say that focusing on your weight is super important. And I think you've got to remember it's small steps. Slowly. Don't try to lose £100, you know, in two weeks. Don't fall for these claims on television, on the Internet. Lose 10 pounds in two weeks or your money back. You know, you have to do what we sort of suggest in people with type 1 diabetes. Reduce your refined carbohydrates, because carbohydrates have the highest calories compared to protein and fat. Of course, you gotta watch that, too. And it's, you know what I say, Jeremy? It boils down to eat the foods you like in moderation. You can't, you know, you get type 2 diabetes later in life. You develop your eating habits that you like. You know, you don't have to get rid of them. You have to slowly think about how much you eat of the foods that are not the best for you, and then slowly learn and educate yourself about foods you really like to eat that are healthier. So I always say that you've heard this saying, you are what you eat, but with type 2 diabetes, it's not, you are what you eat. You are with how much you eat.
- [11:57]
B
I've seen Steve do these opening talks. It's been a while, but, yeah, you're bringing back some of your hits. I like it.
- [12:03]
A
Well, what do you have to say, Jeremy?
- [12:05]
B
Well, totally. And before GLP1s, we would harp on this a lot. We still do. You'll get into exercise and actual recommendations for that and diet. I would say by the time somebody's diagnosed with type 2 diabetes, they've tried five to 50 different interventions of diet, exercise, fads, Weight Watchers, everything. They don't want to be. Nobody wants to be overweight. So they know that weight is an issue. It's probably been an issue in their family. They're struggling with it. And the advent of GOP1s, I think it's really solidified that to make meaningful change with diet and exercise alone, that is sustainable is extremely difficult, and a lot of people need help with that. And we have new medications that can be life changing. So I'm guessing you want to talk about those drugs now.
- [12:55]
A
Yeah, I want you to talk about GLP1s because we now know that they're perfectly appropriate for a lot of Type 1s in addition to Type 2s, even though they're not approved yet. You know, I just want to say that even losing 5 to 10% of your body weight, which is GLP1, you can lose a lot more than that. You can see immediate improvement in insulin resistance, and that makes an improvement in many of the things that's going on in your body. Blood pressure, cholesterol, the amount of medications you need. And the other thing I want to say is I used to quote this study a lot from the old days that they did, a very famous study. They took people who had weight problems and people with type 2 diabetes and weight problems, same weight, same age, same sex, you know, perfectly matched, and they put them in a. They locked them up in a unit and they gave them a caloric restricted diet and the same degree of exercise, like 10 minutes on a treadmill at a certain speed. And it turned out that people with type 2 diabetes lost weight much slower or not as much, because having insulin resistance, you have the gene that makes you resistant to losing weight, which is why you've tried all these thousand remedies that Jeremy mentioned. So it's very tough to lose weight. And I do think the GLP once has revolutionized the way we treat type 2. And I think we wanted to talk about it in this podcast because you don't have to wait. You know, if you have a weight problem, even though you're relatively newly diagnosed, it could help everything you're trying to work on. And Jeremy, take it away.
- [14:27]
B
Yeah, I would say, you know, a couple things you said, like, let's start by targeting 5% of your body weight. So if you're 200 pounds, that's losing 10 pounds. And that's, let's say, a good ballpark for most people. Starting with losing 10 pounds would be a fantastic goal. A lot of people come in and say, I want to lose 50, great. But let's start with something achievable and kind of practical. So starting with 10 pounds, a very aggressive weight loss plan is a pound a week. So if you want to lose ten pounds, you got to map out ten weeks. That's two and a half months. And again, some people, or most people, everybody wants to see kind of immediate, I want to lose this by the end of the week when I go to my ex husband's wedding or whatever it is to look good, but that's not achievable. So 10 pounds, that's going to take a couple months and something to commit to the GLP1s. The great thing is that if you have type 2 diabetes, you very likely can get these drugs. These have been historically difficult to get. I have a laundry list of type ones that are begging to get on these medications. I had somebody today in clinic that told me I want to wait till the long term data on these drugs come out. We've been using these drugs since literally 2005, over 20 years. The positive effects keep building up. Steve and I are not drug pushers, but these are drugs that are really quite remarkable in the history of medicine in terms of sensor development. We keep learning good, positive things about them. It's very common for drugs to come out and a couple years later, oh, oops. Cause bladder cancer or whatever, it gets withdrawn from the market. This is the opposite of that. They help with blood sugars. That's how they were approved. And then it found out that a side effect was that people lost weight. That's nice. Oh, and now another side effect is that people have less heart attacks, less strokes, they have less kidney disease, they have less arthritis, they have less sleep apnea. I'm not making this list up. They're less prone to addiction, fatty liver disease. So we're moving away from, actually, I'd say we've moved away from that. These are diabetes drugs to. These are beneficial public health drugs. And we're not that far away from. Everybody should be on one of these medications. And people with type 2 diabetes are, I think, legitimately lucky to have access to these drugs.
- [16:48]
A
Jeremy, with that speech, you should run for President of the United States. You know what, you had all of them. You listed all the benefits. You know, it's. Remember that there's now two companies that make most of the GLP1s and we have, you know, Novo makes Ozempic and Wegovy, which has a different name because it's indicated for weight. And then Lilly has Mounjaro and Zepbound.
- [17:17]
B
And that's important. The same drug, different names. If you're using them strictly for diabetes or obesity, super confusing, but the same drug.
- [17:25]
A
Yeah. And I just want to say, you know, we're not here to tell you all the details. We have lots of great videos on our website, but we know the prices are becoming more Affordable. And both Novo and Lilly are now making oral GLP1 medications that are also supposed to be more accessible. And even what you mentioned, Jeremy, even like Medi Cal, Medicare is going to allow it with a much lower co pay because of the tremendous benefits. And in reality, it's saving our healthcare system billions of dollars in addition to improving the quality of life for people with type 2 diabetes or people who have serious weight problems. And it's probably the only medication I've ever seen that consistently helps people lose weight.
- [18:11]
B
And, you know, our treatment algorithm for type 2 diabetes has historically been diet and exercise. You add metformin and then you can do these other things. But we're now at a place that as soon as you're diagnosed, you should be on one of these drugs. So if you have type 2 diabetes and you're not on a GLP1, ask why or if you think you should qualify or whatever. But it's that important that I think literally the day that somebody gets that diagnosis, they should be on this drug. Actually, I think they should be before they're diagnosed. But that's a whole different topic in terms of prediabetes. All right, so lose weight, and you have some tools to help you do that. And the GLP1s are very effective.
- [18:48]
A
And everything you do that's not on the GLP1 line will help you lose weight if you get on a glp. So getting good habits is key. All right, ready for number four?
- [18:58]
B
I'm ready.
- [18:59]
A
Exercise. Move your body daily. And it's important to note that we don't expect every person that gets type two is at the age where they're young and fit. And we know that exercise can be something that you may have not have done because you've had weight problems associated with type 2. Maybe you have arthritis in your knees, which has been shown to be helped with GLP1 weight loss. And I think, you know, start and go slow. I think the surgeon general recommends what's
- [19:29]
B
150 minutes a week. So it's basically 30 minutes a day, five days a week of something sustained, which can be walking. This doesn't mean, like you said, you gotta put on spandex and get on a treadmill. It's something to get your heart rate mildly elevated. 30 minutes a day.
- [19:45]
A
Yeah. And things like walking go a long way. And they've shown that even the smallest amount of exercise can reduce insulin resistance immediately. So, you know, just build it into your daily routine. And I have a note to myself that says here, if you're already very athletic and exercising. Just keep it up. We don't want to treat everyone that never hasn't exercised in 10 years and everyone's a couch potato. We know that all of you are not. So any exercise you can do on a regular basis, both aerobic, which is running, and anaerobic, which could be a little bit of weightlifting. You don't need to join a gym. You know, Jeremy belongs to a high level YMCA.
- [20:25]
B
I'm on a YMCA. Steve's at like LA Fitness, LA Fitness.
- [20:28]
A
And you know, I know people who can't afford to go to the gym. Even though if you're of Medicare age, you can get the senior sneaker discount, which is free. They get two jugs of water a gallon each. You can, you can go a long way with that. So remember, you know, daily exercise and what's the last thing that, that I learned from one of our podcasts we did or one of the videos we did at my house?
- [20:53]
B
Stretching.
- [20:54]
A
Stretching.
- [20:55]
B
At the time I said, well, what do you do, Steve? Name one stretch. He couldn't name one. But now he's like, he's actually gotten into stretching. He told me for years, jeremy, you got to stretch. Finally I asked him, well, what do you do? Just blank.
- [21:08]
A
Well, you know what? I blank because I really didn't stretch. But I know it's good for you. Just to summarize, we talked about exercise, but. But stretching is key because the older you get, the stiffer you get and anything you can do earlier on. And same with exercise. All right.
- [21:24]
B
And I would say, sorry, I'm pulling to Steve. I would dissociate exercise from weight. That even if your weight is not changing, exercise has so many benefits. You might be increasing your muscle mass, your clothes fit better, you have more insulin sensitivity. So don't think of exercise as just a way to lose weight. But it's improving strength, endurance, testing, stretching, flexibility, all those kinds of things that usually can lead to weight loss, but that shouldn't necessarily be the goal.
- [21:53]
A
Yeah, you're absolutely right. Ready for number five?
- [21:56]
B
I'm ready.
- [21:57]
A
Well, this is carrying on with the foods we eat. Learn how the foods affect you. And this will be a good lead in to the number six, which will be how do you monitor your blood sugars? Because we're gonna talk spoiler alert. Yeah, we're gonna talk about how CGM can really help you. But basically, but stay away from carbohydrate, rich, caloric rich foods and everything in moderation. That's the underlying bread, rice, pasta, you know, we can't stop that stuff. You know, if you're Italian, you know, if someone said to you, stop eating pasta, that's. And I've seen dietitians tell that to patients. So you just have to learn which foods raise your blood sugar. There are different desserts. There's, like, things like banana bread, and there's icing on a big old cupcake. So there's different types of desserts. And fruit, you know, fruit's great for you, but in large portions, it's going to really jack your blood sugars up. So, you know, you just need to learn how you respond to different medications. Sorry. To different foods. And remember, you don't have to cut out the food you like. You just got to cut it back in moderation and then learn how to make those smart substitutions. And we do have very good videos on our website in the type 2 track by some excellent dietitians.
- [23:14]
B
And not to harp on GOP ones, but this is really how those drugs work, is that people still get hungry, but you get full much faster. So it actually enables you to say, I'm going to have a little piece of that carrot cake rather than half the cake, because it literally shuts that part of your brain off to say, I'm full. I don't need any more food. So all these things kind of can work together.
- [23:37]
A
Yeah. And these drugs affect your appetite center, and what you said is very important, satiety center. And. And you get full faster. And you don't have to say to yourself, oh, you know, Steve, don't eat so much. Stop when you're full. It happens naturally.
- [23:51]
B
It can really help with that, like, kind of mindless snacking, the food noise,
- [23:56]
A
they call it, and that a lot of people have food noise, and it's probably one of the only way to get rid of it. Well, the next section, if we're okay to switch on to that, monitor your blood sugar strategically. So if you're stuck to pricking your finger and getting a blood test, which I'm sure you'll get in the beginning, when you're first diagnosed, there are certain times of the day that are extremely important. First thing in the morning, and then I would say the Next important is 2 hours after your biggest meal to see how high you pop up. And lastly, if you want to basically, bedtime.
- [24:31]
B
What? You wake up in the morning and kind of like after dinner. Bedtime.
- [24:36]
A
Simplify it. The less the better. Right. And then if you think you're having problems, you can test anytime you want. If you feel Funny. Check your blood sugar, your doctor, you know, I mean the educators out there in the world, it's not rocket science. But you don't have to test your blood sugar four times a day and turn in your logbook and learn what the numbers mean. We try to shoot for that. Morning blood sugar, less than 130 in the beginning, less than 130, 140. I'm sorry. Yeah, that's a good start. And then you want to keep your post meal blood sugar below 200 and then you can slowly ratchet it down. But what I wanted to spend time on during this number six is continuous glucose monitoring. It is probably the single most important tool you can use to help control your diabetes. To see what foods do to your blood sugar, how much you eat, the different types of food, exercise, and when you take your medications. You know, if you're on a medication and you've been on it for one or two weeks, it's not doing its thing. Why wait two more months until, until your next doctor visit? So cgm, it's covered for any patient that's on insulin, even as low as one shot a day. But let's just assume you're not on insulin. What's your suggestion?
- [25:57]
B
Well, I would say, yeah, you're right. As soon as you're on insulin, it's generally covered. There are over the counter options. There's still like programs you have to go through to get it. And I don't know the exact cost, but let's say one sensor is around 50, $60 somewhere in that ballpark, can last for 10 to 14 days. And even if you do that just once or once every three months, it is worth the 50 bucks if you can kind of swing it because you're getting a blood sugar every five minutes, you can't prick your finger every five minutes. And everything you're talking about, let's see how this rice affects me, let's see how alcohol affects me, let's see how exercise affects me. Sleep, all these kinds of things. You learn so much. And what I love about CGM is some of the older studies now where they took people with type 2 diabetes and put them on a CGM. They didn't do anything else. And their A1C improved by half a percent to 1%. And CGM doesn't do anything other than provide information. So the reason that people's blood sugars improve is because they were using that to enact change. They saw this information, oh, maybe I'm going to steer away from rice or I'll exercise more or whatever. And what a beautiful concept that if you provide people with information, they can enact positive change.
- [27:12]
A
You know, it is so true. And you know the two devices over the counter called the Stello and the Lingo, they're both 15, 14, 15 days. And they have programs where if you get it regularly, you can get it for a cheaper price and you can look around. Now, the other suggestion, you could ask your healthcare professional if they have any samples in the closet, because we have closets full of the Dexcom and the Libre. You just download the app and just trying it for two weeks. And I'd say if it's hard for you to afford even getting one every couple months, go to your friends, they'll help you out. Yeah.
- [27:50]
B
And we do have these sensors and I would love to give it to somebody who's newly diagnosed with type 2. So if you're listening, don't feel sheepish about asking. I've said this before, that at ucsd we're generally not allowed to have medication samples, but we can't have technology samples, which means if we can get it, anybody can, because we have all these firewalls and stuff. So ask your provider, hey, can I just try one of these? And you'll learn a lot.
- [28:16]
A
Yeah, for sure. I mean, it's eye opening for people with type 2 newly diagnosed, and it just helps you understand how your body responds to so many different things.
- [28:28]
B
And I want to be clear that our goal would be for everybody to be on these all the time, that we think there's consistent benefit. And the most benefit you get out of it is wearing it all the time. They've actually studied this and shocker, the more you wear it, the more benefit you get out of it. So we're saying if you can't afford it, then do it when you can. But our goal would be for everybody with diabetes, period, type 1 or type 2, to be on these all the time.
- [28:53]
A
Yeah. If the world was a better place, and I think there probably will be someday when it's available for everybody, it could be better.
- [29:00]
B
I mean, it used to be tough for us type 1s to get it. Now that's like kind of cross that threshold. Nobody with type 2 could get it. And now it's people with insulin and pretty soon it's going to be like if you're on any medications or something. So as the cost of these come down, which they have dramatically, the availability is increasing.
- [29:18]
A
Yeah. And normally if I give someone to a newly diagnosed type 2, you can't buy it back from them, and then they find some way to get it on their own. Okay, number seven, take medications consistently. Why do I say that? Because the big medical phrase is adherence. And you type 2s out there have a bad reputation for being non adherent. And here's the issue. Type 2 diabetes is what I call a polypharmacy condition, because if you're treating the glucose and you also have to take medications to control your lipids, which is very important, your blood pressure. No, you're on a lot of medications. And how many times have someone said to you, jeremy, gee, do I have to take all these medications? And the problem is if you don't take them, you don't feel that different. And so there's no sense of urgency. And that's not your fault, that's just the nature of the beast. And so I can tell you that if you think that you're on a medication that you don't need to be on, have a discussion with your healthcare professional. Does this really help me? What does it do? Do I have to continue it? And do your own research as well. But that's a big problem and that's why I have it as a whole. Number seven.
- [30:29]
B
And this is where CGM again can be really helpful to confirm that these drugs are doing something. Ideally, you're on cgm, you start new medication, you can see the improvement. Or the opposite. You're on cgm, you stop taking your med because you're tired of it. And you can see that your blood sugars deteriorate versus going to your doctor every six months and getting an A1C. And that's your only feedback. You have literally real time feedback that these drugs actually matter. But we have sympathy for the number of medications, the cost, potential side effects, all of this, and the rates of people being on a type 2 diabetes drug a year after it's prescribed is about 30% of people are still on that drug, meaning 70% stop for some reason. And you got to find a way to buy in. Whether it's your long term health or that there's something about it that actually makes you feel better or you think you look better or whatever it is, there's gotta be some positive you associate with taking that medication. Otherwise if it's all negative, you're gonna stop.
- [31:28]
A
Yep, yep, you're right. And don't believe all the crap on the Internet about other drugs that help that are not proven. And please don't stop the medications on your own.
- [31:39]
B
So many people, like, I don't want to spend $60 on this sensor, but I do want to spend it on, you know, ginkgo biloba and, like, whatever. Like, if you want to take the supplements, great, but they're not a replacement. You know, that's it.
- [31:51]
A
And, you know, we hate to harp on that, but it's so common. And so we want to give you that emphasis to learn about the drugs you're taking and take them consistently. Don't stop unless, you know, you have a good reason or you've talked to your physician. Okay, number eight. Jeremy, this is important.
- [32:07]
B
Okay, great. The other ones were garbage, so let's see what this one's got. This one's important. Glad to hear it.
- [32:14]
A
Protect your heart. Start early. Why do I say early?
- [32:18]
B
Early is a theme, you know, intervene early. But the sooner the better for all these things. Because it's better to prevent than to treat.
- [32:26]
A
Heart disease is associated with type 2 diabetes because it's associated with insulin resistance. And there are no symptoms of heart conditions in the earlier stage. It's a silent issue until it isn't when you have a heart attack or stroke. So how many times have I seen one of my patients who developed a problem, they see a cardiologist, and they have extensive heart disease. You know, I'd say bad on me for not doing some. Maybe some type of treadmill test early enough, but that's the primary care doctor's issue. So I mean to quickly go through them. There's just basic ones. Blood pressure, you should be less than 130 over 85 most of the time. Get your own blood pressure.
- [33:06]
B
Let's go through the abcds. This is a good way to do it. So. So first of all, most people in the world die from heart disease. People with diabetes, type 1, type 2, are five to tenfold increased risk. So as soon as you get that diagnosis, you gotta be really on top of this. So A stands for what?
- [33:20]
A
Well, I would say A1C and aspirin.
- [33:23]
B
So get your A1C less than 7. Consider taking a daily baby aspirin. B is for what?
- [33:29]
A
Blood pressure.
- [33:30]
B
And your goal, like Steve said, is 130 over 80. And don't kick that down the road. Oh, I'm high because I don't like doctors. Bullshit.
- [33:39]
A
Get your own blood pressure cuff. Have it at home. You don't have to test a zillion times a day, but your measurements at home are much more valuable than you run into the office and the doctor's wife is collecting the copay. It's very stressful.
- [33:53]
B
Yeah, like a $20Amazon blood pressure cuff first thing in the morning when you're kind of relaxed, see what it actually is. If it's consistently above 130 or 80, do something about it. C is for cholesterol. What's our goal there?
- [34:05]
A
Well, LDL is the key. Cholesterol less than 70 for everybody less than 55. If you've already had heart disease and you always say everyone's going to need something.
- [34:17]
B
I have never seen a person, diabetes or not with an LDL less than 70, just walking around. So I think what we're saying is that if you have diabetes, you need to be on some kind of cholesterol lowering drug to get your cholesterol into range. Now, do we want you to be on all these drugs? No. But when people do this, you can stave off like the heart disease and these blood pressure and cholesterol pills, they've been around for decades and they're cheap and they're really, really effective. So please don't shy away from them.
- [34:46]
A
Yeah, absolutely. And this always comes back to the fact that type 2 diabetes is a condition that you're going to be on lots of medications, but if they're doing the right things, embrace it, don't fight it.
- [34:58]
B
And then D, just to round it out, is for drugs for diabetes that help with heart disease also. So the GLP ones we've harped on a lot being on one of those. And then these other class of medications called SGLT2 inhibitors, which is like Farziga and Jardians, they're once a day pills, help with blood sugar, weight and also help with your heart and kidneys. So I personally think that as soon as you're diagnosed with type 2 diabetes, you should be on a GLP1 drug like Ozempic or Mounjaro and one of these SGLT2 drugs like Farzig or Jardine, it's just out of the gate.
- [35:32]
A
Well said. Okay, number nine. I think we can do that quickly because we did go through a lot of the basics. But I always talk about your diabetes warranty program, which is get the things you need to be tested on a regular basis, keep your own records. And my list is really what we've talked about, the A1C but and the lipids and the blood pressure. But other things on this list is specifically your kidney function that's important, the microalbumin to creatinine ratio. Hopefully when you're first diagnosed with type two, you don't have kidney problems, but that wouldn't be out of the question, if you were undiagnosed for years because it's so asymptomatic, look at your liver function tests on your chemistry panel. And a yearly or sooner, depending what your eye doctor says, a dilated eye exam. And if you have any circulation problems in your lower extremities, seeing a good podiatrist is key.
- [36:26]
B
Yeah. So I would say totally. So basically, your take home is once a year. You need your full lab panel, and hopefully your provider knows what this is at least once a year. And then getting your eyes dilated once a year. Some people like to kind of time those up together every January, February. But a lot of that is on you. We'll do our best to remember, but you got to schedule your eye appointments. You got to stay on top of that and trust us for all these things. The intent is to catch things early and treat them so they don't become a problem.
- [36:54]
A
Yeah. And you do have a lot of things to follow, but I think once you get into a good groove and the earlier you start it, the easier it'll be. Last one. Jeremy, I think you start off on this because there are many things that relate to our podcast on type 1 diabetes, which is build a support system.
- [37:14]
B
Yeah, I would say build and educate your current one. Hopefully you have friends, family members, loved ones. How can they help you? How can they not be the diabetes police and be the diabetes. I don't know, supporters, Whatever. Here are some things that are helpful. Here's some things that are not. When my blood sugar is low, I would love for you to have some juice or something to give me. I don't want you criticizing everything I eat. Maybe we can come up with conceptually some things that we're going to agree on for diet or whatever, or times that I get a hall pass to eat whatever I want. But how can we work together? And I always say having these conversations when it's calm, diabetes is not in the forefront. It's not like you just came back from the doctor and there's some critical result you got to talk about. It's when things are generally kind of going well. This is a condition that somebody in the Friendship Network is living with. They're struggling with it, and the goal of everybody else is really to help them, and those people want to be helpful. So how do we come to what actually can be impactful in a positive way? Yeah.
- [38:14]
A
Thank you. I would add on that everyone in this country should live like they just got type 2 diabetes, because what's the recommendation? Eat Healthy, lose weight. If you need to lose weight, exercise, take the medications that keep you healthy. And my suggestion to people is get your whole family involved. You're probably not the only one that may have been struggling with weight. If you're 30s, 40s, 50s and beyond, make it a positive thing and make it a family affair. And in type 1 diabetes, it's a little different, but in type 2, I think really is. We should all be treating ourselves like we have type 2 diabetes. We'll live a lot longer.
- [38:56]
B
Yeah. And it really can be a heralding positive event. Okay, here's, you know, whatever's happened previously to getting that diagnosis doesn't matter anymore. We have it and we have all these tools to improve your overall life. And again, not just for you, but maybe loved ones, your whole kind of support network. So hopefully trying to flip that on the head from this is doom and gloom and I'm going to die to okay, I'm here, I've got this diagnosis. What can I do to improve it? And there's a lot. If we did this podcast 10 years ago, we'd be harping on the different kinds of walks versus runs.
- [39:28]
A
You can do the same old things which don't work.
- [39:30]
B
Exactly. So we have a lot of new tools now. It's a new day in diabetes and we're just seeing a lot of positive, life changing results. So embrace it, get out there, engage with your healthcare team. If you don't like them, find another doctor, another healthcare provider that's part of your support network and you'll live a long and healthy life.
- [39:48]
A
Yep. You know, tcoed, we just did ask the endos for people with type 2 that's on our website. But I want to say that we love the fact that you would comment on this podcast and we go through every comment and if you want to ask a question about anything you'd like, put it in there. We will respond to you because those numbers, you know, that makes us feel good. When people comment, they send questions and
- [40:14]
B
oh, Steve loves when I do this. I'll do a quick recap. All right, number one, understand what type 2 diabetes is. Knowledge is power. Number two, don't panic, but appropriately panic. Number three, focus on your weight. Consider GLP1s move your body daily exercise. Number five, learn how food affects you, ideally through using a continuous glucose monitor. Number six, monitor your blood sugar strategically. You can test in the morning or at night or use a cgm. Number seven, taking your meds, consistently, buying into diabetes long term health. Eight, protect your heart early. Nine, the diabetes screening warranty program, getting your labs, eyes checked, things like that, and then finally building your support network. What a fantastic top 10 that I did not interrupt at all. Unlike you on the Top Type one podcast. So thank you everybody for listening. We hope you enjoyed it. This is always great and really encouraging for us to keep us going. We love, like Steve said, particularly the comments, please like and follow and subscribe and all those kinds of things. But we really like hearing from you. Hey, I like this part. I didn't like that Steve's numbers weren't so succinct. Stuff like that. But we hope to see you guys on the next one. Take care.