Diabetes Care:

Hello everyone I’m Dr. Rahman I work at the Makena office with the Rancho Family Medical Group and today we’re going to be talking about diabetes which is my passion first of all diabetes it’s a chronic medical illness it’s very complex to treat and unfortunately patients who are diabetic are most of them have uncontrolled diabetes which can lead to micro and macrovascular complications and that includes complications that can you know create a coronary artery disease in our patients peripheral arterial disease sometimes leading to infections and unfortunately amputations of the lower extremities and it also is the a lot of our patients who have uncontrolled diabetes can get retinopathy which is eye disease and that is also the most common causes of blindness in diabetics the labs I usually check for all of my patients who have diabetes is of course an A1C and this is a marker that tells me how well their diabetes is controlled over the past three months or so when that kind of accused me and on what we need to do in terms of treating our patients with the right medication we also get a fasting lipid profile and that is a cholesterol test because a lot of our patients have high high cholesterol in addition to having high blood pressure and everything else we also do a complete metabolic panel that is a test to check for your liver enzymes your electrolytes as well as your kidney function because a lot again a lot of our patients are are at risk of getting kidney failure oh this is very important like I stressed before a lot of our patients who haven’t controlled diabetes they tend to get retinopathy and again this is the main cause of blindness in the us so it’s really important to screen our patients annually with a with a retina kind of specialist or an ophthalmologist to make sure that they don’t have any bleeding vessels or eye disease like cataracts or glycoma yeah statin use is very important for our diabetics because it lowers their overall risk of getting cardiovascular disease it lowers their ldl because we know that having a high LDL in addition to them being diabetic puts them at risk of getting strokes and heart attacks so for all of you out there that have diabetes we are here at the Mckenna office and we’re looking forward to meeting any patient who has diabetes and we’re here to help all of our diabetic patients get on the right path of good care

Dr. Rahman on Diabetes:

Hey everyone my name is Sienna Boyd and we are back in the Choose Health studio this time we are with Dr. Rahman who is one of our physicians at our Mckenna location and today we are going to be going over all things diabetes we will be going through um the most frequently asked questions just learning more about it Dr. Rahman is somewhat of a diabetes guru within our practice so I would love to just hear um first of all if you could just tell us about diabetes the general knowledge of it yeah so diabetes it’s a complex chronic disease that you know it can it can cause a lot of complications in our diabetic patients and it can cause a lot of kidney problems strokes and all that so it’s really important for patients who have either type 1 or type 2 diabetes to really get good care and and unfortunately with newer medications that are out there they can really prevent a lot of these complications and a lot of the patients don’t really know what type 1 or what diabetes is in general and what type what diabetes is that their bodies are unable to metabolize the sugars and the carbohydrates that they eat for energy and it could be due to many reasons okay so tell us some of those reasons that you talked about as far as why someone would not be able to metabolize those sugars or carbs sure so just to make sure that our patients know we mainly classify diabetes in two categories okay so we have our type 1 diabetics who don’t have any insulin at all and in those patients they really need insulin in order for them to metabolize their blood sugars and to effectively you know do well clinically and for type 2 diabetes this is the second classification this is 90 of our patients who have diabetes have type 2 diabetes type 2 okay and type 2 diabetes it’s kind of multifactorial one of the main reasons that we see type 2 diabetics in our offices today is because they are a lot of our patients are overweight they’re obese they have a lot of inactivity especially now with covid season everybody’s staying at home and they’re not really exercising right and they’re gaining weight therefore either if they do have diabetes it’s becoming more uncontrolled and if they were pre-diabetic they’re kind of going into that that type to uh diabetes okay and so you said that if you were talking about people who have type 2 diabetes and you were talking about it being even more controlled or uncontrolled so tell us the differences between type 1 and type 2 and how you would even control them yeah so for type 1 diabetes it’s really important to um to treat our patients and because type 1 diabetics were are going to need insulin so they’re going to need insulin but we need to manage them in a way that’s really similar to a physiological replacement of insulin okay so that means they’re going to need a long-acting insulin and a short-acting insulin okay in addition to that they really need to be mindful of course of their diet their sugar intake and to also maintain a consistent carbohydrate diet consistent carbohydrate diet what does that look like so consistent carbohydrate diet means that our patients need to be very especially when they’re on insulin they need to have the the same amount of carbs say for breakfast lunch and dinner because if they eat less they’re more likely to develop low blood sugar events okay and we do have some type 1 diabetics we do teach them in our clinic how to do carb counting and the amounts of carbs that they take in we we teach them and educate them on how much insulin to take for that meal wow so it’s a lot of education that goes into basically maintaining your body as a type 1 diabetic absolutely okay so what does the lifestyle look like for somebody who is a type 1 diabetic is it a change in lifestyle a big change is it something that is easily mitigated yeah so with type 1 diabetes again it can occur any time in their age group a lot of the time okay they’re diagnosed early on in childhood okay we’ve had a lot who are diagnosed like mid-teens or even young adults wow okay um and then for them the majority of them they’re not really overweight or anything it’s just that their body is not making enough insulin because their beta cells and their pancreas has been completely destroyed by most likely an autoimmune process okay so with diabetes maybe be considered an autoimmune issue at some point for type 1 or type 1 type 2 again it’s multifactorial genes play a role in it okay but the majority of the time it’s the environment it’s it’s you know what our patients in terms of uh their physical inactivity uh their weight gain if whether or not they’re um considered overweight or obese those are more of you know their bigger factors in developing type two type two okay so type one is more of like a an autoimmune issue it can be diagnosed throughout your lifetime usually earlier that’s what I’m hearing type two is that something that you develop over time more as you get older absolutely okay yeah so um more and more patients like especially with age as we age yes we’re more prone to getting diabetes and many other chronic diseases sure yeah interesting and sometimes the risk factors of diabetes I’d like to go over those because I get a lot of patients that I see in clinic that come in for physical exams and and I in some of the risk factors that I look for for patients who may get type 2 diabetes are considered age as we talked about so as they get older anybody over the age of 45 we do need to screen them for diabetes any woman who’s who had gestational diabetes is also at risk of getting type 2 diabetes is that when a woman had had diabetes when she was pregnant that is absolutely okay yeah and some of the other factors include of course the main thing is obesity overweight or maybe a patient who ha who’s taking chronic steroids for some reason so chronic steroid use can uh predispose a patient to getting type 2 diabetes wow so it’s interesting that a drug that is meant to help another condition can also then cause exactly diabetes and I also see a lot of patients with mental health issues and they’re sometimes prescribed antipsychotics antipsychotic medication and some of the antipsychotic medications can also predispose a patient to weight gain therefore they’re predisposed to getting type 2 diabetes so so some of those patients we definitely need need to take a look at and screen them and make sure that they don’t develop type 2 diabetes is a pretty common when someone gets older and they are more on the overweight side or on the b side is it pretty much common knowledge that everybody who is obese or overweight would have type 2 diabetes or no that’s not necessarily the case they are at risk okay it’s not necessarily i have patients who are you know in the 200s 230s 240s and their A1C is 5.5 genetics plays a big role activity plays a big role okay but again that obesity again is a risk factor so they may not develop it right now but down the line if nothing is done in terms of losing weight or taking care of themselves um they they can get you know type 2 diabetes it’s just waiting to happen so really wanting to take care of yourself and eating a good and healthy balanced diet so you had mentioned that diabetes is also or might be a genetic risk factor can you speak more to that yes absolutely so diabetes uh can be a lot of patients can be genetically predisposed to getting both type one and type two diabetes can you have both at the same time you mean type one and type two or no it’s no one or the other yeah one or the other um so for type 2 diabetes they they can have a genetic predisposition but usually these um if they have a genetic predisposition what goes into when your body kind of if you if you’re genetically predisposed and you’re obese you’re you definitely will go down the route of getting type 2 diabetes but if you’re genetically predisposed and you’re pretty mindful about your diet your lifestyle and knowing that you have this predisposition if you take care of what you eat you’re most likely going to prevent getting a type 2 diabetes you had said if you take care of what you eat so going deep into that wrap yeah I know that’s a huge factor in mitigating diabetes can you talk to the the health the diet health portion of that yeah so diet is a big factor like 90 percent is that we’re more than 90 percent okay more than 99 90 yeah 99 um more than 90 okay and the reason for that is because our society what we’re teaching our kids what to eat and and just they just have a very poor diet everybody’s eating a lot of carbs and sugars and we know that carbohydrates and sugars cause inflammation and if you’re eating carbs and sugars your body’s producing insulin a lot you know more insulin and that insulin what it usually does is it helps store fat so people are gaining weight so I get a lot of patients how do I lose weight well you need to stop eating carbohydrates and sugars because if you are eating more than usual or more what you know than what your body is using or metabolizing everything that you’re eating in terms of carbohydrates and sugars is going to be stored as fat okay and then that fat over time causes inflammation and a lot of inflammatory issues to go on in your body not just in your pancreas but throughout your body in your joints and in your vessels and your pancreas and that’s what sometimes leads to insulin resistance in in patients who get type 2 diabetes so it’s not necessarily just calories and calories out to maintain a healthy weight what I’m hearing is you also have to restrict or maintain a healthy carb intake exactly healthy carb intake and making sure it you know you’re eating more plant-based okay and then protein but having a minimal amount of carbohydrates uh what I usually recommend is less than 60 grams of carbs a day for our diabetic patients if they can go to below 40 or 30 that would be even more optimal wow so really protein rich breakfasts like scrambled eggs and then for lunch having a nice chicken salad and then dinner salmon and asparagus that’s something like that yeah that’s like the perfect diet very healthy actually okay that sounds really healthy so do you usually just coach people your patients who have diabetes on what to eat what would be best for them and then go from there I one of the things that I do is most patients don’t know um you know much about nutrition and so I spend a lot of time explaining why they shouldn’t eat sugar or carbohydrates because most of them don’t know how that is metabolized in our system and they don’t know that it can make their diabetes worse in addition to other chronic diseases that they may have it can make it worse as well well it’s interesting because growing up I mean I’ve heard of diabetes my grandpa had diabetes so i’m definitely in that genetic risk category but I remember my grandpa all he really knew was okay i have diabetes type two um I just won’t eat chocolate I just will stay away from cookies but he still had pasta he would still have bread he was still eating burritos and tacos and which you know um but it’s interesting because yeah we’re not really educated that carbohydrates and sugars aren’t just cookies and cakes but it’s also those pastas those breads those refined sugars that exactly our body really can’t process well exactly um I’ve heard the term pear is it pre-diabetes uh pre-diabetes pre-diabetes um I’ve heard the term pre-diabetes thrown around a lot what does that mean okay so pre-diabetes is a condition where a patient has elevated blood sugars but they’re not high enough uh for them it’s they’re not high enough for us to say you have type 2 diabetes and having pre-diabetes we call it a you know a kind of a chronic disease because we want to wake up our patients and tell them listen your blood sugars are elevated most likely this is going to lead to type 2 diabetes so we work on the lifestyle because we know with pre-diabetes most of our patients are pre-diabetic because of you know their obesity again and we work on we work with our patients to help them lose weight and help reverse that pre-diabetes so it doesn’t become type two so if they were to stay on the same lifestyle path that they were on being a pre-diabetic that would then lead them down the path to develop okay and so then we want to work on the lifestyle so aside from diet and maintaining a low carb diet what other lifestyle changes would you encourage somebody who is pre-diabetic so mainly lifestyle you know I would talk to them about their diet mainly weight loss because okay um in the major randomized controlled studies the only way it’s actually worked better than metformin on some patients who are pre-diabetic is actually losing about seven to ten percent of your body weight so if you’re able to lose that amount of weight you’re more likely to reverse the process and maintain um and kind of decrease your chances of getting that type two diabetes down the line so you had talked about people who then are overweight um who are pre-diabetic and then they become and have type 2 diabetes yeah that they need to lose weight so that’s what you had just let us know um how do you recommend your patients then go about that weight loss journey is it that low carb what else would you recommend for them so weight loss is a huge challenge for all of our patients so I just saw a lady this morning and she’s like I’ve tried everything I can’t lose weight I’ve been walking I’ve been and and I feel with with our patients because unfortunately even though she’s walking and she’s eating you know the diet like a better diet like cutting down on the carbs she still can’t lose weight and you know we we talked about the main thing I tell them is to motivate them because they could do more so this is what our patients are doing they’ll exercise for a half hour a day and then they’ll come home and not move at all they’ll watch tv so that’s the problem so not in in when we say increase your physical activity that means you need to be physically active throughout the day and then in addition to that you need to be exercising you know on the side it’s not just exercising coming back home and sitting down watching tv okay so that’s the problem with the majority of the patients are not really active they just want to sit down and kind of do what they need to do they’re really inactive they get in the car they go shopping they they do min you know they try to park the close they try to park in the closest parking lot to their mall or their grocery store um but and then when they get home they’re not really moving again right and they’re eating and they’re not burning what they’re eating that’s that’s that’s basically it so it’s inactivity um so they really need to be more active during their day not just you know exercising or walking for that half hour a day and um they also you know I think Dr. Madrid may have mentioned this the intermittent fasting they need whatever food that you’re eating you need to give time for your body to burn it down so you you know what I recommend for those patients that have a hard time losing weight to do the intermittent fasting with a low carbohydrate diet wow and that tends to the majority of the patients that I counsel them on this diet they go home they start doing it and they get a lot of results good results so they start to lose weight and that sounds like it’s something that is sustainable is that you’re able to have your eating window within a certain amount of hours so from 12 in the afternoon to 6 o’clock at night and it makes a lot of sense because you’re allowing your body to tap into that you know fat reservoir that you have those fat cells and those vessels are going to start to you know break down into energy okay if you do the intermittent fasting and I explain this to my patients every time they come in so once they understand that okay oh now this makes sense you know so it’s a lot of counseling gosh I think it’s hard because really like you said we are not taught or told how to really eat or how to live our lives and how to have the best lifestyle exactly but it’s been wonderful meeting with doctors and seeing okay how can we then educate our patients and then educate our children to then just have a healthier life or healthier world healthier kids in general yeah um I just think that’s awesome well if you guys are interested um we also have a nutrition course on our choose health website as well as a keto and intermittent fasting course done by two of our doctors one was done by Dr. Madrid and one was done by the wife of one of our doctors and so if you’re interested in learning more about those two things that go hand in hand it sounds like with diabetes absolutely you’re more than welcome to go on Choose Health and learn about those those are our free courses um but aside from that if you are looking for another primary care provider and Dr. Rahman is wonderful she is currently seeing patients at our Makena location so give us a call if you’re looking to learn more about diabetes or if that’s something that you’re interested in Dr. Rahman can help you out so thank you so much for being with us today you’re so welcome