Ep 81 - Top Diabetes Mistakes

[00:00:40] So today we're going to talk about some of the big mistakes that most doctors make when they're working with people in managing type 2 diabetes. Here's the thing, type 2 diabetes, in my experience in over 30 years of practice, is preventable, and in most cases reversible within a short period of time. Now, of course, it depends on how far along and how long it's been since it was diagnosed and how much damage has been done. But there's so much that can be done for type 2 diabetes and most doctors are just not educated on it.

[00:01:38] Type 2 Diabetes, we all know it's a blood sugar imbalance, hyperglycemia. The blood sugar gets too high. It is usually preceded by a period of insulin resistance. The period of insulin resistance is not just when the person's blood sugar goes above 100 over the course of several weeks or months.

[00:02:20] So let's talk about the first mistake, and that has to do with testing. When the average person goes in to the doctor for their annual, they get fasting blood sugar amongst other markers tested. And when the blood sugar goes above a hundred, the doctor says, Hmm, you have pre-diabetes. Now, at least that's what they're supposed to say. Usually it's on three consecutive occasions to make the diagnosis of insulin resistance, and so oftentimes they'll send the person away and say, Hey, just watch what you're eating, manage your weight, come back in a few months, let's test it again. Rather than telling them how to watch their weight, what they should be eating, what they should be avoiding, and all the things they should be doing.

[00:03:44] In fact, I've seen studies showing as much as 4 times the risk of cardiovascular disease, and those people are typically on the path to diabetes. But in medical school, nobody taught that. So nobody really looks at prevention. Nobody looks at early signs. We look at when does the person have a diagnosable disease, and there's an ICD-9 code for insulin resistance. There's an ICD-9 code for type 2 diabetes. There's no ICD-9 code for pre-insulin resistance, the period of time where you're heading towards diabetes, but you're not quite there. And so these people are missed, these poor people.

[00:05:08] So, getting them to get a $15 meter at the grocery store, at the pharmacy would be a good thing to do, and teaching them how to read it and how to see what's going on. That's postprandial testing. So that's number one. The testing, well, number one of the testing, the first mistake is not testing appropriately.

[00:05:40] Number two, mostly they're not testing A1C, and should a doctor be aware that this person's at risk of insulin resistance or type 2 diabetes, they can put a diagnosis code of insulin resistance and then run a hemoglobin A1C to see what over the time has been the average. Now, in my opinion, every annual should have an A1C if the person has any risk factors, if the person has family history, if the person has genetic markers, any of that, they should be routinely monitored for A1C. But even if it's not routinely monitored for A1C, like every year you do a baseline, and if A1C looks good, then you test it again in five years. If it starts to creep up, then we start testing it more regularly, and then we get to what we're going to talk about in mistake number three, which is education.

[00:07:25] And when they get to 5.7, it's an average glucose of 119. What's wrong with that picture? That means that while they're sleeping, counting their fasting and counting all their peaks after eating, 119, way too high. Whereas at 5.0 it's more like 90 something, which is good because it averages the peaks, which are going to go higher in people who are uncontrolled. And then the valleys, which is mostly the fasting, the in between meals and overnight.

[00:08:47] And the third mistake in testing that is almost a hundred percent made is not testing insulin. Generally speaking, doctors test insulin after a person's been diagnosed with type 2 diabetes, but not always. Definitely in type 1 or if they suspect a lot of latent autoimmune diabetes of adulthood. But everybody needs an insulin test. You don't know how many people I have tested on their insulin levels and found that their insulin levels were sky high.

[00:09:37] Why do we need insulin when we're fasting? Why should insulin be elevated when we are fasting? Insulin is a fat storage hormone. Insulin will constrict blood vessels, insulin will put a person at risk of hypertension and a whole lot of other things. So we don't want it up like that. We really want it in that two to five, or ideally two to three range in a really functionally optimal person

[00:10:42] So the other mistake doctors make is that they don't treat people as individuals. It's like this is routinely the way we handle type 2 diabetes. Oh, okay. All diabetes patients are the same. No, they're not. We really need to look at their eating behaviors, their lifestyle behaviors, their glucose measurements over time, over the course of a 24 hour period, which is why I'm such a big fan of CGMs and I wish that they would become commonplace, and I think the more people that are prescribed to the more the drug companies are going to recoup their investment in the research and the prices will come down. There's no reason these little discs should be $70 a person. There's no reason they should be prescription only. We need to get them into the hands of everybody to help them prevent this horrible disease.

[00:12:22] As an adult, I feel like I need to be chained to the refrigerator because I can't go very long without eating because it drops. That's a clear indication of high insulin. And then once the insulin gets depleted enough or the cells get resistant enough, that's when the sugar starts to go up.

[00:13:46] And then finally, Education. Educating people to take charge of their health. Empowering people to know how to manage their glucose levels, how to manage their insulin levels through proper attention to diet and lifestyle. And this goes back to CGMs and meters, $15, not very expensive. You can get very inexpensive ones with test strips that people can afford to do, and you teach them how to figure out what dietary approaches, what stress responses they're having, their exercise, and you get to manage all of that. The lifestyle factors are critical, and as doctors, we need to be able to educate people. As health coaches, nurses, anybody who is in contact with the public, we need to be able to educate them as to not just how to manage their diabetes, but catching them early on so we can help them manage their blood sugar, their metabolic health. Before it becomes diabetes.

[00:16:08] So I encourage you to start to adopt a patient centered, a client centered approach, not the routine. Run this test. This is okay. Send him out for a year and test him again. Educating them as to how to prevent going downhill whenever we see even those earliest of warning signs. We have a free guide to. I think it's called fasting. The benefits of fasting. It's an intermittent fasting guide and tells you all the different kinds of fasting. Not everybody is open and amenable to fasting. Not everybody's in a place where fasting is good, but there's different kinds of fasting that you can use with people to help them manage their glucose and insulin levels and help them prevent and even reverse.

[00:17:23] So you can go to inemethod.com and check that out. And until next time, shine on.