Ep 1: What Is Diabetes?

[00:00:00] Grace Silverio: There's type 1 diabetes and there's type 2 diabetes and then there's prediabetes. 

[00:00:07] Dr. Bayo Curry-Winchell: Type 2 diabetes is a common condition in the United States. The Centers for Disease Control estimates approximately 37 million people are living with type 2 diabetes, 28 million who are diagnosed and about 8 million who are undiagnosed. Type 2 diabetes can be a silent disease. The CDC found one in five people don't even know they have it. And there are even more people who are at risk of developing type 2 diabetes.

[00:00:37] Sandra Leal: So one in three people, about 100 million people, have prediabetes right now. 

[00:00:43] Dr. Bayo Curry-Winchell: And while type 2 diabetes is a serious health condition, it can be managed, and most importantly, it can even be prevented by making lifestyle changes. Those changes need to be made when someone is going through prediabetes. In other words, the time before they fully develop type 2 diabetes.

[00:01:03] Sandra Leal: It is not a death sentence. It's really a wakeup call. 

[00:01:07] Dr. Bayo Curry-Winchell: Lifestyle changes, medications and resources like diabetes prevention programs can help you manage your blood sugar, stay healthy, and even keep diabetes at bay.

Welcome to the Preventing Type 2 Diabetes Podcast. In this first episode, we'll talk about diabetes, highlighting what causes it, who is more likely to get diagnosed, and symptoms you should look for. We'll also cover risk factors that can increase the chances of developing type 2 diabetes. 

[00:01:39] Adrienne Maye: A sedentary lifestyle, obesity, being overweight.

[00:01:44] Dr. Bayo Curry-Winchell: And throughout the series, we'll hear from people about how they took charge of their health. 

[00:01:49] Oscar Camejo: I have pictures of me in the hospital looking out the window and I was thinking about my life like, okay, Oscar, you've been given a chance to redeem your life. What are you going to do with it? 

[00:02:03] Dr. Bayo Curry-Winchell: I'm your host, Dr. Bayo Curry-Winchell. I know that's a mouthful, so you can call me Dr. BCW. I'm a board-certified family medicine physician based in Reno, Nevada. I'm the medical director for two health centers and founder of Beyond Clinical Walls, a health education resource. I'm also a medical journal contributor and columnist.

And at the time of this podcast, I've delivered two TEDx talks. You can find me on social media by searching for doctor underscore BCW or using the links you'll find in the show notes. I'm passionate about health and health equity, and I'm thrilled to be your host of this Health UNMUTED miniseries about preventing type 2 diabetes and to guide you on what steps you can take to avoid developing it. Now let's get started.

The Preventing Type 2 Diabetes Podcast is a production of Mission Based Media and was made possible with the support from the American Pharmacists Association Foundation. This series is for educational purposes only. It is not a substitute for formal medical advice, diagnosis, or treatment. So if you have questions about your health, talk to a qualified healthcare provider.

So let's start with the basics. What is diabetes? To understand diabetes, we first have to understand how our bodies make and use energy. Here to explain it is Ryan. 

[00:03:30] Ryan Aiazzi: My name is Ryan Aiazzi. I'm a licensed family nurse practitioner in Reno, Nevada. Every cell in our body needs glucose, which is basically sugar, to run. So our body lives off of glucose.

[00:03:44] Dr. Bayo Curry-Winchell: Like Ryan said, glucose is another word for sugar and our bodies need sugar in order to produce the energy we use to breathe, move, dance, to do anything. The sugar in our bodies comes from the food we eat, like the sugar in a cup of coffee, but also from other things like bread, pasta, rice, and lots of other foods. When the food we eat is digested, it gets broken down into glucose and then it travels to our cells. You'll hear the word glucose a lot throughout this podcast series. So when someone says glucose, just think: sugar. 

[00:04:18] Ryan Aiazzi: In order to get glucose into the cell, you have to have what's called insulin.

[00:04:22] Dr. Bayo Curry-Winchell: Insulin is a hormone made by the pancreas. The pancreas is an organ that you don't hear about as often as the stomach or intestine, but its role in digestion is just as important as those other organs. The pancreas is located just below the ribs and it sits behind the stomach on the left side of the body. 

[00:04:42] Ryan Aiazzi: And you think of it as like a lock and key, so when we have a lot of glucose in our bloodstream and the cells need it, insulin unlocks that door, glucose can walk on through and do what it needs to do.

[00:04:55] Dr. Bayo Curry-Winchell: So sugar isn't all bad. The problem is when there's too much of it or the body isn't able to use all of it. 

[00:05:02] Ryan Aiazzi: When we have too much glucose, those cells become resistant to insulin, and so we get what's called some insulin resistance. I liken it to if you've been married long enough, or with someone for long enough, you kind of start tuning out their voice unintentionally.

They'll be talking to you from across the house, and all of a sudden, you'll realize they've been trying to have a whole conversation with you. That's what your cells are doing to insulin. They're like, okay, I hear a lot of you. There's too much going on here. We're just not going to let in as much glucose.

[00:05:34] Dr. Bayo Curry-Winchell: And if the glucose can't get into your cells, it builds up in your bloodstream instead. 

[00:05:39] Ryan Aiazzi: When you have excess glucose in your bloodstream, it causes all sorts of damage. It creates inflammation, which puts you at a higher risk for cardiovascular disease. And your kidneys and every other organ in your body kind of have to deal with that.

[00:05:51] Dr. Bayo Curry-Winchell: When your blood sugar levels are consistently too high, that's diabetes. And there are two main types, type 1 and type 2. In type 1 diabetes, your pancreas either doesn't make any insulin or doesn't make enough insulin to move sugar from your blood into your cells. We don't know exactly what causes type 1, but it's thought that type 1 happens when the body starts attacking the pancreas by mistake.

That's why we call type 1 diabetes an autoimmune disease. And developing type 1 diabetes doesn't have anything to do with what you eat or how much you exercise. Development and treatment of type 1 diabetes is entirely different than the way type 2 diabetes is developed and treated. Since it's so different, we won't cover type 1 diabetes in this podcast series.

So let's move on to type 2 diabetes. In type 2 diabetes, high blood sugar can cause insulin resistance, preventing cells from taking in glucose. This high blood sugar can also cause the pancreas to work overtime and eventually wear out and stop producing enough insulin. And without enough insulin, the glucose can't travel from your blood and into your cells.

So the sugar stays in your bloodstream. High levels of sugar in your blood causes damage to your organs. And that's called high blood sugar. 

[00:07:15] Adrienne Maye: So when we talk about risk factors for type 2 diabetes, we're really talking about a sedentary lifestyle. 

[00:07:21] Dr. Bayo Curry-Winchell: That's Adrienne Maye. She's a registered nurse and certified diabetes care and education specialist. You may have heard the term sedentary lifestyle before. It's used to describe people who spend a lot of their time sitting or lying down and doing very little or no exercise. It is a significant problem in modern society. 

[00:07:43] Adrienne Maye: Are you moving your body? Obesity, being overweight, that puts you at increased risk factors for type 2 diabetes.

[00:07:50] Dr. Bayo Curry-Winchell: When you move or exercise, your muscles use glucose from your bloodstream, which lowers your blood sugar. That's why a sedentary lifestyle is such a big risk factor. 

[00:08:00] Adrienne Maye: And then a lot of it is hereditary. So do you have maybe a mom or a first generation person that does have diabetes? 

[00:08:08] Dr. Bayo Curry-Winchell: Anyone can develop type 2 diabetes, but it's more common in adults who have a family history of the disease. And like Adrienne says, family history, weight, genetics, diet, and exercise can play a large role in developing diabetes. 

Before someone is diagnosed with type 2 diabetes, there is a period of time where the condition is starting to develop, and the body is going through some changes. This stage is called prediabetes.

[00:08:38] Grace Silverio: I am someone who lives with prediabetes.

[00:08:42] Dr. Bayo Curry-Winchell: This is Grace. 

[00:08:44] Grace Silverio: I am Grace Silverio, registered nurse and certified diabetes care and education specialist. 

[00:08:50] Dr. Bayo Curry-Winchell: Prediabetes is more common than type 2 diabetes. Approximately 37 million Americans have type 2, but it's estimated that nearly a hundred million people in America aged 18 or older have prediabetes. That's 38% of all adults in the U. S. and it can affect children too. 

[00:09:11] Grace Silverio: When I was diagnosed with prediabetes, it was over the pandemic. I was the most sedentary I’d ever been in my life. I was gaining some weight. I knew that being a Hispanic woman in my forties with a family history of type 2 diabetes was going to put me at increased risk.

[00:09:28] Dr. Bayo Curry-Winchell: Prediabetes is the step before crossing the threshold to a diagnosis of type 2 diabetes.

[00:09:35] Grace Silverio: What that is, is where you're starting to become a little insulin resistant, where the body is still producing that insulin, maybe not using it as effectively or as efficient as it's supposed to. 

[00:09:48] Dr. Bayo Curry-Winchell: And prediabetes is caused by many of the same things as type 2 diabetes, poor diet, lack of exercise, being obese or overweight, and having a family history of diabetes. Adrienne often tells her patients that prediabetes is both a warning sign and a call to action.

[00:10:07] Adrienne Maye: With prediabetes, your blood sugars are elevated, but not high enough for you to have the diagnosis of type 2 diabetes. I always tell people it's the bridge. You're at one end of the bridge, but if you cross over, you're at type 2 diabetes. So, when we're thinking about that, we're really talking about managing your prediabetes, managing your lifestyle, making some lifestyle changes, so it does not progress to type 2 diabetes. 

[00:10:33] Dr. Bayo Curry-Winchell: We'll talk more about these lifestyle changes in future episodes. It's important to treat prediabetes as soon as possible, not just because it can lead to type 2 and other health complications, but because there is no cure for diabetes. This may sound scary, but the good news is that having prediabetes doesn't mean you will definitely develop type 2 diabetes. In fact, prediabetes is a great opportunity to start making changes that can help you avoid type 2 diabetes completely. Now, you may have heard that some people from certain ethnic backgrounds are at a higher risk of getting prediabetes and type 2 diabetes.

[00:11:15] Adrienne Maye: According to the research, African Americans are at higher risk for prediabetes and type 2 diabetes. 

[00:11:22] Dr. Bayo Curry-Winchell: Several studies in the United States show African Americans are about twice as likely to develop type 2 diabetes than white Americans. Prediabetes and type 2 diabetes are also more common among Hispanics and Latinos, Native Americans, Alaska Natives, some Pacific Islanders, and Asian Americans. If you're interested in some of these studies, you can find links to them on our website at healthunmuted.com/resources. Researchers don't know exactly why some people of certain ethnicities are at a higher risk of prediabetes and type 2.

[00:12:00] Dr. Robert Oh: Southeast Asians are probably a little bit more at risk for it. 

[00:12:04] Dr. Bayo Curry-Winchell: Dr. Robert Oh worked in family medicine for years and was diagnosed with prediabetes in 2011. 

[00:12:10] Dr. Robert Oh: At that time, the recognition that Southeast Asians, which I am of ethnicity, as a risk factor was not as well recognized at that time. While we tend to look thin on the outside, we do tend to have more visceral fat on the inside. And therefore, that is hidden and a lot of people don't screen for that because they look at us and view us as not fitting the mold of prediabetes. 

[00:12:32] Dr. Bayo Curry-Winchell: Another reason some people are more at risk of prediabetes and type 2 diabetes is diet and lifestyle. 

[00:12:39] Adrienne Maye: A lot of it is actually related to maybe some of our upbringing, some of our access to care, some of our eating habits are cultural. So you also have to be aware of that. 

[00:12:25] Dr. Bayo Curry-Winchell: Staple foods like rice and bread, traditional cooking methods like frying foods in lots of oil, and cultural attitudes around sharing big meals together, can put people at a higher risk of type 2 and prediabetes. And finally, social factors of health can make it harder for people in some communities to access affordable food, healthcare, and safe spaces to exercise.

These challenges are called social determinants of health. The CDC reports that they contribute up to 80% of health outcomes. Just because some people are more at risk of developing prediabetes and type 2 diabetes does not mean they will develop it. Genes, being overweight or obese, where you live and how you live all play a role.

And the good news is that with the right support, you can make important changes to your lifestyle to improve your health. 

[00:13:46] Adrienne Maye: I'm at higher risk for prediabetes or diabetes. Does that have to be your final diagnosis? Absolutely not. Does that have to be the final way that you're gonna live your life and feel like you're gonna have complications and not have a long, healthy, productive life? Absolutely not. We actually have the power and the positivity to change our lifestyle.

[00:14:12] Dr. Bayo Curry-Winchell: In the next episode.

[00:14:14] Oscar Camejo: I felt myself being tired a lot. Just going up and down steps was a struggle.

[00:14:21] Dr. Bayo Curry-Winchell: What are the symptoms of pre-diabetes and how was it diagnosed?

In the meantime, if you want to learn more about what diabetes is, what causes it, or anything else we discussed in this episode, you can head to our website at healthunmuted.com/resources for links to the National Diabetes Prevention Program, Lifestyle Change Programs, and other resources that can help reduce the risk of type 2 diabetes. 

This is the Preventing Type 2 Diabetes Podcast hosted by me, Dr. BCW. This show is part of the Health UNMUTED audio library by Mission Based Media and was created with support from the American Pharmacists Association Foundation. To listen and learn more, visit healthunmuted.com and follow our show on your favorite podcast player.