293: Understanding Type 2 Diabetes: Symptoms, Risks, and Preventions | DOCTOR IN THE HOUSE

Dr. Rizwan Bukhari  00:00

Type Two Diabetes is insulin resistance. Okay, so our body is making the insulin, but for some reason our body is not utilizing the insulin appropriately. Okay? And therefore is not managing our bloodstream. Welcome

Maya Acosta  00:13

back to another episode of the healthy lifestyle solutions podcast. This is another segment of Doctor In The House. Welcome Dr. Riz.

Dr. Rizwan Bukhari  00:23

Hi, thank you very much for having back.

Maya Acosta  00:25

Yeah, we've gotten really good response for the first four episodes that we recorded. And so we're going to continue. This time, we're doing a four part series on diabetes. And this is a very important topic. For all of us. Most of us know at least one individual living with diabetes. And so we were going to take you through all of it. What is diabetes? How do you manage diabetes? What are some lifestyle changes that you can make and all sorts of recommendations that we're going to make? Before we start today's episode? I thought it would be fun doctor is to do rapid fire questions. What do you think?

Dr. Rizwan Bukhari  01:02

Okay, let's go for it. I hope I know the answers.

Maya Acosta  01:05

All right, these are really true or false. You know, because there are a lot of myths associated with type two diabetes, true or false. type one diabetes is caused by eating too much sugar. False. All right, pre diabetes is a medical condition in which blood sugar levels are higher than normal, but not yet high enough to be classified as type two diabetes. True. Okay. You want me to wink with one eye for sure.

Dr. Rizwan Bukhari  01:34

If I get it wrong, let me know.

Maya Acosta  01:36

Okay. And you guys, I want the listeners, I want you guys to kind of take notes if you want and also take some guesses, because we want to make sure we address a lot of these things. Okay, the power plate is a meal plan that emphasizes whole plant based foods and recommends limiting animal products and high fat foods. True, okay. True or False? Eating High fiber foods like legumes, vegetables, can help regulate blood sugar levels and reduce the risk of type two diabetes. True. All right. Another question true or false? Consuming too much added sugar can increase the risk of developing type two diabetes. False. Right. And this is a myth, and we'll get into it. But I used to believe that sugar was the issue.

Dr. Rizwan Bukhari  02:24

Correct. And sugar is sugar is an issue because it is a symptom of diabetes, but it is not part of the root cause of diabetes. That's

Maya Acosta  02:33

right, we're talking about root cause. So this is this is why I'm glad we're doing this because we're going to address some of those myths. All right. Other things. Eggs are a healthy source of protein for people with diabetes, false. Eating foods with high glycemic index can cause a rapid increase in blood sugar levels. True. Yep. Very true. Just because we're saying that the root cause is not sugar doesn't mean that we're saying hey, consume high levels of sugar. Right? Okay. True or false plant based diets have been shown to improve insulin sensitivity and lower the risk of type two diabetes. True to more consuming dairy products like milk and cheese can help regulate blood sugar levels in people with diabetes. False, right. And you know, what's interesting, Dr. Is, is that nowadays, no matter what sort of diet you have, many people are moving away from dairy products, period.

Dr. Rizwan Bukhari  03:29

That is true. I think there's a large recognition out there in the population, that dairy products are unhealthy. And people recognize that and are now moving towards non dairy alternatives, knowing that that's a healthier way to live their

Maya Acosta  03:43

lifestyles. Yeah. Okay, last one, true or false regular physical activity can help lower blood sugar levels and improve overall health in people with diabetes. That is true. Yeah. Awesome. I can't wait to talk about that. Because I feel that whenever we talk about, I say we but whenever you hear people talk about type two diabetes, you don't hear a lot of people emphasize the importance of exercise.

Dr. Rizwan Bukhari  04:04

Absolutely. So I mean, obviously, the one of the primary ways to manage your diabetes is through your diet. But there are other lifestyle choices that you can add on to it to tweak and help as well.

Maya Acosta  04:16

Yeah, yeah. Okay, Dr. Riz, I was hoping that I could start with a quote form from Dr. Michael Greger. One of the chapters in his book addresses diabetes, and I thought it would be great to talk about the prevalence of diabetes. So let's start with that type two diabetes has been called the Black Death of the 21st century in terms of its exponential spread around the world, and its devastating health impacts instead of robotic plague. Though the pathological agents in obesity and type two diabetes are identified as high fat and high calorie diets and instead of fleas and rodents, the causes are advertisements and inducements to poor or lifestyle. He says more than 20 million Americans are currently diagnosed with diabetes, a tripling of cases since 1990. At this rate, the CDC predicts that one in three Americans will be diabetic by mid century. Currently in the United States, diabetes causes 50,000 cases of kidney failure 75,000 lower extremity amputations, 650,000 cases of vision loss and about 75,000 deaths every year.

Dr. Rizwan Bukhari  05:32

Yes, ma'am. In the world that I live in, I kind of think that that's an understatement. The reality is, I've seen a tripling in the rate of diabetes in the 25 years, I've been in clinical practice, we used to say about 10 million adult Americans had type two diabetes, and that number is closer to 30 million at this point. So we've seen a tripling just in my medical career of 25 years. And then with that number, where he quoted, maybe nearly a third of Americans will have diabetes. Right now, I think the consensus is that nearly 50% of Americans either have diabetes, or are pre diabetic. And so and the thing is, most of those people are running around, not knowing it.

Maya Acosta  06:24

Mm hmm. Wow. In this episode, I'm hoping to answer some of these questions. And I have my notes here, because there's so much content to cover, but I'm hoping that we can just talk about diabetes, what is diabetes, the different types that you hear about? What causes this insulin resistance? Because, again, there are those myths that people think it's all about the sugar, but what are the root causes? What are those risk factors? Many people seem, seem to think that genetics plays a significant role, especially with type two diabetes, all of us have been affected by some loved one that is living with type two diabetes. And then we want to give you some recommendations, and, you know, a call to action at the end of this episode, but can you first start Dr. Riz by talking about diabetes, what is diabetes?

Dr. Rizwan Bukhari  07:14

So in its most basic definition, diabetes is the body's inability to effectively manage glucose. So and then there are different types of diabetes that, you know, describe the different kinds, you know, there is the type one diabetes, which is typically associated with younger people or juvenile diabetes. And that's oftentimes a genetic problem, or an autoimmune disorder. Okay. And so those are the kids who grow up with diabetes. And there, they actually don't make insulin. So it's not a it's not a insulin resistant problem, which is type type, type two diabetes, and we'll get into, but it's a problem where their pancreas is not making insulin, so we have to replace that insulin in order for them to live. If there's a type one diabetes, then there must be a type two diabetes, and type two diabetes as what I consider acquired diabetes, that means you weren't born with it. You didn't have a genetic predisposition to it, but you developed diabetes later in your life. And that is not a situation where our pancreas is not making insulin, our pancreas does make insulin, but the problem is, we are not utilizing that insulin appropriately to manage our glucose. So we are insulin resistant. Okay, and so type two diabetics are insulin resistant for some reason. Okay. And that constitutes the majority of the diabetes that exists today, about 90% of the diabetes that is out there is type two diabetes, it's acquired. And the vast majority of that is lifestyle related.

Maya Acosta  08:51

Yes. So my first experience with a family member with diabetes many, many years ago was my mother's mother, who died from complications associated with type two diabetes, she had just had an amputation and never left the hospital. I don't know if I ever told you that. No, actually,

Dr. Rizwan Bukhari  09:11

I did not know that. Yeah, I don't talk too much, considering that I deal with type two diabetes and amputations so much. You know, that's, that's nice. To me.

Maya Acosta  09:20

What I think what shocked me the most was that she was only in her 60s When she died. And I remember her being a partier, and a heavy drinker and all of that. And then one day, she has to have an amputation and never left the hospital. She died and I believe there was some heart disease associated with that. So very important to talk about this. Diabetes is also a type two diabetes is also very prevalent in my family. And I used to think that it was, you know, many of us believe that it was the ethnic part of who we are. So if you're Latina, or of Latin descent, you're more likely to develop this condition. So This is where you're going to help educate us all. You know, I've heard of 1.5. I've heard of pre diabetes. And I've also heard of gestational diabetes, which I've only learned as a podcast or what that is, because why else would I know this?

Dr. Rizwan Bukhari  10:13

So the other ways I described diabetes, I do talk about one and two, and then I don't use, I don't usually use the term 1.5, I actually will use the term pre, pre diabetic. And so and then the other term, which you mentioned is gestational diabetes. So pre diabetic is those people who are kind of in the middle, it's someone whose blood sugar management is starting to show some problems. But they don't actually qualify for the formal diagnosis of diabetes. And so typically, their blood sugar's are running higher than normal, but they don't quite hit that level, which constitutes diabetes. You know, so in other words, it's a spectrum, there's a normal, and then there's, you know, higher than normal. And then finally, when you hit a certain level, it's called type two diabetes. So pre diabetes is that level right below it, where you're above normal levels, but below diabetes levels, okay. And gestational diabetes is is is, is a insulin resistance that occurs in some women who are pregnant. And the the bad thing about that is that is it's called a harbinger or a possible signal of the possibility that that woman will develop Type Two could could develop Type Two Diabetes further on down the line, they are more predisposed to do. So before we

Maya Acosta  11:33

talk about risk factors. Can we talk about symptoms? How do people know that they might have diabetes?

Dr. Rizwan Bukhari  11:39

Well, you know, like many of the chronic diseases that we have today that we live with today, the bad part about it is many times it can be quite silent for many, many years. So it can be developing underneath and going on, and we don't know about it, and causing damage. So and then finally, when it's discovered, it's because we've fallen over the edge, and suddenly, there's all sorts of symptoms related to it. And a lot of damage has occurred from it. So diabetes can develop quite silently over time. Okay, but some symptoms that are common symptoms of diabetes are what we call poly dipsea, which means increased thirst, okay, and polyurea, which means having to pee a lot. And those are consequences of having too much sugar in the bloodstream. Okay, too much sugar in the bloodstream makes you pee a lot. And because you pee a lot, you're thirsty. So you want to drink a lot. And so there's those are actually two fairly common symptoms in people who may not know anything else is going on. And then they have, but they might have diabetes or prediabetes. Other Other symptoms might be something like someone who develops a neuropathy, that's the neuropathy is where they develop numbness, tingling, or kind of funny feelings in the, in the, in the tips of their toes or, or in in their fingers. So that's what neuropathy is, another symptom might be someone who's slow to heal. So typically, if we get a cut, or scratch or a bug bite on our lower extremities, like on our limbs, or our foot or toes, we'll heal normally. But diabetics have trouble healing as as a consequence of their diabetes and, and other multifactorial issues. Because most of our diseases do not exist as a solo disease, they, they're a part of the entire physiologic process of the body. But anyway, slow healing might be another sign of diabetes,

Maya Acosta  13:36

it's interesting risk factors. And you're going to tell us about risk factors,

Dr. Rizwan Bukhari  13:40

there are both what I call genetic and lifestyle risks for type two diabetes, and you can look at certain populations of people and know that there's a difference in the possibility of them developing it. minorities, such as the Latin population in the black population are at higher risk for developing type two diabetes. And then even my ethnic background, Southeast Asian is very, very, has a very, very high risk of developing type two diabetes, I think more, I'd have to look, restate the statistics, but I think the Southeast Asian population has a much higher risk of developing type two diabetes than blacks and Latinos. And so there's that risk that is underlying, okay. But it doesn't, that doesn't mean that you have to have it or have to get it. It's the lifestyle factors that then contribute to it. And you know, I often use up a, an anecdote or a story, you know, where someone will come into my clinic and say, Well, my dad had this and that and that, and my aunt had this, and my grandfather had this, and my grandma died of this, so I'm doomed to have it. And so yeah, there might be some familial predispositions to it, but what I tell them is, yeah, you're you're probably doomed to get it. If you Live the exact same lifestyles that they did, but you have an opportunity to live a certain type of lifestyle, which puts you at less risk for developing these problems. And therefore, you don't necessarily have to develop it. And so, you know, the if you, we there are we and we're going to get into the type of lifestyle and nutrition and any other things you can do to lessen your risk of diabetes. One thing I will say is that, and we will also probably talk about this too, at some point, either in either in this talk or in further on in our series, is that the reason it's important to keep an eye on your blood sugars and things is because the earlier you discover it, the easier it is to manage. Okay, the earlier you discover it, the easier it is to reverse. And so those are those are really important things, they are very much so. So genetics, there's also another terminology I use is genetics might load the gun, but lifestyle is what pulls the trigger. That's right. So you don't if you never pull the trigger, then you'll never get it. Yes, yes.

Maya Acosta  16:05

What exactly is happening? When insulin resistance is happening? Yeah, I

Dr. Rizwan Bukhari  16:10

think you can come up with all sorts of analogies to help describe what's going on. But and we started to talk about it when we talked about type one diabetes versus type two. So type two diabetes is insulin resistance, okay, so our body is making the insulin, but for some reason, our body is not utilizing the insulin appropriately, okay. And therefore, it's not managing our blood sugars. So what happens is when we eat whatever forms of sugars we eat, are converted into glucose. And that's what's absorbed into our bloodstream. So we have glucose in our bloodstream, that's one particular form of sugar, that's the form of sugar that our body uses. And so then that glucose, then it causes our pancreas to release insulin, in order to help the glucose then be sent into our cells, whatever cells of the body need the glucose to function as an energy source.

Maya Acosta  17:04

So is the insulin sort of guiding the glucose? Like, how like a passenger in a car, hey, come with me, we're gonna go into that cell, or how does well, insulin

Dr. Rizwan Bukhari  17:13

is a hormone, okay? And so the insulin binds to the cells, and then kind of opens the door for the glucose to go in

Maya Acosta  17:22

into the cell into the muscle into where we can use it as fuel as energy. Yeah,

Dr. Rizwan Bukhari  17:27

whatever cell needs it. Mostly, it's the muscular cells of the body. But a lot of cells, I mean, our brain functions on glucose, okay, and those are not muscle cells. But so the insulin does open the door. So you could say the insulin is the key, that opens the door for the glucose to get into the mom and into the cell. So when we are insulin resistant, for some reason that insulin cannot open the door. Okay, so we got the insulin, and it's, it's there, but it's not opening the door for the glucose to get in. So then are our blood sugar rises, it's like traffic jam. Yeah, so we get more blood sugar, we get more sugar in our blood. And therefore, that's what type two diabetes is. It's an elevated blood sugar, secondary to the inability of insulin to work or insulin resistance, okay. And so that's kind of the process of, that's why we then get elevated blood sugars, secondary, even though we're making insulin, it's not the sugar that's causing the diabetes, there's something else that's causing the insulin to not be effective, and that is fat. Okay, so what happens is, fat causes the key not to function, and therefore, the insulin is ineffective. Okay. And so this is why we've seen as we've seen a concurrent rise in obesity in the United States, we've seen a concurrent rise in diabetes in the United States, specifically type two diabetes. So there is a relationship with between obesity, and diabetes, and we call that diabesity. So, as we've as we become fatter as a society, we've got more type two diabetes. Yeah. And so the the fat in our body causes the insulin resistance. Yeah. And then, in particular, there's something called intramyocellular. Lipid, which it contributes to the ineffectiveness of the insulin.

Maya Acosta  19:37

Yeah. Okay. And the good news is that as we move on to the next episodes, we're going to talk about how patients and listeners overall can make healthy lifestyle changes so that the weight comes off without so much of a struggle while they're improving. They're improving their insulin resistance. I'm very excited about that. It Anything else you want to say about risk factors? Before we wrap up?

Dr. Rizwan Bukhari  20:03

I think we kind of covered it. Okay. Yeah,

Maya Acosta  20:05

yeah, this, this has been wonderful. So friends, Dr. Riz, and I put together a really nice guide where he addresses cardiovascular disease. If you haven't grabbed a copy of it, I really want to encourage you, you grab a copy. And that takes you to subscribe to our newsletter. But you know, our goal is to send out literature and all sorts of great resources to encourage you and your health. But here's the link, and it's going to be in the show notes. It's Bitly bi, T dot L Y, forward slash, join Dr. risks. And that's all kind of like one word. And also, I would love to hear from you guys. So please drop us a question. You can leave us a voicemail, I really love that idea of hearing from you and for a chance to be featured on the podcast. And so the link is speak pipe.com forward slash HL s.

Dr. Rizwan Bukhari  21:00

Yes, I agree. I would love to hear your questions. I like to answer questions. You know, I think that, you know, we can we can talk forever. But there's still probably questions in your head. And if there's something we didn't answer, by all means, reach out to us, and we can answer those questions for you.

Maya Acosta  21:15

That's right. All right. Stay tuned for next Monday when we continue part two of diabetes and we're going to talk about what it's like to manage diabetes and also the costs of living with diabetes. So thank you, Dr. Risk.

Dr. Rizwan Bukhari  21:31

It's been fun. See you next time.