296: The Importance of Early Detection of Type 2 Diabetes | Doctor In The House with Dr. Riz

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It's never too late to change your lifestyle. Not only can you improve the underlying chronic conditions that you have, but it can improve your overall health. If you're my patient who is going to require multiple procedures, the better health you're in, the more likely you are to have less complications with the procedures that I do, and the more likely you are to recover quicker and better after the procedures. Welcome back to another episode of the healthy lifestyle solutions podcast. This is the doctor in the house segment that I'm doing every Monday as a bonus episode for you my listeners with Dr. Risk. Welcome back. Dr. Risk. Hi, good to have you back. So people are really loving this doctor in the house segment. And I also want to remind you Dr. Riz has social media very active on there. On Instagram, it's Dr. Dr. Underscore RIS ri Z underscore BaKari, B UK, h a r, I also look for him on Facebook, because he has a lot of great content and reels are are fun to watch. And also the segments doctor in the house, we actually put them on the reels as well on his social media, so make sure to follow him. Dr. Res. Last week we spoke about really diabetes, we lay down the foundation for what diabetes is what are the symptoms that people develop if they have any symptoms at all. And then we talked about risk factors. In today's episode, I'd like to talk about early detection, because one of the things that you said last week was that some people can live with diabetes for years and never know they have it. Is it possible that someone can be so far along with our type two diabetes, that, you know, making lifestyle changes won't matter. And also, I want to bring it back to your clinic, your patients the prevalence of type two diabetes among your patients, you have a limb salvage program that is associated sometimes with type two diabetes, and sometimes with other injuries. We've also spoken about that in previous episodes.

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And then finally, what does it mean when type two diabetes is not well managed? What are the risks down the line for the for people? So let's start with why is it important to detect type two diabetes early on? Well, I mean, it's it's important to detect type two diabetes, because Diabetes is a serious chronic medical condition that has several bad complications. It's not just that, oh, we've got high blood sugar and, and that's it. The high blood sugar and the insulin issues lead to multiple complications over the course of a lifetime in patients who are not well managed. And those can be things such as blindness, kidney problems, limb loss neuropathies. So there are multiple complications related to diabetes. And then diabetes is a significant contributor to cardiovascular disease, which is the number one killer of Americans. So you know, I see in my practice, what I see diabetes,

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present as is

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the potential for limb loss and amputation. I see people with heart attacks, I see blind people I see Pulpo. Diabetes is one of the main reasons that people lose their kidneys, and then I have to put in graph so that they can go on dialysis for life. So there are multiple complications of diabetes that exist. And if gone, untreated or not well treated, our people are bound to happen. And even something as simple as neuropathy, which you know, no one gives a thought to until they get it. But once you get it, it sure is a pain. neuropathy is can cause numbness, they can cause tingling. They can cause pain, or a combination of all those things. And no one likes to have them and we got patients who come in all the time complaining about their neuropathy, and they're on multiple medications for these neuropathies. And the medications themselves are, number one, not that effective. But number two have multiple side effects. Yeah, so there's, you know, you when you think of something as my, quote, minor as a

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neuropathy, even that is a terrible thing to get. Yeah, what you're describing is the loss of quality of life. And that's always what I want to emphasize on the podcast is, it's not that when you're close to dying, you'll just drop dead. It's more like every day you can be feeling, you know, this devastating existence when you're not living your best life physically. Now, there's a significant amount of inflammation associated with chronic diabetes. And then inflammation to is not only making you feel bad, but it's contributing to these chronic diseases that I also discussed. Yeah, yeah. Do you remember in 2019, we went to the lifestyle medicine

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conference and heard Eric Adams to give his testimony of how he reversed his type two diabetes. He said he was going blind? Yes, absolutely, yeah. And he made lifestyle changes and then supported his mother, who was also living with type two diabetes. And you know, it's incredible when you see him today. So we're gonna talk about resources, he also has a book out called Free at last. And it's his story of his type two diabetes. And also it includes recipes. And so we want to give our listeners like all these kinds of resources so that they can take charge of their health doctor is Do you yourself, diagnose patients, or most of your patients that do have type two diabetes are just already come to you that way? Yeah, I typically am not the one to diagnose them, because by the time a patient gets to me, they have multiple chronic medical conditions that

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combined, typically, we call it metabolic syndrome. And I may or may not have mentioned that on our

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podcast before on the podcast. But typically, they have multiple chronic conditions that when combined lead to atherosclerosis that I treat, and diabetes is very, very common in my patient population, although it may only constitute 10%, of the adult American population. Diabetes is literally seen in 50 to 75% of my patients. So that tells you how important or significant it is in the development of atherosclerosis. Wow. So it's not I don't typically diagnose the diabetes are typically already diagnosed and on medication for it.

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But I might be the first person to talk to them about lifestyle changes that can improve their diabetes, but there is the occasional patient, but I see hundreds, if not 1000s of patients a year. So there is the occasional patient, where I'm the one who diagnosis it because it hasn't been picked up before, right. And I'm shocked at the prevalence 50 to 70% of your patients are living with type two diabetes. And just a reminder to the listener, we are really focusing on type two diabetes, for the most part in these conversations, because that's the one condition that we know can really be reversed with lifestyle. If you have other questions about type two, type one diabetes, we can, you know, give you resources for that. But you can actually live a healthy life too. Even if you have type one diabetes with these recommendations that we are going to make? Yeah, what I might say is that, you know, we address type two diabetes, because it is one that's required, typically through lifestyle choices, but also a living a healthy lifestyle, makes managing your type one diabetes better, it gives you have less complications, your your the effectiveness of the insulin that you take is better. And you might even have to take less insulin. So the healthy lifestyle can be important in managing type one diabetes as well. Yeah. Next week, we are going to tackle those lifestyle changes, recommendations that we want to make. But we you just said about early detection, why that's important. And also just that most of your patients are already very advanced with other chronic diseases. I'd like to touch on that a little bit. Because I wonder, is it possible that someone is so far down the line with type two diabetes, that it doesn't matter whether they change what they eat, or whether they exercise? You know, of course, the patients that I treat are already have very significant problems that need typically need to have some sort of operation or procedure, like an angioplasty or a stand torn atherectomy oral bypass

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in order to treat the advanced problems that they have. But it's I always say it's never too late to change your lifestyle. And that being the reason being that not only can you improve the overall or underlying chronic conditions that you have, but it can improve your overall health. And if you're especially if you're my patient who's going to require multiple procedures, the better health you're in, the more likely you are to have less complications with the procedures that I do. And the more likely you are to recover quicker and better. After the procedures, it just makes sense. I mean, if you're sick when you go into an operation, there's a high chance of complications, but the healthier you are when you get into what I'm doing, the better chance for better outcomes. Okay, I love that answer. Because that reminds me of conversations we've had in the past where you can't do a procedure on a certain patient because there's inflammation happening or something else that could put the the patient at a higher risk for losing their lives. Yeah, everything. Everything we do in medicine has a risk profile. You know, we're doing something to somebody

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And we have to manage the risk of the procedure versus the benefit that we're doing. And that might be so that's that's, that's as far as the procedure, which I do. But the same thing with pills and medications is, what's the risk of that medication versus the benefit of that medication? And therefore, you have to weigh those things and decide whether it's appropriate. And so yeah, I oftentimes have patients who might need something done. But the risk of the procedure ends up being too great to fix them because they're so sick or is in such bad shape. Yeah, very true. There are two other complications as a result of living with type two diabetes that I want to touch on in that you have experience with and one is dialysis. Because I know that oftentimes, it seems, on a regular basis, I hear you say, I have to go into the hospital and check on a dialysis patient or I have to go in and put a what is that catheter? Yeah, dialysis access is what we call it. That's a general term. But yeah, typically, like today, we had a patient who needed an emergency access for dialysis. And you know, that's we put it in a catheter, so they can have dialysis. Yeah, so dialysis is one and the other one is amputations, which you work really hard at preventing the amputation, it's, you have a limb salvage program, that you're very passionate about amputations don't are not always as a result of living with type two diabetes, it could be an injury, but can you talk about what leads to what can lead to an amputation on a type two diabetes patient? Yeah, to talk to both points you brought up is that diabetes is one of the leading causes of kidney failure. Okay, and so if people knew earlier about their diabetes, and manage their diabetes earlier, they might not ever end up on dialysis. And living with dialysis is not an ideal lifestyle, it's actually a very, very troublesome lifestyle, it's very depressing. And, and, and, and many, many dialysis patients are quite unhappy. So you don't, you don't want to be on dialysis. It's not a panacea. And so the earlier detection of diabetes and, and therefore treating it both with lifestyle choices and medication, if necessary, might help you avoid being on dialysis. So that's what I'd have to say about that. And then as far as I do, I, the, the, the primary focus of my practice is limb salvage, or, in other terms, Amputation Prevention. So that's what we that's what we focus on in my practice. And, as I said, 50 to 75% of my patients, somewhere in that range are diabetics. And diabetes is a significant contributor to atherosclerosis, which is blockages in the arteries. And diabetes is a significant contributor to inflammation, both on a general level, but also at the microscopic level, and inflammation at the microscopic level, doubles the rate of atherosclerosis. So a poorly managed diabetic, will get atherosclerosis and one of the problems that we see in my, in my patients is that it's very hard for people to understand, I'm not just fixing, I'm not just a plumber, fixing a particular problem, and then your problem is over. I fixed their blockage, but the disease is still there. And so guess what, they continue to develop blockages, and they come back over and over again for further procedures. And that's why it's very often challenging, especially with diabetics, and that's why they're at such high risk for limb loss. So can you guide us through what happens because I've seen your lectures, and you talk about how a simple scrape or a cut on a diabetic patient can lead to gangrene, which then can lead to that amputation what's happening? Yeah, so in a normal person, if we get a cut, or a scratch, or a scrape, or a bite, or even a bruise or a blister, we have good healing capability. And, and because we can we have the blood flow to get down there. And even if we develop an infection, if we get on antibiotics, we have the blood flow, to get down there with the antibiotics and treat the infection. So healing does occur over time, and usually in a timely manner. But in diabetics, the inflammation impairs healing. And, and then also in diabetics who have developed atherosclerosis, they also have a lack of blood flow. And so that's where, you know, I come in and try to open up their arteries in order to improve their blood flow, but they still have diabetes. So that's why I even tell my diabetics. Sure we've opened up your arteries and we've gotten the blood flow there, but that's not the only factor that's important in healing. And now we have to address the other lifestyle factors that are there in order to optimize your opportunity for healing. So you know, so what is what is gang

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During gangrene is typically a wound or a Festering Wound on the lower extremity, or it can even be on the fingers. But But basically, it's a non healing wound that's expanding, and necrotic tissue starts to become a part of it so, and then it can go down and not only chew away or eat at your skin, but it can also get into the bone. And then when it's in the bone, that's called called osteo myelitis, which means infection of the bone. Once Once it gets to the bone, we're talking about nearly a 100% amputation rate of at least a toe or a half foot or even your leg, depending on the extent of the problem. And also the nature of what their blood flow is. I before we move on to what happens once a patient loses a limb, because the quality of life again significantly changes. As you know, my mother, she's been living with type two diabetes for many, many years. And I remember consulting with you talking to you about it, that I wanted her to just go and have a pedicure to treat herself and you advise me not to yeah, my concern about diabetics, especially diabetics with poor blood flow is that nail clipping occurs and and filing occurs. I have seen diabetics who got a pedicure, who eventually lost their leg. And so I'm not trying to scare I'm not trying to ruin the pedicure industry. But what I'm saying is diabetics have to be particularly careful. And you know, if a diabetic needs foot care one thing is go to a you know, a good professional who knows how to take care of that such as a podiatrist Oh, that's good to know. So podiatrists are very skilled in managing diabetic feet, and toenails and things like that. So you know, I don't know that a diabetic,

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especially in advanced diabetic should be allowing people to

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cut on their toenails and stuff like that, where there's a risk of cutting too close or causing some problem, right. So once a patient has gone through a limb loss, you know, an amputation, which I can imagine the psychological and emotional part of it is already a lot for them to endure. What happens once now they're wheelchair bound, I'll tell you, it's it's devastating limb loss is absolutely devastating. It's not only bad enough to be a diabetic and have just the complications of diabetes without that such as going blind or having kidney failure, or the neuropathies. And maybe even just not even feeling well in general. But once someone loses a limb, it changes their life entirely. And, and they become you know, either crutch reliant or wheelchair bound. It changes the quality of their life, it changes everything about their life, they have to now make their their house, ADA compliant with ramps and they can't go upstairs and they lose all this mobility. It can be quite depressing.

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And, and depending on the age of the patient who loses a limb. We've seen, for example, someone who's 80 years old who loses a limb.

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Typically 50% of those patients don't live another two years. And it's not because of losing the limb. But it's just also it's a conglomeration of all of the issues going on in that person. But that's just an indicator of what's going on. Yeah, it's like you said, I mean, you removed the leg, but the root cause of their health issues was not the leg. They're the they're the it's a systemic issue. And can you talk about what that still because if they're not managing their, if they haven't made significant lifestyle changes, which we'll talk about in the next episode, we're going to give you lots of recommendations. But if they're still not managing their type two diabetes, now they're still at risk for they're still at risk for all the chronic diseases that are associated with diabetes. And isn't. It's not unusual for me to have patients who end up being double amputees. Yeah. Because if they don't clean up their lifestyles, or if they've already got advanced problems, they end up losing their other leg as well. Yeah. So patient education, nutrition, education, all of that is so important to me to put the power back in the patient's hands so that they know that they're not at the mercy of this diagnosis. There's something that they can do, no matter how far along they are, they can take control of their health, you and I have put together a really nice cardiovascular prevention guide. That is like 20 pages of explaining what atherosclerosis is how we contribute to that disease. We also have information on how you can reverse or at least manage and prevent advanced diseases. And also, we put in there some recipes. So I want to give everybody a link to that so that you can download it and it'll also take you to subscribe to our newsletter so that you can stay informed with all of these things we're talking about. So that's bit bi T dot

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li forward slash, join Dr. Ris and also drop us a voicemail. I would love to hear from all of you tell us what you're thinking in terms of how we're recovering type two diabetes, and also like, do you have loved ones living with type two diabetes? Are you living with type two diabetes? And have you seen any improvements as a result of making lifestyle changes? So the link for that is speak pipe.com forward slash HL s. Yeah, you know, what I would love to hear is, number one, share your stories. I think it's nice to hear real life stories of real life people out there, we'd love to hear your stories, and we can share some of those stories here. Second, is we'd love some feedback on our is what we're sharing with you meaningful. And then lastly, if you have any questions, you know, ask your questions, and we'll do our best to address those questions on here. That's right. We don't have to live with the fear. I've had friends and I myself, really thought I was at risk like that I would eventually be at risk for having type two diabetes because of the prevalence in my own family. And thank God I know differently today. And so my passion is just to help empower everyone else to know the same it's it's really education, the information that we want to share that is empowering. Any final words. So we're wrapping up doctress. I'm looking forward to our next episode, which will be on what lifestyle medicine? Oh my god, we're really going to get to the solutions of what we can do to empower and improve our health. All right, Dr. Riz, thank you again for joining us. It was a lot of fun. Thank you. You've been listening to the healthy lifestyle solutions podcast with your host Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well at rate this podcast.com forward slash HLS. This helps us to spread our message. And as always, thank you for being a listener.