Dr E devient réel au sujet des affections liées au diabète: gastroparésie neuropathie & rétinopathie

By | March 16, 2023
Dr E devient réel au sujet des affections liées au diabète: gastroparésie neuropathie & rétinopathie

Hello for those of you who have not met Me yet my name is Steve Edelman I am the Founder and director of taking control Of your diabetes as well as a physician Specializing in Diabetes Care I am also someone living with type 1 Diabetes for 52 years diagnosed as a Teenager in 1970. I'd like to tell you a deeply personal And emotional story about myself Relating to my experiences dealing with The chronic complications of diabetes Something quite frankly I have never Done until today I have overcome my hesitancy and Embarrassment to speak about them and I No longer feel that getting Complications is a sign of failure or my Fault I no longer feel it labels me as a Bad diabetic I am hopeful that by telling you about My experiences you can avoid diabetes Complications completely or help you Deal with them if you are already Affected As I mentioned I was diagnosed at the Age of 15 and 1970. I was put on one Shot of insulin a day measured the Glucose in my urine and was put on a Strict diet using the old exchange System There were no glucose monitors no A1C Test no insulin pens no pumps no CGM Devices and no hybrid closed loop

Systems It really was the Dark Ages and not too Different Than the treatment in the early 1920s When insulin was discovered My sugar levels must have been all over The place but I had no way of knowing Despite doing everything I was told to Do my control must have been terrible as I was thirsty and urinating a lot and That's just the way it was These are signs that my glucose levels Were out of control as well as having Severe hypoglycemic reactions that seem To come out of nowhere If they had the A1C test available then I am sure I would have been above nine Percent for several years but once again I had no idea as urine testing is just Not that helpful and one shot a day are You kidding me there is no way in hell That could have kept me in a glue a good Glucose range most of the time I was never educated in a way that I Truly heard what was being said to me About the complications of diabetes and How to avoid them I was too young naive and ignorant and Thought that these things would never Happen to be no matter what You know my mother was a saint she did The best she could to help me control my Diabetes however my father who was very Mentally and physically abusive did not

Believe I even had diabetes and refused To get involved or help me with my care In any way you know in looking back on Those days I think he was just ignorant And scared to death of diabetes so he Coped By ignoring and acknowledging and He cope by ignoring and not Acknowledging that I had it it made my Diagnosis and Adolescence very painful In many ways My story with diabetes complication Starts with my eyes during my last year Of medical school at UC Davis in Northern California my good friend John A big Burly rugby player gave me a huge Bear hug His way of showing affection however I Quickly noticed blurry vision The next day I went to a retina Specialist Who told me that I had leakage of fluid From the blood vessels in the back of my Eyes causing my symptoms He said very clear to me I had the beginning of diabetic Retinopathy or diabetic eye disease Now it was 1982 and I was 27 years old Only 12 years after my initial diagnosis Of diabetes No therapy was offered at that time Mainly because there were no proven ones The treatment would have been quite Different today which I will get to in a Few minutes

I did my medical residency at UCLA and Then went on to the Joslin clinic in Boston in 1986 for my specialty training In diabetes and soon after I got there I had a vitreous hemorrhage One of those leaky blood vessels in my Eye bursts and filled my eye cavity with Blood and I was almost instantly blind In my left eye Let me tell you that that experience was A wake-up call for sure At first it scared the hell out of me And then I became pretty depressed uh Thinking about what was in my future Would I lose my vision entirely how Would this affect my career in medicine And personal life And since I am the glass half full type Of person and always looking for a Silver lining and things I had this Thought that having sex by Braille did Not sound that bad uh that does sound Funny but um Gotta Gotta Laugh with the good and the Bad Um I saw one of the best retinal Specialists in the United States and he Administered laser therapy to the back Of my eye not the kind you get to avoid Wearing glasses but the type that Cauterizes and stops the bleeding vessel Or vessels I had to sleep with a ton of pillows Under my back and eventually the blood

Settled and I slowly got my vision back After several months You know and this is one complication That is with you every single minute of Every waking hour during the day because You had to look through blood in the in Through your through your vitreous So over the next five years while Furthering my training at UCSD I Received a few thousand more laser Treatments to both eyes to keep them Stable and reduce any further bleeding Now this treatment did stop the bleeding But at the expense of reduced peripheral And night vision And I remember going to a movie theater With my girlfriend as we shuffled down The aisle the row of seats to find two Open ones in the middle I sat down on What I thought was an empty seat and it Turned out that I sat on a lady's lap Who had a huge container of popcorn Which went everywhere And so when you go when you have when You lose your night vision it just takes You a long time to adapt when you go From a lighted area to a dark area so Now in 2022 let's let's talk about What's going on now the treatments are Incredible For diabetic retinopathy and another Condition called diabetic macular edema Or DME We have monoclonal antibodies now you

Hear that word a lot it's a waste basket Term for a certain way they make Medications you know you've heard that For coven but they make these monoclonal Antibodies that are extremely effective At slowing and halting diabetic Retinopathy sometimes completely now These site-saving medications have to be Injected directly into the eyeball And that's the vitreous of your eye now It sounds like some type of torture but It but in reality is relatively painless You can follow me through an eye Appointment where I actually get Injected in my eye in our Video Vault Off of our website So what can you do to prevent Diabetic eye disease or slow down its Progression over time so that includes All of you who don't have any eye Disease now and those of you that do so Number one glucose control over the long Term is crucial diabetic retinopathy Does not occur overnight or with one Episode of high glucose levels so don't Panic if your blood sugars go up here And there Keeping your blood pressure at goal is Also extremely important and three Regular screening There are no symptoms of diabetic Retinopathy in the early stages so this Is why yearly screening is so important If diabetic eye disease in the early

Stages cause pain we wouldn't have to Scream you develop eye pain you go to The eye doctor you would you would be Treated very quickly but it's Asymptomatic and you're going to see This theme throughout So official screening starts five years After you have been diagnosed with type 1 diabetes and for those of you with Type 2 diabetes it starts the year you Were diagnosed and the reason for this Is because of individuals with type 2 Diabetes may have been undiagnosed for Years and years before the diabetes was Discovered So number four is make sure you see an Eye doctor that specializes in the Retina who has lots of experience taking Care of people with diabetes I feel Confident I feel very confident in Saying to you that if you see a diabetic Eye specialist regularly You have an extremely Excellent chance of never going blind It is the individuals who do not get Regular Eye Care who have the serious Eye problems As for me I had over 2 000 laser Burns To each eye uh years many years ago and More recently Uh over the past two years I had Multiple injections of those monoclonal Antibodies in both eyes and I'm happy to Report my vision has improved greatly

And are quite stable So remember glucose control blood Pressure control and regular eye Screening by a retinologist that's it Right there and oh yeah avoid getting Poked in the eye And I'm serious when I say if you're Ever in a situation where you're working Where something may shoot up in your eye You know where it goggles Okay We got the eyes out of the way let's Talk about diabetic kidney disease also Called diabetic nephropathy So diabetic kidney disease usually Appears in parallel with diabetic eye Disease they are both what we call Microvascular complications So as elevated glucose levels over the Years leads to damage to the small Vessels that feed blood to the eyes Kidney and nerves so that's that's Basically the three classic Microvascular complications In addition to glucose control elevated Blood pressure over the years can also Cause major damage to the kidneys I will repeat this but your blood Pressure should be less than 135 over 85 With what we call millimeters of mercury That's the units we use most of the time But in reality less than 120 over 80 is Ideal but it's possible to get too low Causing you to get dizzy when you stand

Up or bending over so there is a sweet Spot in there the lower the better but Not too low Remember that blood pressure jumps Around more than airline tickets and Hotel room prices so that's why it's Important to get a blood pressure cuff And measure frequent times throughout The day during certain periods over the Month not every single day When I entered practice in Portland Oregon in 1991 21 years after my Diagnosis I had to submit a urine sample To get life insurance At that time I was married with one Daughter and I remember getting rejected Because there was an excess amount of Protein in my urine one of the very First signs of diabetic kidney disease You know what this was another wake-up Call for me all of my other kidney tests Were normal and I had no symptoms Once again this is why screening is so Important for diabetic kidney disease You know you're gonna get this theme Throughout that many of the Complications of diabetes have no Symptoms in the early stages which is so Which is why you need to set up your own Screening program we'll talk about that Currently the screening tests are cheap And easy Uh the first is the egfr estimated Glomerular filtration rate this test

Tells you how well your kidneys are Functioning I.E filtering the toxins out Of your body normal is above 60. and you Don't have to remember these numbers uh You'll see them on your lab test for Sure this test is typically on most Routine laboratory work that you get Before seeing your your health care Professional now the second important Test is a is called uacr You're an albumin to creatinine ratio Which helps to define the structural Damage of the kidney one is functioning One is structural normal is below 20 and Your Healthcare professional can plot Your results over time as it's important To follow these numbers longitudinally Make sure you ask about these two Numbers when you see your doctor let me Just say say that many doctors don't Know about the urine albumin to Creatinine ratio so it just takes the The results from your typical blood test But you have to turn in your urine to Measure the protein in your urine which Is the albumin Let's review Again prevention and treatment Strategies for diabetic kidney disease I Want to make sure you leave with some Really important points one make sure Your blood pressure is at goal less than 135 over 85 less than 120 over 80 is Even better if you're not getting

Hypotensive Get a blood pressure cuff learn how to Get accurate measurements and test at Different times of the day they make Them for the wrist the arm you don't Have to be testing a zillion times every Day but it's important to get tests when You wake up at the end of the day when You're sitting sometimes when you're Lying down this is write this down and Give it to your caregiver Number two if your blood pressure is not At goal your health care professional Will most like to prescribe a class of Blood pressure pills called Aces or arbs Angiotensin converting enzyme Inhibitors Angiotensin receptor blockers and a lot Of medical words here but they are Classes of blood pressure medications That have been proven to protect the Diabetic kidney So it's important for you to know that You may need more than one blood Pressure medication to get to goal Remember it doesn't matter how many Pills you're on But what your blood pressure is so That's important get your own blood Pressure cuff as I said earlier and Learn how to use it properly so Important So three glucose control glucose control And glucose control you see that's a

Central theme throughout every Complication get your A1C as close to Seven percent as possible if your Control is really not that ideal and if You're on the conference today or Looking at this video at some point it Most likely you're going to be above Seven percent let's just say you're an Eight or nine percent Please don't panic But just work slowly with your caregiver Your doctor your nurse practitioner your Physician assistant to bring it down Over time it's it's not a Sprint it's a Marathon number four is Two relatively new medications have been Proven to slow the progression of Diabetic kidney disease they are Sglt2 Inhibitors such as farziga and Guardians and also a relatively new Medication called corindia K-e-r-e-n-d-i-a these medications have Also proven to be very effective for People with chronic kidney disease and To slow down the progression over time So our toolbox for diabetic kidney Disease is getting larger ask your Healthcare professional about these and Better yet number five Find a good kidney doctor or Nephrologist that is knowledgeable about Diabetic kidney disease this is Important if you have abnormal Laboratory values and probably and Probably not needed if your egfr and

Urine album to creatinine ratio is Normal so you know it really you should Use these Specialists when you have Issues and number six goes without Saying avoid anything that would damage The kidneys such as radiographic dye Like you get a CAT scan they say with or Without dye and non-steroidal Anti-inflammatory agents such as Motrin So these are medications that can cause Damage to the kidney especially used Over the long term in high doses Whenever you start a new medication no Matter what it's for you should ask your Doctor if it has side effects that Adversely affect the kidney So back to my story I do have diabetic Kidney disease stage 3A which means I Have about 50 percent of normal kidney Function However I have been stable for about 10 Years and my egfr is around 45 to 50. Normal above 60. and my urine albumin to Creatinine ratio such an important Number is 345 normal less than 20 which is well Above normal obviously but at least it Has been stable and it has gone down Since I started the medication farziga The sglt2 inhibitor I also take two blood pressure Medications as well and I obviously have A blood pressure cuff So I do have an excellent nephrologist

Who specializes in diabetic kidney Disease and I am doing all the measures To avoid dialysis or the need for a Kidney transplant you know what and if That time ever comes I will learn how to Deal with it as best I can So the third classic microvascular Complications is diabetic peripheral Neuropathy so we had the eyes the Kidneys the nerves we call it Retinopathy nephropathy neuropathy We the triple apathies we talk about That in clinic all the time so diabetic Peripheral neuropathy Kinds of run kind of runs its own course And does not go in parallel with eye or Kidney disease There are many causes of peripheral Neuropathy other than diabetes such as Certain vitamin deficiencies exposure to Toxins receiving chemotherapy and many Many more etiologies so sometimes you Might need a good neurologist to figure Out where your neuropathy is coming from Now what helps us make the diagnosis is There are classic symptoms that first Appear in both feet not one foot but Both feet including burning tingling Sharp shooting pains like being stabbed With pins and needles and eventually These symptoms subside over time Sometimes years followed by numbness and Complete lack of sensation In other words the signs and symptoms of

Diabetic peripheral neuropathy change Over time So prevention once again is dependent Primarily on glucose control and Avoiding nerve damaging agents or toxins If you can you need to have a level of Awareness of these type of potential Issues that may affect your nerves In terms of therapies there are too many To count and they all work in many Different ways none are a hundred Percent effective and it turns out that The best way the best piece of advice is To find a podiatrist specializing in Diabetic foot care or a neurologist who Specializes in the area To methodically try the different Treatment options depending on your Symptoms Many are listed in the tcoid book which Is free to be downloaded you can get That in our booth in the health fair and The foot chapter is written by Dr Ingrid Cruiser who is extremely knowledgeable About diabetic peripheral neuropathy so Basically if you have extreme pain like Sharp stabbing pains you know it's one Type of medication if if you have Numbness and tingling it might be a Difference so it's it's really trial and Error and so it's it's really important That eventually you will find a Treatment that will benefit you and your Particular symptoms

Now lastly if you are truly numb in your Feet we call that insensate your doctor Might do that 10 gram monofilament and You don't know where it is you need to Be super super careful and inspect your Feet every night to make sure you did Not step on attack and didn't and didn't Know it and it was getting infected for Example get good supportive shoes and Very importantly do not wait one minute Before seeking out a good podiatrist if You develop an ulcer or sore on your Feet you know if you if you scream Bloody murder if you step on a little Pebble or something sharp then we're not Us as caregivers we're not worried about You that is a good thing and your risk For developing a diabetic foot Ulcer goes way down So What about me Um I do consider myself lucky in that I Do have only partial lack of sensation And Mild numbness and occasionally I Still will get those really sharp Stabbing pains in my feet and I might Just yell out and then my girlfriend Says what's wrong and I just say nothing And they the good news is I don't I Don't need any medications and the sharp Stabbing pain only comes once in a great While so I'm in that Gray Zone So the the basically Um it's important that you stay in touch

With your symptoms and that you seek out Help when you need it now my good friend Craig Morgan who's also a podiatrist he Bought me a pair of Hoka tennis shoes Which are really protective for for Using during exercise so once again uh Be uh be sweet be kind to your feet Autonomic neuropathy Is different from diabetic peripheral Neuropathy autonomic neuropathy occurs When there is damage to the nerves that Manage everyday bodily functions such as Blood pressure heart rate sweating bowel And bladder emptying digestion and Sexual function Wow I hope that did not sound too scary Symptoms of autonomic neuropathy really Depend on what bodily function is Affected and how severely and typically In people with diabetes of long duration With regards to digestion the nerves That control the gastrointestinal tract From the esophagus all the way to the Large bowel are not working properly And one of the main problems that I see And for me and many other folks Is gastroparesis is a real pain the Peristaltic muscles of the stomach Controlled by the autonomic nervous System are commonly affected so when I Eat food Stays there in my stomach way too long I Get full really fast and experience Bloating and sometimes abdominal pain if

I overeat And it takes a long time for the food in The stomach to be propelled out of the Stomach into the small intestine and Down the rest of my GI tract and let me Tell you that causes Havoc with my Glucose levels and is really hard to Match the absorption of nutrients with The insulin I take Okay I may get hypoglycemic shortly After eating which is unusual like Within an hour because I've given myself Insulin but the nutrients have not been Absorbed yet and later on the glucose Levels go really really high Than getting off that roller coaster is Difficult Now many folks living with diabetes for Over 10 years may have a mild form of Gastroparesis so mild that they may not Even be affected severely at all and not Even know they haven't To make the diagnosis it usually made by Your symptoms and there's also a test Called the gastric emptying study which May or may not be helpful mainly we make The diagnosis primarily by symptoms So the basics of treating gastroparesis Is not to stuff yourself at any one time Which can be tough if you're starving You need to eat slowly and try to avoid Foods that take a long time to be Digested Such as a tomahawk sized steak for two

That you order for yourself at Ruth Chris Steakhouse You know and there are many Therapies For diabetic gastroparesis but it comes Down once again to trial and error they Even have a gastric nerve stimulator That can help and I'd say if you're Having serious issues once again it pays To see a specialist a gastroenterologist Who has experience with diabetes now my Good friend from Medical School Dr Jamie Wolison is a Knowledgeable gastroenterologist he's Given a a lecture in our Video Vault and Wrote the chapter on the GI Manifestations of diabetes uh in the Tcoid book once again free Uh to be downloaded from our booth Well I think that is enough Complications for now remember to check Out our Video Vault our website and the Tcoid book 5th edition For a lot more detailed information you Know when I wrote this lecture getting Ready for today I said wow this is one Complicated topic with a lot of Information and please write down your Questions on our blog and I will do my Best to answer each and every one of Them In closing since I started taking Control of your diabetes in 1995 I have Been speaking about the diabetes Warranty program

It is all about doing the tests and Evaluations every year to help prevent Or make an early diagnosis of one of the Complications of diabetes Early detection is the key to nipping These complications in the bud and Preventing them from progressing to End-stage health problems so the main Message is that you can live a long and Healthy life with diabetes and remember It's never too late to take control of Your diabetes All of you I hope you stay well