Hi I'm Schaefer Bader I'm an Endocrinologist and diabetes specialist And today we're going to be talking About type 2 diabetes so if you have Pre-diabetes if you're recently Diagnosed with type 2 diabetes or if You've had type 2 diabetes for a long Time but want to kind of get back to the Basics this is the talk for you we're Going to be covering what type 2 Diabetes is we're going to be talking About treatments for protective diabetes Including diet and exercise and we're Going to talk about some ways that you Can monitor your own blood glucose at Home so without further Ado let's get Into it so what is Type 2 diabetes and Why me like why do some people get this So it's a complicated question and the Short answer is we don't know all the Details but what we do know is that it Has to do with the way your body uses Insulin Insulin helps your body use glucose That's its main job when your body Becomes resistant to the effects of Insulin it can't use the glucose well Your body is unable to absorb that Glucose and put it in the places it's Supposed to be so the glucose stays in Your bloodstream and that's why you get High blood sugar So in short type 2 diabetes is from Insulin resistance that's the main
Driver of type 2 diabetes and there's Also a contribution from relative Insulin deficiency so that's when your Body's making insulin but it can't make Enough to keep up with the insulin Resistance to get your blood sugar down Where it wants to be Insulin resistance and Insulin Deficiency kind of come from a Combination of genetic and environmental Factors so genetic factors are very Strong in type 2 diabetes so if you have Type 2 diabetes you can in part thank Your parents for it it really runs in Families but the environmental factors Includes things like what we eat what's Your weight Um you know do you have exercise these Are all important components that that Move your risk for type 2 diabetes How do we actually diagnose type 2 Diabetes Well there's a few different Tests that we can use but I'm just going To focus on two of them that are the Most common the first I think and the Most easiest to understand is just what Is your blood sugar so we use a fasting Blood sugar what is your blood sugar First thing in the morning when you Haven't eaten anything overnight if that Blood sugar is above 126 then that Suggests that you may have diabetes a Normal blood sugar and someone who Doesn't have diabetes would be expected
To be less than 100 when fasting now Another really common test that many of You may have heard of is the glycosa Glycosylated hemoglobin or A1C so the A1C test gives us an idea of what your Blood sugar might be over an average of Two to three months so that that average Blood sugar over the past two to three Months and the higher the A1C percent The higher your average blood sugar has Been Again someone who doesn't have diabetes We'd expect an A1c to be less than 5.7 But if that A1C number creeps up and it Gets above 6.4 so in other words 6.5 or Higher that's consistent with type 2 Diabetes now there's a range in between There so between 5.7 and 6.4 percent on The A1C is considered pre-diabetes and Pre-diabetes is means you probably have Some insulin resistance but it has an Advanced to full diabetes and you may Not ever advance to full diabetes some People don't and the way to reduce your Risk of advancing from pre-diabetes into Diabetes is through lifestyle Modifications primarily so that's things Like improving your diet and finding a Way to lose weight and kind of maintain A lower body weight over time to help That insulin resistance Just real briefly this is how A1C and Blood glucose compare okay so if you Know what your last A1C is you can look
At this chart and get an idea of what Your average blood sugar is and if your A1C is for example seven which is a good A1C for people who have diabetes then That that matches up with an average Blood glucose of around 150 okay so so This is just kind of an idea to get you Oriented to how those numbers relate to Each other All right so why do we care about Diabetes why do we care about blood Sugars at all well we know that type 2 Diabetes can increase your risk for all Sorts of bad things okay I'm not going To spend a much time talking about the Bad things but they include heart Disease cardiovascular disease also Kidney disease we call that nephropathy Vision problems or retinopathy which is Damage to the retina on the back of the Eye and nerve problems or neuropathy so These are examples of complications from Diabetes that we want to prevent so if We can improve blood glucose control Then we can reduce the risk of having Any of these bad complications so that's Why we care that's what we're all here For Let's talk a little bit about heart Disease and diabetes because diabetes Does increase the risk of heart disease We sometimes frame this as the abcdes of Heart Care in diabetes so a stands for A1C right that's your blood sugar
Control that's really important for Reducing the risk of heart problems in Diabetes we also sometimes put aspirin On that a list aspirin therapy can be Important for reducing the chance of Heart problems in certain individuals And that's something to talk to your Doctor about b stands for blood pressure Control blood pressure is one of the Major drivers of heart disease so make Sure your blood pressure is at goal same With cholesterol right so sometimes we Use medications like statins or pcsk9 Inhibitor medications to lower the bad Cholesterol LDL and to help raise the Good cholesterol HDL D is for diabetes medications that help Protect the heart and we'll be talking More about those they're really Important they're tools that we use all The time in type 2 diabetes and E stands For eliminate smoking we know smoking is Very bad for the heart Let's talk about some essential diabetes Related screening and this kind of Relates to some of these other Complications of diabetes and high blood Sugars over time The first is retinopathy so we you can Screen your eyes to look for damage to The retina and we do that with a dilated Eye exam that should be done when you're First diagnosed with type 2 diabetes and Then every one to two years after that
We screen for nephropathy or kidney Damage using kidney function and urine Test where we look for protein again Should be done at diagnosis and then Every year after And then finally neuropathy looking for Nerve damage that should be done looking With a foot exam and sensation testing Again a diagnosis and every year Thereafter so just kind of a reminder That these are important parts of Diabetes Care and certainly during the Covid pandemic a lot of these things Were pushed to the Wayside because People weren't getting to the doctor as Much some of the visits were Telemedicine some of these things got Forgotten so if you're behind on these Screenings or you've never had them and You have diabetes Now's the Time to call Your doctor and say hey I think I need To get some of my screenings done All right so what about treating type 2 Diabetes how do we actually improve your Blood glucose and your health well of Course we use medications we'll be Talking about some of those medications Today It's something that we doctors talk About all the time but we can't forget About how important diet is as well as Exercise and physical activity and also The ability for you to monitor your own Blood glucose and follow that so you
Know what's going on with your own blood Sugar So let's get into it let's talk about Diet all right now first of all there's Not really such a thing as a diabetic Diet the closest thing in my opinion Though is a low carbohydrate diet so What's a carbohydrate carbohydrates are A type of nutrition that when we eat it Our body turns it into sugar okay so Sugar actually is a type of carbohydrate But there are many other carbohydrates That aren't sugar until we eat it so It's a little confusing but when you When you think about a healthy diabetic Diet I want you to be thinking about Carbohydrates and reducing the amount of Carbohydrates that you're eating because Those will turn into sugar carbohydrates Come in things like tortillas and rice And bread and pasta right so all these Delicious carb things Okay so the approach to a healthy diet For people with diabetes is to eat foods That you like but in moderation so you Can still eat some carbohydrates right We don't expect you to completely cut Out carbohydrates but it's limiting the Amount so the goal is to limit those Carbohydrates to a reasonable amount With each meal and really that comes Down to portion sizes right so reducing The the portion sizes of those Carbohydrates in your meals and it's
Also a good idea to minimize snacks Between meals that include carbohydrates That contain carbohydrates because that Is going to really help you maintain Your blood sugar at goal So what's a reasonable amount of Carbohydrates per meal so a good place To start would be to aim for 45 to 60 Grams of carbs per meal How much is that So a good way to think about it is you Can either use the grams of carbs which Is what you'll see on the back of a Nutrition label or you can think about It in terms of carb servings and we use 15 grams of carbs equals about one carb Serving per meal and you can have about Three to four servings per meal if you Want to Target around 45 to 60 grams of Carbs per meal which again I think is a Good place to start some people might Want more some people might want less So these are just some examples of one Carb serving or 15 grams of carbs so a Single piece of bread 10 Skittles 10 French fries a small piece of fruit 1 3 Cup of pasta which is about the size of A tennis ball or my personal favorite a Half cup of ice cream so these are just Some examples now if you want to know How many carbs are in a specific food Sometimes that can be difficult Sometimes it's pretty easy the first Place to look is at the back of the
Nutrition label look for total Carbohydrates and you have to look at That and then see the serving size and Then calculate how many carbs you're Going to eat of that food whatever it is Now some foods if you're cooking at home If you're eating out become more Difficult because they may not have a Nutrition label so one really good tool For that is an app so there's all sorts Of different apps out there that can Help you count carbs keep track of your Carbs or find out how many carbs are in A specific food these are just some Examples figwi MyFitnessPal Calorie King I'm not going to get into the details of These are all a little bit different and They all offer some different features But they're good options for figuring Out how many carbs are in food so if You're looking at carbs and trying to Kind of keep a consistent amount of Carbs with each meal and minimize carbs Between meals go check out these apps So again Um you know reduce carbs between meals So either zero carb or low carb snacks Is a good approach these are just some Examples of delicious snacks that I like And that don't have carbs in them are Very low in carbohydrates And I think really importantly when You're thinking about ways to reduce Your carbohydrate intake and to improve
Your blood sugar is to not drink your Carbs and what I mean by that is if you Drink regular soda it's full of sugar or You drink juice there's a lot of sugar In that if you can cut those out of your Diet completely and switch over to zero Carbohydrate drinks it's going to make a Major difference in your blood sugars And so that's not always easy but it's a Simple way just to make one big change That can really improve your blood sugar There's all sorts of great zero Carbohydrate drinks out there so just go Try them whether it's Crystal Light or Diet soda or Gatorade zero go to store Look at them check out the nutrition Label look for zero carbohydrates give It a shot and find some drinks that you Really like All right moving on to exercise so this Is an important topic exercise is not The primary driver of your blood sugar But it certainly contributes and it's Important part of your overall health so The American Diabetes Association has Some specific guidelines related to Exercise and Diabetes they recommend 150 Minutes or more of moderate to vigorous Intensity aerobic activity per week Ideally spread over at least three days Per week or even daily with no more than Two consecutive days without activity if You can include two to three sessions Per week of resistance exercise that
Helps to build muscle keep you strong And importantly decrease time spent in Sedentary Behavior right that just means Kind of sitting around not moving Interrupt prolonged sitting every 30 Minutes this is something I have to work On because I'll get behind my desk and I'm doing work hours will pass and I Haven't moved and I wake up you know I Stand up stiff and that's because I need To move more so try to move every 30 Minutes it's good for your body If you aren't very active right now but You want to become more active or you Want to start doing some exercise how do You kind of approach that what's a good Way to do that well a good Recommendation is to start low and go Slow in other words don't jump into it a Hundred percent expect to run a marathon Next week okay starting too aggressively Can lead to injury and plus it's Probably not going to be sustainable so A better approach is to set a goal that Can't fail and then build on that Success really sustainability is the key So whether it's walking to your mailbox Every day to get the mail or just taking A stair at work instead of taking the Elevator maybe it's going on a 15 or 20 Minute walk every day after dinner just Set that goal and and really stick with That first goal make it a habit okay so Try exercising at the same time every
Day or making a schedule so that you can Build in time for that physical activity Otherwise it can get pushed to the side And it doesn't really become part of Your normal life Finally track your progress and Celebrate your success okay and you may Not get your get your goal of exercise Every single week that's okay don't Don't let that bring you down just Remember that just doing some exercise Is good it's good for your body it's Good for your health And this is a statement from the American Heart Association that I think Is is really powerful they say the Simplest positive change you can make to Effectively improve your heart health is To start walking it's enjoyable free Easy social and great exercise a walking Program is flexible and boasts high Success rates because people can stick With it it's easy for walking to become A regular and satisfying part of life so There's a lot of little pearls in that Statement but I really agree with that So if you don't have other exercises That you have planned start walking it's A really good way to do it Okay moving on to medications so there's A ton of type 2 diabetes medications Available out there in fact there's 12 Classes of medications that we can use To help treat diabetes and improve your
Blood sugar and in each of those classes In most cases there's many different Medications so there's a lot but we're Not going to talk about every single Medication but to kind of walk through The history because I think it's Interesting interesting to see how far We've come insulin was the first Diabetes medication it was used first as A therapy in humans in 1922 then many Decades passed and you know since then We've had developments in insulin where We have long-acting insulin rapid acting Insulin mixed insulin and all types of Different better insulins The sulfon ureas were developed later on These include medications like Glipizide Glide red and glimepiride these are Still used frequently today they're good Medications in that they lower your Blood sugar but they have their problems They can cause hypoglycemia or low blood Sugars that are too low and they can Also promote weight gain so personally Not my favorite but we still do use them In some cases Metformin was developed after that Metformin is a great medication and in Fact it really still forms the basis for A treatment for many people with type 2 Diabetes In recent decades we've just had an Explosion of different options and Medications for type 2 diabetes
Including Actos which is pioglitazone The glp-1 receptor agonists like Trulicity and ozympic one called wegovi That's actually specifically approved For weight loss and the sglt2 Inhibitors Like farsiga and Guardians and I've Highlighted these two classes of Medications because I'm going to be Talking about them a little bit more Because of their specific benefits for Weight loss and protecting your heart So gop1 is a natural hormone from your Gut it gets released when you eat and it Does many things around the body but in Short it leads to lower blood sugars and Decreased appetite so it helps promote That weight loss and improve your blood Sugars there's many different glp-1 Receptor Agonist medications available Some of them are once a week injectables Some of them are once a day including a Pill but as a class these medications Lower the A1C they improve your blood Sugar they promote weight loss They do not cause low blood sugars or Hypoglycemia which is really important And they protect against heart attacks And strokes so the cardiologists the Heart doctors also really like these Medications for that reason The sglt2 Inhibitors make you pee out Glucose that's how they work these are Once a day pills and they you end up Peeing out the sugar right into your
Urine so that's how it gets out of your Body and it lowers your blood sugar this Is the amount of sugar that you pee out In one day with this these medications Working So the slt2 Inhibitors also improve your Blood sugars they lower A1C they also Promote weight loss they help blood Pressure they lower blood pressure a Little bit And they also do not cause low blood Sugars so and also important okay they Protect your heart and in particular They work really well in people that Have congestive heart failure CHF They're really powerful medications for This and again the cardiologists the Heart doctors love these medicines for People with CHF they also do amazing Things for the kidneys and help protect The kidneys against diabetic kidney Disease so the kidney doctors are Frequently not prescribing these Medications These two classes of medicines are the First Choice often along with metformin If you have heart disease diabetic Kidney disease if you're overweight or Obese or if you're at risk for low blood Sugars like if you've had low blood Sugars from other medications like Sulfonurias or insulin There are some newer options like fixed Ratio combination medications where
There's a glp-1 medicine plus a basal Insulin so you basically get two Medicines in one injection per day it's A really good option for people that are You know requiring once a day insulin or Basal insulin and would also like the Glp-1 benefit zoltify and soliqua are The two options that contain both an Insulin and a glp-1 once a day shot All the benefits And lastly let's talk a little bit about Monitoring your blood sugar and knowing Your glucose trans this is important Because you're the one who's living with Diabetes every single day right so it's I'm sure your doctor is going to want to Know how your blood sugars are doing but How often do you see your doctor right You're the one who has this every day And is going to be making the day-to-day Decision so you should know what your Blood sugars are To do so we can use glucose meters Obviously these um have you know Progressed a lot over time they're small Now they're quick they don't take a lot Of blood and they give you the power to Know what's going on with your own blood Sugar so these are just some examples of Glucose meters if you don't have a blood Glucose meter I encourage you to get one How often should you check well if You're only on for example metformin or Maybe another pill and your A1C is at
Goal let's say less than seven percent Or six point five percent or something Like that well then you don't need to Check all the time you can check Occasionally just to know where your Blood sugars are running and to make Sure you're still on track Now if your A1C is not a goal if it's Too high and you're trying to bring it Down or if you're making medication Adjustments especially if you're using Like a once a day basal insulin then Really you want to be checking your Blood sugar at least once a day in the Morning and sometimes later on Throughout the day or at night so that You know what's going on with your blood Sugar throughout the day If you're on multiple daily injections Of insulin right so if you're giving Insulin multiple times throughout the Day or Meal Time insulin then really you Need to be checking with each meal and At bedtime and of course you can check Your blood sugar at any time so if you Don't feel well for example and you want To know hey do I have a high blood sugar Or low blood sugar it's a good idea to Check your blood sugar What about continuous glucose monitors We call these CGM So what is the CGM first of all a Typical CGM system consists of a small Sensor that's inserted Under the Skin
And it's basically a little tiny Filament that sits right under the skin You don't feel that it's there but it's Measuring the glucose every five minutes And then that sensor sends it to sends This information to a wireless Transmitter which in turn sends the Glucose information to a receiver now a Receiver can be a little Standalone Device like a little pad or it can just Be your smartphone with an app that's Receiving storing and processing all of This glucose information so anytime you Want to know your blood sugar you can Just look at the receiver or your Smartphone app and see what your blood Sugar is Now these cgms provide way more Information than your A1C and your Glucose meter can okay As the name suggests they give you Continuous glucose data so anytime Throughout the day or night if you want To know your blood sugar and you're Wearing one of these you can just take a Look it's going to be there it's going To tell you what's going on this Ultimately in addition just so that you Know what's going on it should support Your decision making it can help guide You in deciding you know making changes In your diet deciding what's good to eat What maybe causes high blood sugars what Doesn't cause your blood sugar to spike
It can help guide your exercise and it Can help guide you in medication dosing Especially if you're using insulin Needing to adjust those doses You also get something called a trend Arrow which shows if you can see in this Little picture the current blood sugar For this person is 112 that's a good Blood sugar but the trend arrow is Pointed up so that means that it's 112 But the blood sugar is actually Increasing a little bit so that adds Additional information that we just Can't get from your glucose meter There's alerts and alarms for high and Low blood glucoses this is really Important especially if you've had a History of low blood sugars or if you're On insulin or one of the sulfonuria Medications that can cause low blood Sugars so these can help protect against Low blood sugars and they provide Reports of your overall glycemic trends For your healthcare provider which I Personally love as a provider but also For you to look at you can download These reports and see what's been going On with your blood sugars they can help You pick out problem areas or areas that You want to improve on it can and it can Show your improvement over time These are the four available CGM systems Currently in the United States and I Won't spend too much time talking about
The differences of each of these Um there's more information about that In other places and on the TCI tcoid Website but briefly the one on the far Left the Abbott systems these are great Systems I think for most people with Type 2 diabetes they're they're easy to Use they're they're very accurate they Provide you with all of this continuous Glucose monitor information and these Tend to be the ones that are most likely Covered by insurance for people with Type 2 diabetes the Dexcom device is Another great option it's a little bit More of a complicated device in some Ways in that it adds some extra features But it's a really good very accurate CGM Both the Abbott and the Dexcom device Will completely take the place of any Finger sticks because you don't have to Do finger sticks with your glucose meter To calibrate the devices they come Factory calibrated they're ready to use You put them on and they're accurate and Good to go the other two devices the Sensionic device is a tiny implantable Old device that they just got approval For 180 day wear so it's a tiny device That's implanted in your arm you wear it For six months and that's sending Continuous glucose on our data so you Don't ever have to change out the sensor Every 10 days or anything like that and Then the other is Medtronic both of
These systems require some calibrations Between you know up to one or two times A day where you still have to poke your Finger to calibrate to make sure that They stay accurate but otherwise they're Running on their own without having to Do finger sticks the big takeaway for Cgms is that currently they're covered Mostly for patients with type 2 diabetes Who are on basal and bolus insulin in Other words multiple daily injections of Insulin per day otherwise they can be Difficult to get covered so this is a Discussion to have with your provider And your insurance company if there's Coverage and we hope over time as we see That these devices really really help People even if they're not on insulin to Improve their blood sugar and improve Their health we hope to see them get Covered for more and more people So In short uh there's a lot to cover a lot Of the basics of type 2 diabetes we Squeeze a lot into 25 minutes I hope you Had fun I hope you learned something I Do encourage you to go to the tcoid Video Vault and to check out all the Videos that we have there for more Information on these topics so if you're Interested in CGM if you're interested In checking you know learning more about Monitoring your blood sugar diet Exercise any of those things or specific
Videos and other information with that Can really help guide you moving forward So I want to say thank you and stay Healthy