Diabetes Part 2 with Dr. Laura LaFave

By www.Pixel.la, public domain photo

Hi, everybody and thanks for stopping by.  This is Part 2 of our look at diabetes, aided by my colleague, endocrinologist Dr. Laura LaFave.  Click on Part 1 here if you missed it from last week.

 

 

 

In this part, I’ll cover:

  • Risk factors for developing diabetes.  (Includes a BMI calculator that you should try).
  • Complications of diabetes.
  • Tips for reducing your chance of getting diabetes.

Here we go!

Continue reading “Diabetes Part 2 with Dr. Laura LaFave”

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Diabetes Part 1 with Dr. Laura LaFave

Endocrinologist Dr. Laura LaFave

This week we did a Healthy Matters show about diabetes and I wanted to write a post about that topic while it is fresh in my head.  So I sat down to write but quickly realized that diabetes is probably the most wide-ranging medical condition of them all.  It has complex causes, different types, multiple risk factors, numerous complications, and lots of treatments.  It is a chronic illness that requires a team of health care professionals and dedicated patients to manage.  So I really can’t cover diabetes in a blog post.

At least one that isn’t of Tolstoy-like length.

Then I remembered a comment from a caller to last Sunday’s show.  Betty had called in with a question about diabetes, and she noted on the air that she had learned more in the previous 15 minutes of our broadcast than in all the years she had been living with diabetes.  (I love our listeners!)

So I thought, hey, I don’t have to cover all of diabetes, I’ll just summarize what we talked about in those 15 minutes, putting it in progressive levels of detail.  Sort of like college.  Except without the tuition.

Of course, those first 15 minutes of diabetes discussion didn’t come from me.  It was my guest, Dr. Laura LaFave, who skillfully broke it down for us.  That’s Laura in the photo above, taken just before we went on the air from the WCCO studios in downtown Minneapolis.  Dr. LaFave is an friend and colleague with whom I did my training at Hennepin County Medical Center many years ago.  Recently, she re-joined our clinical and teaching faculty at Hennepin.  (Hint:  you, too, can see Dr. LaFave as a patient if you need an Endocrinologist by clicking this link).

For the aurally-inclined among you, I really encourage you to listen to the podcast of the broadcast by clicking the banner here.  For those drawn to the written word, I’ll summarize the key learning points in the the following paragraphs.  Your choice!

Continue reading “Diabetes Part 1 with Dr. Laura LaFave”

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“Decade with Dave” and Here 4 Health series

Hi, friends!  See that sign in the picture?  Those signs are all over the campus at Hennepin Healthcare.  Let’s just say my co-workers have shown no mercy in teasing me about them.

But hey – we have something to celebrate!  I’m super pumped to be launching “Decade with Dave”  – our celebration of 10 years of our Healthy Matters broadcast!

We’re starting with a live broadcast of Healthy Matters from the atrium at Hennepin Healthcare’s Clinic and Specialty Center complete with a LIVE audience.  That’s where you come in.  I’m inviting you –  my Healthy Matters listening friends – to be that live audience on Sunday, June 10.   Denny Long will be there, I’ll be there, and I hope YOU will be there.

Here’s what we’re planning for the live broadcast of Decade with Dave . . .

Diabetes and the Sweet Life.  I’ve invited an old friend from my medical training, Dr. Laura LaFave, to introduce her to Healthy Matters listeners.  Dr. LaFave recently rejoined the Hennepin Healthcare faculty in Endocrinology – in fact I don’t even have a link to her picture yet!  She’s a friend, a smart doctor, and a genuinely good person.  She’s been practicing for over a decade but only been back to Hennepin for a few months, so to welcome her back to our family I’m putting her in front of a live audience.  She’s a good friend, eh?  We’ll talk about diabetes and other hormone-y topics.

Arthritis Treatment Options:  Moving from Pain to Gain. Dr. Rawad Nasr is Hennepin’s Director of Rheumatology and another colleague with whom I go way back.  We dragged him back from his practice in Bemidji to join our Hennepin faculty.  His recent show about arthritis was a huge hit with listeners so he’s coming back to chat with me about arthritis and joint questions.  You’ll love this guy.

 

Sleep Health:  What Keeps You Up at Night. Another really popular topic – in fact, perhaps the most popular topic – is sleep.  We all need it, we all want it.  Many of us struggle to get the best sleep we can.  Another Healthy Matters veteran, Dr. Ranji Varghese, will be at the broadcast to meet you, to help us understand sleep, and to answer a few questions.

 

Following the broadcast, we’ll have a bit of Q&A and show you around the place a bit.  We’ll have coffee and munchies (donuts, anyone?).

Let’s fill the place!  The broadcast is free to attend, but we need you to RSVP if you plan on attending.  Click here to RSVP for our special “Decade with Dave” LIVE broadcast.

But that’s not all . . .

Announcing . . . Here 4 Health

Hennepin Healthcare’s Clinic and Specialty Center

After kicking off the summer with “Decade with Dave” we are launching an exciting new health education program for the curious and inquisitive among you.  “Here 4 Health” is a series of three educational sessions on a variety of health topics sort of like a mini Medical School.   Except more fun.  And not nearly as grueling.  Come to learn about health topics from cool experts from Hennepin.

You can attend 1, 2, or all 3 sessions.  They’re all free of charge, but you do need to send your RSVP by clicking here.  All events are at the Hennepin Healthcare Clinic and Specialty Center.

Here’s what we have planned for “Here 4 Health” (subject to change if any of these colleagues chicken out):

Session 1:  Thursday, July 12, 5-7 p.m

How to live to 100 or die trying.  Dr. David Hilden (that’s me) will be updating a popular session I’ve been giving for years.  I’ll take you behind the scenes at a state-of-the-art working clinic with insider tips on staying healthy.

The Ins and Outs of GI Health.  OK, some smart aleck (probably the same guy who decided to make a career of doing colonoscopies) made up the name for this informative session about colon cancer.  Learn from Hennepin gastroenterologist Dr. Jake Matlock  about colon cancer and colonoscopies!  I know Jake.  Great guy.  Ask him to show you a colonoscope.  Then ask him why the heck he thought it would be cool to look at people’s intestines all day.  You’ll also get the special chance to tour a colonoscopy suite – when you’re NOT on the cart getting your own colonoscopy


Session 2:  Saturday, August 11, 9-11 a.m

Dermatology – your skin questions answered.  Hennepin dermatologists Dr. Sara Hylwa and Dr. Jenny Liu will be on hand.  You’ll never get a better chance to tap into a skin doctor’s expertise.  They are smart and they know skin like the back of your hand – literally.  Just don’t ask them if you can skip wearing sunscreen.   (Spoiler alert. . . you can’t .  . these two are so stingy on that point).

 

The Ancient Art and Modern Practices of Integrative Medicine – Acupuncture and Chiropractic.  A certified acupuncturist and chiropractor will show you around the world of integrative medicine.  Maybe you’ll come away just a little less mystified at these ancient practices.  Ask to see an acupuncture needle.   Dr. Richard Printon and acupuncturist Jessica Brown will be on hand!


Session 3:  Saturday, September 15, 9-11 a.m.

You Gotta Have Heart.  Recent Healthy Matters guest and cardiologist Dr. Michelle Carlson will show you around the world of heart health.   You’ll learn from her particular expertise in women’s heart health and the link between heart health and cancer.  You may want to check out the recent post I did with Dr. Carlson here.

 

Best Practices in Breast Health.  Leah Hahn is the supervisor of the mammography program at Hennepin.  See a mammogram machine for yourself.  Men, you too should attend this session.  It will give you a new appreciation for the women in your life.  And men get breast cancer too!  Check out this post I did with Leah Hahn from a few months ago.

 

A Little Help for your Friends.  Hennepin has the best Physical Therapists AND therapy facilities in the region.  Come see a PT gym and look at the amazing possibilities for therapy.  This is state-of-the-art stuff which you can learn from Senior Physical Therapist Beth Stegora.

 

 

Attend all three sessions or pick and choose the ones you want.  They’re all free and all at the Hennepin Healthcare Clinic and Specialty Center in downtown Minneapolis  Probably the most important part of all .  . . the parking is right there underground.  Could not be simpler.

Why should I go learn something?

Here’s why I think you should attend the LIVE Decade with Dave broadcast and why you should attend the Here 4 Health series . . .

You could sit home and watch TV.  Or stare at the grass and watch it grow.  Or sit on your couch and get bad health information from the Internet.

Or you could get out of the house, come to the Here 4 Health series, and learn from fun, smart, and reliable doctors and health professionals.  All while taking in the art-filled and warm setting of a state-of-the-art health facility.  

RSVP here.

Looking forward to meeting lots of you!

David

 

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Quick tips: influenza, angina, kidneys, & blood pressure

Hi, everybody.  I’m back with one of these “Quick tips” posts where I answer questions that were sent to me on a recent Healthy Matters radio broadcast.  Regular listeners will know that I never can get to all of the questions, particularly those sent by text message, so I will try here to do some brief answers.  I’ll keep it to just a few topics, and will do more posts in the near future.

Here are the topics in this post.  Click the links to jump right to a specific topic.

As always, I invite you to listen to the Healthy Matters broadcasts, either live or via podcast.  Here are ways to listen:

  • Live on News Radio 830 WCCO on your AM dial.  Sunday mornings, 7:30 Central Time.  You’d be surprised how far the WCCO signal reaches from our downtown Minneapolis studios.
  • Live on WCCO.COM.  Sunday mornings, 7:30 Central Time, from anywhere on Earth with Internet
  • At your convenience, via podcast.  Simply click on the “Listen to Podcasts” link right here on MyHealthyMatters.org or go directly to WCCO.COM on the “Audio” link and find Healthy Matters.   You can listen directly online or you can download the podcast to your phone, tablet, or computer and listen anytime at your own convenience.  Without commercials!
  • Or just click the logo here:
Podcasts

Continue reading “Quick tips: influenza, angina, kidneys, & blood pressure”

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In case you missed it: our most popular topics

I have been writing My Healthy Matters for nearly two years, and over that time there have been over 50,000 views to the site.  To all of you who read along with me, THANK YOU!

I took a pause in writing new posts today to look at the statistics on what most of you are reading on the blog.  It is really fascinating to see what strikes your collective fancy, so I thought I’d do a little retrospective post to highlight the most popular posts of the past.  You may wish to go back and read what you missed.

I’ll rank them in order of popularity, based on number of people who viewed them in 2017, and I’ll include links to the posts in case you want to read them.

Continue reading “In case you missed it: our most popular topics”

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Coffee, WHO and You: the best news in a long time

cup-of-coffee-1414919__180OK, before I say one thing about this topic, we need to set the mood by playing this very short audio clip.  Make sure the sound is turned up on your computer or mobile device and click the “play” arrow.

This is going to be epic:

 

 

Hallelujah!  Yes, indeed, the medical community has determined that drinking coffee is not only probably not bad for you, it may actually be good for you.

Here I am celebrating (undoubtedly after having had a couple cups):

20160211_hcmc_408

That news is proof of a divine being, I say.

Continue reading “Coffee, WHO and You: the best news in a long time”

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Quick tips: stroke symptoms, swollen legs, and glucose levels

Lots DRH Letterboxof questions from listeners on the show this week and time did not permit me to get to all of them.  So nothing fancy in this post.  Just quick answers on a range of topics from actual listeners.

If you missed the show, the podcast is here (click the logo) for you to listen to on your computer, phone, or whereever:logo_healthy-matters

 

 

Just like on the radio show, I can’t give complete answers to questions here.  Always good to check with your own doctor.  

Here’s how this post will go.  I’ll cover 3 topics in a bit of depth:  swollen legs, blood glucose, and recognizing a stroke.  Although all are important, I really want you to know the symptoms of stroke so I’ll start with that.  At the end I’ll do a few quick “lighting round” questions.  Fasten your seatbelts. Continue reading “Quick tips: stroke symptoms, swollen legs, and glucose levels”

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Healing wounds, preserving limbs

Drs. Tom Master and Nikki Bauerly visit the WCCO studio for live Healthy Matters broadcast
Drs. Tom Masters and Nikki Bauerly visit the WCCO studio for live Healthy Matters broadcast

This post is all about wound healing, hyperbaric oxygen, and fluorescent microangiography.   Now if that doesn’t get your attention . . .

Here’s a preview of what you will find in this post – lots of multimedia clips and info:

  • Basics about leg wounds
  • A video about hyperbaric oxygen
  • A news report from TV highlighting a recent patient undergoing LUNA angiography
  • Links to more information

Read on! Continue reading “Healing wounds, preserving limbs”

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When weight loss surgery makes sense

“Ohartley in studionly 1-2% of people who could benefit from weight loss surgery are actually getting it done”

So says Dr. Gil Hartley, my radio guest this week on Healthy Matters.  Dr. Hartley is an internal medicine physician, like me, who specializes in the care of people who are very overweight.  We focused our conversation on bariatric surgery – which is the medical term for weight loss surgery.

Here is the Healthy Matters podcast page to listen to this show or any of our recent shows.

BMI checkerThe first step to knowing if weight loss surgery may be right for you is to calculate your own Body Mass Index, or BMI.  You just have to know your height and weight, and it takes less than a minute to do.  Find out your BMI by clicking the button —>

What does the BMI mean

Here are the categories of BMI:

  • <18.5       = Underweight
  • 18.5 – 25 = Healthy weight
  • 25 – 30    = Overweight
  • 30 – 40    = Obese
  • >40          = Severely obese

It may be emotionally hard to find out which category you fall into – and you’d be right to note that it is just a number.  But think of it as a starting place, and if your BMI is high, perhaps now is the time to take action.  Especially if your BMI is greater than 40 in which case  I really encourage you to see a weight loss surgery expert.  For people with diabetes, the BMI at which to consider surgery drops to 35.

Is weight loss surgery right for me?

As Dr. Hartley mentioned, weight loss surgery is the best option for many people who are excessively overweight – the people who are at risk for complications due to their weight – diabetes being the most prominent example but also including high blood pressure and obstructive sleep apnea.  I won’t get into all the details, as there are lots of good resources for people who are overweight or obese (for instance, check here for good info from the National Institutes of Health – a source you can trust).   But what struck me about my conversation with Dr. Hartley was when he said the resistance of people to getting weight loss surgery is still a real problem.  And he isn’t trying to peddle unnecessary surgeries on anyone.  He simply knows firsthand that surgery is the best solution for many people.

And don’t be too hard on yourself.  Being overweight is not a character flaw.  For most people, it is also not just a problem with overeating (although that is the problem for some).  Rather, obesity is a complex chronic condition with lots of causes and contributing factors.

I’ll close with a few more things I learned from Dr. Hartley today about weight loss surgery:

  • Weight loss surgery may be the most effective treatment for diabetic patients who are obese.  Some patients actually leave the hospital after the surgery without needing their diabetes medications anymore!
  • We used to think it did not matter when you did your surgery.  We told people to just think about it and do it whenever you are ready.  Doctors are reconsidering this due to more recent evidence that suggests that getting it done earlier leads to better longer-term health in patients with diabetes.  So waiting for years and years to do the surgery may not be the best idea after all.
  • The laparoscopic banding surgery, which showed great promise 10 years ago, is used much less today.  The two more common surgeries are gastric bypass (Roux-en-Y), and vertical sleeve gastrectomy.
  • You can drink liquids without problem after weight loss surgery.  One caller to the show was worried about being thirsty after surgery.  Not to worry, you can still drink liquids normally as they just pass through your system just like they always did before surgery.
  • Loose skin can be a problem for some after weight loss surgery (to the degree that cosmetic surgery is considered), but for many people the skin does remodel back to a less bothersome condition over time.

If you are in Minnesota and want to take action on your weight . . . here is information on Dr. Hartley and his team at the Hennepin Bariatric Center.

Thanks for joining me on the air, streaming online, and on MyHealthyMatters.org!

 

 

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Diabetes care and research with Dr. Elizabeth Seaquist

If you missed the show this morning about diabetes with Dr. Elizabeth Seaquist from the University of Minnesota, you’re going to want to check out the podcast.  She is not only a terrific person to hang out with but she is also incredibly accompHesy-Ra_CG1426_clished in her career as a clinician and researcher.  And she is terrific at explaining diabetes, why it matters, and how she and others are doing research that promises to help us all in managing diabetes into the future.  No, that is not Dr. Seaquist in this picture (I think it is Hesy-ra, the Egyptian who first described diabetes in 1552 BC).  I was going to take a selfie of Dr. Seaquist at the microphone but alas and alack, I forgot.  Here’s her bio page at the University of Minnesota.  There is a short video from Dr. Seaquist later in the post as well.

For those of you checking for information about the GRADE study that we discussed on the air today, the number is 612-301-7040 or grade@umn.edu for the University of Minnesota location.  Read more about GRADE later in this post.

And I’ll do a couple quick tips from the phone and text line at the end of this post.  OK, on to the business of honey sweet urine.  Ew.

Sweet urine

First I can’t resist a quick aside about the origins of the name “diabetes mellitus”  (which is the full name of the disease).  Diabetes is from the Greek for “siphon” (or “passing through”) and mellitus from the Latin for “honey” or “sweet.”  Put ’em together and it loosely means “sweet urine” – sugar passing through the body and kidneys into the urine.  Ancient people were aware of what was probably diabetes in Egypt, China, India, Persia, and Greece, but it was an intrepid British doctor who really latched onto the sweetness of urine (and now for the “ew” factor – I guess that they used to actually taste the urine.  Makes one immensely thankful for modern lab equipment).

OK, enough history.

Diabetes basics

For Type 1 diabetes, the body lacks the normal function of creating insulin, which is necessary for life.  This is the less common form of diabetes and it always requires insulin for treatment.  I’m not going to talk about it here.

Type 2 diabetes is in some ways more complex and thus harder to summarize.  Basically, the body creates some insulin, but it is either in insufficient amounts or the body is resistant to the usual effects of insulin.  This is called insulin resistance.  It correlates with excess body weight, so being overweight does put one at higher risk for developing diabetes (and conversely, diabetics who can lose weight can improve their sugar control).  However, as Dr. Seaquist mentioned on the show today, there is more to the story than being overweight, something that should be evident when you consider that some lean people develop diabetes while many overweight people do not.  So there is a genetic component that we are still trying to understand.

Diabetes is such an important topic that people spend their whole careers diagnosing, treating, researching, and support patients with diabetes.  It is certainly too much for a blog post.  I would refer you to the American Diabetes Association for solid information.  Just a couple of points here.

If you have Type 2 diabetes, you should:

  • Know your A1c and your A1c goal (usually aim for <7%, but this can vary with your personal situation so ask your doctor).
  • See your doctor regularly (every 3 months, or more frequently if sugar control is not adequate).
  • Manage your glycemic control (aka sugars) with diet and exercise, and if that is not enough to reach your A1c goal, then with medication.
  • Pay attention to the parts of yourself that are vulnerable – get eye exams, protect your feet and wear good shoes, monitor your kidney function, and do what you can to lower your risk of heart disease (keep cholesterol down, consider taking an aspirin a day, do not smoke . .  ).  Of course, these are general guidelines only – you should do all of this in consultation with your doctor.
  • And finally, consider enrolling in the GRADE study if you meet the criteria

GRADE study

There are oodles of treatments that are FDA-approved to manage Type 2 diabetes.  A healthy diet and exercise are important for everybody  After that, the first choice for most people will be a medication called metformin.  Medical data has shown that this is the most effective at safely bringing blood sugars under some control.

The problem is that for many people, metformin alone does not control the high blood sugars adequately.  In other words, metformin alone does not bring their glycosylated hemoglobin, or A1c below ~7%.  (You may have a slightly different goal based on factors unique to you, but for most people getting below 7% is a good goal).  So a second agent is needed, and that’s where there is not rock-solid data to tell doctors and patients what to use next.  Is it insulin? One of the older classes of drugs called sulfonylureas?  Or perhaps one should use some of the newer drugs, of which there are many.  After all, they are all FDA-approved, but after metformin we still don’t know which ones are best.

So that is the big question that the GRADE study is going to help us answer.  Check out the short video about GRADE:

If you have diabetes type 2, ask yourself these 2 questions:

  1. Have I had diabetes less than 10 years?
  2. Is metformin my only diabetes medication?

If the answer is YES to both of these, then you may qualify for the GRADE study.  If you enroll, you can expect the following:

  1. Ongoing care at the University of Minnesota (in Minneapolis, or at another GRADE site near you) for medical visits 4 times per year.
  2. You will get your diabetes medications at no cost to you.
  3. You will get your physical exam and diabetes lab tests also at no cost to you.

Great care for your diabetes, free tests and medications, and you will be doing an important service to people living with diabetes everywhere by helping us all understand the best treatments.  I encourage you to give the GRADE researchers a call.  Their University of Minnesota number is 612-301-7040 or e-mail them at grade@umn.edu.  If you live elsewhere, go to the GRADE site at gradestudy.com to find a location in your part of the country.

I really want to thank Dr. Betsy Seaquist for joining me this morning.  HCMC and the University of Minnesota are partners in clinical care and research!

Quick tips from Healthy Matters text line

I received way more questions from listeners than I can answer on the air Sunday mornings.  Here are short responses to a few text questions from today (I paraphrase the questions a bit here).

Is macular degeneration the eye condition associated with diabetes?  Although macular degeneration is a common eye condition, it is not the one we most associate with diabetes.  Diabetes does lead to a higher risk of retinopathy (sometimes with excess blood vessel growth in the eye), macular edema (swelling in the back of the eye), cataract, and glaucoma.   These are treatable conditions, so people with diabetes should get regular eye exams.

Is it possible to stop taking diabetes medications if I lose weight?  For many people, yes, this is not a myth.  Sometimes losing just 10-20 pounds may be enough to control blood sugars.  Certainly there is strong evidence that people who are very overweight and then get a weight-reduction surgery often are able to stop their diabetes medications almost right away.

Can prednisone raise blood sugars?  You bet it can!  We touched on this on the radio today a bit.  Any corticosteroid (like prednisone pills that you swallow, or intravenous steroids that some people in the hospital need, or even injections into your knee or other joints) can and usually do raise your blood sugar levels.  Usually the blood sugar levels come down after these anti-inflammatories are stopped, but be prepared to adjust your diabetes medications if you are also on these corticosteroids.  As always, consult your doctor before changing any of your diabetes medications and be sure to let your doctor know if you need to take these steroid medications.

Healthy Matters – next week on the radio:  Open Lines!  Get your general health questions ready.

 

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