Diabetes care and research with Dr. Elizabeth Seaquist

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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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