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”


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”


Should you trust the latest “medical advance”? And koalas too!

Hey friends!

The plaque in this photo above was a gift from a medical student and hangs on my wall right above my desk. It is a saying reportedly from Michelangelo that I use in teaching medical students and residents fairly often.

I even gave a speech to some graduating medical students called “I am still learning.”  I don’t even think Michelangelo actually said this at age 87 but the sentiment still resonates.  This post is about learning medicine.

This past week I’ve really been going back to school.  I’m now back from several days in San Diego at the American College of Physicians Internal Medicine conference.  ACP is my professional organization, and our annual conference brings many thousands of us together to learn about the latest in medical science, pick up tips for our practice from some of the country’s top experts, and re-connect with colleagues from around the world.

In the next several posts, I am going to highlight for you some of what I learned at the ACP conference in San Diego.  Look for short posts in the coming weeks about:

  • Clostridium difficile infection
  • Lyme disease
  • Zika virus
  • Menopause and depression
  • Pain control and opiates
  • Sleep disorders
  • Restless legs syndrome
  • Blood pressure in older adults
  • Antibiotic resistance
  • Weight loss and exercise
  • Iron replacement
  • Osteoporosis

I’ll try to keep these future posts really short and helpful.

Continue reading “Should you trust the latest “medical advance”? And koalas too!”


Apple cider vinegar: a Healthy Matters investigative report!

On a recent “Open Lines” radio broadcast (in which we have no topic and I simply answer the sundry questions from listeners) somebody asked about the health benefits of apple cider vinegar.  Fair enough.

Well as a highly educated medical professional I am here to firmly and unequivocally state after my extensive exposure to the best in medical science that I know nothing about apple cider vinegar, whether it be the health benefits or culinary benefits or counter top cleaning benefits.

abby-and-acvBut happily, I’m not 100% ignorant about apple cider vinegar any longer.  Just about 90% ignorant. That’s since my daughter introduced me to the stuff while I was visiting her far from home at college.  Here’s how it all went down.  I was having some queasiness in my belly or some such thing and she goes to the cupboard and pulls down a giant bottle of ACV (apple cider vinegar = ACV).  Then she starts telling me all about how ACV improves everything from colds to upset tummy to sunburn and cancer and everything in between.  But she does live in Los Angeles so I naturally wondered what the crazy Californians are teaching my level-headed Midwest-raised daughter.

But I was game to give it a try.  So  we poured some ACV into a glass of water, I held my nose, and drank it all down.  It wasn’t too horrible to drink so that was a plus.  And dang if my stomach queasiness didn’t get a little better!

So I chalk up my rapid improvement to one of two possibilities:

Placebo effect – I convinced myself that it helped because I wanted it to help.


Apple cider vinegar really does help upset tummies.

Which is it?

So in the spirit of hard-hitting investigative journalism and to be true to my medical credentials and only stick to the best science, I’ve done some looking into ACV as a health option.  Here’s what I found: Continue reading “Apple cider vinegar: a Healthy Matters investigative report!”


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):


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

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


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”


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”


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.