Your Diabetes Questions Answered

Transcript:

KARA: Welcome to Dishing Up Nutrition. Today's podcast is brought to you by Nutritional Weight & Wellness. I'm Kara Carper, a Licensed Nutritionist and a Board Certified Nutrition Specialist. So I want you to think for a moment. Have you recently been to the doctor and been told that your fasting blood sugar numbers started creeping up a little bit too high?

Did your doctor say you have prediabetes or perhaps you received a diagnosis of type 2 diabetes? According to a study in JAMA, which is the Journal of American Medical Association, more than half the U.S. adult population has either diabetes, type 2, or prediabetes.

So it's a topic that we think many of you can relate to. My cohost today is Brandy Buro. Brandy is a Licensed and Registered Dietitian. I always love hosting podcasts with Brandy.

BRANDY: Thanks, Kara. Likewise.

KARA: I mean, you just have a great way of explaining health and nutrition topics so that people can really start taking actionable steps immediately to improve their health.

BRANDY: Yeah. Thank you. I appreciate that. It is a passion of mine. And I think this topic really hits home for me. It's actually something that inspired my interest in nutrition, just watching family members, with diabetes develop health complications later in life. So seeing that it really made me motivated to learn more about it and understand what I could do to sort of prevent that same future for myself.

KARA: Yeah.

BRANDY: So it's awesome to be able to teach other people how to do that very thing without, you know, going to a dietetic school.

KARA: Absolutely. Yes, you have the personal and the professional background with this.

BRANDY: Yeah, definitely and just knowing you know looking at those statistics that half of Americans, adult Americans have either prediabetes or diabetes, that's, I mean, that's a serious thing, you know, and the disease doesn't just stop at diabetes. So if this disease is not managed well, long term, you can develop some really scary side effects or other health issues. So I think this will be a great episode for people to pay attention to and take some steps to better their lives.

Risks of having diabetes

So I just want to give a few examples of how diabetes can impact your life moving forward if you don't take steps to manage the disease. So there is a higher risk of developing heart disease after being diagnosed with diabetes. And in more severe cases, you can experience issues with your vision. You can even develop kidney disease.

There's also issues with nerve damage, so you can actually feel like numbness or tingling in your feet, your hands, your arms and legs. Sometimes if this goes on long enough, people will need to amputate a leg or a foot, for example. So that's from the nerve damage and loss of blood flow to those areas. Or maybe like a foot ulcer that just wouldn't heal because there's issues with circulation.

KARA: Sure. You know, that's interesting. After we were preparing for the show, I came across a statistic that said the most common reason for amputation of the lower extremity, like a foot or a leg or part of a leg is from diabetes complications. And I didn't realize that was like the leading cause.

BRANDY: Yeah. Yeah. It's, it's pretty scary to think about. So yeah.

KARA: Very scary.

BRANDY: So, I'm sure a lot of you out there, if you've been diagnosed with prediabetes or have diabetes, you have questions. There's a lot of questions out there. So what Kara and I have done today is we've put together a list of the most common questions that we receive about diabetes, and we're just going to answer them for you. So it's a little Q and A today.

KARA: Yeah. I think it's great we're starting to have more more podcasts in sort of this Q and a format.

BRANDY: Yeah, me too.

KARA: And you know, what we're doing is we're essentially taking all of your deepest questions and we're compiling them and giving you answers. So first Brandy and I are, we're going to start by explaining the different types of diabetes. We'll also dive into the science of what's going on in the body that creates these out of control blood sugars. Then of course we're going to offer lots of tips on what you and your loved ones can do nutritionally to bring those glucose or blood sugar levels back down.

What is diabetes mellitus?

BRANDY: Awesome. So I'm going to get us started with a pretty basic question. But, it's worth exploring. So, what is diabetes mellitus? So, diabetes mellitus is what the traditional term for diabetes, what we, you know, casually know as diabetes today, used to be referred to as diabetes mellitus.

KARA: Diabetes, or as Brandy stated, diabetes mellitus, like it used to be called, it's a condition when the body either does not produce enough insulin or isn't able to use insulin effectively. And this results in something called high blood sugar levels. You'll also hear this referred to as high glucose levels. And that can be dangerous for a lot of reasons.

BRANDY: Definitely. You know, and when I was getting ready for this show, I got a little curious just to understand more about where this term diabetes mellitus came from. So I just did a little quick search and found that diabetes mellitus has Greek and Latin origins, and it literally translates into “passing through sweetness”. So that's a little more descriptive of what this disease actually is.

KARA: That's really interesting because that's what's happening with diabetes. It's sugar that's passing through the bloodstream in excess.

What are the different forms of diabetes?

BRANDY: There are several forms of diabetes, all kind of with unique causes and, symptoms. So there's type one diabetes, type two diabetes, gestational diabetes, and a condition called prediabetes. So this is basically when somebody does have elevated blood glucose numbers, a little outside of that optimal range, but it's not quite high enough to qualify clinically as type 2 diabetes.

KARA: So we'll start with type 1 diabetes to explain that a little more clearly. This happens when the immune system attacks and destroys the cells in the pancreas. And the pancreas makes our hormone called insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. And listeners, you know, some of you may remember about 40 years ago; I remember this; when type one diabetes was referred to as juvenile onset diabetes. And type two diabetes, we'll talk more about that, was referred to as adult onset diabetes.

BRANDY: Yeah, and even when I was going to school in college, they were still sort of referring to it as adult onset and juvenile diabetes.

KARA: So it's even more recent than I recall.

BRANDY: At least in the textbooks that I was using.

KARA: Yeah.

BRANDY: So it is a pretty recent shift, because about 30 years ago, physicians were starting to see cases where kids and teens were being diagnosed with the adult onset form of diabetes or type two diabetes. So now we know it's not just limited to adults, you know, it's not age specific.

KARA: Yeah. So changing the name definitely made sense.

BRANDY: For sure.

KARA: And for type one diabetes, doctors also realized that it wasn't just kids and youth being diagnosed, but that type one diabetes could technically occur at any age. So then hence no longer the name juvenile.

BRANDY: Yeah. And I do have several clients who develop type one diabetes middle age and, you know, in their thirties, forties and fifties, some, in some cases. When you have type 1 diabetes, what that means is you do need to take insulin every day just to stay alive. So like you mentioned, Kara, when you have type 1 diabetes, your body attacks the pancreas and that is the organ that's producing insulin.

So with type 1 diabetes, you don't have your own supply. You need to get an external supply of insulin. So type 1 diabetes accounts for about 5 percent of all cases of diabetes. So it's, it's not as common as some of these other forms that we're going to talk about.

KARA: We definitely wanted to bring it up though, because I mean, I have a couple of close friends, colleagues that have type 1 diabetes. So we really want to inform you, you know, so you know the differences of all these different types.

So gestational diabetes, this is a different cause of diabetes, and that can develop in some women when they're pregnant. Most of the time, this type of diabetes will go away after the baby is born, however, those with gestational diabetes during pregnancy, they do have a greater chance of developing type 2 diabetes later in life.

So if this is a relevant topic to you, the nutrition tips that we're going to be giving during our podcast today are still applicable. You know, if you're someone that had gestational diabetes in the past, you can follow the tips that we're going to give to help you lower your risk of becoming type 2 diabetic in the future.

BRANDY: That's a good point. And I would say the recommendations we'll give are probably great for just about anybody to follow just as a proactive preventative measure.

More on the most common form of diabetes (type 2)

So I want to move on to the most common form of diabetes and that is type 2 diabetes. So in the case of type 2 diabetes, your body is not making enough insulin, or it is not utilizing the insulin you are producing very efficiently. So you can develop type 2 diabetes at any point in life.

Like we mentioned, even children are developing type 2 diabetes. But I would say it is more common to get that diagnosis later in life. You know, in your thirties, forties, fifties, so more middle aged and older folks, but this it's important to know that this is a progressive disease.

What can contribute to type 2 diabetes?

It doesn't just happen overnight. It is a consequence of your, your lifestyle choices, particularly your eating habits over the years. So it can take many, many years of specific food choices and beverage choices, that contribute to this disease. So think really high sugar foods, really high sugar beverages, processed carbohydrates like, chips and French fries and candy and muffins.

Fast food is another example of the types of foods that can contribute to this disease. I would say about 90 to 95 percent of all cases of diabetes would fall under this category of type 2 diabetes.

KARA: So by far the most common out when we're comparing type 1 diabetes, gestational diabetes during pregnancy, and now type 2, like Brandy said, 90 to 95 percent of diabetes cases fall under type 2.

What is prediabetes?

But we do also want to bring up this term called prediabetes. Even though it's not considered full blown type 2 diabetes, prediabetes occurs when someone has higher than normal blood glucose levels. But not high enough to, you know, be diagnosed as a type two diabetic.

BRANDY: Right. And we'll talk about those specific numbers of how they diagnose prediabetes versus type two diabetes. But first I do want to just make a comment about the term prediabetes, because I think that can be really misleading for a lot of people, who even receive that diagnosis.

So many times I have clients come into my office and they'll, you know, show me their lab work and sometimes they'll even say like the doctor said everything was normal, nothing of concern. But looking at their lab results, actually their blood sugar numbers are in that range of prediabetes. Or sometimes they'll even get the diagnosis of prediabetes, but maybe their doctor just said, we'll watch this for a year or two and see what happens. We just don't want it to turn into type two diabetes.

So I think that attitude, that kind of laissez faire attitude around these high blood sugar numbers gives the impression that it's okay to have prediabetes as long as it doesn't progress to the full blown type two diabetes.

KARA: I'm so glad you mentioned this and gave some real-life examples of clients, you know, coming in with their labs.

BRANDY: Yeah.

KARA: And this aligns with something I just found from PubMed in the journal, Clinical Diabetes. And it stated that “Recent studies have demonstrated that patients with prediabetes can suffer from coronary artery disease and diastolic heart failure, even before progressing to type two diabetes.” So that article was published in 2020 and here's the title, Brandy: Prediabetes Deserves More Attention.

BRANDY: Yes.

KARA: We couldn't agree more.

BRANDY: Absolutely. I mean, prediabetes is, it is a warning, you know, it is a very big red flag, like things need to change, or you will be heading down the inevitable of developing type two diabetes if you change nothing. But as you just mentioned, you're even at risk now for developing some more serious complications.

Commonly asked question: “Which type of diabetes is worse: type 1 or 2?”

KARA: Well, hopefully that helps explain the various types of diabetes. And now that we've differentiated between the two types, type one and type two, let's go to another commonly asked question. We got this question, “Which type of diabetes is worse; type one or type two?” It's a valid question. It's a complicated question because both are serious, but they are different diseases that come with different challenges.

BRANDY: That's right. And as we mentioned before, type 1 diabetes is an autoimmune condition where your body is attacking itself and it's specifically attacking your pancreas and that's the organ that produces insulin and insulin's big job is to help manage your blood sugar. So when you have type one diabetes, you do not produce insulin.

KARA: Absolutely. Yeah. And managing blood sugar levels requires constant monitoring and like you said, external insulin, often coming from a pump or a shot or both, and a really regimented eating plan when someone has type one diabetes.

BRANDY: Yeah. So careful monitoring. Many people that I work with that have type one diabetes will have like a continuous monitor. So they always know what their blood sugar is and they're always managing their insulin.

KARA: So they have like, they may even have like an insulin pump and then a monitor and they can see everything.

BRANDY: Yes, exactly. It's pretty sophisticated. But you know, as we described about type two diabetes, it is much more common. So 90 to 95 percent of all cases of diabetes fall within this type two category. And this is often linked to what somebody is eating. So the body is still making some insulin, but it is not using that insulin very effectively, and that leads to something called insulin resistance.

KARA: Now the good news is that type 2 diabetes can usually be managed and actually prevented. So to answer this question, you know, is one worse than the other, when it comes to type 1 or type 2, it depends. Type one is more immediately life threatening, of course, without insulin, but type two, as we stated at the beginning of our podcasts, type two can really lead to serious complications if it's not properly managed.

BRANDY: Right? And no matter what type, type one or type two, if you do not treat this and manage it well, both cases, all cases of diabetes can lead to complications with heart disease, nerve damage, and even kidney disease. Okay, well, we have a lot of questions yet to be answered, so we're just going to take a quick break. When we come back, we will be discussing more of your questions about diabetes. We'll be right back.

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KARA: Welcome back. You're listening to Dishing Up Nutrition podcast. I'm Kara Carper here with Brandy Buro. And today we're answering the most common questions that we have received about diabetes.

What are the symptoms of diabetes & are the symptoms different for men & women?

BRANDY: All right, so we've got another great question and this one was submitted by one of our Dishing Up Nutrition listeners. So this one's kind of a two part-er. What are the symptoms of diabetes and are symptoms of diabetes different for men and women?

KARA: Really great question. Some common symptoms are needing to urinate frequently, feeling excessively thirsty, feeling fatigued. And this makes sense because when blood sugar or glucose numbers are out of balance, people often complain of being very tired and fatigued most of the time.

Some other signs could be blurry vision, slow healing wounds. So think about if you get a cut, normally, you know, it starts to heal in a typical amount of time. But if it seems to be taking longer than normal, that could be a sign. There's also something called neuropathy or peripheral neuropathy.

Neuropathy means there's a dysfunction of the nerves. So what this looks like is either nerve pain, tingling, or numbness, and it often begins in the feet or the hands. So the feet and the hands, those have peripheral nerves because they're on the outer part of the limbs. And so those are the nerves on the parts of the body that are affected first.

BRANDY: Yeah, I always think of, you know, where are the smallest blood vessels in the body? And that's what's going to get impacted the most, well first, so extremities, small organs, like your eyes, even your kidneys.

KARA: Yeah, that's a great way to phrase it. And then, you know, later on there could also be issues with some of the organs such as, you know, the liver, the heart, but it's the other ones that we were talking about that occur first.

BRANDY: Exactly. So I think all of those symptoms you just mentioned could occur in men and women. But for women, there are some very unique symptoms. And what I see a lot in clinic is urinary tract infections or yeast infections that just will not go away. You know, they just keep reoccurring. That their treatment isn't really effective and it's just kind of ongoing. How annoying.

KARA: Yeah, seriously.

BRANDY: But another condition that many women are diagnosed with is called PCOS or polycystic ovarian syndrome. So this doesn't mean that if you have PCOS, you have diabetes or vice versa, if you have diabetes, you have PCOS. But many women that have PCOS are insulin resistant and insulin resistance basically means that you're not using insulin very efficiently and you are, you struggle with balancing your blood sugar naturally, and that puts you at an increased risk of developing type 2 diabetes or prediabetes.

KARA: You know, and talking about type 2 diabetes and prediabetes, of course the best way to determine, you know, where you're at with your blood sugars is to get a simple blood test from your doctor or your medical provider. And we'll talk later in the hour about what specific tests to ask for and also what the healthy ranges are for both blood sugar levels and insulin levels.

BRANDY: That's a good one. I don't think a lot of people are talking about insulin levels.

KARA: No.

Is type 2 diabetes caused by diet &/or lifestyle?

BRANDY: Well, I want to move on to a little more of a complex question related to diabetes. So is type 2 diabetes caused by diet, as in not following a very balanced diet or lifestyle? And we've kind of hinted on this already, but what do you think, Kara?

KARA: Well, I imagine people wondering if type 2 diabetes is caused by poor diet, poor lifestyle, they're probably also wondering whether type 2 diabetes has a genetic component and might be hereditary. So let's start by addressing that. I'll let you take that one, Brandy. Is diabetes genetic?

BRANDY: Mm hmm. Yes, I would say in some cases it can be. Type 2 diabetes is influenced some by genetics, but also largely by lifestyle factors. So there are studies that show on average, your risk of developing diabetes increases by about 15 percent if you have a close family member that also has diabetes. So if a parent or a sibling or both parents or all siblings have diabetes, then you are at an increased risk. It doesn't mean you will get diabetes, but it does mean that you have a higher likelihood compared to somebody who has no family history of diabetes.

KARA: Even though family history and genetics do play a role, you know, most type two diabetes, as we already stated, most type two diabetes cases are linked to other things like what people are putting in their mouths, what they're eating, what they're drinking on a regular basis has a huge effect. Of course, things like lack of exercise, lack of movement can be another risk factor.

BRANDY: Yes.

KARA: With our current lifestyles, we're inundated with fast food, processed food. And there's just a lot of sitting and not moving or exercising. I think that's kind of the nature of our just more sedentary lifestyles.

BRANDY: Yeah. Yeah. A lot of the work that we do doesn't require a lot of movement. You're getting in your car to get to your job, or maybe not even getting in your car. You know, working remotely is so common these days. And we're working so much, so we don't give ourselves enough time to actually prepare food for ourselves.

So in a lot of cases we turn to fast food or convenience foods that don't require a lot of energy to prepare, but also aren't really giving us great nutrients either. So it's, it's a pretty vicious cycle. So if 15 percent of type two diabetes cases are linked to genetics, that means about 85 percent are primarily related to food and lifestyle choices.

And if you have a family history of diabetes, again, it doesn't mean you'll automatically get it, but it does mean you have to be really careful about those food and lifestyle decisions because you're at an increased risk.

KARA: And that's such an important point. In fact, you were telling me, you were talking about a client who is able to reverse his prediabetes.

BRANDY: Yeah, it was pretty amazing. You know, this was a very dedicated client, and, you know, he's not the only client that I've had that's successfully reversed their prediabetes. I just think this is kind of a special case because he was able to do it so quickly. Each case is different.

Every person is different. A lot of different factors come into play: age, how progressed the disease is, how severe the symptoms are, how long they've been dealing with insulin resistance. So the client I was telling you about was a man in his late thirties and he had his annual physical sometime in the fall in October.

And he made an appointment shortly after because he, he got that diagnosis of prediabetes and he got kind of scared, you know, he had some family history, he could, he saw what could happen and he really wanted to prevent that future for himself. So the first thing we did was we put together a meal plan.

So we just took a look at what his current habits were with his food and his drinks. And we put together a meal plan to balance blood sugar. So he worked really hard at that; pretty committed and dedicated to that food plan. And, you know, in a few months he was able to see some dramatic change in those blood sugar numbers.

KARA: That is fantastic. And I know we'll talk more about like levels and numbers in a little bit, but prediabetes is when your fasting glucose is between 100-125. So it sounds like he had started out somewhere in that range and he was able in a few month span to get it under 100.

BRANDY: Yes. So in October, his fasting blood sugar on that day was 110. His hemoglobin A1C was 5.7. So. You know, enough evidence that he's at least insulin resistance and clinically could be diagnosed as prediabetes. So that was October. I think he met with me in November. He emailed me the first week of January and was very happy to share he got his fasting blood sugars consistently in the low 90s.

KARA: Oh, that's fantastic.

BRANDY: Yeah. Really, really happy to hear that.

KARA: That's a really significant change in a pretty short period of time.

BRANDY: Yeah. So, I mean, it wasn't just food there. Like I said, there are a lot of factors at play here, but big changes with food. But as we know, movement and exercise can also help your body become more sensitive to insulin. So that was something he had working in his favor. He was already pretty active. You know, he walked three miles a day, with some weightlifting a few times a week at home. So he had already been sort of implementing some of that before we met.

BRANDY: So I didn't have to convince him. But that, that actually does have a really huge benefit on your blood sugar numbers. And I'm sure that's what contributed in part to his success.

KARA: So it sounds like he really, he really honed in on his diet. He had already incorporated some movement. Didn't you also say that he prioritized sleep a little bit more?

BRANDY: Yeah, that was a big one from my perspective, cause we know that sleep deprivation can increase your risk of insulin resistance. And I learned that he was only sleeping about five hours a night. You know, that was kind of the routine for him. That was normal. So I really encouraged him to kind of move the dial a little bit, try to shift his bedtime earlier to get him closer to that seven, eight hours a night range. And yeah, I checked my notes again for this client and the last we met, he was consistently getting at least seven. So I consider that a huge victory.

KARA: That's a win.

BRANDY: Yes.

KARA: I mean, from five to seven is a huge win.

BRANDY: So another, aspect of what I think helped him become so successful was that he was testing his blood sugars regularly. So he just, he got a basic glucometer, you know, the handheld version where you prick your finger. But he was testing his blood sugar like before and after meals occasionally just to understand how his blood sugar was responding to different types of foods and based on that information, he adjusted his meal plan here and there so that basically he was optimizing his blood sugar control with that data.

KARA: Yeah. I have not experimented with one personally, but I've heard they can be really eye-opening because biochemically we all respond differently to different carbohydrates. So somebody might be pretty sensitive to like a white potato and another person may not. So it's important to know what your blood sugar’s, how they're responding to different carbohydrates.

BRANDY: Useful information.

KARA: Yeah. I wonder if people realize how much power and control they have over their bodies and blood sugar levels. So I'm glad that you brought up that client story and especially the part about sleep, because people may not realize that lack of sleep can really elevate blood sugar and insulin levels. So over time, that's just one more risk factor for either prediabetes or type 2 diabetes.

BRANDY: And it takes a toll on your heart health too. So sleep is so important. So we just answered 2 diabetes is caused by diet or lifestyle. So there is a small genetic component, but in most cases, we can tie that disease from either eating or drinking the wrong foods or beverages. And I think that that's a nice segue into another question that we received from lots of our clients and class participants.

What are the best foods for diabetes & which should be avoided?

What are the best foods for diabetes? And on the flip side, what are the foods that we need to avoid in order to prevent diabetes?

KARA: So this is kind of our wheelhouse, right, Brandy, as a dietitian and a nutritionist. Let's break it down. You know, it all gets down to what we call eating real food. What is real food? It's food that you buy at the grocery store and you prepare in your kitchen. Real food is not premade meals that come from either a freezer, a can, or a box.

You know, the biggest contributors to the fact that over half of Americans have prediabetes or type two diabetes, it's because they're eating too many processed carbohydrates and too many sugars, and sugary beverages are also part of the picture.

BRANDY: Definitely. Yeah. There's so much sugar that you can cram in a glass of soda or a special coffee drink. So I just want to give a few more examples of the carbohydrates that tend to be the biggest culprits and spike your blood sugar the most. I think bread, bagels, chips, pasta, muffins, crackers, pizza, French fries, and of course like the sugary treats and desserts, cookies and candy, we already mentioned soda, but even something like lemonade and sweet tea. Lots of sugar hiding in those drinks.

KARA: Oh gosh. Yeah, we really want people to start reading labels, too, because it's really eye opening, you know how much sugar can be in just like one little coffee drink like you said.

BRANDY: Absolutely.

KARA: But it's not just the one coffee that you get that has you know 20 teaspoons of sugar at one time. Chronic high blood sugar numbers occur from daily and weekly habits that build up over time. Maybe it's not a coffee drink that is your go to, but if you don't have time to prepare and eat breakfast, you might grab a bowl of cold cereal with milk.

And then for lunch, if you didn't have time to pack a lunch, you might pop into a sandwich place and get a sub sandwich, chips, and often it will come with a soda and a cookie. And you know, that really all starts to add up. And even without the cookie, I did add up the sub sandwich, half of a sub sandwich, a bag of chips with a soda is 25 teaspoons of sugar. So with a cookie, I don't know, we're probably looking at 40 teaspoons of sugar.

BRANDY: Yeah, that's a big sugar load. And I just want to give a little bit of context to that because some listeners might not realize that 25 teaspoons of sugar or 40 teaspoons of sugar really is quite a bit. Our bodies were not designed to handle that many carbohydrates, that much sugar all in one big swoop.

KARA: Right. And so if you want to keep your blood sugar, your glucose levels and a healthy balanced range and maintain a healthy weight, most people need to be watching their carbohydrate intake and keep it to 25 or 30 grams of carbohydrates with a meal.

BRANDY: So that converts into about around five, six teaspoons of sugar.

KARA: I'm glad you said that because we had just talked about the 40 teaspoons of sugar.

BRANDY: So, so really only about a quarter of that sub sandwich meal is really what your body prefers. So you can eat a lot of vegetables for 25 grams of carbohydrates. I would, you know, that would look something like probably three cups of salad greens with another cup of like carrots with tomato and cucumber, you know that's almost four cups worth of food there for only 25 grams of carbohydrates.

KARA: On the flip side you can't eat a lot of volume and a lot of quantity when it comes to starchy carbohydrates if you want to keep it to that you know, 25 grams or less. For example, a piece of bread has about 20 grams of carbohydrates. So a simple sandwich with two pieces of bread, that already bumps you up to 40 grams. If we divide by four we're already at 10 teaspoons of sugar.

BRANDY: Right. So there's four grams of carbohydrates and one teaspoon of sugar. That's the conversion we're using. So if any of you out there want to do some math at home with some of your favorite foods, by all means, but I'll give you another example.

A cup of cooked pasta has over 40 grams of carbohydrates. A cup of cooked rice has 45 grams of carbohydrates. And even if you have prediabetes or insulin resistance, just having a cup of rice or pasta or two pieces of bread in a sandwich, that is too many carbs for your body to handle. But the good news is, vegetables are fair game.

Eat as many vegetables like leafy greens, cucumbers, peppers, tomatoes, as your heart desires, because they are very low in sugar, very high in fiber, and that helps prevent blood sugar spikes.

KARA: And it's interesting that a cup of a starchy carbohydrate: rice, potato, or pasta adds up so quickly. A true serving of, you know, something like cooked pasta is actually a half of a cup.

BRANDY: Yeah.

KARA: And Melanie, our colleague, she will often say, half cup of pasta, that just makes me angry.

BRANDY: Yeah, it makes me angry too.

KARA: I know where she's coming from. Hardly seems worth it. I'd rather have two cups of spiralized zucchini noodles or zoodles is what they're called.

BRANDY: Yeah, much more satisfying to me. I'd much rather have like a full plate of zucchini noodles or spaghetti squash and top that with my favorite marinara sauce instead of just a little half cup of pasta. It's much more satisfying. It fills me up and I just feel so much happier. And just like I mentioned with the salad, you know, a very common lunch for me is a big salad because it's I can get like several cups of vegetables with tomatoes, peppers, cucumber.

And the carbohydrate content is going to be low enough so that I don't crash in the afternoon. You know, it's not going to give me a big energy crash. So that big salad has only about 20 grams worth of carbohydrates. And I'm also pairing that with some protein and a little bit of fat. So it's even more satiating.

KARA: Yeah, I'm picturing a meal like that, and yeah, there's really, I would be very satisfied, maybe even full.

How do you know if you have diabetes or prediabetes? (Lab tests to consider)

BRANDY: Yeah, definitely. So we've been talking a lot about numbers like grams of carbs, teaspoons of sugar, but I want to get back to the numbers that are really important. How do we know if we have diabetes or prediabetes or insulin resistance? Because there are some really great lab tests that can inform you where you are.

So the fact is that if you have insulin resistance, so if your blood sugar numbers start to get outside of that optimal range, insulin resistance very often turns into prediabetes. And this is something that you can monitor yourself before it gets to the really advanced stage of type 2 diabetes.

So if you go to the doctor and you have your physical done, most of the time they will test your fasting blood sugar or your fasting blood glucose. So if you find that your fasting blood glucose is between 100 and 125, that is clinically considered prediabetes.

KARA: And frequently, both the conditions insulin resistance and prediabetes will end up escalating to type two diabetes and clinically if you get lab tested but at your physician's office it's when your fasting blood glucose is higher than 125 milligrams per deciliter.

BRANDY: Yeah and many of my clients want to know well how do you test for diabetes? And we do recommend that everyone knows what their fasting blood glucose level is. And I encourage my clients often to get a glucometer so that they can test it at home periodically outside of that one day of their physical so they know what their trends are.

But there are other lab tests that you can test for to get some early warning signs of insulin resistance before that fasting blood sugar numbers become you know, within that prediabetes range or diabetes range.

KARA: Yes, because earlier in our show, we were talking about how even having slightly elevated blood sugar levels, you know, can Make you at higher risk of heart complications and certainly for the type 2 diabetes. So, slightly elevated fasting blood sugar is a risk factor for type 2 diabetes. So then, what would be a more accurate test to kind of catch that even further in advance?

BRANDY: Well, Look at your fasting blood sugar. If you are seeing that your fasting blood sugar is above 90, that's something to watch. I really like to test fasting insulin as well, especially if you are seeing high blood pressure, high cholesterol, or if you have a family history of heart disease or diabetes; knowing your fasting insulin is actually so important because that's, that's the number that's going to start to increase even before your fasting blood sugar.

KARA: Yeah. So we really encourage, especially if you have this family history of diabetes or heart disease, ask your doctor for a fasting insulin. It should be, a healthy level is five. And another measurement, Brandy had mentioned this earlier, but you can also ask for hemoglobin A1C, and that's just a general picture of a, like an average of three-month average of your blood sugar levels and a healthy normal range for that A1C is 5.1 or lower.

BRANDY: Right. So I like to look at all three of those numbers together because just looking at your fasting blood sugar alone doesn't really tell us the whole picture. So when I have the fasting blood sugar with fasting insulin and an A1C, then we can have a more accurate understanding of where they are in the progression of insulin resistance to diabetes.

Recap

KARA: Well, we want to thank you for listening today. We compiled some of the most commonly asked questions about diabetes and hope that you learned something about the different types of diabetes, the signs and symptoms, the risk factors, and also how to go ahead and test. We say test, don't guess, when it comes to something as serious as blood sugars.

BRANDY: Yeah that's good. I like that. Because if you get that diagnosis of insulin resistance or prediabetes, that should be a warning. That should be a wake up call to you. That is not something to ignore and “wait and see what happens”. It's a really serious condition and it's, you know, something that you have control over.

You know, this is something that you can take action to change. And if somebody with prediabetes changes nothing about their habits, the research does show that 50 percent of those people will develop type two diabetes within five years. And as we've learned today, the complications from type two diabetes can be life threatening. So I hope you've all taken some good recommendations from today's show so that you can be in control of your own destiny.

KARA: And please take a moment to share this podcast with friends and family. Our goal at Nutritional Weight & Wellness is to help each and every person experience better health through eating real food. And it's a simple yet powerful message. Eating real food is life changing, so thanks again for listening. Have a wonderful day.