Hartford HealthCare Podcast
The Hartford HealthCare podcast covers a wider range of topics on health, wellbeing and career opportunities within the healthcare industry.
Hartford HealthCare Podcast
What's Your Type? Identifying and managing diabetes
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Dr. Eglis Bogdanovics, a Hartford Healthcare Medical Group endocrinologist with the Diabetes Center at Charlotte Hungerford Hospital, discusses the different paths taken with managing type 1 and type 2 diabetes, some alarming risks of not treating diabetes and the all important access to care.
If you are experiencing any of the symptoms discussed in this episode, be sure to schedule an appointment with your primary care physician.
Find a Doctor that's right for you and your family.
Learn more about Endocrinology, Diabetes & Metabolism at hartfordhealthcaremedicalgroup.org
Urination, thirst, infections of the skin. Some of these things that that for most of us make make perfect sense. You'd be surprised how many people have had some of those symptoms for years and and uh never tell anybody about it.
SPEAKER_00Welcome to more life. In this episode, Hartford Healthcare's Steve Coates talks with Dr. Edward Bogdanovich, an endocrinologist with the Diabetes Center at Hartford Healthcare's Charlotte Hungerford Hospital. They discuss the different paths taken with managing type 1 and type 2 diabetes, some alarming risks of not treating diabetes, and the all-important access to care. Here's Steve Coates.
SPEAKER_05Before we started taping, I learned a very interesting uh fact about you is that not only do you treat diabetes, but you're also a patient. Forty years it's been since your diagnosis for type 1 diabetes. Take us a little bit through that and how that impacts you as a physician.
SPEAKER_04Yeah, well, you know, I was I was supposed to be uh an officer in the Marine Corps, and I had gone through officer candidate school, and about two months before flight school, I started urinating a lot, drinking a lot of fluid, and lost 30 pounds in two weeks. And long story short, it was something called diabetic ketoacidosis, and I had type 1 diabetes, and and the uh government didn't trust me to fly a $30 million plane. So plan B was to go into medicine. And I had sort of planned on doing it eventually anyway, but that's sort of moved the plan along a lot faster. So I've been interested in treating people with diabetes, and you don't have to have diabetes to treat diabetes or patients with diabetes, but I think it sometimes helps to understand how it's impossible to be perfect.
SPEAKER_05Do you share your story with with patients? Do they know that that you have diabetes?
SPEAKER_04Well, they know now.
SPEAKER_05Sorry about that.
SPEAKER_04Yeah, I you know, usually most of the time I do. Most of the time I do. And and particularly if somebody has had long-standing disease and is sort of just in a rut, I try to you know tell them that I've been there, done that, and sometimes it actually helps to uh you know know a couple of tricks about how some of our medicines work that maybe you don't know if unless you do take them.
SPEAKER_05You know, I've worked in healthcare marketing a long time and I've written about diabetes type one, type two, and have such a kind of rudimentary understanding of it. If somebody were to ask me what the difference between type one and type two, I might just say, oh, you get type one, you know, when you get diagnosed when you're younger. Explain to me the differences for people that might not know.
SPEAKER_04Yeah, you know, um, I like to use the analogy of a lock and a key. You know, both types of diabetes are pretty much an inability to use glucose or sugar as fuel. You know, you've got it everywhere, you've got a high sugar, yet you're you're literally starving. So in in type 1 diabetes, the hormone insulin that's required for that sugar to go into the cell is completely missing. And it happens overnight. So these are, as you alluded to, younger people usually, although I've seen an 80-year-old get that. Um, and and lack of insulin, the weight loss is there, the ping and the excessive thirst, and they need insulin from day one. So they don't have any of the keys for that lock. In type 2 diabetes, there's plenty of insulin initially, plenty of keys, but the lock is broken. So they need to make excessive insulin in order to make that glucose go into the cell. So we can often start with various other treatments, namely pills and and other injectables, to make that lock work better. But eventually, eventually, they actually run out of enough insulin to overcome what we call insulin resistance. So, type 2 diabetes, yes, it's usually later in life, but these days, um with our children being more overweight than in the past, we're starting to see type 2 diabetes in younger, younger kids, adolescents, and even younger.
SPEAKER_05Some people might say that type 2 diabetes is preventable. Is that the case?
SPEAKER_04Not always, not always. There are people that are overweight and don't have type 2 diabetes, and there are people that are type 2 diabetic that aren't quite as overweight as you'd imagine. So there's a certainly a genetic predisposition to it, but uh lifestyle certainly does play a role in developing diabetes in those patients that are genetically predisposed to it.
SPEAKER_05Is management of type 1 and type 2 diabetes similar? It seems that there would be a different path.
SPEAKER_04Yeah, you're right. You're absolutely right. Remember that we just said that type 1 diabetes, all those cells that make insulin are gone. So you literally have to start insulin from day one. In type 2 diabetes, typically we start with lifestyle modification. So diet, cutting down on carbohydrates, cutting down on everything, really, but but seeing a dietitian and a nutrition educator, exercise, metformin, which is our drug that we usually go to first. And after that, there are so many other pills that we can use. But they sort of come together later in the natural history of type 2 diabetes because many times people with type 2 diabetes need insulin eventually. In fact, if you look at all the insulin used in this country, about 70% of it's used by type 2 patients. And that's basically because most diabetes is type 2, about 90 to 95 percent.
SPEAKER_05We've also seen higher rates, much higher rates in some cases of the prevalence of diabetes in certain racial or ethnic groups. Why is that?
SPEAKER_04Yeah, that's that's a really great question because there definitely is a disproportionate effect on uh certain racial groups, African Americans, Asian Americans, uh Latinos. Part of it may be access to care. It's important to diagnose pre-diabetes or or diabetes early on. There's uh inability to see a primary care position on a regular basis, that might be part of it. Some of it could be socioeconomic status, and some of it is just cultural uh attitudes, diet alone. So there's a there's a couple of things that we could potentially do that many uh stakeholders in in diabetes are working on right now, including the American Diabetes Association, including Harper Healthcare.
SPEAKER_05And what's the key in addressing these disparities?
SPEAKER_04Connecting people with a primary care physician, I think, is probably one of the most important things. But also increasing awareness of what the symptoms of diabetes are. Various advertisements, including those basic symptoms that we talked about earlier, urination, thirst, infections of the skin, some of these things that that for most of us make perfect sense. You'd be surprised how many people have had some of those symptoms for years and and uh never saw anybody about it.
SPEAKER_05So with untreated diabetes comes a whole host of other situations, health situations that can be damaging and even life-threatening.
SPEAKER_04Oh, yeah. You you have to nail right on the head as far as what we call the small vessel or microvascular complications, namely blindness, kidney disease, diabetes is a leading cause of loss of sight as well as dialysis, and nerve disease, neuropathy. Those are all related to high sugars and can be prevented. Then even the other ones, the heart disease, the stroke, those also can be prevented specifically with certain medications. So you really have to hit these early. We call them comorbidities or multimorbidities or cardiovascular, cardiometabolic multimorbidity. There's so many terms for this, but you don't just have high sugar. You have high sugar, you have eyes, you have kidneys, you have heart, you have stroke. They all go together. So, yeah, I like to say nobody ever died of a hemoglobin A1C, but they uh you know certainly are affected by the things that are affected by high blood sugar.
SPEAKER_05You're 40 years in now to your personal journey with diabetes and nearly as long as a physician. How has management treatment of diabetes changed over that time?
SPEAKER_04Well, it has changed, but I'd love to say that my first doctor was right. He said there would be a cure in five years, and obviously there wasn't. Insulin was discovered, or the first injection in a human was in January of 1922. So we're coming up to the 100-year anniversary, the centenary of the discovery of insulin. So we're still using the same insulin. We've had some really great changes in insulin therapy, but we're still injecting insulin. Where we've seen a big change is in monitoring. You know, I was checking my urine for sugar when I first started this. Then it went to doing finger sticks, and now it's these devices that are under the skin that transmit to my phone. So it's come a long way there, and we've come a long way in the treatment of type 2 diabetes, where 40 years ago we had two classes of medications, and now we have 12 classes. So, you know, it it's never a great time to get diabetes, but if you if you have to pick a time, uh, you know, right now it's okay. And unfortunately, one in three kids born today will have diabetes. So it's a we we've got to work harder and and we've got to develop more treatments and and preventative measures.
SPEAKER_05Obviously, medication management monitoring are crucial uh to managing the disease, but exercise and staying active is also important, correct?
SPEAKER_04Exercise is our best drug. You know, realizing that not everybody can exercise, but if you can, you know, 30 minutes of exercise five days a week, whether you have type 1 diabetes or type 2 diabetes, will decrease your risk of uncontrolled hyperglycemia, if you will. And the other thing is that that realize that that you can't be perfect. Doesn't mean that you have to go out and you know eat uh 50 munchkins every day, but you know, realize you're not going to be perfect 100% of the time and don't beat yourself up about it.
SPEAKER_05Doctor, thanks so much for your time today.
SPEAKER_04Yeah, it's been nice talking to you.
SPEAKER_00Thank you. Steve Coates and Dr. Bogdanovich. Learn more about endocrinology, diabetes, and metabolism at Hartford Healthcare Medical Group.org. And be sure to check this episode's notes for more information and important links. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_03I'm ready for my clothes up on the face of life. We can go anywhere we want to go.