Prevention of Pre-Diabetes

It’s always nice to see people in the medical community backing your beliefs. I found this quote recently by Dr. Michael Valentine, the President of American College of Cardiology (2018-2019) that said “While we are constantly finding innovative ways to treat existing heart disease, we must continue to focus our efforts on preventing heart disease. It will require efforts from more than just the medical community, but from communities and government as well.” 

In this blog, we’ll be covering pre-diabetes, obesity and how to prevent both of these things from occurring in the first place. Many people have heard about diabetes, but what most people don’t know is how the sequence happens from pre-diabetes to full-on diabetes and the process that the body goes through during this time. 

High blood pressure, diabetes, and obesity all go hand-in-hand. 

When you have a meal that is rich in carbs, where do those carbs go? They are absorbed into the bloodstream and go knocking on the door of our working cells in our liver, muscles, and other arteries to tell them that blood sugar is available. The cells listen and use this to go about their routine and create the energy that we use daily. However, as blood sugar continues you to come around and tell us that blood sugar is available, not all doors open. Now, the pancreas already secretes insulin into our bodies, and when that blood sugar comes knocking, they say - “Knock louder, I can’t hear you.” The blood sugar or insulin must be louder and work harder to get through those doors, hence the creation of insulin becomes higher. Insulin continues to come back with more and more insulin in order to open those doors, but after it accumulates such high levels over and over, it eventually says, “What do you expect of me? I can’t keep up with these levels anymore” Hence insulin resistance starts its journey. 

The main reason this occurs is when our bodies are not getting the proper treatment tactics - a healthy diet, exercise, and of course, too many carbohydrates. As we know, everything is okay in moderation, but when your body starts to become unresponsive, it’s because of unwanted belly fat and lack of care for our bodies. Our bodies try to help us maintain healthy weights, even from the inside, hence the resistance to insulin production trying to help keep us healthy and fit. For people that have diabetes and other health-related issues, this fight can be challenging. Your blood test will be where you see the difference in your body.

Your number should look something like this: 
Pre-Diabetes: between 100-126
Diabetes: 126 or higher 

1 out of 3 people in the United States test positive for pre-diabetes, and had no idea that they were even in a categorical place for pre-diabetes or diabetes in general. This is where we wrap everything back to our previous lessons: stay on top of your health and make your primary care physician your best friend. Get your checkups, monitor your own health at home, and do the things that you know are good for your bodies in the long run. Your physicians will tell you how to take care of your bodies before diabetes can kick in, or how to prevent your body from getting to a diabetic level.

To your health,
Dr. Anthony

Shared Decision Making

In an era where there are so many options in the medical field, having the opportunity for shared decision making is more important than ever. Shared decision making is when a doctor and patient decide together on what needs to be done next. This contrasts with the more traditional practice of medicine in the 19th and 20th centuries, where the health care providers had the knowledge and dictated to the patients and their families of what needed to be done. Shared decision making is important when more than one option is being presented and it’s not 100% clear on what needs to be done. In a more “clear cut” situation, the role of shared decision making is less pronounced. For example, a young person comes in with acute appendicitis. We know that if we don’t operate and remove the appendix quickly, it can burst, cause peritonitis and ultimately lead to death. We wouldn’t converse about it for an hour with the patient and his family; we would say that this is what needs to be done and this is what we are going to do. Another common case (that I have often experienced as a cardiologist) is when someone is having a heart attack. We know that it’s important to move quickly and take care of the situation, and giving a variety of options is not the best use of time. 

In instances that have more than one option and are not as acute (or urgent), shared decision making is a very ethical option and practice with most physicians. Here’s an example of how this tends to play out: say we have a patient who comes in for an appointment. She feels fine, and has no symptoms of an impending heart attack or stroke, but is considered high risk. As a doctor, I offer the option of prescribing a statin (which lowers cholesterol). These medications have been widely used since the 1980s and have been credited for cutting the number of heart attacks in half. They have been very powerful and useful, but they need to be taken on a daily basis. While they are generally safe to use, it’s important to remember that there are no medications without side effects. Statins are not “muscle friendly”, and approximately 1 in 5 patients develops muscle aches while taking this medication. This is not life-threatening, but it can inhibit daily activities. It becomes a back and forth discussion that takes time and effort from both the patient and the doctor. Of course, it is much easier for a doctor to say “here is your prescription, take this daily and come back in two months so I can check your cholesterol levels”. But the approach where the physician invites the patient to make decisions together based on the patient’s comfort level can be extremely beneficial. On one hand, we want to educate the patient on what we think is best; but on the other hand, we want him to be able to follow through with that decision. 

Shared decision making is a wonderful thing. It’s what patients deserve, but it takes time and a good attitude from both the patient and the physician. It takes the realization from the patient that there are no easy fixes in medicine and that prevention is the first line of defense. Does your doctor practice shared decision making? If you’re not sure, have a discussion with her and find what fits your needs the best.

To your health!
Dr. Anthony