Diabetes Awareness with Dr. Rachel Kilpatrick

I am interviewing Dr. Rachel Kilpatrick for Diabetes Awareness Month!

Dr. Kilpatrick is a full time practicing endocrinologist who spends most of her time managing patients with diabetes, and other hormone disorders including insulin resistance, polycystic ovarian syndrome, thyroid disorders, adrenal disease, pituitary disease, and other complicated endocrine disease.  She has a special interest in Lifestyle medicine and is pursuing a certification in lifestyle medicine.  She believes that most diseases can be modified positively with lifestyle intervention. 

Dr. Kilpatrick is board certified in both internal medicine as well as endocrinology, diabetes, and metabolism.  She did her medical school training at the University of Texas Southwestern Medical School, and did her internal medicine residency and endocrinology fellowship at Washington University in St Louis. Dr. Kilpatrick is a member of the American Diabetes Association, the Endocrine Society, the American College of Physicians, and the American Association of Clinical Endocrinologists.  She is also a Fellow of the American Association of Clinical Endocrinologists.

You can find Dr. Kilpatrick on Instagram and Facebook :
Facebook: @rachelkilpatrickmd
Instagram: @rachelkilpatrickmd
Twitter: @rachelkilpatrickmd
TikTok: @rachelkilpatrickmd

During the Podcast, we discuss:
What are the different types of Diabetes?

What Causes Diabetes ?

What are the symptoms of diabetes?

If I have Diabetes, what should I be the most worried about?

What are three things you would ask every diabetic to start doing today?

What three things would you like all diabetics to stop doing right now?

How does stress affect diabetes?

Mindfulness has been shown to improve diseases related to stress, such as anxiety, depression, and chronic pain.

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Transcript

Speaker 1: 0:54

Hello and welcome to the Art of Healing Podcast. This is Charli, and thank you so much for joining me. This is a special episode. I am a very lucky and privileged that I'm able to have a diabetic specialist and a endocrinologist who's gonna be on the show since this show will be airing in November. And this is the Diabetes Awareness Month. I had the opportunity to ask her to discuss diabetes. So let me introduce Dr. Rachel Kpa. She is a full time practicing endocrinologist who spends most of her time managing patients with diabetes and other hormone disorders, including insulin resistance, polycystic ovarian syndrome, thyroid disorders, adrenal disease, pituitary disease, and other complicated endocrine disease. She has a special interest in lifestyle medicine and she's pursuing her certification in lifestyle medicine. She believes that most disease can be modified positively with lifestyle intervention. Dr. Kpa is board certified in internal medicine and endocrinology. She did her medical school training at the University of Texas Southwest during medical school, and she did her internal medicine residency and her endocrinology fellowship at Washington University in St. Louis. Dr. Gilpatrick is a member of the American Diabetes Association, the Endocrine Society, the American College of Physicians, the American Association of Clinical Endocrinologists. She's also a fellow of the American Association of Clinical Endocrinologists. So the following is our conversation about diabetes. I think this is gonna be helpful if not for some of us life saving. So I do hope you enjoy as you are listening to this podcast. If you so feel move, please leave me a rating. This is a small production and it always helps a small shows. If you'll leave us a rating, it helps a scope a little bit in the ratings. So thank you so much for joining me, Doctor, how are you doing today?

Speaker 2: 2:58

I'm doing so fantastic. Thank you so much for the invitation to come on here and, and speak. I'm very excited to talk about our topic today. It's wonderful.

Speaker 1: 3:11

So I love that. Um, while I have your attention and I was deciding like this time is so viable, I felt that we needed to talk about diabetes. This is a disease that if you don't have it, you care for someone that has it, you know, someone that has it, you're at risk of developing it. So, um, to launch us into it, would you mind describing the different types of diabetes?

Speaker 2: 3:38

Absolutely. I would be happy to do that. So just kind of taking a step back just to know sort of where my perspective comes from with all of my training. I currently practice in the state of Arkansas, and my practice right now is probably at least half of my patients have diabetes. And so in taking care of diabetes, you know, it becomes very apparent the, um, you know, the sort of heaviness of this disease and frankly, the frequency of the disease and how common it is. And so really for your listeners, I think it's very relevant to know about this because it's not this esoteric topic. It's, it affects so many people. So before I talk about the types of diabetes, I'm just gonna say a mention as to why this matters. So the prevalence of diabetes, at least in the United States, um, of course some of your listeners are outside the United States, but, um, 11 and a half percent, I believe is the most recent statistic from the Center for Disease Control. 11 and a half percent of the population has diabetes. And um, up to, I think it's 38% of people actually have pre-diabetes, and it's almost half of people over age 65. So, such an important topic and just really drives home. I think the fact that, you know, the words that I use are, um, maybe we are not evolved in a way our genetics, uh, are not evolved to live in the world we live in. So with that all being said, the types of diabetes, there are two very different types, and the rise is in both types, but really the, the lion's share of that is type two diabetes. So type one diabetes is a different animal altogether. We see, um, that these are people who have developed an autoimmune disorder. They, um, essentially don't make insulin anymore. Um, they're cells and their pancreas, the pancreatic beta cells have been attacked and, uh, no longer function and you must have insulin to live. And so these patients, uh, require administration of insulin, very different contrasting to the patients who have type two diabetes, which is a disease really of sort of insulin resistance. And so typically that, you know, understanding the disease comes from understanding the treatment. So we're trying to improve our insulin sensitivity, uh, in patients who have type two diabetes. So their pancreas is making tons of insulin and it's just not doing the job well or well enough. So their blood sugars go high and uh, you know, they develop diabetes. How'd I do?

Speaker 1: 6:46

So, um, thank you. That was a beautiful explanation. Um, I actually, um, so, and just for the listeners to understand, I'm an internal medicine doctor. If you're a listener, mine, you'll hear me use that term a lot. And Dr. Kirkpatrick is a specialist in endocrinologist. So I actually did not know that the incidence of type one diabetes was starting to increase. I didn't actually realize that

Speaker 2: 7:11

It is, it is. I don't have the numbers in front of me. Yeah. But it is going up as well. I think, you know, a lot of these sort of autoimmune diseases, maybe were becoming better at detecting it, but certainly with type one, we do know that the incidence is increasing as well. So important.

Speaker 1: 7:29

Another question, um, that I get from my patients, uh, get from clients, from listeners, what causes diabetes,

Speaker 2: 7:41

Right, Absolutely. Well, yeah. So I mean, you know, kind of what I was saying with regard to, um, type one, um, I think, you know, there's this autoimmune destruction of the pancreas, and then type two, there's a similar destruction of the pancreas, but it's not necessarily autoimmune in nature. So we know that at the time of diagnosis of type two diabetes, the average patient has lost at least half of the cells in their pancreas that make insulin at the time of diagnosis. And then those cells continue to die, um, as time goes on. And so how the person manages themselves really impacts the outcome of if their pancreas is working and making insulin or not. So, um, again, there's this also insulin resistance. So the patients not only are maybe making inadequate insulin for themselves if they have type two diabetes, but the insulin itself isn't working as well, they've lost the sensitivity. So risk factors for development of type two diabetes, which can then lead to this pathology, or of course being overweight or obese. Um, physical inactivity, smoking is actually a risk factor as well. Um, and I think I said physical inactivity already, and then, you know, an unhealthful diet. So eating a lot of maybe more processed foods, uh, can certainly contribute to that as well.

Speaker 1: 9:19

So, um, I think most of us are probably familiar with the symptoms of diabetes. Um, so I know on my end when a patient first presents to me, they know that if they're really thirsty and they're urinating a lot or they're losing weight, that those are probably signs of diabetes. Um, if you don't mind from your perspective, maybe you could share some of the symptoms of diabetes that most of us actually don't think about. Maybe some of the, um, rare symptoms of diabetes or some that you think of that the rest of us may, may not.

Speaker 2: 9:55

Great question. I love this. Okay. So one of the things I think that's important to point out in the world we live in is you have the opportunity to diagnose a disorder maybe before it's actually symptomatic. And so to that end, for your listeners, if you're somebody who doesn't go to the doctor very often, it might be a reason to make sure you are getting your regular health exam. Because the reality is a lot of times when I'm seeing a patient in my clinic for, you know, some other medical problem that they may have, um, then I somehow on their labs or something can see their blood sugars elevated. We check it, it's abnormal, and they have no symptoms at all. So I think the, the point here is, especially for early type two diabetes, no symptoms, maybe the symptom. Um, other more subtle things that often I'll see is people will come in and say, Oh, well, you know, years before I ever developed diabetes type two in particular, of course, um, I developed, you know, I had numbness and tingling in my feet. Uh, so, you know, neuropathic type symptoms that can be kind of a harbinger of something going on. And probably the most common symptom actually that I see in my clinic that is really apparent is simply blurry vision. Um, that's a really common one that patients suddenly their, um, you know, their vision changes, they can't see, they can't read as well, they can't see, um, far away or close up. And so those are the things, no symptoms at all. Sometimes numbness and tingling, and then the blurry vision. And then of course the typical things you think about for diabetes. So weight loss, feeling more thirsty, uh, maybe getting up at night to urinate. Um, that's one that's, you know, pretty classic, but maybe not always like talked about. Um, so if that's a new thing. And then women, um, yeast infections. So if you've got a, you know, frequency in, uh, yeast infections, uh, particularly vaginal yeast infections, that could be a sign that your blood sugars are high and you may wanna seek out, um, you know, medical evaluation for or

Speaker 1: 12:10

Thank you so much. That was a really, really good list. And is I'm dealing with my own patients. Sometimes I get so drowned in the details that I, I forget those that, I mean, I don't even think of like the vision I should, but that's actually one I won't think about until like a little bit later. Like, wait, they did mention their vision was changing. So, um, right, absolutely. Diabetes is a dense topic and it's a big topic, and I know for Dr. Kirk, Patrick, same for me, that when we have to discuss with our patients what it means to be diabetic, it's just like, it's overwhelming. So I thought I would ask her from her opinion, if you were diabetic, is there one thing that as a diabetic, no matter what made me diabetic, my immune system, or, you know, other things that added up in my life, um, what is the one thing that I should worry about the most today with my disease?

Speaker 2: 13:09

Oh, that's a good question. Hmm. One thing, huh?

Speaker 1: 13:12

Okay. Of all the things you would worry about, just the, the one that you feel is the most important as a diabetes specialist?

Speaker 2: 13:20

Sure. Well, there's so many ways I think to answer this question. Um, so I think, you know, from my perspective, the big picture, okay, and it's sort of a lot of things. So it's very, I think that it's almost an impossible question to answer that way because of the density and the heaviness of the disease. And I always talk about the fact that diabetes has such a heavy disease burden, but I think the take home point is the long term outcomes and the fact that it's, you know, it's just like, it's like compounding interest. So over time, if you make better choices and you have better glycemic control, meaning blood sugar control, that in 10 years or 20 years you're gonna have less complications of diabetes. And so it really boils down to those microscopic changes you make from day to day in your mindset about maybe not being perfect, but um, being able to make, uh, you know, small choices to prevent those complications down the road. So it's hard to say like one particular action or inaction necessarily. It's the, it's the long term that I see. And to that end, that's why we care because who cares about diabetes, right? Like a lot of the patients, like I said, already come in and maybe they've had, we see some pretty significant pathology. They've had blood sugars in the 400 s and they're living and they don't feel bad, They feel great. And in fact, when I put them on medicine, they feel bad when their blood sugars start to turn to normal. And so the reason we care, and the reason we don't leave blood sugars so high is because of, you know, blood vessel damage essentially. So we know that diabetes complications long term, we can develop retinopathy, which is microvascular, uh, disease in the eyes, neuropathy, so microvascular disease in the feet. So you get numbness and tingling and that can lead to, you know, amputations potentially, um, the, one of the dreaded complications. And then of course neuro nephropathy. So, um, you know, protein in the urine and eventually the potential for needing, um, dialysis in the long term. And then the big thing, right? The, the thing that I always talk about, the thing that like most commonly leads to, you know, poor outcomes with diabetes is cardiovascular disease. So the big blood vessels are also affected the vessels in the brain and the vessels in the heart, vessels in the legs all over the place. So, um, you know, those are the things that I think in the long term, those microscopic changes in your diet and lifestyle and making sure you're managing yourself can make a long term outcome so that these are not problems for you or they're less of a problem. And you know, my thinking with these complications is simply I want patients to live better. Um, it's not just about how I think how long you live, it's about how, how you know, how your quality of life is. And so not having all these medical problems is, you know, really important.

Speaker 1: 16:36

I think that's a beautiful answer. Thank you so much. I think that's a great answer. Yeah. So as I was thinking about my diabetic patients when they're speaking with me in the clinic or friends or family, I wanted to ask Dr. Kirkpatrick, and this is, this might be a hard one, but we're gonna try, what are the three things that you would want every diabetic to start doing today?

Speaker 2: 17:04

So the three things, Um, okay, so three things to start doing if you know you have diabetes. So number one, just a plug for health providers, Every patient who has diabetes should see diabetes education. So every single patient, they are gonna have it for the rest of their lives. They need to go to a, you know, good like intensive educational place where they can really learn about these things. So from my perspective, the three things, if I had to pick three things, so number one I'm gonna say check your blood sugars and know what your blood sugar numbers mean. Um, if you don't know you, like if you don't, if you're in a new city and you're without your phone and you don't have a gps, you, you have, it's really hard to get around, right? And so it's the same kind of thing. You can't make decisions about how to manage yourself if you don't know your blood sugars. So number one is check your blood sugars. I'm gonna say number two is to start working, um, exercise into your lifestyle. Um, so you know, the recommendations from the American Diabetes Association is 30 minutes per day, five days a week. And that's true for I think the American Heart Association too, everybody. I mean, we know that exercise improves, um, you know, long-term outcomes and um, people live longer. But for people with diabetes, particularly type two diabetes, where it really matters, it improves insulin sensitivity. Um, and so it's all the more important. And then the third thing, and this is speaking to, um, you know, to people who have type one or type two diabetes, and that is take your medicine. Um, and I say that being somebody who I really believe in lifestyle and I do a lot<laugh> of education about diet in my clinic, but if you are prescribed medicine for your diabetes, um, if you are, if you have type one diabetes and you have to take four shots a day, it's really important that you take those, those shots of insulin every day. Um, and if you're at somebody with type two diabetes and you've reached the point where you need to take your, you know, some kind of medicine, it's really important to do that because it will help your long term insulin sensitivity. So those are the three I I'd say check your blood sugars, start exercising and take your medicine. If medicine is indicated.

Speaker 1: 19:41

You actually gave us four things, so thank you very much. I did, yeah, you told us to get diabetic education and check our blood sugars and to move more and to take our medications. So those are actually the four things a diabetic specialist would want you to do, starting to today, starting tomorrow, or wherever you are in the world. So thank you so much. Yeah, you gave us four.

Speaker 2: 20:06

Absolutely.

Speaker 1: 20:07

So my next question would be just the opposite. If there are three things you would want every diabetic to stop doing right away, that's a hard one. Cuz I know your list is probably 2,869 really long when she would want them to stop<laugh>. Yes. So,

Speaker 2: 20:32

Okay, number one is so easy. Stop smoking. Okay? Not everybody has diabetes has to do this, but if you are a smoker and you develop diabetes, I, I always tell my patients in the clinic, it is not an additive risk. So if having diabetes is a risk factor for cardiovascular disease and it's, you know, I don't know, I'm gonna make something up. Let's say it's this five points, okay, on whatever scale I'm using. And if smoking is a risk factor for cardiovascular disease and it's five points and then you smoke and you have diabetes, it's, it's a multiplier. Maybe it is 25, you know, points on whatever scale. Anyway, the point is, is it's an exponential risk for, you know, cardiovascular disease. So, you know, stroke, heart disease and peripheral vascular disease. So number one, stop smoking, number two, um, stop drinking your calories. Um, my words are when I have patients come into clinic, I give them four lifestyle, uh, modifications. And number two, number one on the list is exercise. We already talked about that. And number two on the list is to drink water. I tell'em, you know, if the concept here is if you wouldn't feed it to your dog or your cat or whatever animal you have, then don't feed it to yourself. Um, I, human beings, from my perspective, were not meant to suck down large amounts of sugar and calories in the form of liquid, you know, sugar. So it's great treatment if you need to treat a low blood sugar. If you have type one diabetes, it's just not a great plan, uh, for liquids. So drink water and don't drink juice and soda. Um, and then the third thing that I want people to stop doing, um, when I see them in clinic is late night eating actually. Um, and I notice I haven't really said anything about diet. I'm not gonna like harp on that right now, but, um, just, you know, I try to explain to people that you can make a huge impact on your diabetes if you change the timing of your eating and stop drinking your calories, those two things can be so powerful. So, um, you know, nothing good I think really happens after dinner. We're, when we get tired, our hunger hormones rise and it, they make us think we're hungry. So we need that late night snack or a bedtime snack. And unless you have, you know, some medical indication where you're maybe taking insulin or you're having problems, we do have a few people who take snacks at bedtime that's almost never necessary. Um, and just drives up. And I, the way I talk to my patients about it is, I think it drives up, you know, your need for insulin. If you eat right before you go to sleep, the only thing that's gonna clear that sugar from your bloodstream is the insulin you're making. And if you are eating during the day when you're more physically active, your skeletal muscle can actually help you help your pancreas out a little bit. You don't have that at night, so stop the late night eating. You know, there's pretty good evidence that not eating three to four hours before going to sleep is medically beneficial and people don't have to be perfect about this either. Um, perfection is not required here. Just try to do that most of the time. So stop smoking, stop drinking your sugary liquids and stop the late night eating. Those are the three things.

Speaker 1: 24:23

Thank you.

Speaker 2: 24:24

So, and the diet stuff, just, yeah, absolutely the diet stuff comes along with all of that too, but you know, those are pretty practical things you can

Speaker 1: 24:32

Do for the listeners. Um, you may notice that oftentimes for this podcast, I often encourage you to download it so that you might wanna listen while you're taking a walk. So maybe this is a good episode that you download and listen to later while you take some of Dr. Kill Patrick's advice and you actually use some of those skeletal muscles. We all could burn off a little of that sugar in our bloodstream. It's never a bad thing. So yeah. Thank you. Those are great answers. I love it. Thank you. So my next question, um, and, and my patients ask me this quite a bit and sometimes I don't have it, it's hard for me to find a good answer. Um, the stress affect diabetes. Um, so if someone's just been through a really stressful time and their sugars, they know they're diabetic and their sugars are just, they can't get'em in control. Can you tell us like why that might be that like stress would do that to their blood sugars?

Speaker 2: 25:30

Oh, for sure, absolutely. Stress, I get that question on the daily, I'm sure you do too in your practice. So, um, you know, it's a very, very common thing. Absolutely. Stress makes blood sugars go up and I think we know more about that now with the use of continuous glucose monitoring devices, uh, where, you know, people who maybe just have impaired glycemic uh, control can put on a continuous glucose monitor and see, you know, if they have a stressful day at work, for example, they can see their blood sugars go up. And so we definitely know that's the case. Uh, you know, family stress, stress at work, we get an increase in counterregulatory hormones, so specifically growth hormone and cortisol. And those two hormones have the effect of causing your liver to, um, make more sugar maybe inappropriately so in the setting of somebody with diabetes. And so blood sugars will rise. So definitely we see that increase, um, for sure in the setting of stress. It makes a big difference.

Speaker 1: 26:39

You mentioned growth hormone and I, I probably have not, um, sort of begged you for this, but of course I'm very much hoping I can have you back as a guest cuz some of the more popular episodes that we've had on this podcast we're discussing hormones and I I'm imagining that the, the listeners would really want to hear about hormones from a hormone expert. I've explained it, I think last year we did a series on it. So, um, at some point I may beg please bribe you back to discuss all of hormones because that's a common question. Um, so as

Speaker 2: 27:14

Absolutely happy

Speaker 1: 27:15

To do it. Thank you. Thank you. As an endocrinologist and a diabetes specialist, is there anything in your work that you find gives you the most joy? What makes you the happiest?

Speaker 2: 27:27

Absolutely and pertaining to this, of course this, uh, you know, what we're doing right now. So, I mean I love endocrinology just in general. It's a great, it's a very cerebral field. I love learning about hormones and all the nuances. Um, but by far in my daily practice seeing patients, I absolutely love my patients with diabetes in a way the most, uh, and the way I view this, I mean, you can make, i, we can make such a huge impact on people's lives with not a huge, um, burden necessarily. I think, um, we can present it in a way that they can really, um, make major changes. And so being able to follow somebody, um, over the long term and see that these impacts, maybe they've lived with diabetes for a number of years and now they're actually able to make changes and believe in themselves and, you know, change their mindset maybe about how they, um, are able to take care of their diabetes. So that is absolutely my favorite thing in diabetes and why I love taking care of patients who have the disease so much.

Speaker 1: 28:45

So for the listeners who have, um, joined us today, I have a feeling that they'll want to stay connected to you in some way. You are a practicing physician of course, but do you mind sharing your social media so that the listeners that wanna see what you're posting, cuz you're very active on Facebook and I'm one of your followers. Do you mind sharing where the listeners could find you?

Speaker 2: 29:08

Oh, for sure, absolutely. Simply my name. It's actually, and I, I apologize, I should have said this, Rachel kill Patrick md. So Rachel, kill Patrick md. I'm on, uh, Instagram, I'm on Facebook and I'm on TikTok actually, that's a new endeavor for me. So we'll see where that takes us. But yeah, absolutely.

Speaker 1: 29:31

So, um, this topic, which I'm, I'm just so happy, especially because this will be for November, it'll be for a diabetes awareness month. So I just have so much gratitude for you joining and the information you shared is so valuable. I know for us, we, we do this every day, but for a lot of our listeners, they don't get a lot of, a lot of time to devote to this. And particularly if they're living with the disease and they're busy with work and family and care taking, they don't get to focus on this enough. So this is very much, so much value. Thank you so much for joining me.

Speaker 2: 30:12

Absolutely. And I hope, you know, I hope it does, I hope it helps somebody out there in the world. I hope that somebody takes something away from this and makes a difference in their.

Speaker 1: 30:26

Thank you so much for having joined me for the special episode of the Art Healing Podcast. I hope you found this helpful. And if you did, you should like this. You should share it. Share it by email with all of your friends, coworkers, anyone you think could benefit to learn about diabetes. As a special gift to you listeners, one of the things we discussed during this episode is how stress can impact diabetes. Uh, Dr. K Kpa and I talked for several minutes about what stress can do to the body. And if you followed any of my content, we frequently talk about what stress can do to the mind and the body. I'm working on a very special program to help those of us. We're trying to heal our minds and body and we're trying to recover from diabetes or high blood pressure or anything. So if you are interested in learning more, this program is a mindfulness certification for those who are ready to take their journey to mindfulness. And for those that are interested, I'm gonna include some information and some freebies in your show notes. So you might wanna have a look in the show notes of wherever you're listening to this podcast. Thank you so much.