Do You Know with Dr. Dwain Woode

Mastering Diabetes with Essential Lab Tests and Dietary Insights

• Dwain Woode

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How can you take charge of your health and potentially reverse type 2 diabetes? Join me, Dr. Dwayne Wood, as we explore the essential lab tests that can transform your health journey. In this episode, we dissect the significance of crucial tests like hemoglobin A1c, fasting blood glucose levels, and lipid profiles. These tests are not just numbers on a report; they are vital markers that give a comprehensive overview of your metabolic health and the effectiveness of your diabetes management plan.

We'll dive into the details of my recent lab results to bring these concepts to life. Understanding your complete blood count, glucose levels, creatinine, and liver functions can provide critical insights into your health. I'll discuss the importance of maintaining specific ranges for cholesterol and testosterone levels and how fasting and improved metabolic health can be pivotal in managing diabetes. Real-life data from my journey will illustrate the tangible impact of these markers on overall health.

Lastly, we'll examine how dietary choices influence your health markers. My personal experiences with diet changes, including a review of my lipid panel after increasing my intake of cheese and sausage, will highlight the direct correlation between what we eat and our health outcomes. By the end of this episode, you'll be equipped with the knowledge to monitor your health more effectively as you work towards diabetes remission. Let's make 2024 the year of reclaiming your health!

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Speaker 1:

I can't tell you the number of people that ask me all the time hey, dr Wood, what labs should I get checked? I'm trying to work on my diabetes, I'm trying to work on my health, I'm trying to work on getting healthier and I want to reverse my diabetes. What should I look at? And so tonight we're going to spend some time looking at the labs that we should get as we are working on getting better, and we're going to actually some time looking at the labs that we should get as we are working on getting better, and we're going to actually take a look at some of my labs. I think I've been telling you for a while now that we're going to take a look at that. That's what we're going to be doing tonight.

Speaker 1:

Hey, if you're new to me, I'm Dr Dwayne Wood. That's Wood with an E. The E stands for endocrinology. And here on the channel, I am educated, educating, empowering and encouraging our patients, our clients, our viewers to take charge of your health and your life, avoid complications and go to the next level. And in this year new year, new you. I'm talking to adults with type 2 diabetes who want to put their diabetes in remission, who want to improve their health, who want to get off of diabetes medications and who want to reverse their diabetes. If you're new to me, I'm Dr Dwayne Wood, that's Wood with an E the E stands for endocrinology. Here on the channel, I educate, I empower and I encourage you to take charge of your health, your life, avoid complications and go to the next level. We're creating the life we've always wanted and in this year, 2024, our new theme is New Year UU. As we are working on improving our diabetes, there are several things that go on in our body as we're working on getting healthier. There are several changes that we will see as we go throughout our year, our month, as we take visits to our doctor, and there are some key things that we want to make sure that are being checked and that you are mindful of as you are going through the process of working on your health. And I'm going to show you something that happened to me with this most recent set of labs that I got, which I don't know that it was surprising, it was expected, but I wasn't happy about it, and you'll see we'll take a look at that here in just a minute.

Speaker 1:

In metabolic disease, there are several general things that your doctor will check. They will, and if you're having specific items, if you're having specific things go on, there are, of course, things that they will check If you're fatigued, if you're having pain, if you have other disease processes, they'll check other labs. As we talk about diabetes and remission for diabetes, or reversing diabetes, or even as we are managing diabetes in general, there are several things that we want to take a look at and we'll go through those here in just a little while, but you want to make sure, first of all, that you are having regular checkups, right? I can't say that enough. I'm actually doing a presentation next week to a group of men, and one of the things that we're going to be talking about, one of the things I'm going to be emphasizing, is making sure that we're having regular checkups, because, as men, we tend not to do that, as a matter of fact, in general. Sometimes we tend not to go to the doctor, but more so in men. So, making sure that you're having regular checkups. If there are other things going on, your doctor will go through and they will work with you to check those. But, specifically for diabetes, there are several things that we want to look at and you'll see those coming up on the screen and we'll kind of go through those in turn that we want to look at. And you'll see those coming up on the screen and we'll kind of go through those in turn.

Speaker 1:

Number one we want to check a hemoglobin A1c. Why hemoglobin A1c? Because it's a marker of how your diabetes management is going. It tells us whether the plan that you're using is being effective for the management of your diabetes. The hemoglobin A1c is a 90-day average of what your blood sugars are. I won't go through right now how to convert average blood sugar to hemoglobin A1c. We'll come back and we'll do that and we've done a video on that in the past. You can look at the website and it will be coming up again for us to take a look at. So, hemoglobin A1c a 90-day average. We want your hemoglobin A1c to be, on average, about 6.5. Depending on the organization, some people would say less than 7, less than 6.5. I tell my patients 6.5 because it gives us a little leeway in case we drift and we drift, don't we everybody? Yeah, you know that Right. So hemoglobin A1c.

Speaker 1:

The next is a fasting glucose, a fasting blood glucose. This is a surrogate, if you will, and, in conjunction with the hemoglobin A1cc, it helps us to see what those blood sugars are. Now here's an interesting thing that can sometimes happen. You can actually have. You can actually have an abnormal hemoglobin a1c and a normal fasting glucose. Some people, their spike in blood sugars only occur after they eat, but they're eating three times a day, or four times, or whatever the number is in terms of snacking, and so they have blood sugars that are higher more often than just in the morning. So just because your fasting blood sugar is normal does not mean that you do not have prediabetes or even diabetes. And just because your hemoglobin A1c may be normal doesn't mean that you're not still having fluctuations.

Speaker 1:

Okay, because remember that hemoglobin A1c and I guess let me go ahead and talk about it. So if you have a hemoglobin A1c and I guess let me go ahead and talk about it so if you have a hemoglobin A1c of 6.5 or higher, then you're considered to be diabetic, right? 6.5 or higher is diabetes. Below that is considered to not be diabetes, and then, of course, there's the range for normal and then pre-diabetes. So here we're talking about diabetes. So 6.5 or higher is a diagnosis of diabetes, and then, of course, there's a range for normal and then pre-diabetes. So here we're talking about diabetes. So six and a half or higher is a diagnosis of diabetes. So you can have a hemoglobin A1c that is not diabetic range, but your blood sugars are fluctuating and so that fasting blood sugar in the morning will give us an indication of what else could be going on.

Speaker 1:

The other thing is a lipid profile. This is your cholesterol. So there's total cholesterol, ldl, which is your good cholesterol, sorry, hdl, which is your good cholesterol, ldl, which is your bad cholesterol. And there are some nuances for the lipid profile, lipid panel, because we traditionally have always talked about looking at the bad cholesterol, the LDL cholesterol. There are some other surrogates and people can actually have a bad LDL and still be in a good space, or they can have a good LDL and still be at risk for disease processes. Okay, so just because you're looking at just the regular lipid profile, there may be some other things that your doctor may have to check on. So that's the lipid panel, or cholesterol levels.

Speaker 1:

The other thing is to look at your kidney function.

Speaker 1:

Remember the kidneys are part of that triopathy, right? So nephropathy, neuropathy and retinopathy those are the tissues in the body that are most often involved in being damaged from diabetes. So, looking at the kidneys very, very important and the kidney functions, there are three numbers that I usually tell people that we want to look at. We want to look at your creatinine that comes on something called the complete metabolic panel. We want to look at your GFR, or glomerular filtration rate, which also comes on the complete metabolic panel. And then we also want to look at your microalbumin, which we'll talk about here in just a minute. So what are we looking at when we're looking at kidney function? Your kidneys are responsible for filtering and detoxifying, and so diabetes can cause damage to the mechanisms that are involved in the kidneys and if we're not careful then we have difficulty filtering and detoxifying and ultimately, if that progresses right stage one, two, three or four kidney disease, chronic kidney disease. The ultimate of that is what everybody kind of talks about and fears, that's dialysis. But you don't have to be on dialysis to have difficulties with kidneys. So you want to make sure that you are looking at those numbers. There are specific numbers that we look at, depending on age, depending on race, depending on so many different things Not a conversation for this discussion tonight, but just to know that those are things that you want to be looking at as well.

Speaker 1:

So kidney function and then the other organ that detoxifies, and that is the liver, right? So we want to look at the liver functions and specifically here we're looking at AST and ALT. Those are some of the enzymes. You don't have to know that right now, but these are markers of liver functions and sometimes we'll see those start to rise as people get into that thing that we've been talking about all the time, so non-alcoholic fatty liver disease. So people will have difficulty with their liver.

Speaker 1:

And looking at the liver functions gives us an early indication of what's going on, or what can be going on in the liver. So the kidney function and the liver function and the fasting blood sugar are all on the same panel and it's called a complete metabolic panel. Complete metabolic panel. A lot of times the doctor will get a basic metabolic panel and it will give a blood sugar, it will give the kidney function, but it doesn't give liver function and some of the other things that may be required to kind of make sure there aren't other issues that are going on in the body. Remember, the body is this intricate interplay of different organs, organ systems. Hormones, right? So, hey, I'm the hormone guy Enzymes and proteins, and so making sure that you get a complete picture of everything that's going on is where we want to be, and that's what checking these different labs will give us.

Speaker 1:

Okay, so kidney function, liver function, and then microalbumin this is the one I was talking about, remember the three? So creatinine, glomerular filtration rate, or EGFR, and then, of course, the microalbumin. So microalbumin, so your body, your kidneys, are kind of like a sieve or a strainer. Okay, your kidneys are kind of like a sieve or a strainer, and so things that shouldn't pass through, as diabetes affects it, those holes in the strainer and the sieve get bigger, and things that should not go through can go through, and so what we begin seeing is this thing called microalbumin that shows up in the urine. So when your doctor says, hey, I want you to go to the lab and they get a urine specimen, particularly if you're diabetic, what we're looking at we're looking to see whether you have microalbumin and whether we're starting to see effects on the kidneys from your diabetes and your elevated blood sugar. So that's what the microalbumin is, and this is one of those three numbers that I just gave.

Speaker 1:

And then, of course, thyroid functions. Thyroid functions and the thyroid functions fall in play here, because people who have one autoimmune disease or one inflammatory process which we believe is what diabetes is an autoimmune disease then they tend to have another disease because they tend to travel in groups. And so checking the thyroid level very important in terms of making sure that we're not seeing other issues, other disease processes that are going on. Now for the things that we're not seeing, other issues, other disease processes that are going on. Now for the things that you're seeing, right, the things that we just named. So hemoglobin, your fasting blood sugar, your lipid profile, your liver profile, your kidney, your microalbumin many of these are screening. What does that mean? That means that we are not expecting to see damage, we're not expecting to see changes, but what we're doing is we're screening to make sure that, as soon as if something shows up, that we can catch it and begin working on it. That make sense. So it's a screening process.

Speaker 1:

So a lot of people say, well, why do I get? Why do I have to get microalbumin? Why do I have to get this other thing? Because there's nothing wrong with my kidneys. Well, we don't know. There's nothing wrong with your kidneys unless we check. And so that's what many of these are. They are screening tools that we use to check to make sure that we're not starting to see damage. We use to check to make sure that we're not starting to see damage.

Speaker 1:

Often, I'll sit or go into the room and I'll review each of these with the patients. Okay, your sodium, your potassium, your calcium levels are good. Your kidney functions. Your creatinine is good. Your microalbumin there's no protein there. Your cholesterol level I'll go through each of the cholesterol numbers and I'll go through and talk about what the liver numbers are, and we'll see those here in just a minute as we take a look at some of my personal numbers, as we review that. Okay, all right. So, and then there are some other things that I want to. They may not all be labs there are a couple of labs, more labs coming up but there are some other things that we want to make sure that we're looking at as well, and so other things to be checked. So, something called a C-peptide and your insulin level.

Speaker 1:

Now, as we talk about adults with type 2 diabetes and we talk about type 2 diabetes in general, type 2 diabetes is what we call an insulin resistant issue, right? So that's the dogma. There are some changing thoughts that are going on, but right now it's an insulin-resistant issue. What does that mean? That means that in the body, insulin for some reason doesn't work as effectively as it should. As you guys know, the pillars that we've been using here number one is to decrease insulin. Number two, suppress the appetite and number three, get rid of sugar. So that number one, that first pillar that we talk about, is the insulin that's showing up there in that C-peptide and insulin.

Speaker 1:

So when we check a C-peptide and an insulin level, what we're doing is we're trying to figure out how much insulin resistance someone may have or whether their body is still producing insulin. So as I go through the office, as I talk to patients, clients, I'll say to them your body is still making insulin if that's the case. So the question then comes if my body is still making insulin, why is the insulin I'm making not sufficient to reverse my diabetes? And there are lots of reasons for that. As we have been walking through this process of new year, new you, you've heard me talk about several of the reasons, and the reasons. A big reason, of course, is food, exercise, our stress management, sleep and all those other things.

Speaker 1:

Okay, so looking at the C-peptide gives us a marker or an indication of whether someone is making insulin. Now, what's the difference between actually checking the insulin and looking at the C-peptide? What's the difference between actually checking the insulin and looking at the C-peptide? Well, if someone is actually taking insulin medication-wise, then there's no virtue in checking their insulin level, because I don't know when I get that lab. Is this because I'm checking the level of the insulin that they got when they took their shot? Or is this insulin coming from what their body's making? So there's no way to tell. But the C-peptide is a way to look at how the body's making that. All right. So C-peptide, cbc or complete blood count. So what I'm looking for is I'm looking to see is someone anemic? Because having anemia can cause other issues within the body. So I'm checking for anemia.

Speaker 1:

And then these next few things are not labs, but they're things that need to be checked as well. So you want to make sure you're having an eye exam Retinopathy so one of the apathies the triopathy Retinopathy, neuropathy and nephropathy. So making sure you're having an annual eye exam, making sure that you're checking your weight and we have been doing a good job here on the show in our fasting, in our check-ins, of looking at weight so that we can see what's going on as we're making changes in our metabolic health, and then, of course, checking blood pressure and checking your foot exam, and you need to do the foot exam. We normally send our patients off to see the podiatrist and they do an exam, they do an initial assessment and then they schedule you based on what's going on for more appointments. You may be seeing them more frequently, less frequently, but it's based on what's going on for more appointments. You may be seeing them more frequently, less frequently, but it's based on what's going on in terms of your blood sugar.

Speaker 1:

All right, and so then now let's take a look, and we're gonna take a look at some of my numbers, right? If you have questions, make sure you go ahead and put those in the comments about any of the labs, right? So those are the comments about any of the labs, right? So those are the standard labs that you want to make sure are being checked as we talk about improving our health. Now, once again, several of them are screening labs and what we're trying to do is catch things before they become an issue. Let's hop over and let's take a look at and I've been saying to you for the last several months that we're going to come and we're going to take a look at my actual numbers as I've moved through prior to new year, new year process, in the new year for new year process and where I am right now. And so this first set of labs that we're going to do is my labs from December of last year, and you'll see the December labs, but you'll also see labs from the month or some time prior to that, because on the labs, remember, they usually put the current labs and then, right next to it, they'll put what previous labs were, and so let's go ahead and let's take a look at. These are labs for me from the month of, so these are labs that were collected in December of 2023.

Speaker 1:

And the first set of labs that you see there, of course, is the CBC, the complete blood count, as we just talked about a little while ago. You'll see this in a different order as we look at the others. This one was I think there was something that they didn't order in this, but we looked at it in another place. So the things I look at and you'll see there my pointer is not working for some reason. So, about four down, you'll see the hemoglobin and hematocrit, right, and you'll see that those are in the target range and usually you'll see if it's out of the target range. You'll either see it, say, low or high. Okay, so if you don't see something next to it, that means that it's actually in the range that we want it to be. So, yeah, so you'll see there the hemoglobin and the hematocrit.

Speaker 1:

And so for the CBC, that's the main thing that I will look at when we're talking about checking labs. Right below it is that complete metabolic panel we talked about, and the very first one there you'll see is the glucose and the glucose of 103. And you'll see, next to the glucose, it was a glucose of 193. Now that previous one was done in September of 2022. You'll see, down there the creatinine is 0.91 and that's a marker of the kidney function. You'll see, the GFR is 100. We talked about creatinine as one of the markers, the GFR as another marker, and we'll look here in a little while. I don't think on this one there was a microalbumin, but we'll take a look at one of my other labs and we'll see that in just a little bit.

Speaker 1:

Okay, so, continuing on this, in this lab you'll see at the top of the screen that my AST and ALT the last two numbers, those are my liver functions and those were in the target range. And they were in the target range in September, prior the next section. Those are my cholesterol levels, right? So total cholesterol, triglycerides, good cholesterol and then bad cholesterol, and you'll see on the most recent labs there that my bad cholesterol was actually in the good range. It was 84. But prior to that it was 105. We like it to be less than 100. Five, we like it to be less than 100. And in a lot of cases there's a lot of theory that it should be actually less than 70. So here mine was 84. Next, you'll see and we didn't talk about this when I talked about labs that should be drawn For my men a lot of times I will check their testosterone levels, right, because testosterone level, or your low testosterone level, can have a significant impact on health, well-being, life and so forth.

Speaker 1:

And you'll see there that my total testosterone was normal. Prior to that it was actually low, 242. And my free testosterone was low on the most recent labs and we usually treat to the total testosterone. So the total testosterone was normal. So nothing that was done there at that point. Now here's a big one. You see, my A1C was 7.6,.

Speaker 1:

Now here's a big one. You see, my A1C was 7.6, right on this current lab in December, a year a little where we walked through my journey in diabetes and some of the struggles that I have, and you'll see there that A1C is during that phase of those struggles. So if you've not already done so, go back and watch through some of those shorts and you'll get a flavor of what was going on, some of the things that were going on at the time. So, yeah, so 18 months prior, and then 7.6, you'll see the TSH 1.3, or sorry, 1.3, the C-peptide, and look at this one y'all.

Speaker 1:

So back in when the A1C was elevated and the blood sugar was elevated because remember the blood sugar was 193, I think is what it was let's back up there for a minute Blood sugar of 193, a1c of 11.6, c-peptide was low at 0.3. So the body apparently wasn't making a whole lot of insulin. And then, as the A1C improved, look at that the C-peptide improved as well. So we went from looking like there was no insulin being produced. To hey, some insulin is being produced and that's one of the beauty of this process of reversing diabetes, correcting diabetes, improving metabolic health, because as you heal the body, as you heal the body, the body begins to do what it was designed to do. If you remember, as we've been talking about the fasting those days, those of you who are out there who've been fasting those days, immediately following fasting, you will find that you're able to eat things that you weren't previously able to eat and your blood sugars don't spike as much. Why? Because the body is recuperating. The body is recovering, the body is improving and becoming less insulin resistant. That's one of the beauties of the New Year, new Year process and reversing diabetes. All right. So that was the.

Speaker 1:

Those were the labs from December and, of course, 18 months prior to that or so, in February. In February, let's take a look at what the blood sugar was and you'll see there down at the bottom, the glucose was 102. The previous one was 103, you'll remember. Sodium, potassium, calcium, liver functions are all in the target range. Look at the cholesterol levels. Those are in the target range. That's in February. In December, they were in the target range again and we'll see some changes here in just a little while. Now here is the microalbumin that we talked about, and that number down at the bottom, the 7, is where we want to see Normal is between 0 and 29. Some labs you'll see is between 0 and 30. And in this case we're 7. And so we're in that target range. So we're not seeing any microalbuminuria, so we're not seeing any damage to the kidneys in this case.

Speaker 1:

And then if we take a look at the hemoglobin A1c, so we went from a 7, let me back up so we went from a 7.6 on the previous labs, so 11.6, 7.6. And then on this set of labs it was 6.6. We're going to go and look at the glucose. So now we've been fasting. So December, january, february, march, look at the glucose. So now we've been fasting. So December, January, february, march, look at the glucose. So we've gone from being glucoses above 100 to now glucose was 61 at the time that this was done. Still no kidney issues, because look at the creatinine, that's right below that and the EGFR.

Speaker 1:

And then let's hop over and let's take a look at the hemoglobin A1c. We went from a 11.6, 7.6, 6.6, 6.1. What do you think the hemoglobin A1c is going to be. I just got this done last week. Yeah, I know I keep you guys in suspense. So right now we need to know what my ketones are and, of course, what the hemoglobin A1C is. So we're going to hold on to that for a minute and let me hop over and let's take a look at some of the reports. So my average blood sugar here is 93. That's for the last 14 days. If I go back 90 days, it's probably going to be like 107 or 110. Okay, 104. Okay, pretty good. And it says that my estimated A1C is going to be 5.8. So, remember, that's the glucose management indicator. I'm in target 91% of the time. That target is 70 to 180.

Speaker 1:

And if we actually look at the daily graphs and I want to go back to Friday, so we broke our fast out here right around 6, 7 o'clock, if you guys remember we did that show Blood sugar was 62. And then it started climbing as I ate. What did we use to break the fast? I think I used some cheese. Yep, yep, yep, I used some cheese, smoked Gouda and salad. That's right. I had to think back and so into the next morning, blood sugars are climbing into the 140s and then low 100s and then right in here is lunchtime, and then we started going down to 130s and then yesterday stayed in the 115s 120s A couple of spikes there as we had some meals, and then, of course, into today, we're into the 120s 115s.

Speaker 1:

One thing that I did want to show you, and let me hop back over to my labs, and you guys will recall that I have been eating a lot of cheese as part of the process, right? So I've changed what I've been eating. So I'm not eating a lot of the cashews and the almonds because I was getting those spikes in my blood sugar. I moved away from eating the beans, right, because once again, I was getting those spikes in my blood sugar. But I want to show you something that happened.

Speaker 1:

So one of the things people ask about is the differences between different diets. What's the difference between a low-carb diet, a ketogenic diet, a paleo diet and so on and so forth? And here is one of the right. So I want you to look right there, that is, you'll see in the middle of the screen, that's my lipid panel, those are my cholesterol numbers, and if we go back here, you see cholesterol total cholesterol 167, good cholesterol 77, bad cholesterol 79. And as I've changed what I'm eating eating more cheese you guys saw me eating sausage and look at the cholesterol it went from 167 up to 200. The bad cholesterol went from 79 up to 100. Okay, so as we are adjusting the things we're eating, we can look at the labs and see changes in those values that correspond to the things that we are doing in terms of our diet.

Speaker 1:

Let's hop over and let's take a look. I know I'm prolonging this, right, we're going to take a look at what my ketones have been. All right, so 77 was the blood sugar. And look at the ketones the ketones are 0.8. So that means that I've been actually doing a pretty good job, even though I was eating, of maintaining some ketosis post-fast. I mean, one of the reasons that we're doing the fast is because we want the body to be able to burn calories from fat, and the calories that we burn from fat will produce ketones and we get the weight loss as a result of that. We get the improved blood sugar as a result of that. We get the improved blood sugar. As a result of that, we get the autophagy and all those benefits that come from that and in this case, I'm still kind of maintaining some ketones as I go through that process. All right, all right. So, yeah, I know you've waited long enough.

Speaker 1:

Let's go ahead and let's take a look at what my A1C is. And let's take a look at what my A1C is and drum roll, please. And the A1C look at that right in the middle of the screen was 5.8, which is what the Keto not the Keto, but what my Dexcom Clarity app actually predicted. It said that over the course of the last three months, my estimated A1c was going to be a 5.8. And, in fact, when we got the numbers, when we got the levels, my A1c was 5.8. So that's a pretty good marker, pretty good indication.

Speaker 1:

And so the process of improving our metabolic health, the process of doing all those things that we've described in terms of reversing to diabetes, this is a process that works. This is a process that you can do. This is a process that is important and a process that we are working on here on the channel, as we work to reverse your diabetes. This is Dr Duane Wood, that's Wood with an E the E stands for endocrinology. Here on the channel, I educate, I empower and I encourage you to take charge of your health, take charge of your life, avoid complications and go to the next level, creating the life you always wanted. And for this year y'all new year, new you.

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