Diabetes & Insulin: What Every Patient Should Know

In the latest episode of Going Under: Anesthesia Answered, we unpack how diabetes actually works, why “pre-diabetes” misleads, and how care evolved from pig pancreas insulin to smart pumps and GLP-1s. Practical steps on diet, walking, and strength training show how to drive glucose down and the risks associated with it.

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Transcript

Sponsor: Handheld Ultrasound Breakthrough

SPEAKER_01 0:16

This is going under Anesthesia Answered with Dr. Brian Schmutzer. I'm Bahid Sodterzade. We're brought to you by the Butterfly Network.

Setting The Stage: Diabetes Today

SPEAKER_00 0:23

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SPEAKER_01 1:30

Thirty-eight million Americans have diabetes.

SPEAKER_00 1:37

Yeah, which is a misnomer, and we'll get into that. But there's no there I know that the everybody says I'm pre-diabetic. All that means is you have reversible diabetes.

Classic Symptoms And First Diagnosis

SPEAKER_01 1:47

But we're talking about diabetes today on the podcast. We are uh why do people get it, how it happens, how we fight it, and how it's changed maybe over the last 30 to 40 years. Yeah, yeah.

SPEAKER_00 2:01

And so so kind of the classic presentations like somebody who comes in, they're drinking glass after glass of water all day long, still thirsty, even maybe having some urinating in bed at night, tired all the time, going to the bathroom constantly, and then starting to get some blurry vision, and then they kind of go to the doctor and say, Hey, I just I don't feel right. Even people who aren't necessarily prone to diabetes or family history or or any of the the uh predisposing factors, uh, and they find out that their sugar is 300 when it should be under 100. And so that oftentimes they they figure out they've got diabetes at that point. So that's a pretty classic presentation. Like you said, 38 million Americans are diabetic, full-blown diabetic, and then another 96 million are what are called pre-diabetic. Really, they have diabetes, it's just in the early stages.

SPEAKER_01 2:51

How did we figure out the term for this, right? Like what what exactly is it? And how did we figure out wow, this is not a good thing?

What Sugar And Insulin Actually Do

Type 1 Vs Type 2 Explained

SPEAKER_00 2:58

Yeah, so the story of diabetes is really interesting. So um there there were a bunch and and so so diabetes, insulin dependent non-insulin dependent diabetes, like the diabetes we think about, older people, that's a actually a relatively new phenomenon. There weren't a lot of people who got that even 50, 60, 100 years ago. Insulin-dependent dependent diabetes used to be uniformly fatal. So it was often a kid who was probably seven, eight years old, and all of a sudden they just started not gaining any weight, they started getting really sleepy, um, and then they would figure out that they had diabetes. Now, the way the way that they figured it out, there were a couple ways they figured it out. So the initial when they was first identified, one of the initial things that they did was the physician would actually taste the urine because it would taste like sugar water because they're dumping all that sugar in the urine. Now, the next step they took, um, and this is a story that I had heard from a guy I used to do research with, is um, they would have the boys wear often boys, boys more than girls, have the boys wear black shoes, and when they went in to go to the bathroom, because the way bathrooms used to be set up, they'd splash some of the urine out of the urinal onto their shoes. And then when they came back out of the bathroom, by the time it dried, there would be sugar crystals on their shoes because there's that much sugar dumping into the urine. So that's how they actually discovered it. Now, it's interesting. So let's let's talk a little bit about you know what diabetes is specifically. So diabetes mellitus is what we're talking about. There's another kind of diabetes called diabetes incipitous. For purposes of this podcast, we won't talk about that at all. Um so basically, all it is is that the body is unable to handle the amount of sugar that's in it, right? So there's there's two types, and we'll we'll talk a little bit about that here in a minute. But so basically, pathophysiologically, when we eat a carbohydrate, that breaks down into glucose, which is just sugar. It's another name for sugar in the body. Then it goes into bloodstream, right, from your gut. Um, but that glucose, when it's floating around in your blood, it can't be used by all your cells. Now, muscles are a big one that use glucose, but there's others, right? Um, I mean, some glucose goes into your liver and gets turned into what's called glycogen, which is a storage molecule. Some of it gets turned into fat if it's if there's extra sugar in there. But the big thing is that that that glucose goes in and is used by nerves and muscles. In order to get into your cells, you have to have a molecule called insulin. Now, everybody's heard of insulin because of diabetes, right? So your body creates insulin on its own. The pancreas does, yeah. The pancreas creates insulin, releases it in the blood. It releases it into the blood in response to sugar in your blood. Okay, so normally, let's say you and I were not diabetic, I eat something that has some sugar in it. The pancreas senses how much sugar that is, releases the right right amount of insulin. That insulin shoves that glucose, that sugar, into either the muscle cells or the nerve cells, and then there's not really any extra left over. You don't pee it out of the kidneys, and it's and it's all good. It also ideally you wouldn't eat so much sugar that it would turn into fat, right? You might you might eat enough that it turned into glycogen or that storage molecule, but you'd have to eat a decent amount of sugar that if you're not able to use it, that would turn into fat. So insulin is basically the key that unlocks the door of glucose going into cells. So um like I said, it becomes energy metabolism storage. But in diabetes, what happens is one of two things. Type this is this is non-insulin-dependent diabetes, okay? Is the body stops reacting to insulin. Type one, two, non-insulin decision. Oh, type two type two, yeah. And and that we use non-insulin dependent and insulin dependent now, not type one and two, because what's actually happening, we'll talk about it later, is type two diabetics are becoming type one diabetics, insulin dependent, right? Because over time you burn out your pancreas so much that you don't even produce insulin anymore. So type two diabetes or non-insulin-dependent diabetes starts with insulin resistance, meaning that the cells are so used to so much glucose, which means so much insulin that they don't respond to the insulin anymore.

SPEAKER_01 7:22

So, type two, what are some of the like if I'm walking around, like what should I be looking for if I'm type two? So or if I'm pre-diabetic.

SPEAKER_00 7:32

So any type of diabetes, you're gonna have a excessive thirst. You're gonna be thirsty all the time, always feeling dry, okay? Going to the bathroom a lot because you're drinking a ton of water or whatever fluid. Sure. Now, the other part of that is that glucose in your blood actually pushes more of more water into by it's trying to get it out, so it pushes more water into your kidney, so it makes you pee more, also. Severe fatigue, not like, oh, I'm tired today, but like severe fatigue. I can't even get out of bed, like I can't walk more than a block, that sort of stuff. Um, blurry vision often happens. Um, so early on in the disease, they're not really sure why that blurry vision happens. Later on, you can actually get what's called diabetic retinopathy. Uh, and then frequent infections. So, sugar is a very, very good molecule for bacteria. So, the more sugar you have in your body, the more likely it is you're gonna get a bacterial infection. So those are the symptoms for type Well bo any diabetes. Any diabetes. Yeah, yeah. But so so again, type 1 diabetes or insulin-dependent diabetes, especially in a kid, is is a like a medical emergency.

SPEAKER_01 8:46

Why do you see often with diabetic patients you see um you know, kind of flaky skin or like, you know, like blood flow, blood flow, yeah, blood flow reduces over time with diabetes.

Insulin’s Discovery And Production

SPEAKER_00 9:03

So it's just just the name of the toes or fingers. Yeah, that's why they have you know, toes and fingers. Blood flow is is a big thing that reduces. The other thing that reduces with diabetes is the the nerves themselves don't fire as well. Over time, all that sugar in the blood again kind of burns out the nerves, just like it does it does all the other cells. So so let's let's break it down into like what's considered true insulin-dependent diabetes, you know, what we used to call type 1 diabetes, and then true type 2 diabetes or true non-insulin-dependent diabetes. So type 1 diabetes is uh an autoimmune disease. We've discovered that in the I think 60s or 70s. So what happens is there's some sort of molecule, something in there that starts to kill the cells, the beta cells in the pancreas that make the insulin. Okay. So over the course of it usually takes till they're about seven or eight years old, and then they start to notice like they're not gaining weight. They're they've got a uh so your body uses ketones. You've heard of you know, eating a uh uh ketotic diet, right? And it's that sort of stuff. So body uses ketones instead of sugar because you can't use the sugar, and so you start to produce bad breath, and there's all kinds of things that come with that. So um eventually there's no insulin coming from the pancreas at all, which means you can't use any of the sugar in your blood. So usually appears in children. Um sometimes if it's not terrible autoimmune, they can get to like teenagers or young adults, but it's almost always kids. And then a lot of times you don't really notice until those last little few beta cells are gone, and then it's all of a sudden they can't use any glucose at all, and it's in a medical emergency. So um, so and we talked about a little bit about that ketones. Um, the other problem is that if you don't have that insulin, you end up in what's called diabetic ketoacidosis. I have heard of that. Yeah, DKA. So that's a medical emergency as well. Um, so what happens is there's no sugar being used at all, and the ketones go way high, and all the breakdown products of the ketones can make you very, very sick. So the treatment. Oh, go ahead, go ahead. No, no, go ahead. The the treatment for this, you know, pediatric diabetes, insulin-dependent diabetes, type 1 diabetes is insulin, injections of insulin, subcutaneous insulin.

SPEAKER_01 11:24

So that that was kind of the next question I was gonna have for you is do you think producing insulin is one of the greatest inventions that humans have ever so I would say it's top five.

SPEAKER_00 11:38

Um, so I mean, antisepsis stuff, so meaning meaning cleaning off the skin before you do a procedure, that's probably number one. Okay. Uh number two is probably antibiotics. That's probably saved more lives than anything else. But I would put insulin in there in top three, probably. Now it diabetes, especially true insulin-dependent type one pediatric diabetes, is fairly rare. It's not, I'm sorry, rare is probably not the right term. Uncommon, but but not not rare, I guess. It's uncommon, certainly not a common disorder. So you probably haven't saved as many lives with with insulin as you uh or with insulin as you have with with some of these other things. How are we mass producing it? Yeah, so that's funny too. So we talked about this in the last podcast, which is why we're even talking about diabetes this time. And if you want to go listen to the last podcast, you can do that. So Eli Lilly is a company who created Indianapolis, company that I've I've known for a long time. They actually supported my undergrad research or my undergrad um uh training. But um, so they actually were taking the pancreases of pigs, grinding them up, and separating out the insulin from it. That's what they were doing from, I think it was maybe the 1930s when they discovered it, 1920s. Which is expensive. Yeah, super expensive. You have live animals, like, yeah, of course, yeah. And lots of research and development at that point, lots of trials. Um, now what they do is they use a type of bacteria, they convert the genetic code of that bacteria that every time it reproduces, it releases insulin, and then they pull the insulin out of the bath of the bacteria, clean it out, spin it down, and then they have insulin. Wow. And it and they can even make it make different types of insulin. So there's short-acting, medium-acting, and long-acting insulins. They can force that that bug, that bacteria, to reproduce a bunch of either short, medium, or long-acting insulin. And then they just bottle it up and ship it out for you to inject yourself.

Pumps, CGMs, And New Delivery Methods

SPEAKER_01 13:39

So um I I I've seen this over the last probably 30 years with my my dad. Right. Because he's diabetic. Diabetic. Uh type 1 diabetes. He had it from well, no, I'm type two, right? He had it from eight. Yeah. So probably when he was, I'm gonna say 45 years old enough. Um maybe 40. Family history? Uh yes. Okay, so that's probably where it came from. So heart disease and diabetes. Yep, yep. So um that's my dad's side. Great genes, looking forward to it. Um, but you know, he would take shots at first. So the only way to get it would be shots right every day when he became insulin diabetic, insulin dependent. Correct. Then in his older years, now you have the drip. So it'll sense. Yep, yeah. So it's it's connected to him all the time. Yep. So it senses, yep, hey, now's the time.

SPEAKER_00 14:39

Yeah, an insulin pump. Right. Yeah. Insulin pump that he kind of hooks up here. Yeah, and those are cool. So they they actually meant they have a CGM or continuous glucose monitor, and they measure his blood glucose consistently 24 hours a day, 365 days a year. And then that insulin pump is programmed to respond to whatever that number is. So if that number goes to 250, it gives a certain amount of insulin. If it goes down to 75, it doesn't give any insulin because that's too low. So um, so type 2 diabetes, which is probably what he started with, um, makes up 90 to 95% of all diabetic cases and is a an insulin resistance to start with. So this is your classic person who's overweight, eats a bunch of processed food, sugars, all that sort of stuff. And basically what happens is they're they're making their pancreas pump out so much insulin that over time the body becomes resistant to that insulin. Now, what we've now done is we've actually taken type 2 diabetics who continue because they say, Oh, I've got medication for this now. I'll take metformin, I'll take, and we'll talk about the GLP1s later, but I'll take a GLP1, I'll take Genuvia, I'll take whatever these medications, um, I'll take all these things, and then I can just eat like normal. Sure. So now the body is not only, you know, using those medications to force that insulin into the cells, but now it's also producing more and more insulin because you're still eating all that sugar. Right. Right. And so eventually, if you have diet type 2 diabetes long enough or non-insulin-dependent diabetes long enough, you burn out those pancreas cells just like you would have done from the autoimmune disease. And now you have insulin-dependent diabetics because they burned out their their beta cells and their pancreas.

SPEAKER_01 16:20

The other thing I wanted to say too is you know, my there's blood sugar. Yeah, CGMs, yeah. Continuous glucose monitors, yep. So like my mom, yeah, she doesn't I don't believe she's dependent on insulin, but you know, she has a monitor. Yeah. So like it's a little patch. Yeah. Boom. Can check it with the phone, yep, and you can see what the but it's I think it's interesting though how far we've come with insulin and the types of treatments you can get with insulin. Uh, my my sister actually um is in the medical field, but she's a scientist. She's you know, she's in the lab. Um, and she actually worked on an inhalable insulin. Oh, that's cool. Uh, for years. That's cool. And I'm not sure if she's working on that still, but she works for a medical company, pharmaceutical company uh that does some diabetes research. And um they were working on an inhalable insulin. That'd be great. That'd be great. It would be, wouldn't it?

SPEAKER_00 17:25

Yeah. Um but I think it's oh, go ahead. No, go ahead. They have an inhalable uh uh epinephrine now, too. Oh, do they really? Yeah, it's called Nephi for uh for allergic reaction. So Cole, my younger son, has uh has a peanut allergy, and so we've had this the injectable so you don't need the yeah, you just sniff it up the nose.

SPEAKER_01 17:45

So I think it's I think it's really interesting how far we've come with the medication itself, with insulin itself, like that we're talking about inhalable insulin now, right? Where you can just carry it around.

Pricing, Patents, And Access Problems

SPEAKER_00 17:55

And that I would and and the whole reason we brought this up is the fact that pharmaceutical companies charge outrageous prices for drugs, right? So that I would understand, that's a new formulation, a new way to do things. These insulin types of insulin that companies like Eli Lilly are producing cost them almost nothing now. I mean, and they charge you you talk to some of these people,$500,$500,$600 a month for their insulin. And so the whole reason we got into this is there was an episode of the pit where a guy couldn't afford his insulin, right? There's no reason. It's just price gouging, right? At this point, there's no reason that insulin should cost four or five hundred six hundred dollars a month. Now, if you get the new, new and improved squirt up your nose one, then I see it, right? That's a new that's a new drug, it's more convenient. But the the injecting the medication, and and you know what they've done, some of these companies have done, which is just absolutely ridiculous. They've patented the delivery device. So you inject it, right? So it's not just pulling up a little insulin on it, right? They've in they've they've patented the delivery device. Which which is not a drug that goes off patent in seven or ten or twelve. And that makes it more expensive. Correct. And they can continue to charge that price because they patented the injection device. It's a device that now you can't go back and say, well, it's it's in uh seven years or ten years.

SPEAKER_01 19:22

So that leads me to my next point and probably to our next segment here with this is GLP ones. Yep, yep. So you're looking at the cost of GLP ones. Yeah. Uh right? Oh yeah. 200, 500, 1,000, whatever it's gonna be. But have they patented that device? So like Well, but who cares? I mean, who cares? But does that raise the cost of it?

GLP‑1s: Mechanisms And Benefits

SPEAKER_00 19:45

It will if they if they go the route of patenting device. Oh, Zempic device uses that strip thing that you like turn click. Turn and click. Yeah, yeah, yeah. So so what's gonna happen when it goes off label is that the which it started to already? No, but it hadn't been around long enough to go off label yet. So what is the there's compounding. Compounding. So that's different, right? So that's generic, right? Well, no, that's going off label. So compounding is taking the the the compounding pharmacies, they'll actually take that semaglutide, let's say that's the most common, that's in Ozempic. They take that raw semaglutide and compound it with whatever they need to put in it for you to be able to inject, and then it's a separate medication. That's why it's cheaper. Correct, correct. Now, being generic means that every pharmaceutical company out there can now make it. Now you have to produce it in a different way, but it could end up being essentially the same thing. Sure. At that point, that's off-patent generic, and things are less expensive that way. So that I can't remember when that happens. We could probably look it up. It's a few years.

SPEAKER_01 20:48

When there's target labels and Kirkland labels and it's right, exactly.

SPEAKER_00 20:51

That's the same thing. So it's a it's a couple of years away, maybe three or four years away before that they're off-label use for diabetes. Now, the weight loss portion of them, or I'm sorry, generic use for for uh diabetes, the weight loss portion of them is gonna be years and years because just patenting them now. So so every time you patent a drug, you patent it for a specific use. So if you patent it for a new use, like weight loss, then you start that whole seven, ten, twelve year patent over again.

SPEAKER_01 21:21

So when that patent is over, seven, twelve, anybody can make it then. Then it's fine. Yep. Um how effective are the GLP ones at and why at the reduction of or the blood glucose. Right. Or are you talking about weight or both?

SPEAKER_00 21:42

No, no, no, no. Dia diabetes. So so the way a GLP1 works, it's a hormone that's released by the gut. So uh glucagon-like peptide one is the name of it, right? And these these aren't actually glucagon-like peptide one, they're um they are mimics. Of that. So they actually just go to that GLP receptor. They're called GLP1 receptor agonists. So they look like it to the body and cause that receptor to fire, just like there was that that um that in the body. So what do they do? So they stimulate insulin release, number one. Great, right? More insulin, so you're not going to burn out the pancreas necessarily. They suppress glucagon, which is the hormone that kicks it the other way to release um to release uh um um I'm sorry, to to yeah, to release sugar into the blood. Okay. They slow stomach emptying, which is why they work for weight loss. Correct. Makes you feel more full, so you eat less. In theory, you eat less, that means there's more sugar in your body. So was that just happy side effect.

SPEAKER_01 22:52

So the GLP 1 was just a side effect, like the the weight loss was just a side effect, and now it's becoming the reason. Well, there's people who still take GLP 1s for diabetes. So because you're pre-diabetic, do you get written up a prescription for it? Uh so I don't know what what the the I don't know what the insurance companies will, I don't know what glucose number Apparently insurance companies are really strict with the GLP 1s.

SPEAKER_00 23:21

Yes. Very strict. Yes, yes. And so be because of that slowing slowing stomach emptying, it slows down or it reduces appetite. It also reduces appetite in the brain. And they don't know exactly how that all works, but it reduces appetite in the brain as well. Um now there's several versions of these now. There's the semaglutide, which is just the basic GLP one. Then there's the trzepatide, which is like three, does three things. Now there's even a new one called remaglutide or something like that, that does like four different mechanisms. So they're building on that basic molecule of semaglutide and and some people say semaglutide, so whatever you want to correct me, it's fine. But um, so they're building on that basic molecule and getting more and more and more and more and more and more ways to make these work. And so there's actually a lot of evidence that that not only does the GLP ones treat diabetes, they also obviously cause weight loss, but they also reduce your risk of cardiac disease, they increase fertility. There's like all these things that that they do now, and they're finding all these side effects, which are good side effects, right? Not every side effect is bad. They're finding all these side effects within um within the the treatment of diabetes.

SPEAKER_01 24:26

So when you're um when you are, you are an anesthesiologist, when you are um prepping for surgery or performing surgery, performing anesthesia on somebody, uh what is the protocol with diabetics?

Anesthesia Considerations For Diabetics

SPEAKER_00 24:42

Uh so that that depends. So diabetics by default, if you're a diabetic for more than one year, you have gastric paresis. Now, it's not necessarily clinically significant, but that means you're more likely to throw up during surgery, right? So we treat almost every diabetic who's been diabetic for more than a year as a full stomach, okay? Meaning that you're likely to vomit and aspirate. So more times than not, you're going to do a general anesthetic with an endotracheal tube to protect the airway in a diabetic than you are in a non-diabetic. Um, we want patients off of the GLP1s for a week at least for elective surgery. We still treat them as a full stomach. And then we want patients off of the SGLT2s for three to four days, depending on which one it is, which is another type. It's kind of a cousin of the GLP1s, works on a different mechanism. Um, so those are a couple of things. Um we we do ask patients to continue to check their blood sugars. Um, and then the majority of the other medications, you just stop the day of surgery, right? So we don't want people taking metformin the day of surgery because lactic acidosis. We don't want people taking some of these other daily, like you wouldn't take an oral semaglutide or even the daily injectable semaglutide the day of surgery. Um, but people who do insulin, inject insulin, we want them to continue to take it up all the way to the night before. And then usually what we tell them is the long-acting doses that they would take the night before, we say just cut that in half because you're not going to have anything in your stomach in the morning. So um, but but yeah, I mean, diabetes is is definitely an issue. I mean, over time it can cause, like we said, all those um issues with the vascular system. It can cause the joints to get stiff, including the the TMJ, the joint here in your jaw. So sometimes diabetics who have been diabetic for a while have a hard time opening their mouth. Um, you know, why why is that just this the sugar sugar deposits in all your joints? You have that much sugar in your body, it deposits in your joints, and over time it kind of scars it down. So all the joints get tight. Okay. So there's a lot of a lot of side effects to diabetes. Um and so about 75% of those, if you if you treat it well, if you have good blood glucose control, you don't actually progress to any of that stuff. But there are still things like the kidney damage tends to progress even if you control your your blood sugars well. Um a lot of the joint stuff continues to progress. Um trying to think what else. Some of the vascular stuff, but not not all of it.

SPEAKER_01 27:12

So is the GLP one do you think that is going to be, I don't want to say on the same level of insulin, but like it's already the mainstay of non-insulin-dependent diabetics.

SPEAKER_00 27:27

GLP1s are always like are already like probably second line. Most people will try the metformin and that sort of stuff, first line, and then everybody else pretty much gets put on a GLP1. Because there's so many benefits of it, right? So you've you're a diabetic, you're already now at higher risk for cardiac disease, you're already now at higher risk for you know um retinal damage, you're already now at higher risk for sudden death and all that sort of stuff. So the GLP1s reduce all that independent of their effect on the blood glucose.

SPEAKER_01 27:57

So I would just say, you know, we we've talked about this on the podcast before, how how probably within the last hundred years, right, we've lived longer. Right.

Myths, Risks, And Remission Framing

SPEAKER_00 28:11

Yeah, yeah, it's it's interesting. So if you if you believe the biblical um uh telling of of the world, right, people would live till they were, you know, 900 and something years old, and then the blood and then the flood came and God said nobody will live more than 120 years. And then people were living in that 120-year range until um until they they got to the point where um where uh that there were a lot of things like disease and that sort of stuff. And so typically what happened was, you know, for the all of basically modern history up until about a hundred years ago, people would die from either accidents or infections. Okay. And so the first thing that happened before we solved the accident problem um was that the infection problem became better once we had antibiotics, right? So that increased life expectancy. And then you you probably also have some degree of sewage and um, you know, uh just overall cleanliness of society that happened next. And so that increased life expectancy. And then, you know, the other thing that would have increased life expectancy is is just like we talked about, is like just diagnosis and treatment and all that sort of stuff of disease. So yeah, so I you know, you look at this curve and it was, you know, life expectancy was very long and then it dipped and then it got super low like during the Middle Ages, uh, and then it's been steadily increasing with a little blip down during COVID and then back up now. So insulin is a big part of that. Insulin is a big part of that. So so I thought we'd also do so so diabetes, like there's a lot of discussions about what myths and continue. I'm gonna fix your camera. Of course, what myths and um and what's what's true and what's not. Uh and and so the that I'll go through uh just a few quick myths. So um myth number one, eating sugar alone causes diabetes. So that is an untrue statement, okay? Um overall, there's a lot of things that can cause diabetes, right? So I might eat so much sugar, you know, I've got whatever, you know, I'm eating 600 grams of sugar a day, right? That's probably extreme. And I'm genetically, I may not get diabetes, but you might eat 100 grams of sugar a day and still get diabetes. So it's a complex metabolic disease influenced by genetics, weight, diet, and lifestyle. Okay. Myth number two, thin people can't get diabetes. And that's what I used to think before I went to medical school is like you look around and you're like, oh, you know, I mean, I know the I know the young people who get totally insulin-dependent. Right. I get, you know, you you know the young people who get insulin-dependent diabetes are thin, but you're like, eh, everybody else is overweight. Not true. Type 2 diabetes can occur in people with normal weight. And it's probably related to diet. Maybe they don't gain the weight, maybe they don't get the fat on their the visceral fat or the fat on their organs, um, or at least not visibly, but there are a lot of ways that there are a lot of people who are normal weight or even underweight who are diabetic. Myth number three, once you have diabetes, nothing can be done. So that's a myth in the sense of, well, I'm just gonna give up because I have diabetes. It's not a myth in the sense of once you do cause that damage, the likelihood of reversing that damage is infinitesimally small. So now, if you're an insulin-dependent diabetic type type one, you have diabetes forever and you have to take insulin forever, period. Right? That there's no there's no other way around it. Your body does not produce insulin, you have to give it exogenous or outside insulin. The type two or non-insulin dependent, you can get to the point by diet and exercise where it's controlled, but I would not say that you are ever uh cured of your diabetes. Okay, so one other myth, let's the last one here medications fix the problem. This is what I was just talking about, right? Medications treat the problem, they don't fix the problem. And the way that the way that I sort of look at this now, and I'm not comparing these two diseases in any way, shape, or form, morally or biochemically, but treating diabetes and treating HIV at this point are essentially the same thing, right? You have the disease, it's in your body, you know, with HIV, it's a virus. With uh diabetes, it's a breakdown of those beta cells that create the insulin. You have the disease. As soon as you get it, you have it forever. If you do the right things, you take the right medications, you treat it the right way, you eat, diet, exercise, all that sort of stuff, you basically basically are in remission. Okay. Right? So there's people who take these new medications for HIV that you know basically prevent any replication of the virus itself. So uh basically you have zero virus in your blood, you're still HIV positive. You if you're great with the diabetes, you have no extra sugar in your blood, you're basically in remission, but you still have diabetes. Okay. So all right. All right.

Prevention: Diet, Steps, And Strength

SPEAKER_01 33:06

What a podcast here. Yeah, I really like this one. I mean, it hit us home for for my family too, because I mean, it's just both sides of the family. Yeah. Heart disease and diabetes on one side, heart disease on the other side. And so you're like always looking for those. You're always looking for it. Um and and I'm at the age, right? I'm at the age where I've got to look at it. You know, I've got to look at what we eat, how we eat it, um, how how are we um, you know, what are we feeding our children, right? Uh you know, yeah um are they at risk? That sort of thing. And so so um it is multi-generational.

SPEAKER_00 33:50

So I think what we do have to focus on is diabetes prevention and treatment without medications. And so that's diet and exercise. Like diet and exercise are medicine. And again, no matter what you think of our current HHS secretary, diet and exercise are key. So that includes what you reduce processed foods and sugar, right? It's not easy on our modern society, but eating real whole foods with low sugar content is important, and then staying away from refined carbohydrates, right? So, so it's one thing if you've got a carbohydrate like uh sweet potato. Yeah, exactly. Yeah, complex carb, that sort of stuff, as opposed to drinking a coke that's got high fructose corn syrup. That is a highly processed refined carbohydrate. Um, all diet and exercise, but primarily exercise, improves insulin sensitivity. So the more you work your muscles, the more insulin receptors they have on those muscles, the more that you're gonna get that uh uh sugar blood glucose to move into the muscles. Um, when muscles contract, they pull glucose out of the bloodstream. Okay, so again, same thing. You're building up muscle while you're working out, you're driving a ton of sugar into your into your muscles because it takes a lot of energy. That sugar is energy to make those muscles work. Um, and so one of the biggest things, and I actually just talked about this the other day, and I can't remember with who, is walking is like the key, right? So if you look at if you look at all the studies that are coming out now, if you put 12 to 15,000 steps per day, your likelihood of any metabolic disease is infinitesimally small. So you do that every day, seven days a week. Yep. So walking is just as good as anything else, right? Probably better than running because it doesn't hurt your right. But but there is a definite correlation in number of steps and decreased disease. Okay. Um, resistance training is big, right? And that's big for a number of reasons. And I won't mention the guy's name who talks about this a lot because he was in a certain set of files that made him not look very good. But um I know who exactly who we were talking. Yes. So um he talks about like so resistance training is important for this to stay healthy, but it's also important because the more bone density and muscle strength you have, the older you get, the more ability you have to actually do the things you need to do. Do your grocery, you know, buy your own groceries, do your own grocery shopping, mow the lawn, walk up the stairs, right? So you got to have all this functional ability. Um, and then finally, just daily movement, right? And if you can't get that 15,000 steps, just even getting up and like walking around the house. Sometimes when I'm at work or on the phone or whatever, I'll just start doing uh like calf raises just as something to do to move around because I I don't sit still well. But aside from that, yeah. So uh um so those three things walking resistance training and any kind of daily movement, big for overall health. Awesome.

Trusted Sources And Closing

SPEAKER_01 36:45

Yeah. Well, if you want more information too, um again, uh there's tons of publications out there. Who do you trust? Who do you go to?

SPEAKER_00 36:54

Um, yeah, I I mean, so the easiest thing to do if you want just like comprehensive information about diabetes is go to what's called the Cochrane Review. Okay. Um, it's out of England, I think. Um, and they take all the studies about one particular topic. If you just Google or Chat GPT Cochrane Review diabetes, you'll be able to find all the studies. They take them, put them all together, and then do what's called meta-analyses, where they say, like, we've looked at 20,000 studies, and here are the best ways to treat diabetes or prevent diabetes or whatever it is. So that's a big way to do it. Um actually, to be honest, Medscape is actually a pretty decent. Um, like if you if you're not a clinician, you're just somebody, you know, lay person in the public who wants to read about diabetes, Medscape is the name of the website. They do a pretty good job. Um, and then if you want to delve deeper into it and you have access through like a university, PubMed, um, it comes from the like National Science Foundation or something like that. And so um you can get all the articles, real, like the the primary articles and read through them there. But I would say, you know, to our audience, probably Medscape and Cochrane Review are the two places to go.

SPEAKER_01 37:58

Awesome. Well, this has been another edition of Going Under Anesthesia Answered with Dr. Brian Schmutzler. If you want to see any of the podcasts that we've done over the last four seasons, go back and uh check it out on Spotify, Apple Music, uh, Apple Podcasts, uh, and and and YouTube as well. It is all there and it is very comprehensive. We touch on basically every subject over the last four seasons and more to come. Thank you so much, sir. Awesome. We'll see you in the next one. Brought to you by the Butterfly Network.