The Silent Decade: Unpacking Diabetes’ Long-Term Impact

Welcome back to "The Silent Decade" In today’s episode, host Dr. Rangi to explores a fascinating and often overlooked concept in diabetes care: the legacy effect. If you’ve ever wondered why the first ten years after a diabetes or pre-diabetes diagnosis are so crucial for your long-term health,even if your blood sugar seems controlled later, this episode is for you.

Dr. Rangi breaks down what the legacy effect means, why the body “remembers” early years of metabolic control, and how those decisions can influence your risk of complications decades down the line. Plus, together with Leila, they’ll share practical tips and a proactive mindset for anyone living with diabetes,no matter how long you’ve had it.

Whether you’re newly diagnosed or supporting someone with diabetes, tune in for expert advice, encouragement, and the empowering reminder that every choice you make today can shape a healthier future.

00:00 "Metabolic Memory in Diabetes"

05:38 "Diabetes Management at Any Stage"

07:35 "Weight Loss and Health Goals"

12:25 "Design Your Health, Long-Term"

14:17 "Proactive, Positive Health Habits"

16:39 "Elevate Life, Reduce Stress"

Show Website - https://lowerthedosepodcast.com/

Dr. Rangi's Website - https://rangimd.com/

Podcast Partner - TopHealth - https://tophealth.care/

Dr. Rangi's LinkedIn - https://www.linkedin.com/in/jaiwant-rangi-md-face-32226b97/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_00 0:00

So the legacy effect is basically in the first decade of life of diagnosis of diabetes, the better control of diabetes goes a long way. So it really protects your blood vessels, your organs, your eyes, your heart, your kidneys. Patients may feel fine, but inside the body, the high glucose is slowly affecting tissues and the blood vessels. Waiting can make the problems harder to reverse. That's why the earlier you do, you can reverse your diabetes in the earlier years. Later on, we are literally putting band-aid or trying to bring it into remission. The blood sugar stays high for years and the body experiences that ongoing inflammation, that ongoing stress on the blood vessels. The good news is that taking action early on, even if it is a little later than where they should have, it will go a long way.

SPEAKER_01 1:17

It's the idea that what happens in the first 10 years after diabetes or pre-diabetes diagnosis can influence your health for the next 30. So even if your glucose looks controlled later, your early years really matter and your body remembers. Dr. Rangi, you often say that metabolic control is the single most important window for lifelong health. So let's start there and dive into that and talk about the legacy effect, what it is, and why does it matter so much? But before we hop in, it is nice to see you again. And I know that this topic is very important to you. You have touched on it in previous episodes. So I'm excited to actually fully dive into it today.

SPEAKER_00 1:54

Sounds good, Leila. Good to see you again. And I'm so excited to be here again. So this topic is very dear to me because it's very simple but very profound. So our patients really need to understand this message because they may not get the same answer from their doctors, because sometimes there are other things that get priority when we are discussing things with the patients for their small 10 to 15 minute visit. So this is something that they can expect and discuss with their doctors because that can change their trajectory of diabetes over the years. So if someone has diabetes and they're newly diagnosed or they have diabetes for the first few years right after diagnosis, that is a time when they must work with their doctors to get it under as good of a control as possible. We call that a legacy effect, or this is called metabolic memory. What it means is that your body remembers how well your diabetes was controlled in the early years after diagnosis. And that determines what complications you may have years down the road. So even though you may have not so good control in the beginning and you have excellent control later, you may not do as well in preventing your complication risk or protecting your organs. So if you really have a very good control in the beginning and you meet the guidelines for the target or the goal of where to keep your A1C, that really helps because then the patient really knows that I'm secure for decades to come, even 20 to 30 years.

SPEAKER_01 3:29

Absolutely. And if someone does have diabetes, what exactly is the legacy effect?

SPEAKER_00 3:35

So the legacy effect is basically in the first decade of life of diagnosis of diabetes, um, the better control of diabetes goes a long way. So it really protects your uh blood vessels, your organs, your eyes, your heart, your kidneys. They respond to the good control for years to come. So that is why we call those as foundation years, and you want to make sure that the diabetes is under excellent control because that's going to reflect years down the road.

SPEAKER_01 4:09

Absolutely. And speaking about years, I know you mentioned 10 years being a very crucial number. So why are those first 10 years after diagnosis so so important and crucial?

SPEAKER_00 4:21

You know, because a lot of the damage that happens happens earlier on silently, and we don't feel any symptoms. And the patients need to understand that that is when silently your kidneys are getting affected, your blood vessels are getting affected, your nerves are getting affected. And patients may feel fine, but inside the body, the high glucose is slowly affecting tissues and the blood vessels. And when the blood sugar is controlled early, the damage is much less likely to happen compared to if you let go of uncontrolled diabetes in the beginning of the diagnosis in the first few years.

SPEAKER_01 4:58

What happens if someone waits too long to really take diabetes seriously? I know there can be so many complications or so many things that can happen if you if you do wait too long.

SPEAKER_00 5:09

Yeah, waiting can make the problems harder to reverse. Um, that's why the earlier you do, you can reverse your diabetes in the earlier years, especially in the pre-diabetes and the first few years of diabetes. Later on, we are literally putting band-aid or trying to bring it into remission. The blood sugar stays high for years and the body experiences that ongoing inflammation, that ongoing stress on the blood vessels. Um, then you also gradually that stress and inflammation leads to damage of the organs. Um, so that's why we say waiting is not a good idea. It is a bit like rust slowly forming on the metal, right? At first you will not see it, but over time it weakens the structure. Um, so if somebody is someone has uh diabetes and they delay the treatment for several years, the risk of complication increases, including effect on your heart, effect on your kidneys, your vision, your um circulation and your nerves. So the good news is that taking action early on, even if um it is a little later than where they should have, it will go a long way. So whenever you recognize this, that you have diabetes, try your best to make it as good of a control as possible.

SPEAKER_01 6:25

Absolutely. So even if it's not 10 years prior or you're not able to be prevented of taking action even now, it can still make a big difference. But it's crucial to definitely be as early and proactive as possible. And what are some of the most important things someone can do after early diagnosis?

SPEAKER_00 6:46

Yeah. Um, so yeah, I don't want people who are who are either more than 10 years down with diabetes diagnosis or even later 20, 30 years feel defeated. Because you can take control at any time. But all I'm saying is for people who are newly diagnosed, don't miss that window of opportunity than when you can really make a difference in the long run. Okay. But no matter at what stage of diabetes you have, you can definitely make uh changes that will benefit you and prevent you from complications. So you asked me what are the most important things that we can do early after diagnosis. We want to definitely focus on healthy nutrition. We want to make sure we are doing more, taking more vegetables, more lean protein, healthy fats, and whole foods, um uh reduce the sugary drinks, the processed uh food, uh, refined carbohydrates. Uh, we definitely want to encourage more physical activity, and that includes 150 minutes of activity during the week. Um that could include brisk walking, that could include cycling or swimming or strength training, swimming, dancing, any of those, but activity is must. Movement helps the body move the sugar into your uh muscles and other areas so that it does not rise in your system. Weight management. If somebody is overweight, we encourage them to lose at least 7 to 10% of their body weight. Certainly, changing your nutrition and changing your movement uh will help uh facilitate that weight loss. But if you have significant weight to lose, maybe work with your doctor and help them guide you how you can gain that 10% or how you can uh work towards a goal of losing 5 to 10% of your body weight. Uh, that's all you need to benefit on the metabolic picture. You may not even see that as much, and you may feel much better, and your body will handle the glucose much better. Um, but um in the perfect scenario, you may need to lose 20, 30, 40, 50 pounds to decrease your pressure on your knees or pressure on your hips, depending on where you are. So that is a discussion to happen between them and their doctors to understand what is my ideal weight, how much should I lose, um, and what is my goal weight, and then work towards the goals of having short-term goal and the long-term goal. Uh, what I tell my patients is my short-term goal is for me to help you lose that 5 to 10% of body weight in the next three to six months. And my long-term goal is depending on their weight, where they are, uh, because that's all is needed to make your metabolic changes in the body. Number three, after your movement and nutrition, um, stress management and sleep, they are very important. And then comes medications. So if somebody needs to be on medication, they must work with their doctor. Sometimes we use cardioprotective medications earlier on. Sometimes we don't use certain medications earlier on because somebody may have a background retinopathy. So, in that case, I always try to get an early eye exam to see in the back of the eyes how they're doing. Um, so those things are important and along with the lifestyle, right? Medications to be on, and that is for you. Uh, so that's why I prefer to call it personalized care, uh, because one size doesn't fit all. We cannot just go with one same medication for everyone, but your needs could be different. You may have a family history of heart disease, you may have a personal history of some health problem that may dictate what medication is safe for you and what is not. So, yeah, those are the things, lifestyle changes and understanding that get the education you need and get on the right medications.

SPEAKER_01 10:23

Those are really good takeaways. And what is the biggest takeaway for someone living with diabetes today?

SPEAKER_00 10:29

I think the biggest tech takeaway is your future health is strongly influenced by what you do in the earlier years after diagnosis, and of course, what you do every day. So make sure you take care of your diabetes, you work with your doctors closely and understand where you should be or what is your goal and where you are and how to get there if you're not able to do it on your own.

SPEAKER_01 10:53

Absolutely. And we talk about the legacy effects being important, but is the legacy effect only important for people who were just diagnosed with diabetes, or can someone benefit even if they've had diabetes already for some years?

SPEAKER_00 11:07

That's a great question because there are a lot of people who um might think that I have had diabetes for 10 to 15 years, um, so it's too late for me, or should can I still do something to protect myself? So the truth is it's never too late. You can always do something to improve your health outcomes down the road. Um, so even if someone has lived with diabetes for many years, improving sugars can still control them to help improve their outcomes. So they can have much less heart attack risk, they can lower the risk of kidney disease, they can lower the risk of effect on the nerves and the eyes, and overall improve the energy and overall health. You know, it's like slow-moving train, right? The earlier you slow it down, the better it is. Even slowing it down later still prevents further damage. Um, so while the early years are powerful, the better control at any stage is still better than not having a good control. It still brings benefits.

SPEAKER_01 12:09

Absolutely. And if someone already has complications, for example, like nerve damage or kidney issues or even heart disease, can improving diabetes control still help them?

SPEAKER_00 12:20

Absolutely. Better glucose can still help them improve the outcomes by slowing the progression of complications, protecting the organs, because if the diabetes is out of control, that directly affects your organs. Um you can reduce inflammation on the blood vessels so you have better flow of the blood, improve the circulation, and the nerve health stays better, so you have less complication risk. For example, kidney disease can progress, even can you can slow down even if somebody has established kidney problem. And if they have some numbness, tingling, or some kind of neuropathy symptoms, that can slow down too. Heart risk can be lowered. So there's a lot of things that can benefit by improving the control at any stage. Um the goal becomes protecting what is still working well and preventing additional damage. In the earlier stage during the legacy effect, we can even reverse some. But now it's more of a goal of protecting the organs and preventing any additional damage. Even the smallest change or improvement can make meaningful effects. Absolutely. And how should someone with diabetes think about planning their long-term health? Yeah, that's a great question, Leila. I tell my patients you have to design your health now. Design your life. Um, I don't want diabetes to dictate your life, but we need to certainly not be uh not considering it on our daily basis. So um instead of uh thinking that what is my blood sugar today, or what are my numbers today, um, I start asking them bigger questions and to think about what do I want my health to be like 10 years from today or 20 years from today? How do I want to feel every day? So it should not be just glucose-centric or number-centric. You know, we want to think about how do I want to live my life, you know, do I want to stay independent? Do I want to protect my heart? Do I want to protect my brain? Those are the things that help you think about daily control by thinking about it long-term control. Um, there's something called A, B, and C. I always encourage my patients to think about what's their A1C, what's their blood pressure control, and cholesterol. So those are the three things that can help you prevent complications. So you must have a check on blood pressure at home and periodically again at doctors' offices. And the A1C should be done every three months. And we check the cholesterol once a year or twice a year, depending on your risk. Keep your weight in check, um, sleep well, manage your stress, and and be as active as possible. And that's how you design your life. Uh, and then work with your doctor to take the right medications that are prescribed to you because you need to have long-term strategy. You cannot just think about short-term results or goals that I just want my A1C to be good today, but it's the compounded effect that you get from years.

SPEAKER_01 15:14

Absolutely. And if someone is listening now who does have diabetes, what is the most important mindset that they should adopt moving forward?

SPEAKER_00 15:23

Um, you know, what I would say is they need to be proactive. Okay. Number one, be proactive, plan and think ahead. And the second thing I really want them to do is um uh be positive, you know, plan and stay positive. It's about protecting your health over the years to come. Uh, that means staying consistent with your daily healthy habits, working closely with your healthcare team, uh, getting all the education you can, request for a diabetes educator referral or a nutritionist referral. Um, monitoring your glucose is very important. I get a lot of patients who will say, Do I really need to check my blood sugars? Um, if you're taking pills or oral medications, then sometimes checking every day is not needed because you're not changing your medication. Because people who are taking insulin, they change the amount of insulin that they take based on their blood sugars. So there's a different reason for them to check. But everybody benefits from checking to change their diet, to change their sleep or stress or movement, because if you have high or low blood sugar numbers, they help you understand how your body is behaving and how you can do different. So monitoring is important and making adjustments whenever needed. The good news is that many people with diabetes can live long, healthy, active lives, even for years to come. So a proactive approach and working with your team and staying positive goes a long way.

SPEAKER_01 16:54

Absolutely. And if there is one message you want listeners with diabetes to remember today, what would it be?

SPEAKER_00 17:00

Yeah, I think uh the most important message I want to tell my patients or or listeners is um your body responds to the choices you make every day. Um, the earlier you improve your control, the more protection you create. But the better choices at any state still help your future health.

SPEAKER_01 17:17

Absolutely. I think that is so important. And thank you so much for this conversation. I think that this is such an important reminder that early metabolic control isn't about today. It sets the stage for decades of health. So if this conversation felt familiar, do not wait. If this resonated with you or anyone you know at all, make sure you share the episode and know that your metabolic window is now. So if you would like to book a 15-minute discovery call with Dr. Rangi, the link is in the show notes. And remember, lower the dose of sugar, stress, and crisis, and raise your life. This has been another great episode of the Silent Decade podcast with Dr. Rangi. And remember, every year counts, and I can't wait to talk to you soon and continue the great conversation.