Participants: Dr. Meshach Samuel
Series Code: WM
Program Code: WM000354
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00:01 The following program presents principles
00:03 designed to promot good health 00:04 and is not intended to take the place of 00:06 personalized professional care. 00:08 The opinions and ideas expressed 00:10 are those of the speaker. 00:11 Viewers are encouraged to draw their own 00:13 conclusion about the information presented. 00:34 Welcome to Wonderfully Made, 00:36 in today's segment of Wonderfully Made 00:39 we will look into the role of preventive 00:41 medicine in diabetes. 00:45 I am Dr. Meshach Samuel, I currently serve as 00:49 a Family practitioner and I enjoy doing 00:51 what I do in the field of primary care. 00:55 I love preventive medicine and in our study today 00:59 we will try to apply the principles of preventive 01:03 medicine in diabetes, why choose the subject 01:07 of diabetes, let me give you at least 01:10 three good reasons, firstly it is estimated 01:14 that approximately 17 million individuals 01:17 in the United States alone have diabetes 01:21 and it is a growing concern throughout the world. 01:24 Secondly, it is well known that a significant 01:28 fraction of those with Type 2 diabetes 01:31 remain undiagnosed. 01:34 You may want to ask yourself the question, 01:37 could I be one of those who has the disease 01:40 and is not aware of it? 01:43 And the third reason is that, 01:44 diabetes is a condition which in its early stages 01:49 presents with little or no symptoms 01:52 and if left undiagnosed will eventually lead 01:55 to major complications, disability and 01:58 premature death. And remember we will deal 02:02 with this subject of diabetes today 02:04 with emphasis on preventive medicine. 02:09 Before going any further let's cover 02:11 some basic information, 02:13 what is diabetes? 02:16 Diabetes is a condition in which there is excessive 02:19 amount of sugar in the blood, 02:21 and persistent excessive sugar in the blood 02:25 adversely affects our blood vessels and finally 02:29 results in damage of important organs 02:32 such as the kidneys, the eyes and 02:35 the nerves and so on. 02:38 Let's now review briefly the physiology, 02:41 that is the processes that take place 02:44 in the body relating to blood sugar. 02:48 The cells in our body need glucose, 02:51 which is the simplest form of sugar 02:53 that is broken down to obtain energy. 02:57 The body tries to maintain what we call 03:00 normal range of blood sugar 03:04 in a normal healthy individual 03:07 soon after a meal especially one that 03:09 is reach in carbohydrates, 03:12 glucose from the diet enters the blood stream 03:16 and as a result blood sugar levels go up. 03:20 And in response to the raising levels of 03:23 glucose in the blood, the pancreas, 03:26 an important organ in the body, 03:28 produces a substance called insulin. 03:32 Now the most important function for insulin 03:36 is to lower the blood glucose levels 03:40 and it does this in two ways. 03:43 Firstly, the most important one, 03:45 insulin enters into the cells of the 03:48 various tissues and helps the cell 03:51 use up the glucose 03:54 and secondly insulin also triggers the liver 03:58 to take up the excess glucose in the blood 04:01 so that it can be stored and later released 04:05 when there is a need. 04:07 Now, there are other organs, 04:09 enzymes and hormones that play a role 04:12 in processing and altering the blood glucose levels 04:17 but all these factors work together to maintain 04:21 a normal range of blood sugar in our body. 04:25 Unfortunately we live in a world where things 04:29 do go wrong and this applies to the 04:32 way our body functions. 04:35 It could happen as a result of something 04:37 we have brought up on ourselves 04:39 or sometimes due to factors beyond our control. 04:44 In type 1 diabetes the particular cells of the 04:48 pancreas which produce insulin are damaged 04:53 or destroyed and as a result 04:55 there is no insulin production, 04:58 this often happens in the early 05:01 part of our lives. 05:03 There are several explanations 05:05 of how this happens, 05:07 however when a significant number 05:09 of cells in the pancreas that produces 05:12 the insulin are destroyed type 1 diabetes occurs. 05:16 Now, let us see what happen in individuals 05:19 with type 2 diabetes which is what 05:21 we're going to be talking about mostly today. 05:25 We have seen earlier that glucose and insulin 05:29 from the blood has to get into the cells 05:32 where the glucose is broken down 05:34 and used up to obtain energy. 05:37 Normally, insulin enters into the cells 05:41 whenever there is a need for glucose 05:43 to be broken down but in type 2 diabetes, 05:46 there is a gradual build up of some form of 05:51 resistance making it difficult for insulin 05:54 to get into the cells. 05:56 So, we see that individuals prone to 05:58 type 2 diabetes tend to develop what is known as 06:02 insulin resistance. When insulin cannot be utilized 06:07 due to resistance build up, 06:09 blood sugar levels remain high. 06:12 And the pancreas is now constantly stimulated 06:16 due to the persistently elevated blood sugar 06:18 levels and the over stimulated pancreas 06:22 now produces more and more insulin because 06:26 it appears that a larger amount of insulin 06:29 is needed to overcome the resistance. 06:33 And in the early stages of type 2 diabetes 06:36 this seems to work but as the resistance 06:39 continues to increase the pancreas at some point 06:44 is unable to meet the demands 06:46 and appears to give up. 06:49 So, we end up with two problems 06:51 in type 2 diabetes, one the gradual 06:54 progressive development of insulin resistance 06:57 and two the gradual decrease in insulin 07:01 production by the pancreas due to the 07:04 excessive demands placed on it. 07:08 The end result is that glucose 07:11 is not broken down and blood glucose 07:13 levels begin to rise, 07:15 leading to type 2 diabetes. 07:18 The risk of developing this form of diabetes 07:21 is greater in those with a family history 07:24 of type 2 diabetes, suggesting a stronger 07:28 genetic component than in type 1 diabetes. 07:32 We have looked into what diabetes is, 07:34 and what happens in the body 07:37 when one has diabetes. 07:40 Now, let us take a little look about 07:44 how the disease progresses in an 07:47 individual, from its onset to its termination, 07:52 either as a cure or disability or even death. 07:57 Now, we call this the study of the 08:00 natural history of diabetes. 08:03 Let us see if we can illustrate 08:05 this with a diagram. 08:07 The horizontal line that you see on your screen 08:10 represents a time line a period in one's life. 08:15 And the small vertical line that intersects 08:18 it represents the point of onset of the disease 08:21 in that particular individual. 08:24 Now, we have the time line divided into two, 08:27 the line before the point of onset represents 08:31 the diabetes free stage 08:35 that is there is no diabetes, 08:36 and the period beyond the point of onset 08:39 of the disease represents the diabetes stage. 08:45 Now, let us take a closer 08:46 look at the diabetic stage. 08:50 You will recall that when we talked about 08:52 the prevalence of diabetes we learned 08:55 that a significant number of those with 08:58 type 2 diabetes do not know that they have 09:01 that type of disease. And this is because 09:05 although the disease process has started, 09:07 they have not developed any symptoms of the 09:11 disease and therefore they remain unaware of it. 09:16 Evidently, in type 2 diabetes after 09:19 the onset of the disease process, 09:21 there is a period of time when the patient 09:25 is free of symptoms. If the disease process 09:29 is allowed to proceed unchecked at some point 09:33 symptoms will begin to show up. 09:37 So, we now see that diabetes stage 09:40 or the disease stage can really be divided 09:44 again into two stages, one the early stage 09:47 in which the disease process has started 09:49 but there are no symptoms and this period 09:53 we refer to as the pre-diabetic stage 09:57 and then we have the late stage, 09:59 which is the true diabetic stage. 10:03 Let us review the natural history 10:05 of diabetes again. From the natural history 10:08 of diabetes we see at least 10:10 three different stages. 10:13 One could be in the period before the onset 10:16 of the disease representing disease 10:19 free or diabetic free state, 10:23 or one could be in the period immediately 10:26 after the onset of the disease representing 10:29 the early stages of diabetes without 10:32 any symptoms and this we refer to as the 10:35 pre-diabetic state or we could find ourselves 10:40 in the latter part of the time line namely 10:42 the diabetic state. If we should extend this line, 10:48 the time line and leave this diabetic state 10:51 unchecked it will lead to disability 10:55 and eventually premature death. 10:58 So, the first step in dealing with the question 11:01 of diabetes is to know where you stand 11:04 in the natural history of diabetes. 11:06 In other words, are you in the diabetes 11:09 free state or are you in the pre-diabetic state 11:15 or are you in the diabetic state? 11:19 I believe that God desires for all of us 11:22 to be in the diabetes free state, 11:26 but how do we find out where we stand 11:29 in the line of natural history of disease? 11:33 One way to guess is to see if you have 11:37 any symptoms, what are some 11:39 of the symptoms of diabetes? 11:43 Fatigue, excessive thirst, excessive urination, 11:47 unexplained weight loss and sometimes 11:51 blurred vision. Now, there are two problems 11:55 if you decide to guess and go by symptoms, 11:58 the first one is that most of these symptoms 12:01 are non-specific for diabetes, 12:04 so we really can't go by that and the second 12:07 one which is a more important one is that 12:10 most individuals with undiagnosed diabetes 12:14 remain asymptomatic. 12:18 So, we see a very disturbing 12:20 picture here, you could be in the diabetes 12:23 free state or in the pre-diabetic state 12:28 or in the late diabetic state and yet have 12:31 no symptoms at all. 12:34 So the single best way to find out where 12:37 we stand in regard to diabetes is to do a 12:41 blood test and see what the blood sugar levels are. 12:44 We call this process screening. 12:49 Screening is a process where we search for 12:51 unrecognized disease or defect. 12:56 The term screening is not new to many of us. 13:00 You may have heard about screening 13:01 for breast cancer, screening for 13:03 colon cancer or prostate cancer and so on. 13:06 But someone would like to ask, 13:11 is it really important to be screened for diabetes? 13:16 The answer is yes. Undiagnosed diabetes 13:20 is very common, current estimates suggest 13:23 that up to one third of adults with diabetes 13:27 in the United States remain undiagnosed 13:32 and it has also being found that upto 13:35 50 percent of those with diabetes were diagnosed 13:40 after complications of diabetes developed 13:44 and here's the most important reason. 13:47 Screening for diabetes offers the potential 13:51 to not only diagnose and intervene at an 13:54 early stage that is before the complication 13:57 is developed but also screening offers 14:01 the possibility of preventing diabetes itself 14:07 We must ask the question who should be 14:11 screened for type 2 diabetes. 14:15 We need to remember that by screening 14:18 we are looking for people with unrecognized 14:21 disease and the term screening is usually 14:26 applied to a population at risk. 14:30 So, there is no need for everyone to be screened, 14:33 it is recommended for the population at risk. 14:38 What do we mean by population at risk? 14:42 It simply refers to individuals who have risk 14:45 factors for developing the disease. 14:49 Now, based on several studies of the 14:52 many factors that are associated with diabetes, 14:56 the American Diabetic Association has come up 14:59 with some guidelines for screening. 15:03 In other words, they have identified some important 15:07 risk factors and based on the presence 15:10 or the absence of these risk factors 15:13 the commendations are made as to 15:16 who should be screened. 15:19 So, here's what's recommended? 15:21 Number one if you are of 45 years of age 15:25 or more you should be screened for 15:28 type 2 diabetes and if the result is normal 15:31 it should be repeated at three year intervals. 15:36 And number two, testing should be considered 15:39 at the younger age or be carried out more 15:42 frequently if you are obese or overweight 15:48 and you have one of the following six risk factors 15:51 that I will shortly mention. 15:54 What are these six risk factors? Number one, 15:58 if you have a first degree relative with diabetes. 16:03 Number two, if you belong to a high risk 16:06 ethnic group example African-American, 16:11 Pacific Islander, Native American 16:14 or an Asian American. And number three, 16:18 if you have hypertension, 16:20 that is high blood pressure. 16:23 And number four, if you have abnormal 16:26 cholesterol levels most importantly 16:29 low HDL Cholesterol or high levels 16:34 of triglycerides. Number five, 16:37 if you are habitually, physically inactive. 16:43 And the last one number six, 16:45 and this one pertains to women, 16:47 if you are a mother of an infant with 16:50 a birth rate of greater than 9 pounds. 16:55 So, if you have any of these six risk factors 16:58 and you are obese or overweight, 17:02 your chances of developing diabetes 17:04 is higher than the normal population 17:07 and it is recommended that you be screened 17:10 as soon as possible and not wait till 17:13 your 45 years of age. 17:15 We have seen that screening is important 17:19 and we have also seen as to 17:21 who should be screened. 17:23 Now, we ask the question, 17:24 how do we screen for diabetes, 17:28 several different tests can be done, 17:30 but for the purpose of screening 17:32 we always choose the simplest test, 17:35 a morning fasting blood sample is tested 17:39 for glucose levels. If the value obtained 17:43 is less than a 100 mgs, 17:46 it may be considered normal. 17:49 If on testing we get a value of a 17:52 126 mgs or above, it is considered abnormal 17:59 and if repeat tests confirms this value 18:02 the individual probably has diabetes. 18:06 What about values between a 126 and a 100 mgs, 18:11 this is considered impaired, 18:14 so we see three groups on screening. 18:17 The first one normal and then we said 18:20 talk about abnormal and the third one impaired, 18:25 let's review these numbers once again 18:27 and also see how they correspond to the 18:31 natural history of diabetes that 18:34 we talked about earlier. 18:37 The fasting blood sugar value of less than 18:40 a 100 mgs would be considered normal, 18:43 this will correspond to the diabetic free state 18:47 of the natural history of diabetes. 18:50 A value of 126 mgs or above is considered 18:55 abnormal and this would correspond 18:58 to the disease phase or the diabetic state 19:01 of the natural history of diabetes 19:05 and values between 126 mgs and 100 mgs 19:10 would be considered impaired 19:13 and it would correspond to the early stages 19:16 of the disease phase or the pre-diabetic state 19:20 in the natural history of diabetes. 19:24 We now move on to the most important part 19:29 of our study on preventive medicine 19:31 in diabetes and that is 19:34 intervention or treatment. 19:38 Intervention will obviously depend upon 19:41 where you find yourself on the time line 19:44 of the natural history of diabetes. 19:46 Let us say you were screened for diabetes 19:49 and found the test to be normal, 19:51 that is less than a 100 mgs. 19:54 You may now consider yourself in the 19:56 diabetes free state. Is there anything that 20:01 you need to do at this stage? 20:03 The answer is yes. 20:06 The interventions at this stage are actions 20:09 that would enable you to preserve that 20:11 state of health, that is, being free of diabetes 20:16 and also continue with actions that will promote 20:20 better health and the way we do this is by 20:23 following the natural laws of health. 20:26 Eating a well balance diet, 20:28 exercising regularly, by the proper use of water, 20:34 fresh air, sunshine and ensuring adequate rest, 20:38 upstaining from things that we know are harmful 20:42 to the body and living a life free of worry 20:45 and stress by trusting in God. 20:50 This is how God meant for us to preserve health 20:52 and promote health and this is true primary 20:59 prevention in diabetes after that matter 21:02 with regard to any disease. 21:05 But what if on screening you find yourself 21:08 in the early stage that is the pre-diabetic state? 21:15 This is where screening really pays off, 21:18 in fact screening is really aimed 21:21 at picking up this group. 21:23 In finding some one in the pre-diabetic state 21:26 by screening we have actually made an early 21:30 diagnosis of diabetes, early diagnosis along with 21:36 appropriate treatment forms the basis 21:38 for secondary prevention in preventive medicine. 21:42 So, now lets see what is the appropriate 21:45 treatment for those in the pre-diabetic state, 21:49 the American Diabetic Association recommends 21:52 what is called the therapeutic lifestyle 21:54 changes and there are four recommendations 21:57 under the therapeutic lifestyle changes. 22:00 Number one, carbohydrate counting, 22:03 because carbohydrates is, in our diet has the 22:07 largest influence on glucose. Number two, 22:11 calorie restriction, this can done effectively 22:15 by cutting down dietary fact. 22:18 Numbe three, weight reduction, 22:21 diabetes is closely associated with obesity, 22:25 we have noticed earlier that obesity 22:29 is an important risk factor, special reference 22:33 is made to central obesity that is a waist 22:36 circumference greater than 40 inches in men 22:40 and 35 inches for women has been found 22:43 to co-relate with insulin resistance. 22:48 And the fourth one, exercise, exercise 22:51 enhances or facilitates muscle intake of insulin 22:55 and reduces insulin resistance. 22:59 A recent study found that 60 percent 23:01 of Americans do not engage in any moderate 23:04 level activity and that 30 percent do 23:08 not exercise at all. 23:10 So, we see that carbohydrate counting, 23:13 calorie restriction, weight reduction 23:16 and exercise form the basis of therapeutic 23:20 lifestyle changes recommended by the 23:22 American Diabetic Association. 23:26 Now, let me stress here that these four 23:28 recommendations for the pre-diabetic state 23:31 is an addition to the interventions 23:34 we have mentioned for those 23:36 in the diabetic free state, 23:38 that is along with the therapeutic lifestyle 23:41 changes one must follow the natural laws 23:44 of health as well. 23:47 Let's move on to the advanced disease stage 23:50 what if on screening your results confirm 23:53 blood sugar levels that are very high. 23:57 One must initiate aggressive medical 24:00 treatment as soon as possible, 24:04 it is important that we do not leave elevated 24:07 blood sugar levels to go unchecked 24:09 for long periods of time, medications are available 24:13 that lowers insulin resistance which we have 24:16 learned is one of the reasons for developing 24:18 type 2 diabetes. Medications are available 24:22 that stimulate the pancreas to put out 24:25 more insulin. We may even have to resort 24:28 to insulin administration by injections to replace 24:32 the natural insulin that the body is lacking. 24:37 Again, let me emphasize that the aggressive 24:39 medical treatment is to be accompanied 24:41 by the therapeutic lifestyle changes that 24:44 we talked about for those in the early 24:46 disease stage and we also need to the follow 24:49 the natural laws of health that were mentioned 24:52 for those in the diabetes free state. 24:56 This where many miss the mark, 24:59 we must realize that in order for God to bless 25:02 the treatments that we take, 25:04 we must first follow the natural laws of health. 25:09 No matter what approach we take in our treatment, 25:14 our goal should be to move back from the 25:17 late stage of diabetes, 25:19 if you find yourself there, 25:21 to the pre-diabetic state. 25:24 We do that by starting on aggressive 25:27 medical treatment and careful monitoring of 25:30 blood sugar levels. Self monitoring of blood 25:33 sugar has been made simple and patients 25:36 are able to do this at their home. 25:39 Patients on medications are encouraged to check 25:43 their blood sugars frequently 25:46 and when we have brought the numbers 25:49 to the pre-diabetic state, 25:52 we should then try to move from there to the 25:55 disease free state and this could be done 25:58 by following the therapeutic 26:00 lifestyle changes. 26:02 Once we obtain the desired level of 26:04 blood sugar control, we can try and wean 26:08 ourselves off the aggressive medical 26:10 treatments and continue with therapeutic 26:14 lifestyle changes, which is carbohydrates counting, 26:18 calorie restriction weight loss and exercise, 26:23 and of course we always need to continue 26:26 following the natural laws of health to preserve 26:29 and promote health. Which would include a 26:34 well balanced diet adequate rest, 26:37 proper use of water, fresh air and sunshine, 26:41 and attempting to live a life free of stress 26:44 by trusting in God. So, we need to understand 26:48 three steps in dealing with diabetes, 26:51 first, know where you stand in the natural 26:54 history of diabetes by screening, 26:57 then we make appropriate interventions. 27:02 When we study and understand the intricate 27:05 ways in which our body functions 27:08 and the way our body takes care of its energy 27:12 requirements using glucose from the diet, 27:15 and how the body regulates and maintains 27:19 a normal blood sugar level, we are reminded of 27:23 the verse in the Bible in the 139th Psalm, 27:26 I will praise thee; for I am fearfully 27:29 and wonderfully made. 27:32 One of the ways we could praise God is by 27:36 following the principles of preventive medicine 27:39 and learning how to take steps to prevent 27:44 the development of diabetes and the 27:47 progression of diabetes or for that matter 27:49 any disease, in order for us to preserve 27:55 and promote health that God has given us. 27:59 I hope that this presentation 28:01 has helped you understand a little more 28:03 clearly as to what diabetes is and 28:06 how you could prevent it from onset. 28:09 Thanks for joining me today in our study 28:11 of preventive medicine in diabetes. |
Revised 2014-12-17