Preventing Diabetes – Part One

Speaker 0 00:00:00 Welcome to aim for health root cause conversations with dr. James Biddle, all content from the conversations in this podcast are created and published for informational purposes. Only. This is not intended to be a substitute for professional medical advice and should not be relied on for personal medical decisions. Always seek the guidance of your doctor with any questions you have regarding a medical condition now onto the show. Enjoy. Speaker 1 00:00:31 Hello, this is James Robert Biddle, M D at Asheville and grave medicine. Uh, we're doing a show called ask dr. Jim Bob. And today is July 23rd, 2020. And our new patient coordinator, joy Lambert is here to help us out. Speaker 0 00:00:46 Hi everyone. Good to see you. Good to hear with you. What are we going to talk about today? So today we are going to talk about a very big topic that can affect a lot of people, diabetes, diabetes. We hear a lot about it, but I want to know more Speaker 1 00:01:04 Diabetes. What do you want to hear more about? Speaker 0 00:01:08 Well, first of all, I want to make sure I have a solid understanding of what it is. So I'd like to kind of go back to the basics and start with what is Speaker 1 00:01:16 Right. Well, very simply it is uncontrolled blood sugar. And why is uncontrolled blood sugar so bad for us? Right? Exactly. The answer is caramel, caramel, caramel, like the ice cream topping. Yeah, like the ice cream tarping. It caramelizes us. Have you ever made caramel? Yes. Speaker 0 00:01:39 You just put sugar in the pot, cook it with what butter, Speaker 1 00:01:44 Butter and butter has protein in it as dairy protein. And what happens when you cook? It is the sugar gloms onto the protein. It makes that Carmel and that happens in our body. In our bodies. It is a normal part of aging. We are all getting caramelized constantly. It is, it is the major way that we age is the proteins in our bodies get shivered and destroyed. Once you caramelize a protein is no longer functional. So the proteins here that are very important are the proteins on our tiny nerves and our tiny blood vessels and our kidneys and our eyes and our heart. And when your blood sugar is high, they caramelize at a much higher rate. And that causes premature aging, which then causes diabetic damage and complications. Speaker 0 00:02:40 So consuming sugar is literally fueling the fire of aging and the caramelization process with it. Speaker 1 00:02:48 It is, but if you're not diabetic, you can consume sugar and your blood sugar won't move. How do you do that while your pancreas releases a hormone called, which controls blood sugar, because keeping that blood sugar normal at between about 80 to a hundred is vitally important because our, you know, we are a wonderful product of, uh, insert your belief system here, but biology, you know, we, we, uh, have these wonderful mechanisms, uh, for what's called homeostasis and keeping things at good levels. And, uh, so the most important thing to understand about blood sugar is that it will make you age prematurely through criminalization. And then this is what causes the diabetic complications. But again, if you're not diabetic yet your blood sugar will never get very far out of range because your pancreas releases insulin. Speaker 2 00:03:45 And so the insulin regulates our blood sugar, Speaker 1 00:03:48 Right? And how does it do that? Where does the blood sugar go? Where does it go? So you eat a lollipop and your blood sugar tries to spike and your pancreas goes, Oh, no, let's make some insulin. And the insulin says to all the cells in your body take up the sugar and what do we do with it? We have two choices. We can either burn it for energy or stored as fat. So insulin says, especially to the liver and the blood vessel walls and other places store fat store fat stores Speaker 2 00:04:15 Fat. Well, we need fat, especially if we're potentially facing times of famine or crisis. We want to have those reserves to weather. The storm, Speaker 1 00:04:23 We do need fat, but, uh, you know, the majority of Americans are now overweight. So most of them don't need more fat. And when you drive your body into a chronic messaging system of store fast or fast or fat, you can no longer burn fat burn fat burn fat. So you have a metabolic choice to make of either storing fat or burning fat. And that message of, of being stuck in store fat is called insulin dominance or insulin resistance so that you're making more insulin on a chronic basis than people should be making. And here's an interesting, I'm a big fan of medical trivia. Our pancreas is, are actually bigger than they were a hundred years ago Speaker 2 00:05:09 To compensate for our sugar consumption. Speaker 1 00:05:11 Yeah. So in the year 1900, the average amount of sugar eaten per year by an American was five pounds per year. Now it's over 150 pounds per year, plus throwing in about 24 pounds of artificial sweeteners per person per year. Speaker 2 00:05:28 Now, when you say sugar, are we talking about just processed sugar, white sugar, cane sugar, or whatever. Speaker 1 00:05:37 Now this is a great question. Uh, natural sugars do generally, uh, process slower than refined sugars, mostly because they're bound up in fiber and then they have nutrients to help your body process them. But the being bound up in fiber slows everything down. And, uh, so for example, if you're eating refined sugar versus chewing on a stock of sugar cane, you're going to get a much different blood sugar surge on the refined sugar, cause it's no longer bound up in fiber. Speaker 2 00:06:12 So then it sounds like it's better if you're going to have something sweet to have something that has fiber with it to slow down the heat Speaker 1 00:06:21 That's right. Sure. And so, you know, even though fruits can certainly raise your sugar, the type of sugar in it, and the fact that it's still bound up in a natural, uh, substrate, uh, helps mitigate that some yeah. But one of the things that people get very confused about is they will go, uh, avoid sugars, but then they continue to eat starches and potatoes like potatoes, rice, or pasta. Exactly all, all those things. Well, if it's not sugar, then what's that doing well. Starch is basically a whole bunch of sugars stuck together. Uh, and we have enzymes in our saliva that actually break down that starch. And by the time it hits your stomach it's sugar. So eating starches are not much different than eating pure sugar. By the time you hit your stomach. Now, the more fiber you have in there, like for example, broccoli, as the example I use, if you eat a bowl of broccoli, there's some natural sugars in there, but a lot less, and it's really bound up with fiber and you're never going to raise your blood sugar that way versus eating a bowl of potatoes, which is going to rise faster versus eating a bowl of refined sugar, which is even faster. Speaker 1 00:07:34 So this is what we call the glycemic index, this continuum and the way they get the guys to make indexes, they take people fasting, hopefully healthy people, right? And they do a continuous reading of their blood sugar level. Then they feed them one food and they see how fast and how far their blood sugar jumps and how long that lasts. And they'll use something like a table sugar as a value of a hundred to compare everything else to an interesting, there's a few things that are over a hundred, for example, puffed rice is 122 it's much worse. So when you're eating rice cakes to try to, you know, be healthier that ain't working. Speaker 2 00:08:15 Oh no, I didn't know that. No, I mean, you're gluten free, right? But that's all your choice. Speaker 1 00:08:21 You're not getting less sugar. Speaker 2 00:08:23 That's almost a whole other conversation we could have just in terms of gluten-free and then people wind up eating so much more carbohydrates just because it's gluten free. And you're like, well, I can't eat it anymore more Speaker 1 00:08:36 And don't get us wrong. There are many people who should be gluten free, especially if you have Hashimoto's thyroiditis, which we talked about a couple of weeks ago. Uh, but yeah, we got to look at the glycemic index. Uh, whereas something like broccoli has a glycemic index of 30 or 35, and then, you know, sweet potatoes are in between broccoli white potatoes. And so you want to eat low on the glycemic index Speaker 2 00:08:59 There. So everything you eat triggers a response from the pancreas to release insulin. Yeah. Speaker 1 00:09:06 Everything that has sugar, sugar is going to be turned into sugar in your diet. Speaker 2 00:09:10 You have to have systems that way our body can process it. So we're not caramelizing. Right. Speaker 1 00:09:14 But let's say I wake up and I have, uh, you know, a, a cup of coffee with three packets of sugar in it for breakfast, along with an English muffin with jelly on it. That's a big carbohydrate load. I'm going to release a lot. Speaker 2 00:09:30 Right. And I'm not a lot of fiber or protein there either. Speaker 1 00:09:33 Right. Then I have a mid morning soda and then I have a sandwich for lunch with chips, and then another mid morning soda mid-afternoon soda, and then pizza for dinner, you know, uh, or a hamburger with fries, uh, you know, all day long, your, uh, blood sugar is getting tweaked and therefore your insulin is getting tweaked. Speaker 2 00:09:56 So that's making the pancreas work really well, Speaker 1 00:09:58 Hard work really hard. And then over a period of years and decades, your cells get resistant to that constant barrage of insulin. And I have an analogy avenues and it's, uh, smells. So if I invite you over for dinner and I'm cooking something wonderful, you'll walk into the house and you'd say, Oh my gosh, that smells great, but it's not ready yet. So we sit there for a half an hour and now you can no longer really smell it. No, but I send you out to get some firewood and you come back in after being out in the fresh air and you go, Oh my gosh, that smells wonderful. I'm so hungry. Where as your partner who just sat there, can't smell it. And so what happened is those molecules that we smell have been bombarding and desensitizing and creating resistance in our receptors, in our nose. Speaker 1 00:10:50 And the same thing happens with our insulin receptors, but it takes much longer a period of decades. But when you have a pattern of constantly having insulin surges throughout the day, you are going to create insulin resistance. And what happens then is your pancreas starts to release more and more insulin in order to control your blood sugar because that's its job. So one of the things we measure is a fasting insulin level, and that should be less than 10 and perfectly healthy. People have a fasting insulin level of four to eight or so, but you can see people who are shortened to get a little bit of, you know, a middle tire around their belly, the spare tire, or love handles things like that. And they'll get a fasting insulin of around 15. And then you see people who are actually obese and they'll have a fasting insulin over 20, but their blood sugar is still perfectly normal. It's not till years later that they actually develop prediabetes even before the blood sugar goes up. So this is an early warning sign. Speaker 2 00:11:55 So this is something that really does. It really does matter what we eat, because it can just set up this perpetuation, that down the road we have, Speaker 1 00:12:03 Right? And meanwhile, that fasting insulin is saying store fast or fat. It's also telling the liver to make cholesterol. Really insulin says, make cholesterol and your liver makes cholesterol, why does it do that? Uh, why does it do that? What cholesterol is the precursor for all of our hormones? Do you know that your progesterone, your estrogen guy's testosterone, our cortisol, all of that comes from cholesterol. Cholesterol is also a bandaid for inflammation. Uh, but in this situation, as part of that whole storing fat thing, it's a carrier molecule for moving calories around in the body. Okay. Um, but as a heart disease risk factor, then you know, that insulin resistance, uh, is causing heart disease. A lot of people, okay. Speaker 2 00:12:48 That's a lot of information. That's a lot of good information. Speaker 1 00:12:50 So let's move on. We'll move on from the pancreas and, uh, to some more questions. What's our next questions. Well, Speaker 2 00:12:58 Are there, what are the types of diabetes? Cause aren't, isn't there more than one type we're talking about something that's accumulating over decades, but right. Speaker 1 00:13:05 That's some people we're talking about is a historically called adult onset diabetes or type two diabetes. And it is where you make plenty of insulin, but you gradually become resistant and then your body can't make enough insulin to keep up with your body's demands. And then your blood sugar starts to rise. And by the time your blood sugar rises, you're already almost universally overweight, right? Because you've been storing fat for decades. The other type of diabetes is called juvenile diabetes. And that is destruction of your pancreas. You don't make enough insulin and classically that happened, you know, in teenagers, hence the term juvenile diabetes, they can happen even in very young children. And we see it even in adults now, and it's an autoimmune attack on your endocrine pancreas. So the pancreas has two parts. The exocrine pancreas makes digestive enzymes and the endocrine pancreas makes insulin. And you basically destroy your islet cells. Uh, and, and you, and you don't have, uh, any more insulin production capacity. And so that's when you have to actually inject instillation Speaker 2 00:14:12 Insulin so that your body can regulate it. Right? Speaker 1 00:14:15 And meanwhile, when you're low in insulin, you lose weight because your cells can't take up the sugar. Cause you have to have insulin to survive insulin. It's natural. I have insulin. It's just not natural to be insulin resistant. Okay? But without insulin, you also don't live because your cells can't take up the sugar and the sugar goes sky high, you start paying it off. You go into ketosis, which ketones are these little, two carpet short, fast that short as fat we have. And if you're overweight, ketosis is great. People will starve themselves and kind of lose way that you don't have to burn those calories. Cause you're putting them off. But when you're an underweight, one diabetic, it's terrible. Cause now, you know, you're underweight and you're peeing off all your energy. You're basically paying off your life force. So we're not going to talk too much about type one diabetes, except to say that there are links, uh, just like with Hashimoto's thyroiditis to, uh, gluten and dairy proteins being part of what causes type one diabetes. There's also evidence about viral infections. Uh, just, just like with other autoimmune diseases. Speaker 2 00:15:19 All right. So then getting back to the type two or adult onset diabetes, um, you just mentioned a minute ago that this takes time and things can progress over years and decades. So what are some of the early signs that one could be noticing? Speaker 1 00:15:37 Right? Well, the best indicator is actually a waist to hip ratio greater than one. If your waist measures greater than your hips, you're probably in insulin resistance and headed towards pre-diabetes. Uh, when your blood sugar actually starts to rock and roll, uh, there's a saying that what goes up must come down. So often the first symptom of high blood sugar is episodic, low blood sugar, known as reactive hypoglycemia. So you're on a blood sugar rollercoaster. Your blood sugar is now going up and down rather than being steady. You don't feel the high blood sugar so much. What you feel is the low blood sugar crash the crash. So if I'm fasting and I eat a banana with nothing else in my stomach, then my blood sugar shoots up. And if I'm, you know, been on this for awhile, then an hour later, it drops down and I get shaky and jittery and feel like I want to eat maybe a little nauseated. Speaker 1 00:16:29 You know, some people even pass out if it gets really bad. So that's the reactive hypoglycemia. So that may be people's first symptom. When blood sugar gets high enough, you start to pee it off. Once your blood sugar gets above 180, that's the kidney threshold. Uh, and when you're over 180, then, then it comes off and it pulls a whole bunch of fluid with it. You get what's called poly urea. You pee too much. You make more urine in a day than it is natural. And then that makes you thirsty. So you drink too much. That's polydypsia so polyuria and polydipsia is the classic signs of diabetes, but it's a very late sign. Also when your blood sugar goes up, your lens in your eye actually captures the sugar and then that draws fluid into it. And it swells and that causes episodic blurry vision. Speaker 1 00:17:20 So if you're having unexplained blurry vision, especially about an hour after you eat and that lasts for about a half hour to two hours, that could be a sign of diabetes. Really? I had no idea. Yeah. Um, and then neuropathy. So, you know, one of the first things that happens as a complication of diabetes is the little tiny nerves. Uh, and this happens more in the longest nerves, which are the ones to your feet. They get those proteins do, and you start to get a peripheral neuropathy and your feet start burning, especially at night. And I have seen many people who this was their first symptom of diabetes, especially in March in the ER, people would come into the emergency room when I was there 25 years ago and say, Hey, my feet are burning. And it turns out they would have prediabetes, but they've had a long enough that they've actually caused damage before they even have diabetes. They had diabetic neuropathy. Yeah. Speaker 2 00:18:20 Okay. Now I want to circle back to one point something I've heard you talk about before you were mentioning earlier, uh, eating sugars with fibers to help slow down the insulin process. I've also heard you talk before about if you're going to eat sweets sugars, try to pair it with protein. Speaker 1 00:18:38 Yeah. Fat and fat. Okay. So what slows down your blood sugar curve is fat fiber and protein in your belly at the same time. And so in here, I'll use the example of the banana. Again, eat a banana all by yourself. It has a little bit of fiber, but mostly it's just starch and sugar, and that's going to spike you really quickly. But if you take almond butter or peanut butter and put it on every bite of that banana, which is quite yummy, yo it's delicious, uh, and a classic childhood treat, uh, then the fat fiber and protein in the nut butter helps slow everything down and stabilize your blood sugar curve. And so that's what we're always looking for. Now. What's fascinating to me, uh, is that the American diabetic association says that your diet should be 60% carbs, 20% protein and 20% fat. Speaker 2 00:19:34 You just told us that carbs turn into sugars by the time it hit you. Speaker 1 00:19:37 That's right. So we look at this a whole different way. Uh, and we'll, we'll talk a little bit more about it. We get into treatment, but we're looking at how much protein do you need and that's different for everybody, right? You know, obviously at 90 a pound woman with a Walker doesn't need the same amount of protein as a 350 pound a weightlifter. No. Right. Uh, so everybody's protein needs are individualized. And then we talk about how much carbs can you get away with, which has to do with how much protein you're needing and how much you exercise and how old you are, uh, and how active, you know, how active you are, whether you're male or female. Um, and, and, uh, are you overweight right now and needing to slim down or are you underweight and needing to chunk up? Uh, so, and then we figured out how much carbs you can get away with. Uh, and then, uh, we let fat be pretty much unlimited. And the reason is if people know good fats from bad fats, right, it is okay to eat more fat and fat fills you up and is the best thing to satiate your hunger so that you no longer eat excessive calories. So we don't limit calories and fat. What we do is we limit carbs and pair that against protein. And that's, that's all individualized kind of calculation we do for you. Speaker 2 00:21:07 Yes. That takes a little more in depth conversation, huh? Speaker 1 00:21:10 It's all personalized. But for most people, it's, it's between 50 and 150 grams of carbs a day. If they're having health issues, you know, if you're a perfectly healthy person exercising, you know, you can easily 300 to 500 grams of carbs a day, as long as you're burning them up. Got it. It's really about where you are. Speaker 2 00:21:34 Okay. Well, let's get back to lab testing because this is the next part of the conversation. So we've know what it is. And some of the early signs, how do we actually test for it? Speaker 1 00:21:46 Right. Well, the first one is obviously just the blood sugar and the perfect blood sugar is 82 to 84 fasting. And how do I know that's perfect? Cause that's what they have determined people who live to be a hundred have that's a good goal. That's a good goal. So rather than just saying what's average, taking a thousand unhealthy people, if you take people, your goal, if your goal is to live, to be a hundred, those people historically had fasting blood sugars of 82 to 84. So that's where you want to be for your fasting blood sugar. If you have a fasting blood sugar and the numbers keep changing around it's somewhere in the a hundred twenties, if your fasting blood sugar is over 120, that's a problem. If your after eating blood sugar is over 145 to 150, that's a problem because then you're no longer controlling your what's called post prandial or after eating after meal, a blood sugar spike. Speaker 1 00:22:38 So the spikes are also important. And then there's an average blood sugar called a hemoglobin A1C. And this is basically measuring that caramelization process on your blood cells. So your hemoglobin in your red blood cells, those red blood cells live for three months and then the spleen filters out the old ones, right? Uh, and we can measure how much sugar is stuck onto your blood cells. And that tells us your average blood sugar over the last three months. And, uh, prediabetes starts at 6.7, I'm sorry, 5.7. And then diabetes starts at 6.5. So a perfectly healthy person is gonna have a hemoglobin. They want to see of about five or so. And, uh, when you get up to 5.7, then you're prediabetic. And when you're 6.5 you're diabetic. Okay. Uh, and we can track that to see how, how you're doing them. And then the other thing we'll measure is the fasting insulin, which we, I talked about in the other screening you can do is, is a dish to simple dipstick of your urine. Cause if your blood sugar is spiking to over 180 sugar will show up in your urine and it should never be there. I didn't know that either. So glucose should never be in your urine. If it is your sugar has recently been over 180. That's the last time you went pee. That's good to know. Yeah. Speaker 2 00:23:56 What about other ways to get clued in to diabetes other than blood testing or urine? Speaker 1 00:24:03 Well, here, here's what I always talk about. And this comes up on almost every topic and that's checking to make sure you don't have sleep apnea. So what does sleep apnea have to do with blood sugar? Well, because if you have sleep apnea every time your airway gets occluded, while you're sleeping, you have a stress response. And that stress response makes you release cortisol. Yeah. Well first epinephrine and norepinephrine, which drives up your blood pressure and your pulse, but also cortisol, which then, uh, works with insulin to make you store fat. So, you know, untreated sleep apnea is one of the big predictors of who's going to end up with diabetes. Now, myself, I had sleep apnea and I got too thin. So thin people when they get stressed, they lean more towards the epinephrin than the cortisol. So they lose weight, right? And heavy people tend more towards the cortisol. Speaker 1 00:24:56 So they gain weight when they're stressed. Uh, and, and I have seen people with sleep apnea, their sleep studies show that they're having stress responses every 30 to 45 seconds. That's terrible. Right? So you're talking about, you know, a hundred stress responses, you know, an hour through the night. So a hundreds of stress responses in cortisol spikes through the night as is if I come in and choke you and then right before you wake up, I hide. And then as soon as you start to, you know, breathe and relax again, I choke you again and do that dozens of times per hour. Speaker 2 00:25:33 That sounds so hard on the body. Cause that's when we're supposed to be rejuvenated. Right. Speaker 1 00:25:37 That's right. And you wake up and rejuvenated and still tired and wonder why your brain foggy and wonder why you can't remember. So I'll try not to stay on sleep apnea too long, but you know, the usual way is a $2,000 sleep studied asleep in a lab. We do a $35 overnight pulse oximeter, simple machine does read your oxygen on your fingertip with a little computer attached, graph it out overnight. And if inevit stain normal, you're fine. And if it's all zigzaggy, then you're call Speaker 2 00:26:10 Right. Speaker 1 00:26:12 There's the stress response. That's right. Speaker 2 00:26:15 Okay. All right. So I've also heard just in general, that, and you've been talking about this, that diabetes, you mentioned the eyes, uh, fat storage, uh, peripheral neuropathy in the feet. So I want to really understand how does it affect the body as a whole and what different systems of the body are we, should we be concerned about, Speaker 1 00:26:40 Right. It's every cell in the body, right? Cause every cell in the body is actually getting this damage from, uh, from, from getting caramelized and from storing excessive fat. But what's interesting is some cells get that signal of store fat store fat store fat, more than other cells, for example, your liver does. And, and besides making cholesterol, you're getting fatty liver. So currently in the United States, 25% of adults have fatty liver infiltration, uh, known as Deanna hepatitis or nonalcoholic fatty liver infiltration. I call it fagua Tagua yeah. You know how you fatten up, but duck to make hay out of their liver, right? It's it's fatty fagua. Uh, so that's no good, but even more fascinating is the cells that line your artery walls, your endothelial lining gets that signal from insulin that says store fast or fast or a fat. And when they store fat, what does that look like? Cholesterol plaques that cause heart disease and blockage of your arteries. When you have fat being stored on the inner lining of your artery walls, and that can not only be to your heart, it can be to your neck, in your brain, in your eyes and your, in your legs and your pelvis. And you know, to get guys' attention, I'll say this is, can be a cause of erectile. Dysfunction is blockage of the artery to the pelvis. You guys sit up and go, what? No, because of what could be more important to them. Speaker 1 00:28:18 Uh, so, uh, you know, all of that, uh there's so is the circulation throughout your body is one of the big ones. Um, and then specifically in the back of your eyes, uh, diabetics, get this, uh, fatty infiltration in the back of their eyes, that then makes the blood vessels start to leak back there. And they get diabetic retinopathy, uh, one of the leading causes of blindness in the United States. Speaker 2 00:28:43 Um, and that's something that when you go to the eye doctor, they're actually looking for, they're looking for that indication of diabetes or prediabetes. Speaker 1 00:28:52 Yeah. Yeah. And then, uh, even energy levels. And a lot of that comes, uh, from your blood sugar going up and down, it doesn't feel good when your blood sugar goes up and down your energy, it'd be much more stable. Uh, but also it's because your metabolism, all the enzymes of your cells are being trained to, uh, burn sugar because they're not being trained to burn fat. So if I'm in insulin resistance and I go try to exercise, I can't mobilize fat to keep myself going. So even a very thin person has an effect on our body to run several marathons, but, but a heavy person has more fat, but they can't get to it. So all they can burn is their blood sugar. And then, you know, some longer term sugars called glycogen from their liver and then they're out and they should be burned and they should be mobilizing fat to keep exercising, but they can't because the enzymes are induced the wrong direction. They're induced to store fat rather than burn fat. So when we get into treatment, we change people's diets such that they reverse the insulin resistance. They have to go through weeks or months of actually reversing that insulin resistance before they start to lose weight significantly. And that's because they, they're not into a fat burning metabolic mode yet. Speaker 1 00:30:14 So the energy can really suffer. And then the ability to fight infections, you know, it's well known that people get more, more infections in their blood sugars off. Um, so those are just some of the things that we see. Speaker 2 00:30:29 Okay. Now, when you knowing all of this, uh, I'd like to get into some of the conventional therapies, what people may typically expect, if this is a concern or there've been diagnosed, um, things that they would experience it just about anyone's doctor's office, you know, in terms of therapeutics, Speaker 1 00:30:52 Right? What's the solution. So the first line medication, uh, for diabetes is a drug called Metformin and Metformin is actually a very good drug. We use it also, and the reason as good as cause it reverses insulin resistance besides being FDA approved for diabetes is sta it's FDA approved for weight loss. It helps you lose weight. Uh, it, it makes your cells more sensitive to the signal of insulin. So you don't make as much insulin. And that's why you start to lose weight. Cause you reduce that, uh, store fat signal, uh, Metformin can have some side effects. Some people are intolerant of it in their gut. And for those people, you can actually use a compounding pharmacy and put it through the skin and guess what is 10 times more effective? Really? Yeah. So the, yeah, so the usual D I don't, I don't know the usual dosage, uh, through the gut is 500 milligrams starting with one a day, going up to two a day, maybe three or four pills a day. Speaker 1 00:31:51 But through the skin, it's 50 milligrams once or twice a day, I guess, because it's not getting broken down by our digestion. That makes sense. But it's gonna be a little more expensive because Metformin form is generally a very inexpensive drug because it's old and generic, but it can be more expensive to get it compounded up into a cream is not available that way through big pharma. Gotcha. The next medication they use is a category called sulphonylureas. And so Fano urea is a with the pancreas into making more insulin. I never prescribed them because of this. There are cases you can benefit from them, but making more insulin is not the way to control type two diabetes. I mean, you do have to control the blood sugar, but you want to control the blood sugar by changing how you eat and exercise and everything else. Speaker 1 00:32:41 Not by making more insulin. I mean, isn't that what leads to the insulin resistance? Exactly. So still follow urea is actually caused weight gain in the long run, do not improve the outcomes for diabetics when you track things out through time. Okay. Uh, but they're, they're often used and they're often used as a, as a first line therapy along with an F me. Um, after that, you know, there's insulin and insulin is perfectly appropriate, uh, for type one diabetics and life essential. Uh, but insulin should be a last ditch effort in type two diabetics because they're already making too much insulin. Now. That's what the caveat that if you've been type two diabetic for a very long time, you may have burned out your pancreas and we can do tests to see how much insulin you're still making. Uh, uh, but when people start injecting insulin they'll even gain more weight. Speaker 1 00:33:39 And in the long run, uh, things get much more challenging to control. Okay. And then there's a raft of a whole bunch of, uh, new drugs, uh, incretin mimics and, and all bunch of different things. I leave all that to the endocrinologist. That's, that's kind of above my pay grade. Okay. And you know, they they're expensive. They have complications there. They're sometimes very useful. They're sometimes very necessary. Uh, but that's not what we're about. We're about helping people reverse the diabetes and they don't need those. And that is a great word to hear when talking about this, that diabetes is reversible it's reversible that's right. And what we're going to do. That's a good segue. We're going to take a break now since we're at a half hour, and we're going to do a part two of this and come back and talk about what do we do to reverse diabetes, at least type two diabetes. Excellent. Thank you. Speaker 0 00:34:36 Thanks for listening to aim for health root cause conversations with dr. James boodle and our host joy Lambert. Be sure to visit <inaudible> dot com to access the show notes and discover other valuable free content in support of reclaiming your health bye for now.