Thanks for joining our live chat on diabetes today. We're joined by Dr. Robert Rizza from the Mayo Clinic and Dr. Lisa Chow from the University of Minnesota. Let's start with you Dr. Rizza. Please briefly explain the difference between Type 1 and Type 2 diabetes. There is an important distinction between these two forms of the disease, as many patients have pointed out to me during my work on this topic.
People with type 1 diabetes are unable to secete insulin due to the fact that their body's immune system has destroyed the insulin screting cells in their pancreas. People with type 2 diabetes can secrete insulin but not enough for their body's needs
Dr. Chow: Genetics are a factor in both forms of the disease. But obesity is also strongly linked to Type 2 diabetes. Does obesity cause the condition?
Obesity is typically associated with Type 2 diabetes. Obesity, depending on the fat distribution, is considered a cause for insulin resistance which precedes the development of type 2 diabetes.
Dr Chow: if a person is skinny can he or she still get Type 2 diabetes?
For our audience today, feel free to join the discussion by posting questions or observations.
Sort of. A classic example are Asian Indians who can develop severe type 2 diabetes even though the BMI might be in the overweight category, but not necessarily in the obese category.
Dr. Rizza: do Type 1 diabetics need to eat differently than Type 2 diabetics?
No. People with diabetes, as do people who do not have diabetes should try to eat a balanced diet high in fiber, low in saturated fats with the right amount of calories. Same for people with type 2 diabetes but if they are overweight, then they have to pay even more attention to calories
Dr. Rizza: A lot of people wonder if it's it okay to eat sugar once you have been diagnosed with diabetes?
While Dr. Rizza is answering my question, we'll post a few from our audience. Dr. Chow can you answer some of these?
Sugar does not cause diabetes but it is relatively high in calories (particulary when accompanied by fat) so best to eat reasonable amounts as part of meals
Exercise can increase catecholamines (like adrenaline) and cortisol which can increase the sugar in the body.
Yes. Insulin resistance can be due to a variety of reasons, and even skinny people can be insulin resistant.
Dr Chow: What is pre-diabetes?
Pre-diabetes is when you don't meet the strict criteria for diabetes, but you have findings (ie elevated fasting sugar, high sugars after eating) which suggest that your body is having altered sugar processing
Insulin pumps are useful in a variety of circumstances but agree are a challenge in very small children. Usuing a combination of so called "basal" insulin (long acting and flat throughout the day) along with quicker acting insulin at meals appropriate for how much the child eats many times works quite well
Dr Chow: What percentage of people with pre-diabetes will go on to develop diabetes?
It depends. If they adopt lifestyle changes such as diet and exercise, the risk will be reduced by about 60%. Usually prediabetes is a warning sign that lifestyle changes can and should be implemented
Remember the qoal is to "prevent, optimally treat and utimately cure" diatebes. "We" (the collective we of socienty) know how to prevent disease and can appropriately treat it in the vast majority of people. There are a variety of tantalizing recent findings that indeed make a cure within our grasp. However no guaurantees. on the other hand, if not a cure, I strongly suspect we will come close
Needless to say "bad" insulin is a very general term. People with type 2 diabetes commonly are unable to secrete enough insulin during the night to control the amount of glucose released by their liver (which stores glucose after meals in order to feed the brain glucose between meals). In many instance they need a small dose of insulin or a specific type of pill before bed to maintian the balance during the night so their glucose values will be normal when they awaken
Not much. Perhaps Dr Chow does
No, I am not aware of this either.
I agree with you. I think of the insulin pump as a privilege and should be given to patients with type 1 diabetes who have demonstrated a good foundation in insulin administration, blood sugar checking, and dose adjustment.
There are certain things in life you can control and some you can not. Insulni resistance and the so called "metabolic syndrome" can be caused by some genetic abnormalites that you can not change. However, in most instances it is due to more fat than your body can handle and less activity tha your body needs
Dr. Rizza: Would an artificial pancreas or closed-loop system revolutionize diabetes care for Type 1 diabetics?
It depends on your blood sugar control. If you are doing well on oral medications with good control, then you may not need to be on insulin. However, the beta cells that make insulin do degrade over time and thus insulin may be needed.
I think it is very cutting edge and extremely exciting.
Absolutely. We and others showed many years ago that a device that can continuously monitor glucose and then infuse insulin can keep glucose values normal. The challenge has been to make these devices portable. There now are several candidates well on the way to this goal
Dr. Chow: Can you tell us a bit about your research?