Well Wisconsin Radio

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Hello and welcome to Well Wisconsin Radio, a podcast discussing health and well-being topics with experts from all around the Midwest. I’m your host, Alexis Krause, and today my guest is Dr. Richard Bergenstal. Rich Bergenstal is an endocrinologist and executive director of the International Diabetes Center.

This is part of Health Partners, also known as HP. Dr. Bergenstahl has been at Park Nicolet and HP for 40 years and has led multiple clinical trials in diabetes. He has tested most of the new diabetes drugs and devices before FDA approval and worked on many quality improvement studies to improve diabetes care across HP.

Outside of health partners, Rich served as president of the American Diabetes Association in 2010 and was the American Diabetes Association’s Outstanding Clinician in 2007. He also is a clinical professor in medicine at The University of Minnesota, and he teaches the value of patient centered team care across the US and Globally.

Dr. Bergenstal, thank you for joining us this week to discuss Diabetes Awareness Month. Oh, it’s my pleasure, Alexis. Is it all right? Is it Alexis all right. That’s perfect. Yes, and I know you said Rich was okay, so we’ll go by first names. It’s perfect. I’m looking forward to our discussion.

Diabetes is such an important topic. Yes, it is Thank you for being here. I’m so excited to dive in. Would you mind starting off our conversation today by telling me about the work you do at the International Diabetes Center and Health Partners Park at Nicola Clinics? Yeah, no, I’d be happy to, uh, it’s a, it’s kind of a unique, uh, setting we’re in.

The International Diabetes Center is part of, uh, the Health Partners, uh, healthcare system. And we do clinical research studies, testing new drugs. We test new devices. Our organization, uh, The Diabetes Center sort of looks across the quality of our whole health care system for diabetes care. Can we improve it in primary care?

Can we improve it in obstetrics and gynecology, the specialty clinics? So it’s really a great position to just be able to study diabetes and translate our new findings into research across health partners. And then What we learn here, others are interested in all across the country and across the globe to say, Oh, you seem to have a pretty good system.

You know, what, what can we learn together? So it crosses a lot of different areas of the diabetes spectrum. Yep. Could you explain the difference between pre diabetes, type 1, type 2, and gestational diabetes? There’s so many different types that we hear about. Yeah, you know, diabetes is, uh, is, is so prevalent and we’ll come to that, but these different types, I think it’s probably easiest to start with type 1 diabetes.

That is, Usually thought of as, as, as young adults and children, but it can now be of all ages of type one diabetes means your pancreas that makes insulin, which we need the insulin to go into our bloodstream to get the glucose, the sugar into our cells for energy and for well-being. People with type 1 diabetes don’t make enough insulin.

They need insulin, uh, by injections or by pumps now every day of their life. Uh, and that’s type 1 diabetes. It can be children, it can be adults, uh, and it’s about 5 percent of all the diabetes in the country, 5 to 10. And then type 2 diabetes. We used to call adult onset, but boy, now we’re seeing type 2 diabetes and even in children and young adults.

This is where you make some insulin, the pancreas is working, but your body seems to resist its activity. You’re insulin resistant and the insulin doesn’t work appropriately. Um, sometimes it’s related to being overweight and being overweight blocks that action of insulin. Um, and. So we use different medications, we use diet and exercise, and sometimes we need insulin.

And then you get to diabetes in pregnancy, and people with type 1 or type 2 diabetes can be pregnant and have diabetes, which needs special attention. And then there’s a type called gestational, which just means the first time you hear about having diabetes is during pregnancy. The stress hormones of pregnancy blocks that action of insulin again, and you need some help keeping your sugars down.

So we have all these types. And pre-diabetes, just since you mentioned it, is just that state to say your blood sugars aren’t quite normal. We have definitions of normal blood sugars from lots of people, uh, a blood test in the lab. Um, and, but it’s not quite to diabetes yet. So the diabetes definition is a little bit higher than normal and there’s an in between zone we call pre-diabetes.

So it just says. Be careful. Your blood sugars are heading up. We need to take some action now so we don’t get you into that diabetes range, which has other implications we’ll talk about. Great. So with that, could you tell me some of the prevalence of diabetes in the U. S. and more locally, maybe in the state of Wisconsin or where you’re at in Minnesota?

Yeah, in Wisconsin and Minnesota actually are pretty similar on the Midwest of range here. But, you know, Alexis, it’s just, it’s just, Amazing. There are 38 million people with diabetes in the United States. Wow, that’s a big number. That’s a huge number. And the sad part is one in five of those don’t even know they have it.

But maybe we’ll come back to that. How can you, how can you not know if you have diabetes? But a lot of people don’t. So that’s about 12 percent of the population. Now, That’s like one in every nine people. In Wisconsin and Minnesota, it’s down around eight percent. So a little bit less. Um, just because maybe the makeup of the of the states.

There’s this, there’s this diabetes belt in the south where the incidents may be 15 or 20 percent, um, that you, that you hear about. But in Wisconsin and Minnesota, about 8 percent. But remember, that’s about one in every 13 people. So, you know, if you’re, if people are listening and gathered around or in a room, I mean, one in 13, that’s really common.

So we, it really needs, it really needs attention, remember 90 percent of that is type 2 and 5 to 10 percent is type 1 and then a little bit of gestational diabetes. And, you know, and some people are more prone than others and I know we’ll probably get to that, right? But it’s, we say, Everyone should be screened for diabetes and we’ve moved that date down, that, that timing down to like age 35 now.

It used to be, well, we’ll screen at, at, at 50. Oh, well, you know, how about 45? Now, it’s down to age 35, uh, that people should be screened. And, um, and certain people are, are at more risk. And so. If you want to know who’s at risk, you know, probably the best way to sort that out, there’s this little, um, 10 question, 60 second survey that the American Diabetes Association does and they have these survey days or these screen, let’s get screen days and um, And, and there’s the, the 10 questions have to do with how old are you, because yes, the older you get, the more your pancreas can wear out and you just need some help or you’ve gained some extra pounds and you’re blocking that action list and so, uh, age. And then race and ethnicity and African Americans, Hispanic Americans, Asian Americans, a little higher incidence and Native Americans in particular.

Those may be 14, 15, 16 percent as opposed to um, white population where it may be as low as eight or, uh, or six or seven or eight percent. So, uh, and then do you have a family history? Are you active? Uh, are you, do you have high blood pressure? Those are all risk factors. So, uh, people really need to, to know, am I at risk?

Can I get, can I, should I get screened? The answer is yes, if you’re over age 35, uh, and then I’m sure we’ll talk about where we go from there. Could you talk a little bit about any of the factors related to the social determinants of health that might be contributing to the higher prevalence in those communities?

Yeah, no, I’m really glad you asked that, Alexis, because it’s, we think just all about the numbers. We’ll come in and how old are you? And but but there’s a lot of there’s a lot of factors of social determinants of health. And those are just factors that you know, socially impact your health of, Do I have access to really good, healthy, fresh foods and, and, and can I get in to see the doctor?

And, and, and, and what, what are the availabilities of, of medical resources in, in, in my community? And, and, and, and what other stresses am I under with my life? I mean, things are so, so busy and so stressed. And you know, stress and sleep affect your chances of getting diabetes too. And certainly how you cope with it or deal with it.

So all those social determinants of health. So when you say, you know, I’m going to see my doctor, that’s good. But sometimes, you know, you need to talk with the social worker or with the pharmacist or somebody to help, um, you know, Can I afford these medications that you’re prescribing for me and what can I do?

So it all comes together in the community. So I’m glad you asked because medical care is about not only drugs and devices, but community support as well. Absolutely. It’s so important to think about the whole person and how they’re engaging in the world too, not just the disease that they’re dealing with.

And we’re lucky. I think Wisconsin, Minnesota has some really good health plans that, that are taking this into account. That, that say, you know, to take care of diabetes, you need a team. You know, it’s really not just one person. Yes, you, often people have their primary care physician, but they might refer you to a, a, a, a dietician or a diabetes educator or you might need to talk to a pharmacist.

So, so it’s, it’s really the team, the, the teamwork and I think Minnesota, Wisconsin are kind of known for, for embracing, embracing the team, uh, care. We certainly, you know, value that at our, in, in health partners, so. Well, that makes me happy to hear that. Is there any way to reverse either pre type 2 or gestational diabetes?

Yeah, boy, it’s a really good question, and it’s, it’s really become an important, uh, aspect right now. We, we, we talk about, um, you know, all the, all the medications and, and fancy new, new things that we have, but it turns out if you, If you get screened, and that’s why I try to emphasize that up front in our discussion.

If you, if you can get screened and, and learn you have diabetes, the earlier we start intervening, the better. It’s not just like, we’ll put this off and we’ll get to it eventually. The sooner you start with saying, what are you eating? How active are you? You can, the studies show that if you’re in that pre diabetes stage, you’re You have about a 60-70 percent chance of reversing it if you take some action.

It’s pretty high, but you have to do something. You can’t just think about it. You’ve got to say, What am I eating now? Are there some better choices? Could I lose 5 to 10 to 15 pounds? Not back to high school weight. You know, you don’t have to necessarily lose it. You need to, those first 10 to 15 pounds are the most important in reversing this blocking of the action of insulin, this insulin resistance. So yes, the, the, reversing or preventing the progression from pre-diabetes to diabetes is definitely possible. Occasionally we’ll, we’ll even use a medication. But most of the time it’s really getting to these habits and lifestyle changes that, although they’re hard, if you take them step by step, they’re really doable.

That’s really helpful to think about. And as you said, it might be addressing that stress or maybe the sleep first, and then maybe the weight will start to follow after you address some of those needs. Yeah, I think people, you know, have more energy if they sleep, and they, they can, they can think about getting active.

And you lose a few pounds and you start to feel, wow, that’s I think I could do this. You know, my joints are better, 10, 15 pounds less. And yes, I can make it around the block. And so it all, it all adds up. And at the same time, keeping track of the progress you’re making, which I’m sure we’ll come to of how to monitor your blood sugars and know just how you’re doing.

So absolutely. So I wanted to talk a little bit about what some of the signs and symptoms are of diabetes. We touched on it a little bit, um, but how would someone know if they have it and what are some of the risks of developing diabetes? Yeah, so why should we screen? We, I mean, the reason we want to pick it up early is the earlier you treat, the better long term outcomes they are and the more you prevent the possible complications of diabetes. So let’s just get that covered now. The reason we’re concerned about managing and finding it is that, yes, if diabetes is not well managed, it puts you at risk. It puts you at risk for the blood vessels being irritated and the eyes, kidneys, and nerves in particular.

And also the heart. Um, and, and vascular blood flow. So, diabetes has lots of risk factors, you know, and I, I don’t, I don’t really like to dwell on scaring people, but you do need to know there’s a reason that we talk about this, leading cause of blindness and leading cause of kidney failure and one of the leading causes of heart attacks or stroke.

But all those are manageable if we start early, and we, and we, and we work on it together. So that’s why we screen. And if you say, well, I’ll know when I have diabetes. I’ll go in as soon as I feel, …what? Well, yes, there are some symptoms. You know, you’re drinking a lot of, of, of, of water. You’re, you’re going to the bathroom often.

Because when the sugars are high. All that sugar, uh, passes through the kidneys and comes out of the urine and keeps, uh, keeps coming out. And, and you get up at night and, uh, you lose weight when you’re not trying to, which some people initially say, Ooh, this is good. You know, I’m losing some weight, but it’s not, it’s not because of anything you did.

It’s because the disease is really taking a toll on your system. So, but I think Alexis, the main thing I would say is. Don’t wait for symptoms. Please. It can be silent. It can sneak up on you and you’ll think that I’m going to the, I’m going to the bathroom because it’s a hot day and I’m drinking a lot.

No. So get screened. No matter, don’t wait for symptoms. Yes, it’s good to be aware of them. But do the screening, you know, once a year and be sure that it’s not sneaking up on you. It’s good to keep in mind, because I think some of those symptoms that you were just talking about are common things that anyone could be having going on, exactly.

Exactly, so. What are some of the current treatment recommendations for diabetes? Yeah, we have some really good, some pretty amazing treatments. I’ve been in the business, as you said in the intro, for quite a few decades, and we used to have just a couple medicines, and now we have a lot of medicines, but I like to always start with the lifestyle.

You know, if people I said with type 1 diabetes need insulin and need it for the rest of their life, and we’ll talk about that, but, but they still can, the healthier they eat and the more consistent they are at eating, the better the insulin works. And people with type 2 diabetes, often go through a period where the diet and exercise are enough for them to keep them in check.

And then eventually still the pancreas says, the body says, I need some more help and we need some medications. Or they’re particularly overweight at the start of being diagnosed and maybe losing some of that weight, either through diet or medications. So start with start with lifestyle discussions. Um, Type 1, you’ll start with insulin for sure.

Type 2, you’ll talk about some medications and you, I’ll throw some names out just because people will hear about them, but, you know, like metformin is a really common, Uh, starting medication and it’s just safe and it’s effective and it lowers the blood sugars without many side effects. So it’s a really good starter.

You lose a little bit of weight with it. And then there’s these blockbuster medications. Some new ones that everybody hears about. The, um, the, Ozempics of the world of the Manjaro. The, the, we call them semi-glutide. Um, um, and. It’s, they, they, these medications are newer medications, but we’re just learning so much that there are medications now that can suppress your appetite, make you less hungry, make your stomach not empty as fast so the food sits a little bit and you feel full and, um, and so we’re using those medicines in the right patients.

And there are certain medicines that are particularly good if you have heart disease or you have kidney disease. They also lower your blood sugar, but they’re good for those conditions. So if I’m gonna say anything to the listening audience, you know, it’s, we’re sort of in the age of personalization now.

Where it used to be, oh, everybody gets this treatment. You know, step one, two, three. Now it’s everybody gets assessed and say, which would be the best for you? So be sure your team you’re seeing is, is thinking about, we have such a list of medicines now that we can pick the ones that are really right for the right person.

Everyone wants to get their blood sugars in control, but also some people need to deal with weight or, or with, uh, cholesterol, blood pressure, and some of these medicines sort of overlap and help those as well. It’s really interesting to think about how just a few drugs have kind of changed the game a little bit and the treatment plans.

Yeah, no, things, things are really changing and, and, you know, I think the new drugs and they’re targeted and they’re personalized. And then in complement to the new drugs are these new devices that can help you monitor your blood sugar. Because sometimes people say, well, I’m starting this. new medication or I’m trying really hard with my exercise and, and, and choosing, uh, more vegetables and more fruits and whole foods, um, and I want to know if it’s working.

And we, we’ve always had this blood test and the audience, I think, will, will, maybe you heard this term A1C, it’s kind of a funny name, but it’s kind of out there. And it’s a, a test that looks at your blood sugar over the last three months and, and, and, and gives us a sense of how you’re doing. But now we have these devices and people probably seen them now, little patches you put on your arm or on the abdomen.

You see people walking around with them and you wonder, well, that’s, a little monitoring your blood sugar, continuous glucose monitoring. You can put a little patch on and see your blood sugar every one to five minutes right on your phone. And you, and you can see these medications in your walking and your food choices, uh, and your sleep pattern.

You can see how they affect your blood sugars. So it’s really reinforcing. Sometimes we use them and we don’t need to add the next medicine and the next medicine because we’ve got some feedback. We’ve got our own coach, you know, right there with us. I’ve seen those monitors, and I think they’re so interesting.

I’m curious about trying that out for myself. Some of these are now even becoming over the counter, so more and more people will get a chance to try them. But I’m particularly interested in people with diabetes. Um, having that awareness that, um, right now that continuous monitoring, for instance, if you’re on insulin, whether type 1 or type 2, because as I said, even the type 2 adults sometimes need insulin, then, then those monitors are pretty well covered even because insurance companies and the, um, doctors are seeing, well, this really, It does motivate people and helps them adjust their medicines, because when you come into the doctor and they’re thinking of adjusting something, boy, it’s really helpful for them to see your blood sugars and see, is it mostly after meals, is it mostly overnight, uh, which medicine would be best for you.

So the monitoring is, is really helpful. Yeah. It sounds like that knowledge can be really powerful in helping that behavior change. Are there any risks, health risks to consider and questions you would recommend our listeners to ask when talking with their health care provider, um, if they are considering medications to manage diabetes since they are newer to the market, um, specifically with being used for diabetes?

I think clinician, they, they’re, about what’s right for me, you know, that you hear about all these medicines, you know, on the Internet now and in the news and commercials on TV. So I think it’s okay to bring those up to your physician. But just be open to sometimes Well, that’s on the TV, but, but when we look at your situation, here’s what might be best for you.

So it’s, it’s describing, you know, are you, are you a consistent pill taker or not? Will you take the medicine? They only really work if you take them. And, and, and what are the side effects? Some people have, you know, GI side effects. And if they already have some issues. We look for a different medication.

And so, so I think just being very open to, um, to saying, um, here’s my, my history, which is the best medicine for me. And then again, they’ll ask questions about your family history and heart disease and kidney disease. They’ll do those tests and that’ll be how we select medicines. So we’ve gotten a little more sophisticated and, instead of one shop for everybody to really, you know, personalize the therapies.

That makes sense. And I know you talked about this a little bit before, but just wanted to open it up a little bit more on what poorly managed or unmanaged diabetes can do to the body. I know you had said blindness and you didn’t want it to be a scare tactic, but just so people have an understanding of what could potentially happen.

I think we ask a lot of people, you know, managing their diabetes and so it’s worth being honest about well, why are we so focused on that? You know, it’s Diabetes is so common. I talked about it early, but I kind of use the One in four and one in four. It’s You know one in four people over age 60 have diabetes and one in four of all health care dollars go to diabetes So You know, we really have to focus on that, and a lot of healthcare systems are kind of graded or judged by how well they manage diabetes, because if you can manage diabetes well across your healthcare system, you must be doing something right, because it’s a complicated team based care.

So, do you have the setup to, to screen for, for how your eyes are doing? You know, are you getting your eyes looked at each year because we can spot little red spots or dots or to say something’s not right. We’ll check your blood sugar and your blood pressure because both of those are important. But, but you have to get the eyes checked, you have to get a blood test for the kidneys, um, because.

They can progress and yet we have such good markers to tell us you’re on your way. Let’s stop it now. Because when you look at these dialysis centers that people know about or kidney failure, you talk about kidney transplants, more than half of those people have diabetes because they just didn’t know or didn’t have the time or the support to manage it.

So, you know, It’s, it’s tough to manage and, and, and it’s an everyday disease so we can’t, we have to really support people because they have a lot in their life like we all do and now they add diabetes so we’ve got to make it as easy as possible so a lot of our visits now are telehealth. We can, you know, when you’re wearing one of those little devices on your arm that data is all sitting there in the cloud and I can have a visit with you and.

And look at your blood sugars and give you advice. Just, you know, by looking at your data right over the cloud, it comes right into my office. Um, and you don’t have to come in every time for a visit. Yes, we need to see you on occasion, but sometimes we’re adjusting medicines, and to say, come back in two weeks, and you’ve got to take off work, and you’ve got to get child care, and you’ve got to do this, when we can have a conversation, uh, over the screen or over your phone, and, and make really good adjustments with this new technology.

So I think that’s you know, um, we have to pay attention because there are consequences. Um, but it’s glucose, it’s blood pressure, it’s your cholesterol, it’s your sleeping, your good choices of activity. You can put all those together and minimize those risks. Yeah, it’s really all encompassing. Wow. It’s a lot and, you know, the, the cardiologist and the kidney doctors and the other people will, will see, you know, people with diabetes as well, but the primary care doctor is usually the, you know, the beginning, starting point and then they’ll get help from the specialist.

I’m an endocrinologist, that’s a specialist in, in one, but, but we, we, we all work together, um. And, and get the support, you know, when it’s needed. And in pregnancy, too, we’re now learning we can pick up this gestational diabetes maybe even earlier. And, and, and prevent some of the large babies and complicated pregnancies.

Because we have much better, you know, monitoring systems now. Like these glucose monitors that not have to wait for 28 weeks to get this glucose tolerance test that nobody likes. Uh, so anyway, things are changing. So for people just to keep abreast of this and keep talking to your medical team because we’re making, you know, progress slowly, but steady, never fast enough, but, but we are making progress.

That’s good to hear. And just to leave it on a positive note, what advice would you give our listeners who may be facing challenges as they work to prevent or manage diabetes in their own lives? We’re in an era now that we’ve got so much better treatment. So I’d first say to the listeners, don’t be afraid about diabetes.

It’s not, nothing that, it’s something that people don’t want to have, but it’s very manageable. Get screened for it. Find out if you have it. Then take advantage of the resources out there. Uh, your family comes first because they can be really supportive or, or, or friends. But your medical team, uh, and broaden that team to be your primary care physician.

Uh, if they suggest you see a diabetes educator or a dietician, take them up on that. Because, boy, we, we really learned a lot to, to help people. So, so get screened, follow up with your, with your team if, if, if you’re heading in the direction of diabetes or if you have it. And then, um, just go step by step.

Um, each, each little step will help. And now people with diabetes are living. Just as long as people without diabetes, if it’s well managed. We, we give out medals now to people who’ve had diabetes for over 50 years, 60 years. And we never used to see that before. You just now, so, so this is a time where we’ve got good treatments.

So work with your team and, uh, uh, and, um, if there’s anything we can do, you know, let us know. We’re happy to help too. Well, Rich, thank you so much for all of your information today. It was wonderful talking with you. Great. No, really good questions, and I’m really glad that you’re spreading the word across Wisconsin that diabetes is important, needs attention, but we can do a great job with it.

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