The Paid Leave Podcast

A UConn Health Diabetes Specialist Discusses Controlling the Disease and Better Treatments..

• The Connecticut Paid Leave Authority • Season 3 • Episode 27

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November is National Diabetes Awareness Month. As of this year about 38.4 million people in the United States have been diagnosed with diabetes these incudes type I and type 2. The prevalence of diabetes continues to rise, highlighting the importance of awareness and prevention.

In this episode we talk to Dr Pooja Luthra, A UConn Health Endocrinologist, and Director of the Diabetes Education Program. We discuss the 3 types of diabetes, Type 1 and 2 and gestational diabetes, Dr. Luthra Talks about treatments and controlling diabetes with lifestyle changes. For example, eating healthy and including a workout regimen into your daily routine. Dr Luthra also sees the benefits her patience could experience with CT Paid Leave benefits.

To get in touch with the Diabetes Education program go to: Managing Diabetes for 2 - UConn Today

To get more information or to apply for benefits please go to: ctpaidleave.org

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Nancy Barrow:

Hello Connecticut, and welcome to The Paid Leave Podcast. The title basically says it all. I'm Nancy Barrow, and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut Paid Leave and maybe just a little bit more. Connecticut Paid Leave brings peace of mind to your home, family and workplace. Welcome to The Paid Leave Podcast. November is National Diabetes Awareness Month. Diabetes is a serious disease that happens when your body doesn't make enough insulin or just can't use it well. Diabetes has different types and symptoms and consequences, and as of this year, about 38 point 4 million people in the United States have been diagnosed with diabetes. This includes type one and type two, and the prevalence of diabetes continues to rise, highlighting the importance of awareness and prevention. We will talk about how Connecticut Paid Leave can help with up to 12 weeks of income replacement while you take time away from work for your own serious health condition or that of a loved one with our caregiver leave and how we help with chronic conditions that include diabetes, so it allows you to reapply every year for those benefits. Joining me is Dr Pooja Luthra, a UConn Health Endocrinologist and Director of the Diabetes Education Program, and thank you so much for being on The Paid Leave podcast Doctor Luthra.

Dr. Pooja Luthra:

Thank you so much for having me.

Nancy Barrow:

Well, why don't we start at the beginning. So what is diabetes? How do you describe that?

Dr. Pooja Luthra:

So, diabetes is a chronic medical condition, as you mentioned, it is characterized by having high blood glucose levels. It happens when your body is either not able to produce enough of a hormone called insulin, or the body cannot effectively use that insulin to lower the blood sugars. So insulin is a hormone that is used to help glucose enter the cells, and if that's not working properly, then your blood sugars are high. And diabetes, as you pointed out, is a serious health condition. It can lead to if it's not managed properly, it can lead to a lot of complications, including heart disease, eye disease, blindness, nerve damage and kidney failure. So it is very important. And thank you so much for talking about this. Let's start with the types of diabetes like one and two. So let's start with type one. Yes, there are two main types, type one and type two. But I also want to mention a third type. There's something called gestational diabetes that women get when they're pregnant. But focusing on type one diabetes. Type one diabetes is an autoimmune disorder when your body's immune cells attack and destroy the insulin producing cells from the pancreas. Pancreas is an organ that makes insulin, and when the bodies are able to make enough insulin, then again, that causes high blood sugars. So patients with type one diabetes require insulin, lifelong type two diabetes, on the other hand, is a more common form and is more prevalent, and this is a condition in which your body becomes resistant to your own insulin and it cannot effectively use the circulating insulin that is there. So there's enough of insulin, but it cannot help to go make the glucose enter the cells. This can be associated with obesity, and you know, lifestyle factors play a big role. There's a big role of family history patients who have developed type two diabetes, and then the gestational diabetes is seen during pregnancy, usually in the second trimester of pregnancy, and usually resolves after childbirth, but it does increase the risk of developing type two diabetes in later life, so it's important to also keep that in mind.

Nancy Barrow:

And one of the things that we offer if you have complications with pregnancy, we offer an extra two weeks to that 12 weeks for pregnant women. So for gestational diabetes, which can be a serious health condition. For type one diabetes, usually you find out that they have it when they're a child, or what is the age bracket for type one.

Dr. Pooja Luthra:

W e used to think that, you know individuals, if they're less than 40 years of age that the diabetes that most likely they have type one however, we are now seeing even older adults, and it depends on the way they present and or even older adults can present with type one diabetes. So the likelihood of developing type one diabetes is higher if you present with a condition called diabetic ketoacidosis, when your blood sugars are really very high you have symptoms of nausea, vomiting, you're not keeping anything down. Or if you have other auto immune conditions, you know, if you have, let's say, thyroid disorders, or, you know, psoriasis or lupus, so other autoimmune conditions, then it raises the likelihood of having type one diabetes. But yes, a lot of times it is seen in younger individuals. You know, when they present in their teens and they present with, again, very high blood sugars, like DKA, kind of situation, and that's when they're diagnosed.

Nancy Barrow:

Ok, and the treatments for type one, are there different treatments that you can do, and can you ever grow out of type one diabetes?

Dr. Pooja Luthra:

Type one diabetes because it's a deficiency of insulin. You need to use insulin for the rest of your life. There are medications that are, you know, we now have antibodies that are being used to delay the onset of symptoms of type one diabetes. However, they don't prevent it or cure it. So you can, but that's helpful in young you know, imagine a young child who was diagnosed with diabetes at the age of five or six, and then they have to start using insulin at that time. If we can delay the onset of them having to use the insulin till they're a little older, that's a big quality of life issue. So for now, we have medicines and antibodies that help to delay the onset, but there's no cure or no complete prevention at this time for type one diabetes.

Nancy Barrow:

Interesting. So the treatments that they go through, you know, are they different as a child than than they would be as like a young adult? I know I've seen pumps, and I know I'm not sure if that's type one diabetes or if that's type two diabetes, but and now with technology, you can kind of manage it from your phone. And it'sreally interesting how things have really changed with technology.

Dr. Pooja Luthra:

Absolutely, there has been so many technological advances in the last few years for management, and when we talk about insulin therapy for type one diabetes, insulin can be delivered in various ways. You know, we used to have in vials that people would have to draw out in syringes, and we went on to insulin, you know, pumps. We also have insulin pens. Insulin in the form can be given in the form of insulin pen or a pump in patients both with type one and type two diabetes, they are not limited to be given just to patients with type one diabetes. It's just a way of delivering the insulin. We do have continuous glucose sensors that monitor blood sugars every five minutes, and they have an app which you can download on your phone, on your smartphone, and you can monitor and look at your blood sugars every five minutes. And the good thing with those apps are that if you have a child with type one diabetes, the parent can monitor that so they know what's happening with the child's blood sugars and help guide them, you know. Or if they're in school, let the school nurses know how to help them with their blood sugars. So insulin can be given in various formulations in a patient with type one diabetes, that's the only treatment, whereas it can also be used in type two. And how you give it, whether it's in the form of insulin injections or pumps, can be used for both type one and type two.

Nancy Barrow:

I've noticed people who do like the finger prick to find out what their blood sugar is. Is there better ways to do that now, or do you still have to do the same old thing to make sure you know what your blood sugar is?

Dr. Pooja Luthra:

So we still have people, you know, we still recommend that people check their fingers, but now, with the continuous glucose sensors, which is a device that you wear wear on your arm or your body, and it stays on for at least 10 to 14 days, depending on the kind of device that you're using, you can get your blood sugar every five minutes, so that's very helpful, and that way you don't have to prick your fingers sick. Except if sometimes you want to confirm and make sure the accuracy of the device and what the number you're getting is accurate or not, what we do find, unfortunately, sometimes the coverage and the insurance coverage for these devices can be lacking, and not everyone that we feel would be a good candidate for it and able to afford it just because of the cost, but it's but as with any technology, hopefully, you know, it will get cheaper and the availability will improve. So yes, we still having people check their finger six. But then we also have other technological advantages in the form of the continuous gluco sensors, which give an accurate reading of your blood sugars every five minutes.

Nancy Barrow:

And let's now kind of turn to type two diabetes, because I've known people who have gotten diagnosed in their 50s and 60s. You know they were having trouble reading. That's one of the things that a friend of mine happened. He couldn't read stuff, and so when he went to the doctor, they're like, Oh yeah, you have type two. And they said he could control it with diet and exercise. So type two is different, right? Because you can control it better? Can you ever get rid of type two diabetes or be cured of type two diabetes.

Dr. Pooja Luthra:

So because, as I mentioned earlier, type two diabetes is related to weight and obesity and lifestyle factors, sometimes making those changes, you know, monitoring your diet and regular exercising may help decrease insulin resistance. And in some people, they may be able to control their diet, type two diabetes with just lifestyle changes. However, in other people, you may need to give medications, and there are different medications that can be used. But even in those patients, the Cornerstone is still lifestyle changes, still managing your diet, still exercising regularly. So it's very important that, and when we teach our patients about management for type two diabetes, we all start with the same pillar of, you know, diet, exercise, lifestyle changes.

Nancy Barrow:

Lifestyle changes. Yeah, it was really interesting, because he did lose weight, and so he could go off all the medications that they had him on. It's not really cured, but you can control it, that is absolutely right. So the symptoms for type two diabetes, what are some of the symptoms, or what are some of the things that we should be looking out for? Because I, I know another person whose wife had it. She didn't know she had it, and she went away on vacation, and she got really, really ill, and when she got off the plane, they took her right to the emergency room, because they said she was almost into like a coma state. So talk to me about those kind of symptoms and and what should we be looking out for?

Dr. Pooja Luthra:

So in terms for type two diabetes, when you're looking out for high blood sugars, so it depends, you know, it if it's very minimally elevated. So when we make a diagnosis of diabetes, type any diabetes, we say if you're fasting, blood glucose is more than 100, or if you if it's more than 200 you know. So that's when you kind of think you may have diabetes. Now, some people may have no symptoms, and it may be diagnosed just by routine lab testing. So when you go for your annual physical, your physician may tell you that you'll have diabetes. On the other hand, some individuals, maybe, like your friend, had very high blood sugars, and those then can present with symptoms and they're very thirsty, or they go into the bathroom a lot, or they may be tired. Your friend who had blurring of vision, because it can affect the retina and the eyes, so that can cause blurry vision. Some people may have difficulty concentrating, or they may be very hungry. In some people, they actually may be losing weight, because, you know, when your sugars are high, it's actually induces a state of catabolism in the body. So your body, the cells start breaking down. So you may have, you know, inadvertent weight loss can sometimes be a reason for type two diabetes. And then if the sugars become really very high, they may present in situations called TKA or diabetic ketoacidosis, which can present with, you know, significant abdominal pain, vomiting, coma and unconsciousness. So it depends on, you know, how high the blood sugars is, because when the blood sugars are high, it can affect other electrolytes in the body, like your sodium and your kidney function. All of that can have an effect on how the patients present.

Nancy Barrow:

Wow. So it's a really systemic kind of situation.

Dr. Pooja Luthra:

It affects all the cells. Yeah, blood sugars affect all the cells in your body.

Nancy Barrow:

Can you tell me what pre diabetes means, or pre diabetic means? Because I know that a lot of people have been diagnosed with that too.

Dr. Pooja Luthra:

Right? So again, it's a continuum. It's not that in one level of blood sugar, you have all the complications. So when studies have looked at it like, when can we start preventing the complications from long standing diabetes, they have looked at blood sugars and when the sugars start affecting your organs. So for by in terms of numbers, pre diabetes is, if you're fasting, blood sugar is more than 100 milligram percent, but less than 126 milligram percent when you do it on a blood test, okay? Or if it's between 140 or 200 when you are taking it, when we do a glucose tolerances, those patients may be called to have pre diabetes. If your blood sugars are more than 126 and more than once or more than 200 that's called diabetes. Yeah. And we also have an hemoglobin, a 1c is a measures of blood test that is done to look at to to make the diagnosis. And again, there are certain criteria. If you're able hemoglobin a one sees more than 6.5% that's diabetes. Between 5.6 and 6.4% is pre diabetes. So these are some numbers that we look at when you know in the blood work to kind of make the assessment whether the patient has diabetes or pre diabetes. And again, the reason for looking at that and saying, Okay, this is a pre diabetic state, and why do we worry about it? Because the risk of cardiovascular complications like heart disease and stroke, those start increasing even when people in the pre diabetic range. So it's so important at that time also to look and make sure that the other risk factors for heart disease, like your blood pressure and your cholesterol is well controlled, and you start paying attention to that because, you know, the people from die from diabetes, mostly because of early heart disease and stroke. You know, obviously there are other complications from uncontrolled diabetes, which is your like, I said, blindness. Or kidney damage, but there's a such high risk of heart disease and stroke, so it's so important to not only look at the blood sugars, but we look at cholesterol, we look at blood pressure and making sure those are at goal to prevent those complications.

Nancy Barrow:

Do you work with the cardio people at UConn when you get a diagnosis?

Dr. Pooja Luthra:

Absolutely so our you know, we can co manage our patients. But when our patients come to see us in our clinics, we are not only paying emphasis on what the blood sugar is doing, but we want to make sure the blood pressure is under control, making sure the cholesterol is at Target, and if need be, you know, following up with a cardiologist to make sure that all their other effects that we are managing the patient as a whole, and not just looking at one piece, which is a blood sugar.

Nancy Barrow:

What do your patients say is the hardest thing when they get a diabetes diagnosis? Is it hardest? You know, for the families, if it's a young child or emotional or financial or to take time off from work?

Dr. Pooja Luthra:

I think it is all of those. It is a challenging diagnosis for someone to hear, because it has emotional implications, it has financial implications, just like with any other chronic disorders, you have to then manage it almost lifelong. So it is, it can be a little challenging for people, but I think, but we do have a wonderful setup in our institution at UConn health. We have an excellent Diabetes Education Program where we have certified diabetes educators, we have dietitians who actually educate the patient to empower them to be able to, you know, help and make sure that they good, make good lifestyle choices so that they can deal with any chronic disorders. The you know, patients have to make changes in their lifestyle, they have to make changes in their diet. They need to start an exercise regimen if they were not doing all of that. So seeing other people, who may be, you know, in the same boat with them, having that support group and the peer support is so important. So we do encourage patients on, you know, to do offer them all to be seen by our Diabetes Education Program. And actually, literature shows that people who follow with diabetes educators do very well, not only just with their physicians, but they actually do better if they have that support, because it empowers them to make changes in their in their life.

Nancy Barrow:

And you hold them culpable, right? You know.

Dr. Pooja Luthra:

And you can set realistic goals, and you know, visit to visit of what they should be achieving, and you know how they should be managing, because you may see them in just in the clinic for those like half an hour, but they have to manage it on their own, at home, and you know they need to be have the tools that they can do that at home.

Nancy Barrow:

What about the mental health aspect of being diagnosed with a chronic health condition? What are your thoughts on on that?

Dr. Pooja Luthra:

It does take an emotional toll on some patients, and you know people, some people are not as resilient as others. So it can be challenging, which can then affect the care of their blood sugars, because then they may not want to take care of their monitor their sugars or follow a diet plan that we may have for them.So, it is important that we recognize that that we, you know, help them again, trying to give them some skills and tool skills, and connect them to resources that may be helpful for them to manage this better.

Nancy Barrow:

Well, we are one of those. We'd love you to to know that we also cover mental health treatments because depression and anxiety from a diagnosis from a chronic health condition, can really affect your daily life, and so we help them take time off from work and get income replacement for seeing a therapist or going to a support group, if you recommend that. So how important are programs like Connecticut paid leave to the patients that you treat?

Dr. Pooja Luthra:

I think it's a wonderful program that we have here in the state of Connecticut, because we know, as with any chronic disorder diabetes, patients with diabetes may need to take time off, sometimes to take care of their health. Patients can have significant fluctuations in the blood sugar level, it will affect their health, and they need to have regular medical monitoring. They need to have medical appointments. They need to make lifestyle adjustments. So having that time to focus on their health without the added stress of having financial loss is important. So I think by enabling patients to be able to take time off to manage their health, paid leave can help better to treatment plans and ultimately improve the health outcomes.

Nancy Barrow:

Tell me one thing that you think someone should do dietary wise, because I think United States like we are soda and juicers and we eat fast food. So if there's one thing that you could tell people to get rid of, what would you tell

Dr. Pooja Luthra:

I would say the juice and the soda, that's someone? because it's just pure carbohydrates that you're eating or consuming without any other benefit. If you are a juicer, juice it with all the fiber in it, right? Don't just take the just the juice out of it. You need to have the fiber so. So it's so important for managing diabetes that they have a balanced diet they need to have, you know, take it should be low in refined sugars and carbohydrates, higher in fiber, whole grains, lean proteins, healthy fats and plenty of fruits and vegetables. So the juice, really, in my opinion, does not have any role in in that diet plan. It doesn't give you any other benefit besides such sugar high and then that causes your blood sugars to peak so much, and that just is not very healthy.

Nancy Barrow:

No, I was talking to my friend who has diabetes, and she was in a store. She's like, I need to go get a juice or chocolate milk, because it's really my blood sugar has gone down really fast, so she has to monitor that. And so she has to, actually, you know, she she had to go to the aisle and get some juice.

Dr. Pooja Luthra:

Good, good, absolutely. So that's a different situation, right? So when you are treating low blood sugar, that's very important, that you treat it with simple carbohydrates like a juice. So yes, you have that at home in the eventuality that your sugars can become low, if you're in medicines that can cause low blood sugar or hypoglycemia, that's yes, we do need to do that, but in your regular diet plan, right? I don't think that's necessary.

Nancy Barrow:

Okay, well, there's some reports, and I would love to ask you this question, How did all this change you… or your views? that diabetes is tied to dementia and Alzheimer's. I don't know if you've seen that, and some people go so far as saying that dementia and Alzheimer's is type three diabetes. What are your thoughts about that kind of information that's getting and floating around social media? Because it can be dangerous.

Dr. Pooja Luthra:

Um, I think dementia can be various reasons. Some of them is, you know, we talk about Alzheimer's dementia, but there's also a component of vascular dementia. And vascular dementia can be seen in patients with cardiovascular disease, and as I had mentioned earlier, diabetes is a cardiovascular disease, so it can increase the risk of ischemia in the areas of the brain, which can then cause dementia. So maybe that is the association, but it's difficult to say. You know, there's a cause in relation completely one to one. But I think just from the perspective of diabetes being a cardiovascular disease, could that be leading to vascular dementia in people? If the diabetes is not well controlled, and it's just not blood sugars in those situations, it's the blood pressure and the cholesterol, which may play an important role. So it's so important to continue to manage all these medical conditions appropriately. We do see complications from uncontrolled diabetes, you know, bleeding in the eye leading to blindness, kidney damage, so going on to kidney failure, ultimately ending up in dialysis, and then the wounds that we see in the feet and the neuropathy that can lead to amputation. So all of those are complications of uncontrolled diabetes. So so very, very important to continue to encourage people to stay the course, stay with the medications.

Nancy Barrow:

So it is a National Diabetes Awareness Month, and what would you like people to take away from this podcast?

Dr. Pooja Luthra:

So one obviously, please talk to your physicians and your providers to get screened for diabetes. It is a simple blood test that can be done, especially if you have a strong family history or you have other risk factors, if you're overweight or obese, if you have high blood pressure or high cholesterol, or you belong to certain ethnic groups which have a high prevalence of diabetes, or there was a history of gestational diabetes, I would highly encourage you to please get screened, because the more you know, the better you can take care of your health. And if you do not get a diagnosis, it's so important to start early, making those good lifestyle choices, making changes in your diet, exercising regularly is very important to maintain your health in the long term. Yeah, describe your experience working with patients from diverse cultural backgrounds. Are some cultures and racial ethnicities more prone to diabetes? You know, working with diverse cultural backgrounds is now integral part of health care. It's so important to provide culturally competent care so we can understand and respect the attitudes and the health beliefs of those individuals. So that requires establishing trust with the patient you know, really actively listening to them, and then involving the patient in decision making, because what I may perceive as important for my health, the other person may not just because of cultural differences. So I think it's important to first actively listen and see what the patient's preferences are. Language can be a barrier and sometimes and that can be challenging. So utilizing, you know, interpreters providing them materials and their preferred language so that they can really understand and what what we are telling them, why we are telling that's important for the health is so important.

Nancy Barrow:

Yeah, it's so important for inclusion in any kind of health care. It really is. How can people get in touch with you Doctor Luthra?

Dr. Pooja Luthra:

So we they can go on to our website at UConn Health. We have a diabetes. You know, we have an endocrinology clinic where we see our patients with diabetes. We manage all forms of diabetes, just not type one, type two, gestational diabetes. They can also go to our website and look at the Diabetes Education Program. Their physicians can refer patients to the Diabetes Education Program. And we work collaboratively with our educators so that we can continue to provide care for patients.

Nancy Barrow:

Yeah, we've heard a lot about semaglutides. Is that what treats type two or type one?

Dr. Pooja Luthra:

So, right, so semaglutide is one of the medications that we have in our momentarium for management. It is a hormone called GLP one, and it is given as an injection. It is used in patients with type two diabetes. It is also used in patients just for obesity, for weight loss. We also have another, a dual agent called a GLP one and GIP analog, which is called tirzepatide or munjaro. And it's also used for type two diabetes and for weight loss, it's called zepbound. So these are having wonderful medications that have you know, really helped patients lose the weightand improve their diabetes.

Nancy Barrow:

Any last thoughts about diabetes that we missed or Connecticut Paid Leave that you'd like to talk about?

Dr. Pooja Luthra:

No, I do. Thank you so much for raising awareness about the Connecticut leave program for our patients, so that, you know, they can avail that resource and thenstill continue to, you know, take care of the themselves and their families and not be worried about the financial implications of taking the time off.

Nancy Barrow:

Well, I want to thank my guest Doctor, Pooja

Dr. Pooja Luthra:

My pleasure. Thank you for having me. Luthra, a UConn health endocrinologist and director of the Diabetes Education Program. Thank you so much for being on

Nancy Barrow:

For more information or to apply for The Paid Leave Podcast. Dr Luthra. benefits. Please go to ctpaidleave.org. This has been another edition of The Paid Leave Podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut Paid Leave is a public act with a personal purpose. I'm Nancy Barrow, and thanks for listening.

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