Dr. Lois Jovanovic
Exclusive Interview from AACE Orlando
This is a 5-section transcript. Part 1 | Part 2 | Part 3 | Part 4 | Part 5
Steve Freed: So let’s talk regarding a little bit different topic and that is prediabetes. There’s probably 100 million in this country alone along with prediabetes. The whole tip is to steer clear of them from going to diabetes. Yet once you become pregnant, you’re gestational diabetes and you offer birth, the diabetes goes away. Those women are actually at risk dramatically for getting type 2 diabetes. So just what do you do?
Dr. Jovanovic: 10% per year, so that means in five years, they are going to have actually type 2 diabetes. 10% per year. I insist that they have actually some sort of blood test every 6 months, since it’s 10% per year. 50% of those women will certainly get hold of type 2 diabetes. It’s even greater in others countries. Yet they have actually to be told that despite the fact that the diabetes appears to be gone now, 10% per year will certainly get hold of diabetes. So just what I tell them to do is to maintain their sugar monitor and every once in a while check themselves. that should go to a laboratory? Merely check themselves. They’ll understand full well if they’ve eaten something sugary and sweet and they test their blood sugar and it’s 200. They have actually diabetes now. They don’t have actually to wait until the doctor makes the diagnosis. So the very best help is to maintain the machine, go to the drug store ensure they have actually fresh reagent strips. So as quickly as they check their sugar after consuming something actually disastrous, that is absolutely wonderful that their blood sugar’s normal, they don’t have actually diabetes. If their blood sugar’s is elevated they have actually diabetes. It’s that simple.
Steve Freed: So the situation enjoy that, as quickly as do you tell them to monitor their blood sugars? Fasting as quickly as they wake up in the morning? Or postprandial?
Dr. Jovanovic: No, after they’ve eaten something disgusting. since the diabetes has actually gone away Yet the method you make the diagnosis of diabetes is along with a glucose tolerance test. It’s not necessarily along with the fasting. It’s after you eat. And the women will certainly understand that if they’ve eaten something actually sweet and their blood sugar is normal they don’t have actually diabetes. No should waste the sticks on fasting.
Steve Freed: It’s funny that you say that, because, I can easily ask 1,000 people, as quickly as does your doctor tell you to check your blood sugars? Not for type 1s, type 2s.
Dr. Jovanovic: Prior to breakfast, Prior to lunch, Prior to dinner, Prior to bed.
Steve Freed: Yet if they only have actually prediabetes, the doctors, and the doctor is monitoring them. They still are told fasting.
Dr. Jovanovic: since the doctor is sending to them to the laboratory to check out lipids too. And the tier for normal lipids is based on a fasting blood sugar. They’re looking at others examinations that depend that you haven’t eaten something. Yet if you’re Merely looking at sugar and you hope to understand whether the patient has actually hyperglycemia, they actually ought to be sending the patient to the lab after breakfast.
Steve Freed: since even as quickly as you opt for a physical. You don’t have actually diabetes. The doctor’s constantly going to tell you don’t consume anything we hope to check your triglycerides. And the report comes spine and their blood sugar’s 94, no mention of diabetes. You don’t have actually diabetes so why mention anything and the patient goes home. You go out have actually a big pizza and some French fries and the blood sugar’s 275.
Dr. Jovanovic: Now you already know I can’t adjustment the world, Yet we actually shouldn’t send patients to the lab fasting. We ought to adjustment the norms for lipids and tell patients to go to the lab an hour after breakfast so that we can easily see their worst glucose control. Their worst triglycerides. We hope to see exactly how inadequate it is, not exactly how good it is.
Steve Freed: After that why is it the medical community doesn’t already know that? I mean, maybe the standard ought to be… there ought to be a standard for as quickly as a person ought to take a blood test to diagnose prediabetes or diabetes.
Dr. Jovanovic: So you tell your others doctors you interview, they have actually to say that, and they have actually to convince their laboratory to adjustment the lab, since it’s a laboratory individual direction, the patients are provided regarding as quickly as to prove to up, exactly how long to fast. So you can easily adjustment your community in your laboratory by telling your laboratory to do that. You have actually manage over your very own community. Now, yes, they send the blood test out to some diagnostic lab, Yet as far as preparation for the test, it’s an individualized community philosophy.
Steve Freed: So as quickly as you, and by the way, I believe I’ve read that since we only check fasting blood sugars in the physical, that we miss out on regarding 25% of the people that actually have actually diabetes.
Dr. Jovanovic: Of course, Yet exactly how would certainly you even understand that?
Steve Freed: So, in looking at the bigger picture, where do you believe we are as far as knowledge and having healthy and balanced babies? since that’s actually a critical question that they demand much better care. I mean, we’re not seeing people being told that their A1C ought to be 5.3 at least from my perspective.
Dr. Jovanovic: No, Yet we demand Centers of Excellence. since the honest truth is not every obstetrician or endocrinologist should understand regarding diabetes and pregnancy, we have actually to established Centers of Excellence. And we have actually to have actually transportation to enable the women to get hold of to a Focus of Excellence. And they have actually to be scattered, at least throughout the United States. So that in a community there’s not a lot more compared to 100 miles that you have actually to travel to get hold of to see a person that knows regarding diabetes and pregnancy to tell the local doc just what to do. So you have actually to have actually networking and you have actually to have actually the opportunity, Yet you can’t Merely say oh the only place that it has actually a good Focus of Excellence is in Brand-new York or in Los Angeles. You actually demand local communities to have actually Centers of Excellence in diabetes and pregnancy. And that’s just what we should do. It’d be wonderful if AACE took on the responsibility making sure the doctors at least understand where the Centers of Excellence are, so that they can easily refer their patients so that doc in the Focus can easily talk spine to them. Then they can easily do the rest of the care.
Steve Freed: One of the points that you said, that still I can’t get hold of from my mind is the A1C of 5.3. So you actually, especially for type 1s, Yet even type 2s, you basically tell them they ought to not get hold of pregnant until they can easily reach that number.
Dr. Jovanovic: I don’t… I Merely tell them the risk, the baby could die, they could have actually an abortion, and actually that wouldn’t be inadequate news, since that meant the baby was so malformed that they were lucky that they lost the baby pretty compared to have actually a monster. Yet if they actually want a healthy and balanced baby, usually women have actually only two opportunities to have actually a healthy and balanced baby, especially along with type 1 diabetes. They’re told they have actually two healthy and balanced kids, that’s great. So the honest truth is, it’s a window of opportunity to teach them exactly how to restrict carbohydrate, exactly how to take their insulin, exactly how to go to the doc, exactly how to get hold of their blood sugars in much better and much better control. Then boom, they have actually permission to get hold of pregnant. I mean we’re talking regarding a short period of time you have actually to have actually tight control.
Steve Freed: Yet it’s quite difficult for people to get hold of their blood sugars down. Because, mostly, as a result of nutrition.
Dr. Jovanovic: Thus we’re spine to the same question.
Steve Freed: And exactly how essential is bodily activity?
Dr. Jovanovic: Actually it’s probably not that essential since pregnant women are young and healthy. Yet the honest truth is pregnancy has actually its own risk factors on the heart, and surely there are cardiologists that will certainly tell women that they’ve got a heart defect, they shouldn’t get hold of pregnant. That’s a whole different question. Exercise, we’ve done the research on exercise, using Physical exercise as a treatment modality, Yet Physical exercise ends up bouncing the uterus and improves the risk for spontaneous abortion. So the honest truth is, it actually numerous times obstetricians will certainly say lie down, Merely relax your uterus is contracting and therefore pregnancy actually isn’t the time you ought to start to exercise, and if you’re attempting to get hold of pregnant, it could be a demand you’re not getting pregnant is since you’re working out so much that your physique is stressed and tension hormones don’t let you ovulate. It’s not that I’m versus exercise, it’s Merely the right time in your life to believe that you’re going to become a marathon runner.
This is a 5-section transcript. Part 1 | Part 2 | Part 3 | Part 4 | Part 5