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Diabetes/Value-Based Care (transcript)
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>> ANNOUNCER: "SECOND OPINION" IS BROUGHT TO YOU BY BLUECROSS BLUESHIELD. ACCEPTED IN ALL 50 STATES. BLUECROSS BLUESHIELD. LIVE FEARLESS.

 

>> ANNOUNCER: "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

 

>> DR. PETER SALGO: THIS IS "SECOND OPINION," AND I'M YOUR HOST, DR. PETER SALGO. THIS WEEK, "MYTH OR MEDICINE."

 

>> DR. STEPHEN HAMMES: WEIGHT LOSS CAN IMPROVE TYPE 2 DIABETES, BUT WILL IT CURE IT? FIND OUT THIS WEEK ON "MYTH OR MEDICINE."

 

>> DR. PETER SALGO: AND SPECIAL GUEST MARK LEE. HE DIDN'T REALIZE HIS LIFESTYLE WAS MAKING HIM SICK... UNTIL HE GOT A SURPRISING DIAGNOSIS.

 

>> MARK LEE: AND THEY SAID, "WELL, YOU KNOW, YOU CAN GET HEART DISEASE, KIDNEY FAILURE, LOSE A LEG, YOU COULD GO BLIND."

 

>> DR. PETER SALGO: HE'S HERE FOR A SECOND OPINION.

 

>> DR. PETER SALGO: MARK, THANK YOU SO MUCH FOR JOINING US TODAY. I'M GLAD YOU'RE HERE. WE'VE GOT A LOT TO TALK ABOUT. YOU'VE GOT A LOT TO SHARE WITH US, I KNOW. SO, LET'S GET RIGHT TO WORK. LET ME INTRODUCE YOU TO YOUR "SECOND OPINION" DOCTORS. THEY'LL BE HEARING YOUR STORY FOR THE VERY FIRST TIME. THEY'RE DR. ROBERT GABBY FROM JOSLIN DIABETES CENTER IN HARVARD MEDICAL SCHOOL. WELCOME. AND DR. LOU PAPA, OUR "SECOND OPINION" PRIMARY CARE PHYSICIAN, FROM THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. SO, WHY DON'T WE GET TO YOUR STORY? THERE YOU WERE, MINDING YOUR OWN BUSINESS -- YOU'RE A HOCKEY FAN.

 

>> MARK LEE: RIGHT, SIR.

 

>> DR. PETER SALGO: TELL ME A LITTLE BIT ABOUT YOURSELF. WHEN THIS ALL BEGAN, HOW OLD WERE YOU?

 

>> MARK LEE: I WAS 48.

 

>> DR. PETER SALGO: OKAY.

 

>> MARK LEE: 48. FAIRLY YOUNG, I GUESS.

 

>> DR. PETER SALGO: I THINK SO.

 

>> MARK LEE: AT THAT TIME. [ BOTH LAUGH ]

 

>> DR. PETER SALGO: AND WHERE WERE YOU WHEN YOU NOTICED SOMETHING WAS WRONG?

 

>> MARK LEE: WELL, MY EYES STARTED GOING A LITTLE BLURRY.

 

>> DR. PETER SALGO: HOW DID YOU KNOW THAT?

 

>> MARK LEE: WELL, I NOTICED IT FOR SURE -- I WAS A BIG HOCKEY FAN. WE WENT TO A HOCKEY GAME, AND THE FANS ON THE OTHER SIDE WERE ALL BLURRY. THE PUCK WAS BLURRY. THE PLAYERS WERE BLURRY. I BORROWED MY WIFE'S GLASSES, EVEN, TO WATCH THE GAME. AND, SO, THINGS WERE -- STRANGE THINGS WERE HAPPENING.

 

>> DR. PETER SALGO: SO, YOU TOOK THAT AS A SIGN YOU OUGHT TO SEE SOMEBODY?

 

>> MARK LEE: YEAH, YEAH. I DIDN'T KNOW WHAT WAS -- AT FIRST I THOUGHT IT WAS OLD AGE, BUT IT WAS HAPPENING SO FAST THAT I FIGURED IT WAS PROBABLY SOMETHING OTHER THAN OLD AGE.

 

>> DR. PETER SALGO: WERE THERE ANY OTHER PROBLEMS THAT, IN RETROSPECT, YOU'D BEEN SUFFERING FROM BEFORE THAT?

 

>> MARK LEE: OTHER THAN -- IN RETROSPECT, MAYBE BEING TIRED A LOT. I WAS WIPED OUT QUITE A BIT.

 

>> DR. PETER SALGO: OKAY. SO, LOU...

 

>> DR. LOU PAPA: MM-HMM.

 

>> DR. PETER SALGO: ...PRIMARY CARE PHYSICIAN. THIS CAN'T BE AN USUAL STORY FOR YOU.

 

>> DR. LOU PAPA: IT'S NOT.

 

>> DR. PETER SALGO: I MEAN, SOMEBODY COMES IN WITH VISUAL CHANGES, FATIGUE...

 

>> DR. LOU PAPA: FATIGUE, SURE. RIGHT.

 

>> DR. PETER SALGO: ...47, 46, 48. WHAT'S YOUR DIFFERENTIAL? WHAT ARE YOU THINKING?

 

>> DR. LOU PAPA: THERE'S LOTS OF THINGS. I MEAN, THERE'S NEUROLOGIC CAUSES THAT CAN DO THAT. IT WOULD BE UNUSUAL IN BOTH EYES. BUT VERY OFTEN, WHEN YOU HEAR SOMETHING LIKE THAT, I WORRY ABOUT THE BLOOD SUGAR, OR THE BLOOD-SUGAR LEVEL BECOMING VERY HIGH, CHANGING THE WAY THE LENS FOCUSES, AND YOU END UP WITH BLURRY VISION.

 

>> DR. PETER SALGO: IS THERE ANYTHING YOU WANT TO ASK MARK BEFORE WE MOVE ON?

 

>> DR. LOU PAPA: SO, DID YOU HAVE -- IN ADDITION TO THAT FATIGUE, DID YOU HAVE ANY OTHER SYMPTOMS? LIKE, WERE YOU URINATING A LOT? WERE YOU DRINKING A LOT OF FLUIDS?

 

>> MARK LEE: YOU KNOW, I'VE HEARD THAT, BUT I DON'T RECALL THAT. MAYBE I DID AT THE TIME, BUT IT'S NOT SOMETHING I RECALL.

 

>> DR. PETER SALGO: OKAY, SO, YOU'RE POKING AROUND THERE.

 

>> DR. LOU PAPA: RIGHT.

 

>> DR. PETER SALGO: THESE ARE ALL SIGNS AND SYMPTOMS OF DIABETES, RIGHT?

 

>> DR. LOU PAPA: RIGHT, RIGHT.

 

>> DR. PETER SALGO: OKAY.

 

>> DR. LOU PAPA: AND ESPECIALLY SOMEBODY LIKE HIM -- IF YOU THINK ABOUT, AT THIS POINT, ADULT-ONSET OR TYPE 2 DIABETES, IT'S NOT UNUSUAL THAT THEY DON'T HAVE THE URINARY SYMPTOMS.

 

>> DR. PETER SALGO: OKAY. WE'LL GET TO THAT. SO, MARK, YOU DO GO TO YOUR DOCTOR.

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: YOU TELL HIM ABOUT THE FACT THAT YOU CAN'T SEE THE PUCK.

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: WHAT DID YOUR DOCTOR DO, AND WHAT DID YOUR DOCTOR SAY?

 

>> MARK LEE: WELL, THEY TOOK A BLOOD TEST, AND HE BASICALLY TOLD ME THAT I HAD DIABETES.

 

>> DR. PETER SALGO: AND HOW DID HE KNOW THAT?

 

>> MARK LEE: MY BLOOD SUGAR WAS 276.

 

>> DR. PETER SALGO: OKAY.

 

>> MARK LEE: OR MY GLUCOSE, I BELIEVE, WAS 276. MY A1C WAS 7.6 WHEN HE TOOK THOSE.

 

>> DR. PETER SALGO: NOW, THAT A1C -- I THINK MOST PEOPLE KNOW THAT, IN DIABETES, THE SUGAR CONTENT OF YOUR BLOOD GOES UP. BUT THIS A1C IS A RELATIVELY NEW NUMBER FOR MANY PEOPLE. WHAT IS THAT?

 

>> DR. ROBERT GABBY: SO, IT'S A GREAT TOOL 'CAUSE IT GIVES AN AVERAGE OF WHAT THE BLOOD SUGARS HAVE BEEN OVER THE LAST THREE MONTHS.

 

>> DR. PETER SALGO: SO, IT'S KIND OF AN AVERAGING NUMBER. WHEN YOUR BLOOD HAS BEEN BATHED IN SUGAR...

 

>> DR. ROBERT GABBY: YES.

 

>> DR. PETER SALGO: ...FOR A LONG TIME, EVEN IF, AT THE MOMENT THEY CHECK YOUR BLOOD SUGAR, IT'S OKAY, IF THE A1C IS UP, THAT'S A TELL.

 

>> DR. ROBERT GABBY: IT MEANS IT'S BEEN HIGH FOR, YOU KNOW, SOME PERIOD OF TIME.

 

>> DR. LOU PAPA: THAT SINGLE BLOOD SUGAR -- I EXPLAIN TO PATIENTS, THAT SINGLE BLOOD SUGAR IS LIKE TAKING A SNAPSHOT. HEMOGLOBIN A1C IS LIKE A MOVIE. IT GIVES YOU A BETTER IDEA WHAT'S GOING ON LONG-TERM.

 

>> DR. PETER SALGO: OKAY, SO, WE CAN ALL SAY THIS IN UNISON, PANEL. WHAT DOES HE HAVE?

 

>> TOGETHER: DIABETES. [ LAUGHTER ]

 

>> DR. PETER SALGO: AND ONE PARTICULAR TYPE. YOU SAID TYPE 2?

 

>> DR. LOU PAPA: I USUALLY THINK OF TYPE 2. IT'S POSSIBLE HE COULD HAVE TYPE 1, BUT USUALLY THE TYPE 1S ARE PRETTY DRAMATIC IN THEIR PRESENTATIONS. THEY'RE PRETTY SICK. YOU KNOW, THEY'RE VOMITING. THEY GET INTO KETOACIDOSIS. THE TYPE 2 IS USUALLY A LITTLE BIT MORE INLAND. HE'S A LITTLE UNUSUAL IN LOOKING AT HIM NOW. USUALLY THEY TEND TO BE OVERWEIGHT OR OBESE. THERE'S OTHER RISK FACTORS.

 

>> DR. PETER SALGO: FIRST OF ALL, DID THEY GET THE DIAGNOSIS RIGHT?

 

>> MARK LEE: ABSOLUTELY. YEAH.

 

>> DR. PETER SALGO: THEY WENT TO MEDICAL SCHOOL, AND THEY STUDIED.

 

>> DR. ROBERT GABBY: PHEW! [ LAUGHTER ]

 

>> MARK LEE: THAT'S A RELIEF, YEAH.

 

>> DR. PETER SALGO: OKAY, SO. WE'RE NOT HERE TO TRICK YOU TODAY.

 

>> DR. ROBERT GABBY: OKAY.

 

>> DR. PETER SALGO: AT THE TIME, WERE YOU OVERWEIGHT?

 

>> MARK LEE: YES. I WAS ABOUT 200 POUNDS AT THE TIME, WHICH, FOR ME, IS OVERWEIGHT. I MEAN, I'M NOT A BIG MUSCLE GUY, SO IT WAS ALL OVERWEIGHT.

 

>> DR. PETER SALGO: AND WHEN YOU HEARD THE DIAGNOSIS THAT YOU HAD TYPE 2 DIABETES, WHAT HAPPENED TO YOU? WHAT WERE YOU THINKING? WHAT WAS YOUR RESPONSE?

 

>> MARK LEE: I THINK, AT FIRST, I WENT MORE BLANK THAN ANYTHING, 'CAUSE I DIDN'T KNOW WHAT TO THINK. IT DIDN'T RUN IN MY FAMILY. MY PARENTS DON'T HAVE IT. MY PARENTS' PARENTS DON'T HAVE IT. I KNOW NO ONE IN MY FAMILY THAT HAS IT.

 

>> DR. PETER SALGO: OKAY.

 

>> MARK LEE: SO, I WAS JUST -- I WENT BLANK. AND, YOU KNOW, THE DOCTOR STARTED -- I ASKED QUESTIONS, AND THEY SAID, "WELL, YOU KNOW, YOU CAN GET HEART DISEASE, KIDNEY FAILURE, LOSE A LEG, YOU COULD GO BLIND."

 

>> DR. PETER SALGO: YOU GOT THE OLD DIABETES LECTURE.

 

>> MARK LEE: RIGHT.

 

>> DR. PETER SALGO: WHICH IS TRUE, BY THE WAY. IT'S A BAD DISEASE.

 

>> DR. ROBERT GABBY: IT CAN. IT CAN. BUT IT ALSO CANNOT.

 

>> DR. PETER SALGO: BUT YOU ALLUDED TO TWO DIFFERENT TYPES OF DIABETES HERE. CAN YOU MAKE A DISTINCTION? WHAT'S TYPE 2 DIABETES AS OPPOSED TO -- CLEARLY, BY IMPLICATION, THERE'S A TYPE 1. WHAT'S THE DIFFERENCE?

 

>> DR. ROBERT GABBY: SO, MOST PEOPLE HAVE TYPE 2. THAT'S ABOUT 90% OF PEOPLE WITH DIABETES HAVE TYPE 2.

 

>> DR. PETER SALGO: OKAY.

 

>> DR. ROBERT GABBY: AND TYPE 1, ABOUT 10%.

 

>> DR. PETER SALGO: HOW DOES IT DIFFER?

 

>> DR. ROBERT GABBY: SO, TYPE 2, WHAT HAPPENS IS THE BODY BECOMES RESISTANT TO THE EFFECTS OF INSULIN. INSULIN'S THE HORMONE THAT HELPS CONTROL BLOOD SUGAR. BECOME RESISTANT TO THE EFFECTS OF INSULIN, MAKE EXTRA INSULIN TO COMPENSATE. AND WHEN YOU CAN'T MAKE THAT EXTRA INSULIN ANYMORE, YOU DEVELOP DIABETES.

 

>> DR. PETER SALGO: SO, I'VE OFTEN HEARD IT DESCRIBED THIS WAY -- YOU'RE THE DIABETES EXPERT -- IT'S INSULIN RESISTANCE.

 

>> DR. ROBERT GABBY: YES.

 

>> DR. PETER SALGO: THE NORMAL AMOUNT OF INSULIN DOESN'T DO WHAT IT ORDINARILY WOULD DO. SO, YOUR PANCREAS RAMPS UP...

 

>> DR. ROBERT GABBY: RAMPS UP TO COMPENSATE.

 

>> DR. PETER SALGO: ...YOU MAKE MORE, AND EVENTUALLY YOU JUST RUN OUT OF GAS.

 

>> DR. ROBERT GABBY: AND IT'S SORT OF -- EXACTLY RIGHT. AND IT'S TWO THINGS. SO, IT'S THAT RESISTANCE TO INSULIN, BUT ALSO THE INABILITY TO OVERCOME IT BY RAMPING UP THE PANCREAS.

 

>> DR. PETER SALGO: AND THE LONG-TERM PROBLEMS WITH TYPE 2? I THINK HE ALLUDED TO SOME OF THEM.

 

>> DR. ROBERT GABBY: YEAH, SO, IT CAN AFFECT THE EYES, KIDNEYS, AND NERVES. AS THREE -- AND, YOU KNOW, THE LEADING CAUSE OF BLINDNESS IN ADULTS, IT'S THE LEADING CAUSE OF KIDNEY FAILURE. IT CAN LEAD TO AMPUTATIONS, HEART DISEASE.

 

>> DR. PETER SALGO: IS HE DOOMED? DOES EVERYBODY WITH TYPE 2 DIABETES GET THESE COMPLICATIONS?

 

>> DR. ROBERT GABBY: NOT AT ALL.

 

>> DR. LOU PAPA: THAT'S THE THING. THEY'RE NOT DOOMED.

 

>> DR. ROBERT GABBY: YEAH, THAT'S THE GREAT THING, IS THAT WE'VE MADE SO MANY ADVANCES IN UNDERSTANDING WHAT LEADS TO THOSE COMPLICATIONS AND CAN LARGELY PREVENT THEM.

 

>> DR. PETER SALGO: HOW DO YOU PREVENT THEM? WHAT DO YOU RECOMMEND?

 

>> DR. ROBERT GABBY: WELL, YOU KNOW, IT'S A VARIETY OF THINGS. BUT IT'S CONTROLLING, YOU KNOW, THREE KEY THINGS.

 

>> DR. PETER SALGO: YEAH?

 

>> DR. ROBERT GABBY: WE TEND TO SAY "THE ABCS." A1C, WHICH IS THAT MEASURE OF YOUR BLOOD SUGAR. SO, CONTROLLING BLOOD SUGAR. "B" FOR BLOOD PRESSURE, 'CAUSE MANY PEOPLE HAVE HIGH BLOOD PRESSURE THAT HAVE DIABETES. AND "C" FOR CHOLESTEROL -- CONTROLLING THAT. THOSE THREE...

 

>> DR. PETER SALGO: THAT STUFF.

 

>> DR. ROBERT GABBY: ...IF YOU GET THOSE RIGHT, YOU CAN LARGELY PREVENT ALL OF THESE COMPLICATIONS.

 

>> DR. LOU PAPA: BUT THE OTHER PART, FOR A PRIMARY CARE DOCTOR, THIS CAN BE KIND OF A POINT OF EXCITEMENT OR A POINT OF DOOM. BECAUSE FOR A LOT OF PATIENTS, IT'S YOUR OPPORTUNITY TO SAY, "THIS CAN CHANGE FOR YOU." IF YOU'RE OVERWEIGHT, YOU HAVEN'T BEEN ACTIVE, YOU HAVEN'T BEEN EATING RIGHT, YOU CAN REVERSE THAT DIABETES. YOU CAN HAVE A SIGNIFICANT -- IT TAKES A LOT OF WORK, BUT IT'S LIKE A BRANCH POINT IN THE ROAD FOR THAT PATIENT.

 

>> DR. PETER SALGO: AND YOU DECIDED THAT YOU WERE GONNA BEAT THE ODDS...

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: ...AND TAKE SOME CONTROL OF YOUR HEALTHCARE. THEY PUT YOU ON MEDICATION.

 

>> MARK LEE: METFORMIN, RIGHT.

 

>> DR. PETER SALGO: A DRUG -- METFORMIN. HOW'D YOU LIKE THAT DRUG?

 

>> MARK LEE: IT WASN'T VERY GOOD AT FIRST. I GOT A LITTLE QUEASY FROM IT.

 

>> DR. PETER SALGO: AND THEN, WHAT DID YOU DO TO TAKE CONTROL OF YOUR HEALTHCARE?

 

>> MARK LEE: I WORKED WITH THE DOCTOR TO TRY TO GET OFF THE METFORMIN.

 

>> DR. PETER SALGO: YOU WERE ON A DOSE AND DECREASED IT.

 

>> MARK LEE: GRADUALLY. GRADUALLY.

 

>> DR. PETER SALGO: BUT YOU DID OTHER THINGS.

 

>> MARK LEE: WORKED OUT.

 

>> DR. PETER SALGO: YOU LOST WEIGHT.

 

>> MARK LEE: DIET, EXERCISE. YES.

 

>> DR. PETER SALGO: DID YOU WORK WITH A NUTRITIONIST?

 

>> MARK LEE: I WORKED WITH A NUTRITIONIST. I SAW HER PROBABLY THREE OR FOUR TIMES AND DID THAT AND WAS ABLE TO LOSE SOME WEIGHT AND CHANGE MY DIET.

 

>> DR. PETER SALGO: HOW MUCH WEIGHT DID YOU LOSE?

 

>> MARK LEE: 54 POUNDS.

 

>> DR. PETER SALGO: WOW.

 

>> MARK LEE: AND PROBABLY LOST IT TOO FAST AT FIRST.

 

>> DR. PETER SALGO: OKAY. AND YOU KEPT REDUCING?

 

>> MARK LEE: YEAH. I GUESS I SHOULD EXPLAIN IT. I WORKED WITH THE DOCTOR. I WENT THERE ONE TIME, AND I SAID, "CAN I GET OFF THIS METFORMIN?" AND SHE SAID, "WELL, LET'S TRY THIS." AND I SAID ALL RIGHT. SO, I CUT BACK A LITTLE BIT. I WORKED OUT FOR SIX MONTHS. I CONTROLLED MY DIET. AND THEN I WENT BACK THERE AND HAD MY A1C TEST, AND IT CAME BACK NORMAL. I SAID, "LET'S TRY IT AGAIN." WE DID IT FOR ANOTHER SIX MONTHS. DID IT AGAIN. FINALLY, AFTER ABOUT A YEAR, I SAID, "I WANT TO TRY IT WITHOUT ANY MEDICINE." AND SHE SAID, "WELL, YOU'VE DONE SO WELL SO FAR, SO LET'S GO AHEAD AND GIVE THIS A TRY."

 

>> DR. PETER SALGO: WOULD YOU HAVE ALLOWED HIM TO GO OFF HIS MEDICINE?

 

>> DR. ROBERT GABBY: ABSOLUTELY. YEAH. YOU KNOW, I THINK THE OTHER KEY PIECE HERE IS -- AND I DON'T KNOW IF YOU WERE DOING THIS AT THE TIME, BUT -- SOME DEGREE OF MONITORING, WHETHER THAT'S THROUGH YOUR DOCTOR'S OFFICE OR CHECKING YOUR OWN BLOOD SUGAR.

 

>> MARK LEE: OH, I WAS. YEAH.

 

>> DR. ROBERT GABBY: THAT PROVIDES THE ASSURANCE THAT, YEAH, BLOOD SUGARS ARE DOING WELL AND CAN GET OFF THE MEDICATION.

 

>> DR. PETER SALGO: SO, YOU HAD NOT ONLY YOUR DOCTOR...

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: ...BUT A TEAM OF NUTRITIONISTS.

 

>> MARK LEE: YES.

 

>> DR. PETER SALGO: AND YOU WERE AN ACTIVE PARTICIPANT...

 

>> MARK LEE: YES.

 

>> DR. PETER SALGO: ...IN WHAT YOU WERE DOING. DOES THAT MAKE A DIFFERENCE?

 

>> DR. ROBERT GABBY: OH, COMPLETELY NIGHT AND DAY.

 

>> LOU PAPA: IT'S EVERYTHING.

 

>> DR. PETER SALGO: WHY IS IT EVERYTHING?

 

>> BOTH: WELL --

 

>> DR. ROBERT GABBY: GO AHEAD.

 

>> DR. LOU PAPA: I MEAN, PART OF IT IS, IS FROM THE PRIMARY CARE PERSPECTIVE, UNLESS THE PATIENT -- THEY'RE DRIVING THE BUS. UNLESS THEY'RE REALLY SEEING THE NEED TO CHANGE THEIR LIFESTYLE AND THEIR EATING AND TO REALLY WORK ON LOSING THE WEIGHT, I'M NOT GONNA MAKE MUCH OF AN IMPACT.

 

>> DR. PETER SALGO: IS IT FAIR TO SAY THAT WHAT HE EXPERIENCED WAS A REALLY GOOD EXAMPLE OF WHAT'S CALLED PATIENT-CENTERED CARE? WHAT HE NEEDED, HE GOT. AND HE WAS PART OF THE TEAM DRIVING THE BUS.

 

>> DR. ROBERT GABBY: IN FACT, THE DRIVER.

 

>> DR. LOU PAPA: RIGHT.

 

>> DR. PETER SALGO: THE DRIVER.

 

>> MARK LEE: I MEAN, I REMEMBER DOING ALL THE BLOOD -- FINGER-PRICKING BEFORE MEALS, DURING MEALS, AFTER MEALS, TWO HOURS AFTER, AND LEARNING HOW ALL THESE FOODS REACTED TO MY BODY. SO, OVER TIME, I WAS ABLE TO ACTUALLY LEARN, YOU KNOW, JUST HOW THESE -- WHAT FOODS DO CERTAIN THINGS TO MY BODY.

 

>> DR. PETER SALGO: AND WHAT DID YOU DO ATHLETICALLY, BY THE WAY?

 

>> MARK LEE: WELL, OVER TIME, I DEVELOPED -- STARTED PLAYING HOCKEY AGAIN IN MY NEW LIFESTYLE.

 

>> DR. PETER SALGO: GOOD CHOICE OF SPORTS. AND WE'RE GONNA GET TO THAT IN A LITTLE BIT. BUT I WANT TO STOP RIGHT HERE, BECAUSE PATIENT-CENTERED CARE SEEMS REALLY LIKE A NO-BRAINER. THE PATIENT'S THE ONE WITH THE PROBLEM, THE PATIENT SHOULD BE PART OF THE SOLUTION, RIGHT? OKAY. THE PROBLEM IS THAT IT ISN'T ALWAYS THAT WAY. AND, NOW, YOU'VE DONE INCREDIBLY WELL. BY THE WAY, I'M THRILLED, AS ARE WE ALL. BUT NOT ALL TYPE 2 DIABETICS HAVE THIS KIND OF A STORY. THE CARE OF PEOPLE LIKE MARK DOESN'T ALWAYS LOOK LIKE THIS. AND THERE ARE PEOPLE WHO WANT TO CHANGE THAT. THEY WANT YOU TO BE WHAT'S NORMAL, NOT THE EXCEPTION TO THE RULE.

 

>> DR. LOU PAPA: ABSOLUTELY.

 

>> DR. PETER SALGO: AND THEY'VE FIGURED OUT A WAY THAT THEY THINK THEY CAN HELP MAKE THAT HAPPEN. AND WE'RE GONNA TALK ABOUT THAT RIGHT AFTER THIS WEEK'S "MYTH OR MEDICINE."

 

>> NARRATOR: IF YOU HAVE TYPE 2 DIABETES, YOU MAY HAVE HEARD THAT LOSING WEIGHT CAN GET YOU OFF INSULIN AND OTHER MEDICATIONS. AND PERHAPS THE MORE WEIGHT LOSS, THE BETTER THE OUTCOME. DOES THIS MEAN SIGNIFICANT WEIGHT LOSS CAN CURE TYPE 2 DIABETES? IS THIS MYTH OR MEDICINE?

 

>> DR. STEPHEN HAMMES: LOSING A LOT OF WEIGHT WILL CURE TYPE 2 DIABETES. THIS IS A MYTH, AND I'LL TELL YOU WHY. MY NAME IS STEVE HAMMES, AND I'M THE CHIEF OF THE DIVISION OF ENDOCRINOLOGY AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. TO EXPLAIN WHY WEIGHT LOSS WON'T CURE TYPE 2 DIABETES, IT'S IMPORTANT TO FIRST UNDERSTAND WHAT GOES WRONG IN TYPE 2 DIABETES. THERE ARE BASICALLY TWO PROBLEMS. THE FIRST IS THAT THE BODY DEVELOPS A RESISTANCE TO INSULIN, WHICH IS THE HORMONE THAT REGULATES GLUCOSE LEVELS. AND THIS DIRECTLY CORRELATES WITH WEIGHT, SO THE HEAVIER YOU ARE, THE MORE INSULIN RESISTANCE YOU HAVE. THE SECOND THING THAT GOES WRONG IS THERE'S AN INTRINSIC DEFECT IN THE PANCREAS, WHICH IS THE ORGAN THAT MAKES INSULIN. SO, THEN, YOU CAN IMAGINE, IF YOU CAN LOSE WEIGHT, THE INSULIN RESISTANCE WILL IMPROVE, AND EVEN THIS DAMAGED PANCREAS MIGHT NOW BE ABLE TO KEEP UP, AND SO THE DIABETES WILL APPEAR TO GO AWAY. BUT THIS INTRINSIC PROBLEM WITH THE PANCREAS NEVER REALLY DISAPPEARS. SO IF THE WEIGHT COMES BACK ON, OR SOMETIMES JUST WITH TIME OR WITH STRESS, THEN THIS DEFECTIVE PANCREAS CAN NO LONGER KEEP UP, AND THEN THE DIABETES WILL RETURN. AND THAT'S MEDICINE.

 

>> NARRATOR: NOT SURE IF IT'S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE'LL GET TO WORK AND GET YOU A SECOND OPINION.

 

>> DR. PETER SALGO: WE'RE BACK HERE WITH MARK LEE. AGAIN, MARK, THANK YOU FOR BEING HERE. YOUR STORY IS ONE OF REALIZING, WITH YOUR DOCTOR'S HELP AND YOUR TEAM'S HELP, YOU HAD TYPE 2 DIABETES.

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: YOU TOOK CONTROL OF YOUR HEALTHCARE. YOU WENT ON A DIET/EXERCISE PROGRAM, LOST WEIGHT, GOT OFF THE MEDICATION YOU DIDN'T LIKE. ALL OF THIS IS TERRIFIC. NOW, PANEL, I WANT TO TURN THIS UPSIDE DOWN, ALL RIGHT? HERE'S A STORY, MARK, OF HEALTHCARE GONE RIGHT. AND THAT'S, OF COURSE, WHY HE'S HERE TODAY, BECAUSE WE LOVE HEALTHCARE GONE RIGHT. BUT THERE'S SOMETHING ELSE GOING ON OUT THERE IN THE PATIENT-CARE COMMUNITY CALLED VALUE-BASED CARE, WHICH IS WHERE DOCTORS TRY TO MAKE A LOT MORE MARKS HAPPEN IN THE REAL WORLD. WHAT IS VALUE-BASED CARE?

 

>> DR. ROBERT GABBY: WELL, YOU KNOW, IT'S CHANGING THE INCENTIVES. YOU KNOW, EVERY SYSTEM IS PERFECTLY DESIGNED FOR THE OUTCOMES THAT IT GETS. AND SO IF YOU LOOK AT OUR CURRENT HEALTHCARE SYSTEM, THE INCENTIVES ARE, REALLY, FINANCIALLY, FOR PEOPLE NOT TO GET WELL.

 

>> DR. PETER SALGO: WAIT A MINUTE. LET'S EXPLAIN THAT.

 

>> DR. ROBERT GABBY: YES.

 

>> DR. PETER SALGO: "NOT TO GET WELL." AS I UNDERSTAND IT, WHAT YOU'RE TALKING ABOUT IS INDICTMENT OF THE FEE-FOR-SERVICE PAYMENT SYSTEM WHERE, IF A DOCTOR DOES SOMETHING HE OR SHE GETS PAID. IF SOME UNFORTUNATE THING THEN HAPPENS AND YOU HAVE TO FIX IT, YOU GET PAID AGAIN.

 

>> BOTH: RIGHT.

 

>> DR. PETER SALGO: SO THE INCENTIVE IS TO...

 

>> DR. ROBERT GABBY: AND IN A WEIRD WAY, THE SICKER PEOPLE ARE, THE MORE -- YOU KNOW, MORE OPPORTUNITIES THERE ARE TO DO PROCEDURES AND OTHER THINGS THAT ARE WELL-REIMBURSED. WHAT ISN'T INCENTIVIZED, I GUESS, AND MAYBE THIS IS WHERE IT'S HELPFUL TO THINK, IS THE INCENTIVES TO KEEP PEOPLE WELL.

 

>> DR. LOU PAPA: MM-HMM.

 

>> DR. ROBERT GABBY: AND THAT REQUIRES THE KIND OF CARE THAT HE RECEIVED, THAT REALLY -- WORKING WITH A NUTRITIONIST, WORKING WITH A TEAM TO REALLY FOCUS ON LIFESTYLE.

 

>> DR. PETER SALGO: BUT IN ORDER TO MAKE VALUE-BASED CARE WORK -- THE WORD "VALUE" IS IN THERE FOR A REASON. THE FIRST THING YOU TALKED ABOUT WAS MONEY.

 

>> DR. ROBERT GABBY: YEP.

 

>> DR. PETER SALGO: I MEAN, YOU DIDN'T TALK ABOUT DRUGS, YOU DIDN'T TALK ABOUT DISEASE. YOU SAID MONEY.

 

>> DR. LOU PAPA: RIGHT.

 

>> DR. PETER SALGO: AND AT THE HEART OF ALL OF THIS IS TO CAP COSTS, OR KEEP THEM UNDER CONTROL.

 

>> DR. LOU PAPA: ABSOLUTELY.

 

>> DR. PETER SALGO: AND THAT REQUIRES SOME UNDERSTANDING OF WHAT WORKS AT WHAT COST.

 

>> DR. LOU PAPA: RIGHT.

 

>> DR. PETER SALGO: AND IT SAYS, "IF SOMETHING'S REALLY EXPENSIVE AND DOESN'T WORK VERY WELL, DON'T DO IT."

 

>> DR. LOU PAPA: WELL, THAT'S THE BEAUTY OF VALUE-BASED CARE IN SOME RESPECTS, IS THAT YOU REALLY HAVE TO HAVE EVIDENCE-BASED MEDICINE. YOU REALLY HAVE TO ROLL IT INTO WHAT YOU'RE DOING. AND YOU HAVE TO WORK ON SOME OF THE VARIANTS THAT OCCURS IN MEDICINE. SO, ONE WAY THAT DIABETES IS TREATED IN ONE PLACE MAY BE COMPLETELY DIFFERENT IN ANOTHER PLACE, AND THEIR OUTCOMES ARE VERY DIFFERENT. BUT THERE'S EVIDENCE TO SHOW THAT IT SHOULD BE TREATED A CERTAIN WAY ACROSS THE BOARD.

 

>> DR. PETER SALGO: DOES THAT SOUND RATIONAL TO YOU?

 

>> MARK LEE: YEAH. WELL, IT'S INTERESTING, 'CAUSE WHAT IF YOU'RE A REALLY SICK PERSON AND YOU HAVE A LESS CHANCE OF SURVIVING?

 

>> DR. LOU PAPA: THAT'S OUR CONCERN.

 

>> DR. PETER SALGO: RIGHT AWAY, OUR INSIGHTFUL PATIENT HAS FOUND THE WORMHOLE. THE WORMHOLE.

 

>> DR. ROBERT GABBY: BUT IN ANY KIND OF TREATMENT, THERE ARE THINGS THAT ARE HIGHER VALUE AND THINGS THAT ARE LOWER VALUE.

 

>> DR. PETER SALGO: BUT STOP. STOP FOR A MOMENT, OKAY? I'M JUST GONNA PLAY DEVIL'S ADVOCATE, AGAIN, 'CAUSE YOU'RE USING THE WORD "VALUE"...

 

>> DR. ROBERT GABBY: YEP.

 

>> DR. PETER SALGO: ...AND LET'S TALK ABOUT VALUE, NOW, IN TERMS OF PROVEN TO WORK DIVIDED BY COST, RIGHT?

 

>> DR. ROBERT GABBY: DIVIDED BY COST. RIGHT.

 

>> DR. PETER SALGO: THAT'S VALUE-BASED.

 

>> DR. ROBERT GABBY: EXACTLY. EXACTLY.

 

>> DR. PETER SALGO: YOU'VE GOT TO HAVE PROOF IT WORKS.

 

>> DR. ROBERT GABBY: YEAH. ABSOLUTELY.

 

>> DR. PETER SALGO: AND IN MY EXPERIENCE, A HECK OF A LOT OF MEDICINE HAS NO PROOF. IF WE DO VALUE-BASED MEDICINE, ARE WE GONNA STOP DOING THINGS THAT WE THINK WORK?

 

>> DR. LOU PAPA: I THINK A LOT OF IT'S GONNA FOCUS AT LEAST ON THE THINGS THAT WE KNOW DO WORK. I MEAN, ESPECIALLY FOR THE BIG DISEASES. PART OF THE CONCERN I HAVE AS A PRIMARY CARE DOCTOR WITH SOME OF THE VALUE-BASED CARE IS, FOR A LOT OF DISEASE PROCESSES, FOR THE SPECIALISTS, THEY'RE FOCUSING ON A SPECIFIC DISEASE PROCESS. PRIMARY CARE, WE HAVE TO FOCUS ON DOZENS. AND THE PROBLEM THAT COMES DOWN TO VERY OFTEN IS, "OKAY, THE PATIENT STILL HAS TO BE A PARTICIPANT." AND THERE'S PATIENTS OUT THERE, IT'S REALLY DIFFICULT TO GET THEM TO PARTICIPATE. SO HOW DO YOU BRING THE VALUE TO THEM?

 

>> DR. PETER SALGO: IN FACT, LET ME GO ONE STEP FURTHER. YOU WERE VERY AGGRESSIVE, VERY ACTIVE.

 

>> MARK LEE: CORRECT.

 

>> DR. PETER SALGO: WHY DO YOU THINK YOU WERE? WHAT IS IT ABOUT YOU THAT MADE YOU WORK SO HARD AT THIS AND OTHER PATIENTS DON'T?

 

>> MARK LEE: WELL, FOR ME, IT WAS – I MEAN, I WAS TOTALLY SCARED BY IT.

 

>> DR. PETER SALGO: FEAR.

 

>> MARK LEE: FEAR. YEAH. ABSOLUTELY. AND I KNEW NOTHING ABOUT IT. AND THINGS -- WHEN I STARTED READING ABOUT IT, ONE OF THE THINGS I SAW WERE SCARY, TO SAY THE LEAST.

 

>> DR. PETER SALGO: LOTS OF PEOPLE GET SCARED.

 

>> DR. ROBERT GABBY: YEAH.

 

>> DR. PETER SALGO: NOT EVERYBODY DOES WHAT HE DID.

 

>> DR. ROBERT GABBY: RIGHT, SO, I'M INTERESTED --

 

>> MARK LEE: I DIDN'T WANT TO, YOU KNOW, LIVE THAT WAY. I KNEW I WANTED TO DO SOMETHING ABOUT IT.

 

>> DR. PETER SALGO: OKAY.

 

>> DR. ROBERT GABBY: TO WHAT DEGREE DID THE HEALTHCARE SYSTEM HELP YOU IN THIS PROCESS?

 

>> MARK LEE: WELL, THEY DID QUITE A BIT. THE NUTRITIONIST, SEEING THE EYE DOCTORS. I MEAN, I MADE SURE I DID WHAT THE DOCTORS TOLD ME TO DO. I WASN'T GONNA NOT DO THAT. AND THE WHOLE THING, IF I NEEDED TO GO BACK ON THE MEDICATION, I WAS READY TO GO BACK ON THE MEDICATION IF IT DIDN'T WORK. I WAS LISTENING TO THE DOCTORS.

 

>> DR. PETER SALGO: WELL, LET ME PEEL OFF ANOTHER LAYER, ANOTHER ONION PEEL, IF YOU WILL. OKAY, DOCTORS ARE GONNA GET PAID MORE -- OR AT LEAST NOT GET PAID LESS -- IF THEIR PATIENTS DO WELL. SO, WHY DOESN'T A DOCTOR --

 

>> DR. ROBERT GABBY: THEY'RE PAID FOR RESULTS.

 

>> DR. PETER SALGO: THEY'RE GONNA GET PAID FOR RESULTS.

 

>> DR. ROBERT GABBY: YEAH.

 

>> DR. PETER SALGO: WHY DOESN'T A DOCTOR JUST SAY, "WELL, THAT GUY'S REALLY SICK. I'M NOT GONNA HAVE A GOOD RESULT WITH HIM NO MATTER WHAT I DO. HE CAN'T SEE ME 'CAUSE I'M GONNA GET DINGED"?

 

>> DR. ROBERT GABBY: SO, ONE NEEDS TO BUILD IN SAFEGUARDS TO AVOID THAT, ABSOLUTELY. 'CAUSE PEOPLE WILL GAME THE SYSTEM.

 

>> DR. PETER SALGO: I MEAN, I CAN SEE A WHOLE ARMY OF PEOPLE WHO CAN'T FIND HEALTHCARE.

 

>> DR. LOU PAPA: RIGHT, AND THAT'S PART OF THE PROBLEM, IS THERE IS A PERCENTAGE OF -- THERE'S A GROUP OF DOCTORS -- AND I'LL USE PRIMARY CARE -- THAT THEY'RE TAKING CARE OF A FAIRLY WELL-EDUCATED, AFFLUENT COMMUNITY, AND THEY'LL DO GREAT. AND THEN THERE'S PROVIDERS THAT TAKE CARE OF A POORER, LESS EDUCATED COMMUNITY WITH LESS OPPORTUNITY THAT REQUIRE A BIGGER TEAM TO TAKE CARE OF THOSE PATIENTS, AND THAT REQUIRES MONEY.

 

>> DR. PETER SALGO: I MEAN, YOU KNOW THERE'S A CONCEIT HERE, RIGHT? THE CONCEIT OF VALUE-BASED HEALTHCARE IS WE KNOW IT WORKS AND WE'RE SURE OF IT, AND THAT WE WON'T ALLOW YOU TO DO SOMETHING THAT WE DON'T THINK WORKS EVEN THOUGH YOU DO.

 

>> DR. ROBERT GABBY: I DON'T THINK THE IDEA IS TO NOT ALLOW PEOPLE TO DO CERTAIN THINGS. I THINK IT'S TO EMPOWER THEM TO DO THE THINGS THEY KNOW ARE RIGHT, WHERE THEY DON'T INVEST.

 

>> DR. PETER SALGO: I'M SORRY. LET ME JUST COME RIGHT AT YOU WITH THAT. AND AGAIN, I'M JUST BEING DEVIL'S ADVOCATE.

 

>> DR. ROBERT GABBY: NO, NO, THIS IS GOOD.

 

>> DR. PETER SALGO: I THINK YOU'RE BEING A BIT POLLYANNA ABOUT THIS. THERE ARE BUREAUCRATS OUT THERE, MEDICAL BUREAUCRATS, WHO SAY "THIS IS THE WAY WE DO THINGS HERE. DO IT."

 

>> DR. ROBERT GABBY: WELL, SO, THE WAY THE SYSTEM IS SHIFTING IS, IN ESSENCE, PROVIDERS ARE MORE RESPONSIBLE FOR MAKING THE DECISIONS AROUND CARE. THAT'S THE CHANGE. AS OPPOSED TO THE PAYER, WHICH IS THE CURRENT SYSTEM -- YOU KNOW, THE INSURERS DECIDE ON WHAT'S COVERED OR NOT. THE MONEY IS GIVEN TO THE HEALTH SYSTEM, AND THE HEALTH SYSTEM THEN HAS TO DECIDE HOW TO ALLOCATE IT.

 

>> DR. PETER SALGO: I'VE HEARD THIS DESCRIBED AS THE PROVIDERS NOW HAVE SKIN IN THE GAME.

 

>> BOTH: YEAH.

 

>> DR. ROBERT GABBY: AND THAT'S NOT A BAD THING.

 

>> DR. LOU PAPA: EVEN THOUGH IT'S THE SYSTEM, THE SYSTEM'S DECISIONS ARE BEING MADE BY PEOPLE UP HERE.

 

>> DR. ROBERT GABBY: SURE, SURE.

 

>> DR. LOU PAPA: AND A LOT OF THOSE PEOPLE ARE NOT IN THE TRENCHES DOING WHAT THE DOCTORS ARE DOING. AND DON'T GET ME WRONG, I THINK VALUE-BASED CARE IS VERY IMPORTANT. I THINK BASING MORE OF OUR CARE ON EVIDENCE-BASED AND REDUCING VARIATION IS VERY IMPORTANT, BUT I ALWAYS WORRY ABOUT A VERY TENUOUS PRIMARY CARE BASE THAT WE HAVE RIGHT NOW AND TRYING TO EXPLAIN TO MEDICAL STUDENTS AND RESIDENTS THAT ARE COMING OUT THAT, "THIS IS A FIELD YOU WANT TO GO INTO, BUT ABOUT 20% TO 50% OF YOUR INCOME'S GONNA DEPEND ON HOW WELL YOUR PATIENTS DO. AND WE'RE NOT QUITE SURE WHAT THE TEAM IS YET, BUT WE'LL TRY TO GET IT TOGETHER." AND THAT'S THE FEAR.

 

>> DR. ROBERT GABBY: BUT MOST OF IT -- YOU'RE RIGHT, BUT I THINK THE GOOD NEWS IS MOST SYSTEMS THAT ARE MOVING INTO THAT WORLD ARE INVESTING IN PRIMARY CARE 'CAUSE THEY REALIZE THAT'S THE FIRST STEP. IF YOU DON'T HAVE GOOD PRIMARY CARE, YOU'RE NEVER GONNA GET GOOD OUTCOMES.

 

>> DR. LOU PAPA: AND WE'RE FORTUNATE. I MEAN, FOR ME, WHERE I AM AT THE UNIVERSITY OF ROCHESTER, THE HEAD OF OUR PRIMARY CARE NETWORK IS VERY GOOD. HE'S DILIGENT, HE'S ACTUALLY STILL PRACTICING, AND HE'S SOMEBODY WHO REALLY FIGHTS TOOTH AND NAIL FOR US. BUT WHAT IF YOU DON'T HAVE THAT?

 

>> DR. ROBERT GABBY: WELL, BUT I THINK, AGAIN, WITHIN A HEALTH -- SO, WE DID A PROGRAM IN PENNSYLVANIA WHERE, ACROSS THE STATE, WE TRAINED 1,000 PROVIDERS TO DELIVER BETTER CARE ON THIS NEW MODEL, THE PATIENT-CENTERED MEDICAL HOME.

 

>> DR. LOU PAPA: RIGHT.

 

>> DR. ROBERT GABBY: AND THERE WAS AN INVESTMENT BY THE PAYERS, IN THIS CASE, BUT NOW, WITHIN HEALTH SYSTEMS, TO REALLY ELEVATE THE ROLE OF PRIMARY CARE, 'CAUSE THEY'RE CRITICALLY IMPORTANT. AND THE SPECIALISTS, THEN, BECOME AN OPPORTUNITY TO SORT OF GUIDE THE PRIMARY CARE FOLKS ON HOW TO BETTER MANAGE THE COMPLEX PATIENTS.

 

>> DR. PETER SALGO: ALL RIGHT, MARK, WHAT IS YOUR LIFE LIKE NOW? ARE YOU GETTING MONITORED? HOW ARE YOU FOLLOWING THIS DIABETES?

 

>> MARK LEE: RIGHT NOW, I TEST MY BLOOD, A1C, USUALLY, EVERY SIX MONTHS. I JUST HAD A TEST IN APRIL. IT WAS 5.4.

 

>> DR. PETER SALGO: CONGRATULATIONS.

 

>> MARK LEE: SO IT'S STILL GOOD.

 

>> DR. LOU PAPA: WOW.

 

>> MARK LEE: I STILL WORK OUT.

 

>> DR. PETER SALGO: MM-HMM.

 

>> MARK LEE: I DO, REALLY, MORE ELLIPTICAL WORK THAN ANYTHING. AND I STAY ACTIVE. AND I WATCH MY DIET LIKE A HAWK.

 

>> DR. PETER SALGO: AND YOU ROOT FOR THE RED WINGS?

 

>> MARK LEE: I ROOT FOR THE RED WINGS.

 

>> DR. PETER SALGO: [ CHUCKLING ] OKAY.

 

>> MARK LEE: AND THE CAPITALS.

 

>> DR. PETER SALGO: BY THE WAY, DO YOU CARE HOW THESE GUYS GET PAID SO LONG AS YOU DO OKAY?

 

>> MARK LEE: IT'S AN INTERESTING TOPIC. I MEAN, I THINK IT WOULD PROBABLY GIVE THEM INCENTIVE TO -- FOR THE PATIENT MORE. IT'S TRUE.

 

>> DR. PETER SALGO: WELL, I PROMISED YOU BEFORE WE FINISHED TODAY THAT YOU WERE GONNA HAVE AN OPPORTUNITY TO GET A SECOND OPINION FROM THESE TWO AUGUST PROFESSIONALS.

 

>> MARK LEE: RIGHT, SIR.

 

>> DR. PETER SALGO: THIS IS YOUR SHOT. THEY'RE SITTING RIGHT HERE. GO FOR IT.

 

>> MARK LEE: WELL, I JUST WONDER, AT SOME POINT, YOU KNOW -- I MEAN, SINCE IT DOESN'T RUN IN MY FAMILY, I GOT A COUPLE QUESTIONS, BUT I'LL JUST ASK ONE. I MEAN, I'LL RELATE IT MORE TO MY KIDS. ARE MY KIDS GONNA BE SUSCEPTIBLE TO THIS AS WELL?

 

>> DR. LOU PAPA: THERE IS A HEREDITARY COMPONENT TO IT, AND ONE OF THE BEST WAYS THAT THEY CAN PREVENT GETTING DIABETES IS TO DO WHAT YOU'RE DOING NOW -- TRY TO MAINTAIN AS HEALTHY A WEIGHT AND HEALTHY A DIET AS THEY CAN NOW, AND BE COGNIZANT OF THAT. MAKE SURE THEIR PRIMARY CARE DOCTOR KNOWS THAT, TO KEEP AN EYE OUT FOR THAT.

 

>> DR. PETER SALGO: WANT TO ADD ANYTHING?

 

>> DR. ROBERT GABBY: YEAH. I COMPLETELY AGREE. I THINK IT'S LARGELY PREVENTABLE. YOU KNOW, THE GENES HAVEN'T CHANGED MUCH, BUT THE NUMBER OF PEOPLE WITH DIABETES HAS SKYROCKETED. AND WHY IS THAT? WELL, BECAUSE WE ALL EAT A WHOLE LOT MORE AND EXERCISE A WHOLE LOT LESS.

 

>> DR. PETER SALGO: BUT YOU KNOW WHAT'S ENCOURAGING? WHEN I STARTED MEDICAL SCHOOL, WE WOULDN'T HAVE BEEN HAVING THE CONVERSATION LIKE THIS. WE WOULD'VE SAID, "OH, MY GOSH. YOU'RE GOING DOWN THAT ROAD, AND THERE'S NOT MUCH WE CAN DO." THAT'S ALL CHANGED. THIS IS REALLY GOOD. I WANT TO THANK YOU AGAIN FOR BEING HERE. WHAT A PLEASURE TO MEET YOU.

 

>> MARK LEE: THANK YOU.

 

>> DR. PETER SALGO: GENTLEMEN, THANK YOU, TOO.

 

>> DR. ROBERT GABBY: THANK YOU.

 

>> DR. PETER SALGO: GREAT INSIGHTS INTO THIS CASE AND INTO MEDICAL ECONOMICS. AND I'D LIKE TO KNOW WHAT YOU THINK ABOUT TODAY'S DISCUSSION AND MARK'S SECOND OPINION BY TWEETING US OR BY COMMENTING ON OUR FACEBOOK PAGE. AND NOW HERE'S THIS WEEK'S "SECOND OPINION 5."

 

>> DR. LISA HARRIS: HELLO. I'M DR. LISA HARRIS, AND I'M HERE TO TELL YOU FIVE WAYS YOU'LL FEEL BETTER IF YOU CONTROL YOUR DIABETES. THE FIRST IS YOU'LL HAVE MORE ENERGY. GLUCOSE IS YOUR FUEL SOURCE FOR YOUR BODY. AND, DIABETICS, YOU HAVE A LOT OF GLUCOSE, BUT IT'S NOT GETTING TO THE ORGANS THAT NEED IT, SO YOUR BODY IS RUNNING ON EMPTY, MAKING YOU FEEL TIRED. NEXT IS YOU'LL BE LESS THIRSTY. WHEN YOUR DIABETES IS UNCONTROLLED, THE SUGAR MOLECULES ATTRACT WATER, MAKING YOU FEEL THIRSTY ALL THE TIME. THE THIRD IS YOU WON'T NEED TO GO TO THE BATHROOM AS MUCH. SUGAR IS A LARGE MOLECULE THAT PULLS WATER INTO THE BLOODSTREAM LIKE A MAGNET ATTRACTING METAL. BECAUSE YOUR BODY IS NOT USING ALL THE GLUCOSE, YOUR BODY ENDS UP URINATING OUT THE EXCESS SUGAR AND WATER. THE HIGHER YOUR SUGAR, THE MORE YOU URINATE. ANOTHER IS YOU'LL AVOID HEALTH PROBLEMS LIKE KIDNEY FAILURE OR LOSS OF VISION. ELEVATED BLOOD SUGAR DAMAGES ALL THE ORGANS IN YOUR BODY. YOU CAN KEEP YOUR ORGANS HEALTHY BY KEEPING YOUR DIABETES UNDER CONTROL. AND LASTLY, YOU'LL IMPROVE YOUR CARDIOVASCULAR HEALTH. UNCONTROLLED DIABETES IS ONE OF THE BIGGEST CAUSES OF HEART DISEASE, SO MANAGING YOUR BLOOD SUGAR PUTS YOU AT LESS RISK FOR HEART PROBLEMS. AND THAT'S YOUR "SECOND OPINION 5."

 

>> DR. PETER SALGO: THANK YOU SO MUCH FOR WATCHING. AND REMEMBER, YOU CAN GET MORE SECOND OPINIONS AND PATIENT STORIES ON OUR WEBSITE AT SECONDOPINION-TV.ORG. YOU CAN ALSO SEND US YOUR SHOW IDEAS AND SHARE YOUR OWN HEALTH STORY, AND MAYBE, JUST MAYBE, WE'LL INVITE YOU TO BE ON THE SHOW WITH US. YOU CAN CONTINUE THIS CONVERSATION ON FACEBOOK AND TWITTER, WHERE WE ARE LIVE EVERY DAY WITH BREAKING HEALTH NEWS. I'M DR. PETER SALGO, AND I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

 

>> ANNOUNCER: "SECOND OPINION" IS BROUGHT TO YOU BY BLUECROSS BLUESHIELD. ACCEPTED IN ALL 50 STATES. BLUECROSS BLUESHIELD. LIVE FEARLESS.

 

>> ANNOUNCER: "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.