San Diego Health: Diabetes Management and Devices

San Diego Health: Diabetes Management and Devices

August 13, 2019 1 By Jose Scott


(upbeat music) – There are 30 million people in the U.S. who are dealing with diabetes and by the year 2050, diabetes will affect one in three people. Monitoring your blood-sugar levels is critical in dealing with diabetes and technology is helping people do that; making it much easier. So, joining us today is Dr.
Dr. Tsimikas Philis-Tsimikas, who is the Corporate Vice President for the Scripps-Wittier Diabetes Institute and Tyeisha Smith, the mother of five, who has been dealing with
diabetes for almost two decades. Thank you both so much for being with us. Dr. Tsimikas, let’s start with the basics. What is diabetes? – So, diabetes essentially
is when the blood sugars are higher than normal in someone’s body. That occurs because of
two different reasons. One is the beta cell in the
body that produces insulin might decline in function or
stop functioning altogether. The other is that the muscles in our body may become resistant to
the effects of insulin and we need much more insulin to bring those blood sugars down and if you’re not producing quite enough
then those blood-sugar levels again become too high. – And, what’s the difference
between Type One diabetes and Type 2 diabetes? – It’s a common question
and Type One diabetes is an autoimmune function
where our body turns against that beta cell that produces
insulin and destroys it, usually over a fairly
quick period of time, maybe within a couple of months. Type 2 diabetes is a
combination of a decline in the function of that beta cell, together with that muscle resistance causing, again, the effects
of high blood sugars to occur. – And, what are the symptoms of diabetes? – So, the majority of the time, the scary part about this is
that there may be no symptoms. It occurs so slowly that
people don’t even realize that it’s occurring. So, more commonly though, we
might see frequent urination, someone that feels very thirsty. They might be waking up at night to go to the bathroom where
they otherwise wouldn’t and combined with that actually is eating a little bit more to try and overcome some of the effect of this polyphasia, too much eating, too much
urination and dehydration. – Tyeisha, let’s talk about you. You’ve been dealing with
diabetes for almost two decades. Tell us what was going on when you first realized you had diabetes. – When I was first diagnosed with diabetes I was outta control. I didn’t know anything about diabetes. I didn’t know anybody that
had diabetes at the time and I was just, I was sinking really fast. – [Susan] What were your symptoms? – I had frequent urination. I had excessive thirst and I was droppin’ weight
really, really fast, just losing a lotta calories. So, I went to the doctor and had diabetes and it just
progressively got worse. I was seeking for help and you know, I just couldn’t get a handle on it. My blood sugars were still goin’ up. My A1Cs were really, really high. My blood sugars were
ranging in the 400 or 500s all day which is, you
know, very dangerous. – [Dr. Tsimikas] That’s pretty high. – What happens when it gets that high? – Well, if it continues to
get even higher than that you can eventually go
into a coma from that, but we know that high blood
sugar is also attached to different parts of our body. They can attach to the back of the eye, to vessels around our
heart, in our kidneys and our nerves and can lead to some of the complications of diabetes that we know commonly occur as well. So, for all those reasons it’s dangerous. – And, you were also
really depressed, Tyeisha. – I was very depressed. I couldn’t get out of the
bed and leave the house for more than an hour at a time. At night I felt like I was dying, like my body literally felt
like it was shutting down. I had muscle pain. I had back pain. The eye pain from my
blood sugar being so high and I literally felt like
I was not gonna make it, you know, and every night I
would kiss my kids good night and tell them that I loved
them because, I’m sorry, because I didn’t think that I was gonna be able to see them the next day. I felt like there was no hope and I was tryin’ to hold on, but quickly giving up. – So you come to the
Scripps-Whittier Diabetes Institute and you get enrolled in
these clinical studies. That’s okay
– I’m sorry. You’re okay (Susan laughing). That’s all right
– Sorry. And, so, tell us, in the past how you were monitoring blood-sugar levels was kind of a nuisance because you had to prick yourself, right? – [Dr. Tsimikas] That’s correct. – [Susan] How has it
evolved over the years, to treat diabetes? – [Dr. Tsimikas] The usual routine is that you have to use a small needle. It sticks your finger. We ask patients to check two, three, four and, if you have Type
1 Diabetes, sometimes eight to nine times a day. – And then, based on whatever that blood-sugar level read was, that’s how much insulin you
would have to give yourself. – Correct. Insulin or other medications. For Type 1 diabetes we use insulin. For Type 2 it could be oral medications. But you use that value. It’s important, because it tells us how much medication you should be taking. How you should be adjusting, really, so much of your lifestyle. Exercise, food that you’re eating. So many things. Very important measurement for us. – So, we’ve got some– we have
some really high-tech ways now, that we can monitor
your blood-sugar levels. Why don’t you show us what
a couple of those are. – Tyeisha, you want to show
them how you’re doing it now? – Well, I am using the
Dexcom G5, which is here. It is a CGM, continuous
glucose monitor system. And basically what it does is, it monitors my blood
sugar every five minutes without me having to do
any of the finger sticks. And it transmits onto
this little device here. And also, with technology these days, now it also transmits
onto my phone as well. – [Susan] So you can see what your blood-sugar level is all day long. – I can see– it alarms
me if it’s going too high, if it’s going too low, if
I’m going in a danger zone. And I can get up and act quickly. So, this little baby has
definitely made my life easier. I can’t even imagine not
having it at this point. – Show us some of the other devices there. – So, one of the nice
things that this can do is not only does it communicate
to Tyeisha’s phone, but it can actually
communicate up to a cloud and then you can transmit
that anywhere you would like. So, I have patients that,
when we’re trying to adjust things, are also
giving me their numbers and transmitting what
their numbers are doing. And I can look at that over
the last 24 hours or so. – [Susan] So you can follow your patients up in the cloud? – [Dr. Tsimikas] I can follow
my patients through the cloud. – [Tyeisha] Awesome. – [Susan] Which is incredible, so that you don’t have to
come into the doctor’s office for the doctor to actually be able to see in real time, how you are reacting. – [Dr. Tsimikas] Yeah,
that’s exactly right. So, it’s really nice. Now, the nice thing about this device is they just came up with an updated version that doesn’t require calibrations. This now requires you
to check it twice a day to make sure it’s accurate. – When you say that, what do you mean, it doesn’t require calibrations. What does that mean? You still have to prick your– – The extra finger stick that’s
required to make sure that it’s equal to the number that you’re getting on your finger stick. And you need to enter it then twice a day. – So you still do have
to prick your finger twice a day. – Twice a day with this. It alerts me every 12 hours. I have to do a finger stick on the monitor and put in the readings in here, just to make sure that it is accurate. – [Susan] That it’s accurate. – Every 12 hours. – But you’re saying,
now, there’s a new one. – Yay, though. The FDA just approved, within
the last week-and-a-half, the newest device. It’s called the G6, and it
does not require calibrations. It’s smaller than this one. I’m wearing one right
now, just on the abdomen, which is the approved place to wear it. But, as you can see from
patients, they’ll probably be trying it in a few of their own places. – [Susan] But you can test it out where you try it on different parts of your body to see if the read is still accurate. – That’s the way a patient
would probably do it. The way we’re recommending
is here on the abdomen and on the upper back area. So, very exciting. In addition to that, there are a few other new reading
devices, though, as well. I’m wearing another one. So, this one’s called the Freestyle Libre. And this one also attaches
very easily to the body. And this one is pre-calibrated
as well, from the factory. It takes about 12 hours to warm up. But once it’s warmed up,
you also don’t require any finger sticks for that. You simply turn on the
monitor that you have and you just hold it over clothes, and it gives you that reading. With what the number is
at that moment in time. And you can wear both of
these for up to 10 days and not be able to switch them out. You can go in the shower. You can go surfing if you want, swimming. They stay on. – Definitely an upgrade,
because this one is seven days. So that one’s 10 days and I’m
shootin’ for that one next. – [Susan] And no having
to prick your finger to calibrate it
– That’s right. – So, this provides us an
enormous amount of information these reports can come to
me so I can help the patient adjust their therapy. – And they don’t have to come
into the office to do it. You’re able to communicate back and forth via the readings on the cell phone. Now, there’s one other
device that you have there. – So, we have yet another
device that delivers insulin in a different way. There’s a couple different ways. Tyeisha’s wearing an
insulin pump right now. And she’s wearing it up here on her arm. This is the one that she’s wearing. It’s called an Omnipod. We have a number of new devices now. This is the way you deliver it, but you would stick this
on, as well, on the arm. And it’s disposable, so after
three days you peel it off and throw it away and put a new one on. – [Susan] So that’s
automatically delivering insulin to her on a 24 hour basis? – It is, and then when you eat, you have to deliver an extra dose. And that’s why she has her device here, where she has to deliver
her extra dose at that time. – So is that showing you on that device when she eats, what the
blood-sugar level is so that she adjusts the dose. Or it’s just an extra, added dose? – So that’s why you need this device to tell you what your blood sugar is and there are now ways for these devices to communicate with the pumps. – It’s awesome. – And the latest device is
the 670G hybrid closed-loop, which automatically
makes some adjustments. Although you still have to give
yourself a dose when you eat It turns itself off when
your blood-sugars are too low and it increases insulin when
your blood-sugars are too high – [Susan] That’s incredible. – It’s amazing. It’s really wonderful. – Talk about this. – So, if someone wants
a little bit lower tech and doesn’t really want to use the pump and still uses a pen to
deliver their insulin, this pen is nice because
after you dose it, you dial up your dose,
you give your injection. It actually communicates
to my phone immediately what the dose was and how much I gave, what time I gave. And then I can put in the amount of carbohydrates I just ate as well, and it will tell me if that
dose was enough or not. If I need to give a
little bit more or not. And then this also creates
reports that are generated that can go to my physician’s office. – Now, when you talk
about this being a pen it’s actually– that’s something
that you inject, right? That you’re injecting? – Correct. So this would go here. Subcutaneous based with a
really, really small needle. Yet another improvement that they’ve made. These incredibly small needles. – So tiny. It doesn’t even hurt. – It doesn’t hurt. For people who are
embarking on this journey who are just diagnosed with diabetes, they would be very scared
about the pen, the prick. And you’re saying it doesn’t hurt at all. – No, no. If you’re newly diagnosed
and you’re afraid of needles this would be a good one, because it’s so tiny you don’t
even feel it going in at all. – And now there’s also an inhaled device? – There is. So if you didn’t want
to take the injection, you’ve just eaten some food
or your blood sugars are high, you could take an inhaled puff
of insulin with this device which requires just popping
a cartridge in here, with the dose. You pull off the cap. (inhales loudly) You take your inhalation, and
it starts to work right away. – [Tyeisha] Wow.
– Yeah. Pretty amazing. – [Tyeisha] That’s amazing. – How have these devices
changed your life, Tyeisha? – Well, I went from not
being able to leave the house for more than an hour at a time to where now I can go out, I can be active with my children. We go to amusement parks. I couldn’t even work a job, you know, without feeling down and depressed. It’s changed my life. It has definitely changed my life. – Has it made you more aware
of diet and exercise as well? – It really has. You know, when I first got it it freed me up to where I was like, “Oh, you know, I can
eat whatever I want now, “because, you know, I’ll
just click a few buttons “and I don’t have to do all these pricks.” And so I did that, and
I gained all this weight because I was just eating, eating, eating, and taking insulin, taking insulin. And so then I hit a
moment when I was like, “You know what? “Don’t take advantage of this. “But use it for what it is.” And it did make me more
conscious of what I was eating. And I was actually able
to get better control by having these devices. – [Susan] How much weight have you lost? – So far– well, recently
I’ve lost about 10 pounds. But I’d say probably
overall, I’d probably say probably about 20 pounds. – Wow, good job. – So these devices have
basically given you control of your life? – Definitely, definitely. – [Susan] To be able to
move through your life at the speed of your life without having to check, I mean talk about the convenience of that. – Oh my goodness. It is so convenient. I can get up and go, and
just, like she was saying I can shower with it and everything. I don’t have to take it on and off. You can get in the pool with it. I mean, it has definitely
changed my entire life. – You’re saying you can
get in the pool with it. So you can actually go
underwater with these devices? – You can go underwater with it, yes. – So it’s freedom to go– – It’s definitely freedom. And just to be able to
push this button and say, “Oh, you know, I’m in danger. “I’m going too high.” Or, “I’m going too low.” And you can act on it, versus missing a lot of those lows. Sometimes you go too low
and you may not feel it and you’ll be in the danger zone. But these devices have definitely given me the freedom to just live my life. – That’s extraordinary. We want you to hold this thought, because this is all very high tech, and in just a couple of minutes we’re going to talk
about some low tech ways to help you control your diabetes. So hold that thought. That’s coming up. Dr. Tsimikas, can you tell
us, what’s pre-diabetes? – So, pre-diabetes is a
condition where you’re at risk for developing
diabetes in the future. We have a few warning signals for it. But if you intervene
early, you might actually be able to prevent the
onset of Type 2 diabetes. – [Susan] This is Type 2. So Type 1 diabetes is not something that you can necessarily control? – Prevent. Not at this time, although there are studies, which we are doing at our
clinical research center and across the nation. We’re part of a national organization that is looking at ways to prevent Type 1 diabetes as well. It’s called TrialNet. It’s a study that’s funded by the National Institutes of Health. And we’d be happy to
walk people through that. – And, so, yeah– Tyeisha,
you’ve been involved in a bunch of clinical trials with the Scripps-Whittier Diabetes Institute. If somebody wants to sign
up to be a participant how would they go about that? – All they need to do is call us and let us know that they are interested in participating in clinical trials. We actually keep a list
so that when we have trials that come up, that
looked like they might be a fit, they we can call and
connect people with these. And if they work, they’re wonderful. – So the treatments for diabetes is what? – So there are so many treatments now. In the last 10 years,
they’re probably been more than 14 different therapeutic groups of treatment for diabetes. The majority of those have
been for Type 2 diabetes, but even within the options
for Type 1 diabetes, we have new kinds of insulins. We have, even some of the
pills are being tested in some patients with Type 1 diabetes. And we’ve seen improvements. So there’s lots going on. Lots that’s come out in the last 10 years. – How do you know if you’re
at risk for diabetes? What are the warning signs? – Really, the best way
to do this is to get a blood-sugar value. And to do that at your physician’s office or at a lab, and then
your physician reviews it. So, usually, first thing in the morning you would get a blood-sugar value. If it’s above 126, that’s the number, the target that we use, then it’s considered diabetes. We would repeat it twice. And if it’s twice above 126 it means that you actually have diabetes. If it’s between 100 and
126, that’s the range for pre-diabetes that you asked about earlier. And that’s when we would
try and intervene earlier to try and prevent the onset of diabetes. – But what are the symptoms for diabetes? – Essentially none. – [Susan] That’s what’s so scary about it. – Nothing. That is what is so scary. – So is this is the kind of thing that you would test for in an annual checkup? Is that part of your annual check up with your primary care,
internist, physician? – Yes. So that would be one of
the tests that you take once a year. There is a simple paper
test that you could take or you could go online
and take a risk test. And certainly if you have relatives that have Type 2 diabetes. If you had gestational diabetes during your pregnancy. If you are overweight,
these are all risk factors that contribute to the
development of diabetes. And if you score above a certain score it means you should follow
up with your physician and ask if you might
actually have the condition or be at risk. But, again, the way we
actually diagnose it is through that blood test. – So, we talked about this before. I told you to hold that thought. Let’s come back and talk
about the low tech ways to control diabetes. Because, this number that’s very alarming. By the year 2050, that one in three people will be dealing with diabetes. Is that because of
obesity in this country? I mean, how do you control diabetes or maybe prevent it. What are the low tech ways you can do? – Right, so it definitely is related to the obesity epidemic that
has occurred in our country, but in addition to that, fewer places to go out walking and exercise. We’re being inundated with marketing of foods that maybe aren’t
necessarily the most healthy foods and if you don’t know what’s in that, and what might occur? So, maybe a lack of knowledge around that. – [Susan] Are you talking
about processed food? – It can be hidden calories,
it can be processed foods, it can be so many different things. Just the amount itself is a factor. When you look at a large–
you walk into a restaurant you get a much larger meal
that what we ever used to get 20, 30 years ago. So that in and of itself is a problem. So we can intervene. We have a number of classes, really revolving around education and educating our
patients and our community around what this means, how to approach it a
little bit differently. How to make better choices. And that can really lead to
the prevention of diabetes. It’s really fabulous. – Talk a little bit about Project Dulce and Dulce Digital Me. – Project Dulce is a
program in the underserved community here in San Diego, focused really on Latino and
other racial-ethnic groups that are at higher risk for diabetes. And we went into the community clinics and partnered with them. And delivered and developed
programs to educate and better manage their diabetes. And based on that, we actually found lower blood-glucose levels, blood
pressure, and cholesterol levels We, interestingly, transformed
the curriculum of that into a texting program. And we looked at– if
you text people these educational comments and
then they send you back what their blood sugars are, could you improve their
outcomes in blood sugar and found that we could. So we are now translating
that into the next step, which is, if you take devices like these which communicate wirelessly up to a cloud and then send back more
specialized text messages that are more appropriate
to what their actual blood-sugars are, whether
they’re taking their pills or not whether they’re feeling happy or not, because we ask those
questions via text as well, if that works even better
than just receiving the same text message over six months. – So, that’s the Dulce Digital Me study? – That is called Dulce Digital Me, yes. It’s an adaptive way to
help respond to some of your approaches of managing blood glucose. – So you’re really harnessing technology in order to make people more aware of what they’re eating
and how they’re exercising to actually improve their health? – Absolutely, and in real time, which is what’s the amazing part of all these devices that you can use now. That you can do it in real time when people are thinking about it. – [Susan] Tyeisha, when
you look down the road what do you see? – I see a bright future. At one point I felt like
I was not going to make it till the next day, but now I see that I can live
many, many, many, many years. I don’t see myself stopping anytime soon. – [Susan] I know there
was a point that you said that some doctors said that you would never see your kids graduate. Is that correct? – Yes, that is correct. I’ve had doctors tell me
my diabetes was so bad that if I didn’t make a change right then that I would not see my children graduate. And now all my children have graduated except for one, and
he’s got two more years. – But you’re looking down the road, way down the road, to
seeing and to playing with your grandkids. – Yes. Yes. I look forward to it. I’ll definitely be around for it. – And what advice would
you give to other folks who have diabetes? – I think the advice that I
would give for other people is, diabetes is hard. It’s a very hard disease to control. But it’s not impossible. And just to let people know that you are not alone. You don’t have to do it alone. Scripps is here. They have the resources
and the technology, and if they did it for me, they can do it for you. – Dr. Tsimikas, what advice
would you give to folks who are dealing with diabetes? – I think the best
advice is to get educated around your disease. I mean, we’ve seen from
Tyeisha how much she’s learned and has the motivation now
to manage her own disease, and that’s really important. But partnering with your physicians and with your educators,
you’re diabetes educators. And we have such an amazing
team here at Scripps. That really works so well. – Thank you both so much. We wish you continued
good health, Tyeisha. – Thank you, thank you. – [Susan] You come back and show us pictures of your grandkids. – I will, I will. – Scripps takes care of more
than 27,000 folks with diabetes across San Diego County, and is ranked by U.S. News and World Report and number one in San Diego and among the nation’s best in terms of diabetes care. If you are interested in participating in future diabetes research studies, with the Scripps-Whittier
Diabetes Institute, just call this number. It’s 858-824-5453. If you would like more information about diabetes care,
just click on the link. And if you want more critical
information about your health we take care of you from
head to toe at Scripps. Please subscribe to our
Scripps Health YouTube channel and also follow us on
social media @ScrippsHealth. I’m Susan Taylor, thanks
so much for joining us. It’s our mission at
Scripps to help you heal enhance, even save your life. (uplifting music)