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June 13, 2020

Too Much of a Good Thing: Dr. Mistry and Special Guest Dr. Ozer Discuss Diabetes

Donna Lee: 

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762, or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics. Some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.

Speaker 2: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello, and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here as always with my cohost Donna Lee.

Donna Lee: 

Hello, everybody!

Dr. Mistry: 

You know, I think it’s interesting, Donna Lee is that yes, you can do the show without me. I couldn’t do the show without you.

Donna Lee: 

I did that on purpose by the way.

Dr. Mistry: 

Oh boy.

Donna Lee: 

I’m the only one that [inaudible].

Dr. Mistry: 

It’s called making yourself the critical link in the chain.

Donna Lee: 

That’s right. You can’t ever fire me. Job security!

Dr. Mistry: 

Let’s not count on that one. I’m a board certified urologist. This show is brought to you by NAU Urology Specialists. Donna Lee, you’re our practice manager.

Donna Lee: 

That’s right, through all four practices.

Dr. Mistry: 

That’s right, for all four practices.

Donna Lee: 

Round Rock, North Austin, South Austin, and Dripping Springs.

Dr. Mistry: 

And our little cute little one in Dripping Springs. We love Dripping Springs. It’s a great little place. So if you’re looking for an appointment, you need a urologist, you need a general male health checkup, we would love to help you do that and take care of you. One of the health topics that we kind of deal with very commonly is diabetes. I think that when you hear the news, you know, that it’s more common in, you know, as we get more obesity in our country and it affects testosterone and sexuality and all these things. So we run into diabetes all the time. We are very fortunate to have one of our partners in treating diabetes, Dr. Kerem Ozer from Texas Diabetes and Endocrinology. Thanks a lot for joining us again, Kerem.

Dr. Ozer: 

Great to be here. Thank you for having me.

Dr. Mistry: 

I’ll give you an interesting anecdote. We see a lot of men with fertility issues. The next statement I’m going to make, makes sense, but is still a surprise to a lot of them, which is that how their overall health is affects the quality of their sperm. So they come to me because they’re having trouble getting pregnant. And then we do a bunch of lab tests and I find a condition of prediabetes or diabetes in like 10% of them. We help them with their blood sugar and then their sperm counts do better. So I thought maybe you could briefly tell me what is, and we’ll just kind of focus on type two diabetes–what is diabetes? What is pre-diabetes?

Dr. Ozer: 

Absolutely. And that’s a really good point you made about how diabetes affects everything in the body. And the reason for that is simple. Diabetes is basically a mismanagement of energy resources. It’s a change in the way the body processes fuels. Just very simply defined, diabetes is as a sugar level, a fasting sugar level in the morning of above 126 milligrams per deciliter. And that’s the, it sounds like a random number, but it’s not. It’s actually the level of blood sugar above which sugar starts accumulating in different tissues in the body and starts causing problems: potential kidney problems, eye problems, problems with nerve endings problems with fertility, as you mentioned. So there’s that number. And then there’s another number that people hear about, which is hemoglobin A1C, and that’s a blood test that shows us how your blood sugar levels have been over the past three months. If that number is about 6.5, same idea, that means you just have too much sugar and the way your liver, your muscles, your kidneys process sugar has become very inefficient and you just have too much of it.

Dr. Mistry: 

That’s a great point. And I think that people don’t understand how sugar having too much of it can really mess with you. I remember seeing a slide when I was in medical school, where they put the white blood cells in a culture medium, and the white blood cells help us to heal. And if you made the water too sugary, the cells didn’t want to move.

Dr. Ozer: 

Too much of a good thing.

Dr. Mistry: 

Too much of a good thing. And so this is such a, that’s so important for our listeners and patients to understand. If you have too much sugar in your body and your body can’t process it, your body doesn’t work right. All the functions that we have really depend on a delicate balance of being able to use that energy.

Dr. Ozer: 

Absolutely. I totally agree. And there’s a lot of factors that play into this. There’s hereditary factors. We have so many patients who come to us and say, “My uncle, my aunts, my parents, my all my siblings have diabetes. When am I going to get it? Or what can I do to prevent or reduce my risk?” And then there’s lifestyle factors. We’re all living in this super fast paced world of drive through foods and pickups, and anxiety and all these factors all come together and increase our risk of processing our fuels less efficiently.

Dr. Mistry: 

In many ways, I feel like once you’re diagnosed as a diabetic, that kind of sets in motion many things. Usually medications that you’re gonna have to start on, lifestyle changes that are kind of expected of you, and maybe it’s unfair for me to say, but I feel like you’re already on a downward slope once you’ve been diagnosed. We really take that diagnosis of prediabetes really seriously here, because that’s kind of the time we’re at the top of the slope, but you’re not quite gone over it. Maybe we still have time to save you. You know? Why don’t you talk about how did that diagnosis come about? How do we define it and what do we do about it?

Dr. Ozer: 

That’s a really good point because early stages of diabetes, and even more importantly, prediabetes is the point where you want to really jump on because the good news is by making lifestyle changes, potential use of certain medications, you can, you’re at a point where you can reverse things just like said, before walking into that range where this starts to become detrimental to different tissues and organs in the body. The concept came about because of the realization that, you know, we were talking about that three month average blood sugar level, that hemoglobin A1C test. So if that number is about 6.5, we know that for most people, sugar starts to accumulate in tissues and cause problems. If that number is below 5.5, you’re safe from that perspective. If you’re folding into that 5.5 to 6.5 range, you’re in this area where your liver, your muscles are on the way to becoming less efficient in processing fuels, your metabolism is slowing down, but you’re not necessarily getting a whole bunch of longterm, irreversible damage in your body. So that’s the time to jump in.

Dr. Mistry: 

It’s your chance to jump in. There has been data to show that the use of Metformin in that prediabetes population can help kind of stave off some of these side effects, is that right?

Dr. Ozer: 

Absolutely.

Dr. Mistry: 

But I see that, you know, when I suggest this to patients kind of their first mind thought is, “Well, I’m not a diabetic. I shouldn’t have to take medicines.” And really my argument to them is diabetes is a sequence of damage to different organs. I’m going to give you a pill at a time in which we could maybe not have those injuries.

Dr. Ozer: 

And I would agree with that. And a lot of that of course boils down to sitting down and having that conversation about, “Hey, we have this option, you have these hereditary factors, biologic processes that are ongoing in your body. If we put this on, if we bring this on, this may help us reverse this.” And I always talk about pros and cons. Metformin has been around for many, many years. There’s a ton of longterm safety data on it. Some people may be a little more sensitive to it. Stomach wise, it can cause things like nausea, indigestion, things like that. So we would usually start really low and titrate it up slowly. So it’s a very safe medication in general.

Dr. Mistry: 

I give people six months and I say, “You have six months to meet my nutritionist, get on ideal protein, you know, get on a diet. If this is not better in six months, then you’re on a pill.” And that’s what, that’s my take on it. Why do you, and you must get frustrated like me, when somebody has a prediabetes diagnosis and their primary care doctor didn’t treat it, like that’s always very frustrating to me. Why do you think that happens?

Dr. Ozer: 

And I think there are many factors there. It may be that they had that conversation and, I mean, it’s just like everything else. When you tell someone they have prediabetes, they’re going to go through denial and anger and they’re going to go through…

Dr. Mistry: 

The stages of grief.

Dr. Ozer: 

…stages of grief. So the primary care physician, our colleague, may have given us a favor by initiating that conversation. And the patient was in denial at first and they said, “Hey, we don’t want to do anything right now.” And by the time they came, it’s like opening a jam jar. And they’ve kind of made it easier for us to open…

Dr. Mistry: 

That’s right. I like that.

Dr. Ozer: 

[Inaudible.] And we get to be the heroes by actually opening the jar with that last little twist. But some of it may be time. I mean, people present to their primary care physicians. Then they have a ton of stuff going on. They, you know, they may have a broken ankle and the flu, and they have a bunch of stuff going on that just take precedence over, since they’re acute, they take precedence over these longterm issues. And so I think we’re, you’re lucky, I’m lucky in a sense that we get to focus on one aspect of their life, which happens to affect everything else in their life. So it’s a really nice point for us to be able to jump in.

Dr. Mistry: 

And a really important lesson for patients out there. I mean, you may have a lot going on, but if you’ve been diagnosed as a pre-diabetic, let’s take that seriously. You know, you have an opportunity to stave off some really, really bad side effects. And so listen to your primary care doctor, do your reading, and when recommendations are made, really understand it’s coming from a real place of care and concern for you.

Dr. Ozer: 

I would absolutely agree with that.

Dr. Mistry: 

Well, thank you so much for joining us for that. On our next segment, I want to talk about common treatments for diabetes. And, how do people get ahold of you?

Dr. Ozer: 

So we’re Texas Diabetes and Endocrinology. We have three offices in the Austin area: South Austin, Central Austin, Round Rock. Our phone number is (512) 458-8400. And our website is www.texasdiabetes.com.

Donna Lee: 

Perfect. And you can get ahold of us during the week at (512) 238-0762. Our website is armormenshealth.com and our email address armormenshealth@gmail.com. And you can listen to these amazing podcasts for free wherever you listen to podcasts. Thanks guys!

Dr. Mistry: 

Thank you.

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The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at Armour men’s health@gmail.com.

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