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155: Prediabetes: The Silent Epidemic

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155: Prediabetes: The Silent Epidemic

Sep 12, 2023

Think you're in the clear when it comes to diabetes? Producer Mitch thought the same, until a revelation on this episode. Dr. Matt Chabot joins us to discuss prediabetes—a condition many have but don't know. Learn how to get tested for it, and take control to slow or stop the progression into full-blown diabetes. This is a wake-up call you won't want to miss.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.



Scot: All right. Here's a scenario, guys. You go to the doctor and the doctor tells you that you have pre-diabetes.

Mitch: What?

Scot:Yeah. Well . . .


Scot: Mitch already answered my next question. What's your reaction?

Mitch: What is pre-diabetes? I thought it was a yes or no thing.

Scot: Yeah. All right. Troy, what's your reaction? I mean, you're a doctor, but I'm still curious.

Troy: I know. My heart rate would go up about 30 beats a minute, I think, hearing that, just knowing the potential complications of diabetes, hearing I was kind of in that pre-diabetes range. So it would make me very anxious.

Scot: Yeah. So you are aware of pre-diabetes, right, Troy?

Troy: Sure. Yeah.

Scot: It's something you've heard of. Mitch, it's something you've never heard of before?

Mitch: I think in passing in a meeting or two, but it's not something that I've thought about.

Scot: All right. So I was told I was close to the pre-diabetes level one time at a doctor's appointment. And I was a lot like Mitch. I was like, "What? What's pre-diabetes?" But it was kind of a shock to my identity because I was being told I was close to the edge of this health condition and it was a bit of a shock, because I considered myself a healthy person. I mean, at the time, I had a little bit more body fat than I wanted. I didn't think I was really that overweight. I didn't think I was somebody that was at risk of diabetes.

A lot of people would tell me I was skinny. If I said, "I could lose some fat," they'd be like, "No, you don't." I didn't feel any different. I still thought I was eating healthy and exercising.

So it was a bit of a shock to find out that my fasting blood glucose was high enough that I was close to being close to pre-diabetes.

But it was a turning point. I've talked about this on the podcast. Those numbers really forced me to start becoming honest with myself. And I realized I was once active and eating well. I really wasn't at that point in my life. The reality did not match the image I still had of myself.

And pre-diabetes is something that if you're told you have, it's something you should really take seriously. And that's what we're going to talk about on the show today.

This is "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. My name is Scot. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Scot, it's good to be here. Good to be talking about pre-diabetes.

Scot: And he's an "I care about my health" convert, Producer Mitch.

Mitch: Hi. Happy to be here, not happy to be talking about diabetes.

Scot: And Dr. Matt Chabot, he practices internal medicine and he's going to help us better understand pre-diabetes and how to find out if you're at risk and what you should do if you receive the same news that I received. Dr. Chabot, welcome to the show.

Dr. Chabot: Hi. Nice to be here. I am, for one, very excited to be talking about diabetes. I'm sorry, Mitch.

Mitch: That's okay.

Troy: Sorry, Mitch.

Scot: Why? Why are you excited about it, Dr. Chabot?

Dr. Chabot: Dear Lord, why? Mostly because I feel like it doesn't get talked about enough. And like we were sort of alluding to before the show, this is a big deal, right? This is a thing that is out there hurting lots of people and we don't appreciate that enough. So I'm just psyched that we get to take a minute and talk about it.

Scot: How would you want a patient to react if you delivered the news to them that they have pre-diabetes? What would be the ideal reaction?

Dr. Chabot: "Oh, no." I feel bad saying that because it's like, "Yeah, I want to scare people." But I kind of do, right? Because more often I'm met with, "Meh." And we shouldn't be meh about it. We should be driven to action because this is a thing that, while very common, is not normal or good. I mean, it is something that needs to be sort of like the warning bell to do more about it.

Mitch: So when you say meh, is it your patients are just like, "Well, it's not diabetes yet," and then put it off, procrastinate?

Scot: It's like when you're driving and you see the sign that says that the speed limit is going to change.

Mitch: Oh, sure. And it's like, "Eh."

Scot: Yeah. Until you get there, "I'm not going to worry about it."

Mitch: Sure. I got you.

Troy: It's like the yellow light, the traffic light. You speed up. So they're like, "Yeah, more soda. "

Dr. Chabot: This is why I was so excited, Troy, when you were worried about having pre-pre-diabetes. And I was like, "Oh, man, I can't get people to care as much as you, so good job."

Troy: Thanks. No, I'm really surprised to hear that. I thought the response would be, "Oh, wow. I am cutting sodas. I am dropping weight." But it's surprising to hear that people are just kind of like, "Okay."

Scot: Yeah. So talk about how common it is, Dr. Chabot. And if you don't have the numbers I do . . . But in your practice, do you see this diagnosis a lot?

Dr. Chabot: Oh, yeah. Every day. And I'm hoping that we have the same numbers, but roughly a third of adults. It's a little more common in men. It's like 40% in men and 30% in women. But somebody in your house has this if you have a house of four. So it's just enormously common. It is a distinctly Western phenomenon. And by that, I mean an American phenomenon, right? It's the milieu that we live in.

Scot: Yep. One in three according to the CDC have it. So you got that right. Eight in 10 don't know they have it, which is scary, right? Well, I think we'll get into this. There are no symptoms at this point. I mean, the only way you can really find out, and I might be wrong, is a test. But let's hit that in a second.

And this is another interesting statistic. One out of every $4 spent on healthcare is related to diabetes. So once you start on this road towards diabetes, it's not only going to cost you money in healthcare dollars, but it costs the country just a ton as well.

Another interesting thing that I saw too, Dr. Chabot, and confirm this if it's true, race and ethnicity are also a factor. African Americans, Hispanic, Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Dr. Chabot: Yes, definitely. Lots of stuff goes into that. It's the combination of the places and conditions that folks live, but also genetics.

Scot: Yeah, the socioeconomic reasons and genetic reasons as well.

So what is this condition exactly? Let's define what it is. Let's define why I should be more like, "Oh, no," and less, "Meh."

Dr. Chabot: I mean, there are a bunch of different measures for glucose. And that's what we're talking about, right? It's just that your glucose is abnormal, your blood glucose is abnormal, but not yet to a threshold that we've sort of arbitrarily defined as diabetes.

So there are a couple of different things that people might actually see. I usually think of this as the A1C, or hemoglobin A1C. That's a three-month average of your blood sugars that just comes out in one number. So normal is less than 5.7 and diabetes is 6.5 and up. And if you're somewhere in the middle, we call that pre-diabetes.

And then there's a fasting blood sugar, right? First thing in the morning, you haven't eaten anything, you get a blood draw, and that is somewhere between 100 and 126. That's what we call pre-diabetes. Less than 100, you're normal. Over 126, you're just full-fledged diabetes.

Scot: And I was at 99. I mean, is that close to 100 a reason to be super concerned, or could I just run at that level?

Dr. Chabot: I think 99 . . . you've got to draw the line somewhere. Should we be worried at 98? I don't know.

Scot: I'm getting awfully close to that speed limit sign, is what you're saying. I should consider hitting brake maybe.

Dr. Chabot: Yeah. So basically I give you kudos for being concerned, but . . .

Scot: I mean, here's the thing, though. I had a doctor tell me that they were concerned. They're like, "You're really close to that 100." And I've had other doctors since then not too concerned about it at all. So what's going on there?

Dr. Chabot: We're trying not to get alarm fatigue with folks to say, "Oh, man, we need to worry about the thing before the thing, before the thing." The reason we defined diabetes the way we did is that's where you start to get organ dysfunction. And we know that in pre-diabetes you're not yet to the point of having organ dysfunction, but you are very much at risk for developing diabetes later in life, right?

That's the distinction. Pre-diabetes means you are at a huge risk for diabetes. So if you are pre-pre-diabetes, as in your case, I am not sure how to help you, other than exercise.

Scot: Yeah. Let me throw this out there. So, without intervention, many people with pre-diabetes could develop type 2 diabetes within five years, is what they're saying. So if you get that pre-diabetes diagnosis, if you do nothing, you could develop type 2 diabetes within five years.

Mitch: Okay. Pause, pause, pause. Everyone, I'm looking at my results from my latest report. My doctor hasn't said anything, but if the glucose is above 100, that's pre-diabetes?

Dr. Chabot: Fasting glucose. So did you eat that day?

Mitch: No. It's fasting glucose. I'm at 101. Why wouldn't my doctor bring that up?

Dr. Chabot: Oh, revelations.

Mitch: I have a big history of family type 2 diabetes. Wouldn't pre-diabetes be something that the doctor would be like, "Hey, we should probably get this figured out"?

Dr. Chabot: Yep. Definitely.

Troy: Wow.

Dr. Chabot: Sorry. This is high drama. I'm sorry.

Mitch:I hate this show sometimes.

Scot: You hate this show sometimes.

Mitch:Oh my god.

Troy: So, Matt, just hearing that though, you're definitely concerned. If you were Mitch's doctor and you saw a fasting glucose of 101, you'd say, "You're pre-diabetic"? Pre-diabetes range?

Dr. Chabot: Yep. Now, I don't want to throw anybody under the bus, but I am guessing perhaps this was missed and not that they looked at it and intentionally ignored it. I'm guessing somebody thought, "Maybe he ate something that day." I think it's totally valid. And if somebody brought that kind of number to me, I would just say, "Oh my gosh, sorry. Yes, let's talk about it."

Mitch: Okay.


Scot: All right. So could that number Mitch has be a little confusing? There are a couple of tests, right? You said there's the A1C test, which is the average, and then there's your fasting glucose.

But I'm looking at one of my results, which is my A1C and . . . I have a component, an estimated average glucose, and then I have my value, and then I have an HGBA1C. And that estimated average glucose is 111. I mean, that's higher than what I've seen my fasting glucose at, I thought.

Dr. Chabot: Yep. And that reflects where you are with all your meals throughout the day, right? And I don't have the chart in front of me. What was that A1C that they gave you, that 111?

Scot: It's 5.5%.

Dr. Chabot: Yeah, 5.5%. Okay, great. So that hemoglobin A1C is normal and the fact that your average hovers something above where your fasting is totally okay, right? You've got to eat at some point.

Scot: All right. So we're sure that Mitch's . . . Mitch, what'd your numbers say? I'm concerned about you, Mitch. So I want to make sure . . .

Mitch: I know. I'm also concerned about me. Fasting glucose, most recent result 101.

Troy: Since we're all sharing here, I was happy with mine. Now that I'm looking at them too, I just had to reconfirm. I just had some blood work done a couple weeks ago, but yeah, so mine was 83 and then A1C was 5.

Scot: All right.

Troy: Happy to see that.

Scot: Hey, let's look at cholesterol levels then. Why don't we do that?

Troy: We're not. I already told you my cholesterol went up 20 points on this test, so I was . . . My LDL went up 20 points and I was like, "What in the world have I done here?" That's another conversation.

Scot: That is another . . .

Dr. Chabot: I love that you all are disclosing your numbers.

Troy: I know.

Dr. Chabot: Did we sign HIPAA waivers or anything?

Troy: That's all we do.

Scot: No.

Troy: We just disclose and we don't sign waivers.

Scot: None of us are good at anything like darts or anything that we can . . . So we brag about our numbers.

Troy: Yeah. We have to have something to fill the show. We just talk about our numbers.

Scot: All right. So we talked about how do you know you're kind of headed into that territory? And the way I think about this, Dr. Chabot, and tell me if you agree with this or not, is actually being told you have pre-diabetes is one of the best things you can find out because there's still time to do something about it before it develops into diabetes. Would you agree with that?

Dr. Chabot: Yeah, totally. Couldn't agree more.

Scot:It's a good diagnosis.

Dr. Chabot:Yeah, exactly. I think this is the intervenable moment, right? Because once you've progressed significantly in your disease, then certain ships have already sailed. I'm not going to say it's all doom and gloom necessarily, but you really don't want diabetes and you don't have it yet, right?

And you're in good company. If you have pre-diabetes, there are a lot of people in that situation and they don't feel anything yet. And that's the good thing about it, right? You're not going to keel over or anything. You have time to really reevaluate what you're doing in terms of your diet and your exercise.

Scot: All right. So let's hit briefly on what are the impacts of diabetes. So say you do nothing and you head into diabetes land. You're still doing 45, and now the speed limit is 25. What kind of ticket are you getting here? What are some of the things that happen to people that get diabetes? And it's not nice. It's not good, by the way.

Dr. Chabot: Right. So diabetes is basically in every organ system when we talk about end organ dysfunction, but heart attacks and strokes are the big ones because those kill people instantly, or seriously disable them, right? But there are a lot of other things, like vision loss that leads to blindness and macular degeneration and things like that, and retinal disease in the back of your eye.

There's also kidney failure and nerve damage. So the kidney failure is not the kind of thing that people feel immediately, but will set you up for all sorts of bad things later on down the road. I'll just leave it at that.

And then nerve damage, I think that's the other thing that people really feel. That's the numbness, tingling, burning, and pain that happens. It starts at the tips of your toes and creeps up your legs. And then that leads to inability to feel tiny wounds in your feet or heal those tiny wounds in your feet. So you have poorly controlled diabetics that end up losing toes or having ulcers in the bottom of their feet.

All bad stuff, but you can decide which of those you're more worried about, I suppose.

Scot: Right. Plus also, not to be underestimated, just the mental toll, the mental health toll of living with a chronic condition like that. It impacts your quality of life and it can really impact your mental health as well.

Dr. Chabot: Right. And you're living from medicine to medicine and there are lots of doctor's appointments. There's lots of testing. And the people who really do badly ignore their diabetes, but even the people that are on top of it, it is a lot of work.

Scot: Effort and time you could be spending on better things in life.

Dr. Chabot: For sure.

Scot: It's better not to be there. And then for men in particular, is it true . . . I've heard it can impact testosterone production leading to low testosterone levels, and also it can lead to erectile dysfunction.

Dr. Chabot: Yes to all those things. So the testosterone connection, I think, is interesting and we can talk about it, but the erectile dysfunction is even independent of testosterone levels. You start to get blood vessels that don't pump blood well, right? That's the basis of all those diseases I talked about before, the problem going on in the back of your eye, the problem going on in your kidney, and that's also going on in your penis, right? So you don't get good blood flow and that leads to that erectile dysfunction.

Troy: I was going to say in terms of complications, Matt, everything that you talked about. And I think just seeing the other end of that, the people who come in with diabetes that they've had for years and what they face as a result of it, it's a horrible disease. And I feel so bad for people who have it.

I also do a lot of work in wound care, quite honestly. The majority of patients, or at least 40% of patients, I see in wound care are people with diabetes. Like you mentioned, those wounds on their feet, complications/infections in the bones in the feet.

So I'd hate to just pick a disease out there that I just wouldn't want to have, because I'm afraid if I say that, then I'm going to get it, or else I'm going to get another really bad disease. But I can say if I had to pick a disease I'd never want or a condition, diabetes would definitely be toward the top of that list, if not the top, just because of everything you mentioned and everything that just goes wrong as a result of it.

Mitch: All right. So I'm freaking out.

Troy: Sorry, Mitch.

Mitch:No, it's fine.

Dr. Chabot:Poor Mitch.

Troy:You don't have it, though.

Mitch:I don't have it. So I have a family history of diabetes. I apparently have had been in a pre-diabetic for the last year and a half. You said it can be five years until things happen. What could I do to change my life tomorrow that could help me move away from the edge?

Dr. Chabot: I'm so excited that we have a test case right here, right now.

Mitch: I'm so glad you're excited.

Scot: But I will say he's been monitoring it for the past . . . How many years would this be? I guess you're getting it every quarter, so it hasn't even been years, right?

Mitch: Yeah, every quarter. So about a year and a half or so.

Scot: Got it.

Troy: So it's been a year and a half and it's been about the same over that year and a half, kind of like that 101 to 103 range it sounds like.

Scot: Yeah. I mean, the good news is, Dr. Chabot . . . I'm going go ahead and do the diagnosis here.

Troy: Please.

Dr. Chabot:Be my guest. I think you're well-trained at this point.

Scot: The good news is it stayed the same and he's . . . I think that statistic I said about it's going to develop into diabetes, we're not seeing the trend towards that.

Dr. Chabot: Yeah. I think that particular statistic that we said, in five years, that is really variable, it should be noted. And a lot of times while we're doing lifestyle things, what we're doing is monitoring this, right? It sometimes just not progressing anymore is a success in and of itself, right?

So it's not all doom and gloom for our friend Mitch, but we can talk about the other things that we can do by tomorrow and then sort of the long-term stuff.

I think we alluded to diet and exercise, and we can certainly go there, but there's also recently a little bit of prescription medication that's been used in this zone to prevent progression to diabetes. Are we ready to talk about that?

Scot: Before we get there, let's talk about these risk factors, if somebody should even know they should be concerned. We've all had our numbers done. Is this a pretty standard test that a doctor's going to do if you go into a physical, or is it something you're going to have to ask for? If I understand correctly, there are no symptoms to pre-diabetes. You do not know.

Mitch: Yeah. The only reason I have these numbers is because I'm getting tested for a different medication and I just happen to have them.

Dr. Chabot: Yeah. No symptoms whatsoever.

Scot: Let's say somebody comes into your office. What's going to dictate whether you give them a test to determine if they have it?

Dr. Chabot: Age and weight. Well, when I say weight, I mean BMI. And maybe you guys have talked about BMI, but I always sort of define it for people a little bit. It's your weight for your height, right? So it's your weight adjusted for your height. And if you're overweight, that's a BMI over 25, or if you're obese, that's over 30.

That's a little bit of a deceptive number, admittedly, because it doesn't really allow for muscle mass. It just sort of assumes fat mass. So Dwayne "The Rock" Johnson would have an obese BMI, but obviously he's not obese. He is made out of muscle.

But it's sort of a population-based metric that we have. It's to say if you are overweight, then you should be getting some monitoring of your blood sugar with some regularity. Now, people will go in different directions about how often that should be. But for me, it's part of an annual physical.

Scot: For you, it's an annual physical. Every patient that comes through your door gets one?

Dr. Chabot: Who's overweight, yeah.

Scot: Oh, okay. So some of the other risk factors I saw were 45 years or older.

Dr. Chabot:Yep.

Scot:If your parent, brother, or sister has type 2 diabetes.

Dr. Chabot:Mm-hmm.

Scot:If you're physically active less than three times a week.

Dr. Chabot: Agree, but I personally . . .

Scot: Okay, not necessarily for . . .

Dr. Chabot: I don't jump all over that one necessarily, but yeah.

Scot: And then we talked about race and ethnicity are also a factor, but let me tell you, I was none of those things. My BMI was at the edge, but it was normal. I got a body fat analysis. That told a whole different story, believe it or not.

I mean, I'm thankful that somebody decided they wanted to do this test. Maybe they saw something I didn't. Maybe they looked at my BMI and looked at my . . . You take your shirt off and they listen, and maybe they're like, "Well, I better check this guy." I'm a skinny fat guy, Dr. Chabot. Have you ever run into me before?

Dr. Chabot: You have the opposite body composition problem from The Rock.

Scot: Yes, I do. I'm the anti-Rock. I'm The Sponge.

Troy: The Sponge.

Scot: The Squish. Not an intimidating wrestler name by any stretch of the imagination.

So if somebody is overweight, you would suggest this. Is this something that somebody could suggest on their own? And what's the cost? I mean, is it a good investment of my dollars?

Dr. Chabot: A very good investment. I mean, this should be minimal as far as blood tests go. It's almost gotten as an afterthought sometime, which I think might've been the case with Mitch. You probably had a panel that was looking for other things in regards to other medicines, and the glucose just happened to come along with it. So it's really not expensive in any way, shape, or form.

Scot: All right. Now we can get into the things we can do. For somebody like Mitch and myself, we're borderline or a little over the border, but still in pretty good shape, right? What are some things we can do in the short term?

Dr. Chabot: So, in the short term, decreasing the amount of carbohydrates and calories overall will help you to lose weight, but also decrease this number, and then also increasing the intensity and frequency and duration of your exercise. All those things will help.

And what's nice here is that each of those things will help independently, right? So if you change your diet but you don't quite get to the exercise thing, you're still going to see some improvement statistically, and vice versa.

And as I sort of alluded to, there are medicines, right? That's sort of the thing that takes effect tomorrow. Those lifestyle changes are hard, admittedly. I do a lot of talking to patients about those because they're just so tricky to really work into your life. And I think people kind of beat themselves up about it sometimes, so I usually try to approach it as, "This is hard for a good reason, right? Let's try to acknowledge that, but also tackle it."

Troy: Matt, what if someone does those things and they improve their diet and they're exercising and they don't lose weight? Are they still going to see benefit from that even without losing weight?

Dr. Chabot: Yes, definitely. Yeah, that's a tricky thing, right? Exercise makes these sorts of metabolic numbers that we're talking about better, when we're talking about sugars but also cholesterol. But exercise doesn't always make the scale do what you want it to do, right? So you can be changing your body composition but not changing your number. That's why we sort of accept that weight is an imperfect measure of all this kind of stuff.

Scot: If you were to pick one of the two, diet or exercise, which one would you tell somebody to do first? If you had to prioritize it for them and they're like, "I can only do one or the other."

Dr. Chabot: Exercise.

Scot: I think it's a cool story. Tell why exercise works. It gets back to the way that these metabolic diseases kind of formulate and the absorption sugar into the cells. I think this is fascinating,

Dr. Chabot: Right. So exercise works in a lot of different hormonal ways, but at its basis, you're taking skeletal muscle and asking it to do work, and it uses blood sugar to do that work. So then it takes that energy and makes it into motion and heat.

And in the process, you're doing a lot of other things. It's complicated, of course, but that makes the muscle itself grow and be larger, right? So you grow more muscle cells, and those cells just sitting around have a certain basal metabolic rate. So when you're exercising, you're growing that muscle mass, and you're burning blood sugar during the active exercise, but you're also burning more blood sugar between exercise sessions.

Scot: And it also has something to do with if you're insulin resistant, insulin is trying to take that blood sugar and get it into your cells, but it's not working properly, right? So then your body releases more insulin and then that's what starts causing some of these problems. But exercise is kind of the shortcut to getting that energy into the cells without as much insulin or without insulin. Help me with that.

Dr. Chabot: Yes, that's exactly true. There are only two types of cells that use blood sugar without any insulin being involved, and that's the brain and exercising skeletal muscle. So you sort of shortcut that insulin idea.

Insulin is working all the time to try to keep your blood sugar in a normal place despite you eating or not eating for periods of time. So it's just out there to regulate.

But if you have so much energy, so much blood sugar on board all the time that insulin is working overtime and you're just flooded with insulin constantly, then you run into problems that the receptors of insulin start to down-regulate. You become resistant to your insulin, so it doesn't have the same effect anymore. And that's how the blood sugar starts to creep up. You've broken your thermostat at that point.

Scot: Right. Then by exercising, you're getting rid of that sugar without the use of insulin. So your fasting glucose and all that glucose level would go down.

Dr. Chabot: Exactly.

Scot: I think that's neat, guys.

Troy: I think it is, too.

Scot: And is that strength training exercise or aerobic exercise? Or doesn't it matter?

Dr. Chabot: Both. I think most of the evidence is that a combination of the two is where it's at. If you had to pick one, I think it's mostly the one that you can do, right?

Scot:The one you can stick to.

Dr. Chabot:So I'm just excited to get people doing either. And I think there's probably a little debate among PhD types about which is more ideal, but really both in terms of improving all these end points that we're talking about.

Troy: To me, it's great to hear that, number one, exercise is the starting point that you'd recommend. Certainly, diet and exercise, but if you can only do one, just start exercising, start moving more, whatever works for you.

But the simple fact that you may not be dropping weight . . . you probably will, I'm guessing, if you start exercising more, but you may not. But you're still going to see benefit. You're still going to see most likely that hemoglobin A1C number come down over time, your fasting glucose. You're still going to see those benefits even without losing a lot of weight. So that's encouraging.

Scot: And I love that point because a lot of times we equate exercise with weight loss, and if we think we're not losing weight, we think we're not getting healthier. But there's all sorts of stuff going on inside your body that's getting healthy, even if the exterior does not show it. So I love that you brought that up, Troy.

Troy: Quite honestly, I was under the assumption that you would not see the benefit until you started dropping the pounds, but that's not true. So that's good to hear.

Scot: Dr. Chabot, let's pretend that there's a patient in your office. You just told them they have pre-diabetes. They're not meh. They're, "Oh, no." You explain to them, "No, this is actually a good thing because we can do something about it. Now, here's what I would recommend that you do. Here are my beginning recommendations and I'll check back in with you six months later and see how you're doing and we'll adjust from there."

But those very first steps. I'd imagine if they drink soda, reduce that amount of soda. I think that would be easy for you, right? What are some of those easy . . .

Dr. Chabot: I'm so excited that you mentioned soda. Soda is my Don Quixote windmill that I'm tilting at all the time. Here in Utah, the soda consumption is so high. Soda consumption per capita outstrips most other states in the United States. It's very interesting.

So, yeah, mostly I would look at low-hanging fruit in the diet. Diet is complicated and I think it's easy to get overwhelmed, and it's easy to use too much broad strokes to be like, "Just eat less." Nobody is measuring their food from a day to day.

So where I usually start with people is something like soda, right? What is the correct amount of soda? Zero. That is high octane, terrible fuel to put in your body.

There is no redeeming anything because it is such a huge sudden burst of blood sugar that almost nobody's insulin can keep up with that. Unless you are literally just going to run directly after drinking that soda, you're going to go through a transient period of having your blood sugar be abnormally high.

So I would say increase your exercise, decrease your amount of refined sugars that you're taking in, and think about metformin, which is the medicine that I end up talking to people about.

So decreasing those refined sugars like we talked about, it's soda, it's dessert, it's white bread. To some extent, it's also things like pasta, but mostly it's soda and desserts, right? Those things are just hard to mitigate.

And exercise, like we talked about. It's always a negotiation. It's always a little bit of, "What can you do?" But it just has to be more at the end of the day, right? If you ask a doctor, "How much should I exercise?" they'll say, "More." So exercise is as close to a panacea, a cure-all, that we have, and for lots of other reasons beyond what we're talking about here, but definitely for this.

It's important to do changes that you can maintain for long periods of time, that you can conceptualize well and keep up, right? So, as far as a lot of these things, I say, "The perfect amount of soda is probably zero." But admittedly, if you go to a party, maybe that's once a week. That's okay, right? And allowing yourself that. It's the things we do daily that really hurt us.

And then the medication options, right? There have been some studies that show that there's a pill that prevents progression to diabetes, and that's metformin. I prescribe that pretty regularly. There are pluses and minuses for any medication, right? There's no such thing as a zero-side-effect medicine.

But that I think has to be part of the conversation, especially for a lot of people who are going to struggle with this, because it's hard. Even if you follow all my advice, you can have the genetic cards stacked against you, and you can't stop aging. Between genetics and aging, sometimes despite our best intentions, we see the numbers going the wrong direction.

Troy: So hearing those treatment options . . . and let's say again thank you, Mitch, for being the person we're able to kind of talk about some numbers with.

Mitch: No problem.

Troy: I appreciate it. With Mitch's numbers, would you bring up something like metformin, or would you just say, "Hey, you're a little on the high side. Let's focus diet and exercise and recheck this in a year or two"?

Dr. Chabot: Where Mitch is, I would not necessarily jump right to medicines, that's for sure. He is, yes, pre-diabetes, but I think you've got to appreciate the gradient here in that if normal fasting glucose is 100 or less . . . You said you were 101, 102, right?

Mitch: Yeah, 103.

Dr. Chabot: So that's still not so far gone, right? I think you could easily see enough effect size from a lifestyle change to stave this off for many, many years, or forever.

Scot: You feeling better, Mitch?

Mitch: Yeah, I'm feeling better. It's fine.

Scot: I don't know if I believe you.

Mitch: Well, that's just kind of it. Having had diabetes in my family, having seen some of the things that happen, that's always been a fear. That's always been a concern, something to make sure that I don't get to that point, right? And so there's just a little bit of a shock happening right now where it's just like, "I'm not even supposed to be checking that. I was told I was healthy. I'm checking other things." And so it's just this kind of interesting real-time turning point, I guess.

Dr. Chabot: Oh, buddy. I'm so sorry.

Mitch: It's fine.

Scot: I mean, I've been there too. When I got the news, it was not only an assault upon my identity, but it was a little scary because I'm like, "What? I'm heading towards what?" And when you're at the beginning of that journey, then you start watching those numbers. Are they going up? Are they going up? What can I do?

I feel like the answer is not to go completely overboard and eliminate all joy from your diet, right? Is it just managing portions a little bit better? Is it just trying, like Dr. Chabot said, a little bit more exercise when you can? I don't know.

Troy: I was going to say would it be helpful for Mitch to get a hemoglobin A1C checked as well at this point?

Dr. Chabot: Yeah, I think so. I think more information is helpful in this, and I think the hemoglobin A1C . . . I honestly kind of prefer it to some degree because it reflects a larger time period, right? Any one glucose can cheat a little bit, right? Yes, you were fasting, but were you fasting for 10 hours? Were you fasting for six hours? Did you have a midnight snack? I don't know. So the hemoglobin A1C kind of gets rid of some of that guessing. So I think it would be a great test.

Scot: Something else I came across, Mitch, is the National Diabetes Prevention Program from the Centers for Disease Control and Prevention. They have these programs . . . It's not so much that they put it on, but I think they must provide the information.

Dr. Chabot, are you familiar with these? We have some at University of Utah Health Center clinics. There are numerous ones out in the community. I'll put a link up. You can find one near you.

Tell me a little bit about what this is. If somebody is just so overwhelmed that they want to take control of it, but they just don't have the knowledge or the experience yet to do that.

Dr. Chabot: These programs are great, and they're basically a lot of education. I think we were starting to tiptoe into this of like, "Okay, now what do I do with my diet?" There are a lot of things you can think about or do. How do you decrease your portion sizes? How do you decide which things have less refined sugars? We're throwing these words around, but that's not obvious, right?

And these sorts of prevention programs have dieticians involved and exercise therapists and coaches and things like that, as well as people that are there to help you navigate this idea and how to make it better. How you adjust your diet I think is the really complicated thing that they help with the best.

Scot: We talk on this podcast a lot about the Core Four: diet, nutrition, sleep, and mental health. But within nutrition, wow, there's a lot to know. There's a lot that we were maybe never taught or perspectives we never considered before. And these programs can help if you need that extra help. There's no shame in investing a little money if you have to, because it's better than what you're going to spend if you get diabetes or the impact it's going to have on your life.

All right. Well, is there a takeaway you have, Troy?

Troy: Just from hearing about both of your experiences, it's probably not a bad idea just to get a fasting blood sugar checked even if you don't fall into those categories. Matt, I don't know if you agree with that or if you're ever just doing that with people under 45 who are not overweight. But yeah, just kind of hearing your experiences makes me think that it's probably not the worst idea to do that maybe once every few years.

Dr. Chabot: Yeah, I agree with the idea of getting a fasting blood sugar. I often don't, I'll admit, because I'm just trying to access the most people. And if people show up in my clinic without having fasted, I say, "Great, we'll just get the A1C." And we know that's not the same and it's not totally perfect, but the important thing is to get checked one way or the other, right?

And if it takes a second trip to get checked and you're like, "I've got to come back tomorrow and skip breakfast," and things like that, a lot of people let that slide and don't actually do it. So the best test is the one that you do, in my mind.

Scot: Yeah, and I've contacted my physician beforehand and said, "Before I come in for my appointment, I'd like to have this test. Can you make that happen so then we can discuss the lab work during my appointment?" So that's another option.

Dr. Chabot: Yeah. That's totally a great option.

Scot: Mitch, takeaway? I have a feeling there are some episodes that impact each one of us a little bit differently. I think this one impacted you in a major way.

Mitch: I was not expecting it.

Troy: This is like the migraine episode when you realized you had migraines.

Mitch: Yeah.

Troy: And me too. I'm like, "We both have migraines."

Scot: But I think this is a universal experience. I don't think anybody who gets told they have pre-diabetes expects it. Or maybe some people do. I don't know.

Mitch: Yeah. I guess that for me at least, it just kind of continues to prove the thesis of men should talk to each other about their health. How else would I have known, right?

I've been really focusing on mental health over the last year. Mental health and sleep, those were the big ones that I've been focusing on. I've been working on PT to get better. I haven't been working out quite as much as I used to. I'm still doing it a couple times a week. My diet hasn't been quite as much whatever, but maybe I need to reprioritize some things if I'm in a state that could get worse, I guess.

Scot: Dr. Chabot, thank you very much. If you're listening, I think our challenge to you is maybe consider having a conversation with your provider about getting an A1C test or a fasting glucose test, especially if you fall within the higher risk categories.

But even if you don't and you just would like that peace of mind, it doesn't sound like it's a terribly expensive test if you had to pay for it out of pocket. It could give you a lot of valuable information.

And if you've been told you have pre-diabetes, hopefully this podcast is taking you from "meh" to "oh, no, what can I do today? What's one thing I can do today?"

And I think my takeaway from this is that one thing is to get out and exercise, first and foremost. Do a little bit more. If you're doing nothing, start doing some. And then start working on those refined sugars in your diet.

Everybody's got a couple of things probably that they know they shouldn't be eating as much of as they are. Maybe you could look at your diet and see what those things are.

And if you need help, go to that CDC website and find a program near you that can help you get you the information you need to take control of your health. This is one of those rare moments in health where you get news where you can still do something about it to avoid something that's not so great.

Well, gentlemen, as always a great conversation. Thank you for listening today, and thank you for caring about men's health.


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