Fantastic Four: Essential Tests to put Complications to Rest

0:03 [Music]0:15 we are here today to talk about the four important screening tests heart eyes0:23 feet and kidneys to have done the frequency with which which when they0:29 should be done who should perform them and why these tests are so important to help prevent0:35 our delay diabetes complications we're joined by some incredible knowledgeable guests today0:42 who will be sharing their perspectives on the subject welcome doctors Holden B0:49 abala and McFarland we call them our Fantastic Four we welcome questions from0:56 the audience anytime so please feel free to use the chat function to ask your1:01 questions so while you are composing your questions we have some prepared questions so let's get the dialogue1:08 started so that you could benefit as soon as possible from these amazing amazing panelists so let's get started1:16 so the first question is I'm going to be asking Dr Holden what should people know1:22 about the risks to to heart health post by diabetes oh thank you so people with1:30 diabetes are more prone to developing heart disease than people without diabetes and they also tend to develop1:36 it at younger ages than people without diabetes um they can present with heart attacks they can present with angina1:43 they can present with strokes and they can also present with something called heart failure where the heart has1:48 difficulty pumping blood and fluid can build up on the lungs this can cause shortness of breath it can also present1:54 sometimes with cough so it's important for everybody to eat nowadays a lowfat diet exercise2:00 regularly but it's essential for people with diabetes it's also really important that they not smoke and that they keep2:06 their weight and healthy range well thank you so much doctor andDiabetes Eye Complications2:13 that's we're going to be diving a little bit more into these uh questions in terms of what you've answered so uh2:20 we're just getting warmed up so please prepare your questions and we're going to be going to the next panelist to Dr2:26 Bajaj um how does diabetes impact eyes and vision and are eye complications2:32 permanent in people with diabetes yeah hi hi everyone um and for2:39 those of you celebrating the Indian Festival of diali that's why I'm dressed up like this it's the Indian festival so2:46 um yeah about the eye disease and complications um so there are four types2:51 of eye disease complications that can happen in people with diabetes uh um2:57 there's the length the front of of the eye the length of the eye can develop cataract at an earlier age and more3:04 frequently in people with diabetes but there's also the back of the eye the retina which can get more uh more3:12 complications as well which could include uh more bleeding within the3:18 retina what we call retinopathy can happen where there's bleeding and and so3:24 the vision is reduced or there's more edema or swelling within the back of the3:30 eye as well um so what we call macular edema and then glucoma is also more3:37 frequent in people with diabetes glucoma being blood pressure or pressure being3:42 higher in the eye as well so those four conditions are more common in people3:48 with diabetes those four eye conditions is what we call diabetes eye complications now some of the3:54 complications if caught early on and treated appropriately can actually4:00 be prevented or or prevented from escalating to permanent damage so that's4:06 what the goal should be S thank you so much DrFoot Complications4:12 Bajaj um I mean uh I mean the these are again uh really important questions and4:18 we have four panelists here so please prepare your questions and uh we'll4:24 we'll ask next question about our Fe our foot care um Dr ablo I'm sure our we4:31 viewers have heard a lot about the importance of food care for diabetes so why is this important and how can they4:38 ensure regular testing is taking place yeah for sure and hello from Sunny4:43 St John's great to be connecting with everybody here so um yeah I mean foot complications and diabetes are serious4:52 um they matter to people and we've heard from people living with diabetes that the fear of developing one of those4:58 complications is even more than death for some people um and the reason5:03 it's really important to talk about it today is that we have tools that reduce the risk of developing those complications and the majority of them5:10 by up to 85% so thinking about just how serious they are you know it can range on a5:16 spectrum from uh losing a toe to losing a limb um or having an infection that5:21 just put a puts a big big bump in people's life and um and changes the course of of needing Acute Care at that5:29 time um and in terms of the tools many of the ones that we have for reducing the risk5:34 are readily available and um and there's the diabetes team to support with that5:40 so how can people ensure regular testing um I think step number one uh being informed so with everybody being here5:47 we'll share that the basic and standard Diabetes Care is having a foot exam a5:52 diabetes foot exam at minimum once a year um and the goal of that is to find5:57 out where people lie on that risk Spectrum so is it in the low risk category moderate or high risk category6:05 um and because that risk can change over time again at minimum once a year uh so maybe you know inquire if you're up to6:13 date on your foot exam uh maybe uh see your family doctor a diabetes educator a6:19 podiatrist or someone who's trained in diabetes foot exams thank you so much for the answerKidney Complications6:27 doctor um will We'll be asking um Dr McFarlin about kidneys so what makes6:34 Kidney Health so important for people with diabetes and what are these tests and then what are we really looking6:40 for okay great uh thanks Eva and hello uh everybody uh from Sunny Toronto I6:47 guess um so of course I'm biased being a kidney dock but um I think for people6:53 with diabetes this is uh for sure one of the most important complications it's certainly one of the most common so7:00 about half of everybody with diabetes will show some signs of kidney uh damage7:07 in their lifetime if you came with me to my dialysis unit about 40 to 50% of the7:13 people on dialysis are there uh because of diabetes now of course most people7:19 with diabetes who get kidney involvement don't progress that far thankfully um7:24 but the testing is important because as mentioned by some of the other speakers7:30 uh when it comes to the kidneys we have things that can prevent uh kidney damage7:35 and if there is established kidney damage uh there are things that we can do that can slow down further7:41 progression of uh of kidney disease in people with diabetes and the final thing I just wanted to mention is that most7:48 people who have kidney damage have no idea that they have it um unlike7:53 something dramatic like a change in your vision or a heart attack or a stroke uh7:59 kidney disease is by and large silent and most people don't know that they have any problems in their kidney until8:05 they're down below about 10% of normal kidney function so we really do need to8:11 test in order to catch the disease uh at all but in particular if we want to8:16 catch it early so the two tests that we do we check the uh the urine for extra8:22 protein because we can see extra protein for years and sometimes even decades uh8:28 be uh in a person with diabetes uh before they actually start to lose kidney function so for many people that8:34 first sign of diabetes affecting the kidney is going to be U extra protein in the urine the test of choice is the8:41 random urine Al Ratio or ACR and we also check the blood for the level of8:47 creatinin in the blood creatinin comes out of the muscles filtered by the kidneys the higher the creatinin the8:52 lower the kidney function so we uh we combine these two tests to check for uh8:59 early kidney disease moderate and late kidney disease the random urine ACR and the blood test for the serum9:06 creat thank you so much Dr we have a question um about cholesterol uh DrCholesterol9:13 Holden how often do you recommend testing for cholesterol and is one seure9:18 good enough so typically cholesterol levels are checked once a year at least once a9:25 year if you're on cholesterol lowering medication though your doctor will probably check the levels at each visit9:32 um and they typically are looking at something called the LDL or bad cholesterol I want to see it under two9:37 if you've had a heart attack they'll aim for an even lower level typically under9:44 1.8 thank you doct um Dr Bajaj can you have type two diabetes and not have any9:51 eye issues yeah so that question and so when9:57 I counted the DI eye disease those are conditions that that we want prevent10:04 from happening so over the past especially the last two decades or so10:10 the diabetes eye conditions eye diseases that we we you know talked about the four things10:18 so especially the DI reop and reduced over time so the people the portion of10:25 people who get these complications is much less so it Absolut possible and and10:31 I be the right you know approach the right target to have those diabetes eye10:38 disease complications and how we do that there's three things to keep in mind one10:43 is screening uh so screening should start right away in people with type two10:49 diabetes as they diagnosed that's the diabetes Canada guidelines recommend a10:55 diagnosis and at least every one to two years thereafter even without any11:01 symptoms or even without any diabetes eye complications screening test with a11:08 professional whether an optometrist or opthalmologist should be done so that's11:13 one the second is controlling the risk factors of course glycemic control or11:20 glucose control right so diabetes Canada guidelines recommend11:26 targets for people with diabetes uh for most people the target is for the A1C11:32 test to be less than 7% so if we get A1C of less than seven and maintain that11:38 there's much less risk of being compx but also important is11:45 controlling the cholesterol and blood pressure not as important as maybe in11:50 heart disease that Robin mentioned so cholesterol is much more of a risk factor for heart disease is also an11:57 additional risk factor in eye disease in diabetes as well but the more diabetes12:03 eye disease is glucose itself so that's one thing to keep in mind as well and the third thing that we can do to12:10 prevent diabetes eye complication is actually managing the problem early so12:16 the first sign that anybody has of any problems in the eye uh even if you're12:21 not sure if this is important or not it's important to seek management and treatment immediately and not take it12:28 lightly thank you so much Dr Bajaj that was incredibly informative um we have aFoot Care12:35 question on foot care so Dr aoi um a person on the floor had12:41 indicated they have shooting pain in their pain in their feet and toes and very heavy most days um however there12:47 are no Source um but there's discoloration around the toes um skin is very dry so12:56 the person is asking what they should do and do you recommend regular like pedicure what what is the the way to get13:03 uh uh for all of the ailments that they have indicated yeah great question Joan13:08 thanks for sharing that now again of course we can't make any diagnoses online uh but it sounds from what you're describing that you have what we call13:16 clinical symptoms or of peripheral neuropathy uh so it can range from the tingling numbness Burning uh but also13:22 loss of sensation so I I would suggest that you know if you're if you haven't had your annual foot exam make sure that13:28 you have it because the protective sensation needs to be checked um it's done using something called a 10 G13:34 monofilament which looks like a fishing rod but is not sharp and we basically kind of poke the bottom of your feet see13:40 if you're feeling it um and it gives us a sense if your protective sensation is in place so your defense mechanism so I13:47 would say that would be the first thing diabetes Educators Family Physicians Specialists um uh podiatrists um and and13:54 foot nurses can do that uh for you so it's step one uh the other thing it's hard to comment on the discoloration but13:59 it sounds like it needs to be looked at um it could be from different reasons so I would say um epidat you know is an14:06 option unfortunately it's not covered in many provinces uh as part of the public health care plan so depending if that is14:13 an option otherwise um you know your public Healthcare team should be able to at least do an assessment there about14:19 pedicures just a quick note um whether your protective sensation is there or not whether the circulation is uh is14:26 Flowing as expected or not uh may be potential harm from pedicures especially14:31 where and I'll just say this from personal experience the water is always boiling hot so on somebody where their14:37 protective sensation may not be there to give you the warning to pull out you may14:43 get second deegree Burns uh from that so it's really important that it's done professionally so podiatrist uh shopus14:50 they're named differently across provinces um or a trained uh foot care nurse um and various other professionals14:57 uh trained and that would be the best last step diabetes Canada has a nice quick one pager promise not too long15:04 General dos and don'ts from a safety perspective um and it's readily available online so hopefully that'll be15:09 helpful um I'm just going to jump in quickly to Verna uh verna's uh question about the brown staining that's probably15:15 from pooling of blood where the valves in our veins which take blood back to the heart may not be functioning um and15:21 just where the blood may pull in the legs you may get that dark brown staining if you get other reasons that15:27 you have swelling and the skin stretch es or it's thin there may be ulcers or wounds um so again um having a a foot15:34 care nurse or a pediatrist look at it or your family phys to point you in the right direction thanks so much uh doctor um weMuscle Gain15:42 have a question about um muscle gain in terms of um Dr McFarland perhaps you can15:48 shed some light on this like will muscle gain through weightlifting help control blood sugar maintain healthy A1C or does15:55 actually like a physical activity includes blood sugars like in what point is it too much sure so it's a common16:04 question for me um so uh one of the things that happens if you uh build up16:09 muscle is that because creatinin which is our our handy dandy way of measuring the level of kidney function from a16:15 blood test um the level of the kidney function sorry the level of the creatinin in the blood is a function of16:21 the level of kidney function but also how much creatin you make and the more muscle you have the more creatinine you16:27 make but in this case uh having more creatinin is actually a good thing because having generally speaking having16:33 a bit more muscle is probably better than than being depleted so I often get people who come to me with a slightly16:39 high creatinin and they're uh working out um but when we do other ways of16:45 measuring their kidney function that don't depend on muscle mass their kidney function is totally normal so don't16:51 worry about it if you're going to work out uh and put on some uh muscle weight is probably a good thing it will will16:58 make your serum crampon go up a little bit in the blood test but that does not represent a drop in kidney function and17:03 we take that into account and of course uh physical activity of all kinds uh can17:09 be helpful in terms of uh keeping the weight down uh keeping the blood pressure and blood sugars down these are17:15 fundamental to uh diabetes um and uh uh17:20 Central to the lifestyle part of the diabetes Canada guidelines is is a healthy lifestyle as as as Robin had17:26 already mentioned uh including regular exercise I usually try17:32 to tell my patients to do at least 30 minutes of physical activity at least17:38 five times a week um building up to that if they are are sedentary thank you do um I have aDiabetes remission17:46 question for Dr Holden if you're maintaining your type diabetes with diet and exercise with Nomads um of an A1C17:54 let's say 5.1 um are you still looking at complication or or or uh is there is18:00 there any risk um what do you what do you recommend um so if you've been told that18:08 you have diabetes you've worked hard to lose weight you've got your um A1C test18:15 down into the normal range then we actually um Dr um harit FAL is even more18:21 on this topic than I do but we we consider there something called diabetes remission and and if you get into that category of diabetes remission you18:28 really have lowered your risk for developing the complications of diabetes yes Dr baj could you also share18:35 some highlights into that please yeah so diabetes remission is a is18:43 a discuss diabetes Canada and other socities have had we have a18:50 new diabetes Canada guideline chapter that is coming out diabetes Canada18:56 annual conference on Diabetes remission it's basically as Robin mentioned19:01 bringing down the glucose levels so A1C into the normal range um so non diabetic19:09 range kind of A1C without need for medications however this is not for19:14 everyone and some people as Robin mentioned already um you know the weight loss is is what appears to be key uh in19:22 that and and uh and early diabetes so people who've had diabetes not um not19:29 for a long time um appear to be U you know the most or the better candidates19:36 if you will uh to uh to try and achieve this remission Target which could be done19:44 with the weight loss and certain low calorie meal replacements or with19:49 bariatric surgery but we'll have more on this mon diabetes remission but as the19:56 point to be taken home is as Robin mentioned if you reduce your glucose levels you're controlling the blood20:02 pressure and the and the cholesterol is within the target range as well all of those risk factors are reduced and hence20:09 the risk of complications should be reduced as well thank you Dr vaj um Dr abow youFoot exam20:16 what is involved actually in a foot care exam when you see your doctor yes uh I was seeing that question20:22 I was hoping we were going to pick that one uh so we'll give you a quick tour on what that looks like so your in the20:28 office you're going to have your foot exam a question I commonly get is both socks off or one so definitely both if20:34 we want to count all 10 toes both socks shoes off um so five steps the first one20:40 is feeling the uh the pulse on the back of your feet to check your circulation gives us a hint um if there are any20:46 issues there um and then the second thing is the 10 gram monofilament so that's that fishing rod where we have20:51 you close your eyes uh touch different areas in the bottom of your feet see if you can feel them that gives us the20:57 answer on whether you have protective sensation the third is we look at your full foot including the heel and the21:03 back so if you have hip or KN knee issues let us know we'll usually do it slowly just to pull it up make sure we're getting that 3D view um the fourth21:11 is we look specifically for deformities or changes in the foot so if you have a flat foot if your toes are curved or if21:17 there's any area that we think we may provide some direction uh in terms of better Footwear you know we'll suggest21:23 that and then the fifth one is please don't feel uh uh don't do I don't take21:31 it personally if we touch your shoes and we flip it and we shake it we just need to take a quick look into your souls and make sure there aren't many um any worn21:38 out areas uh maybe some rocks or gravel that have made it there and we may provide some input or point you in the21:44 direction uh of proper Footwear it usually takes less than two minutes many21:49 people apologize and go oh I don't know if I took a care of my feet today but you know checking feet saves and21:55 protects feet so I I will say we are more than happy and actually love doing22:01 feed exam um and hopefully giving you that reassurance or giving you some informed um information from the foot22:07 exam that we can take and have a strategic plan to reduce your risk of having22:12 complications and there are lots of YouTube videos if you want to just get a visual on that thank you Dr um this is aCreatin levels22:19 two-parter question um for Dr M McFarlin are creatin levels low dependent and22:27 also um should uh a test be done when you have22:32 high levels of protein in the urine or when should that test be done for kidney22:38 disease okay so maybe we'll tackle the second part first so um as with the eyes22:45 your initial screen for kidney disease with the random urine test and blood test um is done immediately upon the22:52 diagnosis of type two diabetes uh and then is if it's normal is repeated uh22:58 annually uh after that so every single year you should be doing a quick urine sample into the random uh sample23:05 container and a quick blood test um what happens if it comes back abnormal there23:12 can be fluctuations in your kidney function from one day to the next especially if you're um if you have an23:17 intercurrent illness if you're sick with something else um and for a variety reasons sometimes the amount of protein23:23 in the urine can go up temporarily as well and not actually be associated with kidney disease so if one of your tests23:31 come back normal your doctor will probably order at least two more uh23:37 urine tests at least two more blood tests spread out over three to six months and it's only if the tests are23:43 coming back uh consistently abnormal either in terms of the kidney function23:49 um and uh uh if the if the protein levels are high consistently if the23:55 kidney function is low consistently that's when we would have a concern the second part was load dependent which I24:00 don't know if I totally understand the question but I'm going to interpret that to mean like is it the more you lift the24:07 higher your creatinin goes and I suppose it would in that just the as I said the24:12 creatinin is also a function this the cenin in your blood is released from the muscle so it's also a function of how24:18 much muscle you build if you're in an exercise program that's keeping you kind of uh more towards the lean and trim24:25 side it probably won't throw off your serum creatinin any but if you're uh doing a lot of heavy lifting and putting24:31 on a lot of muscle mass your the creatin and the blood will go up but I want to emphasize again that that's not actually24:38 a sign of the kidney function going down it's just a sign that you're making more creatinin that day because there's more24:43 muscle in your24:54 body CA you're muted CA we can't hear you now I apologize I was on mute sorryMetformin25:01 about that um this question is for Dr Holden um if a patient has been taking25:07 uh metformin uh for 20 years and the H H uh A1C is about25:13 6.4 should they continue to take it longer or what is is it a lifelong medication or what is is there any25:20 complications associated with it um metform has been used for very25:27 long period of time it it's considered to be sort of one of those basic25:32 foundational drugs for diabetes um people will stay on it for life um it's25:39 very well tolerated um sometimes the complications are most likely when you first start taking it and then um and25:46 they tend to be like things like loose stool sometimes abdominal cramping but typically over25:52 time your body gets used to it um it can really help you keep the weight down can keep the diabetes under control even25:59 used in people who haven't developed diabetes who have something called pre-diabetes to help prevent them from going on to develop diabetes so I think26:06 if someone's been on Metformin for long periods of time they they should stay on if it's working well for them um26:13 sometimes it can cause low B12 levels so your doctor might want to check your B12 level periodically but but otherwise I I26:19 don't think there's any concern about staying on Metformin for long periods of time lots of people26:24 do uh thank you Doctor uh considering it looking at the time I just want to ask we've had number of26:32 amazing amazing important questions for all these four amazing panelists so the question that I have for all four of you26:39 is working together um is there anything that you could advise if your patient um26:45 when they're coming for a checkup um what what are the top three things that you you would recommend for anyone with26:51 type two diabetes to each doctor maybe I'll go26:57 first because um these days we're a big fan of blood pressure readings taken27:03 outside of the office um so if you have $150 that you were not sure how to spend27:10 you could buy yourself a uh a home blood pressure monitor um or alternatively you can go to your Pharmacy uh and have it27:17 checked um often the blood pressure in my office is higher uh and so because27:23 blood pressure control is so fundamental to so many aspects of diabetes um uh help us out and get bring in some27:31 readings from outside the clinic as well thank you Dr Dr hold or or to Dr a27:40 please sure I'll jump in really quick I'll just say that you know I understand that complications just overall can27:47 weigh heavily just thinking about them um and I know working with people with diabetes it keeps people at night um27:53 really impacts their quality of life so I just encourage if you could share that with us um if we forget to ask about27:59 that um we'd like to know and hopefully try to you know use us and uh uh we're28:05 part of your diabetes team we really care to work with you to reduce the risk of complications maintain safety and try28:12 to balance quality of life um and hopefully we can in our roles try to leverage at least the facts um share the28:19 information and try to leverage some of the system support support in place uh28:24 which you don't have to shoulder on your own um and hopefully we can make this journey uh a bit better until we all28:30 wait for the final cure and on that I'll just add that28:35 prevention is better than cure um so uh if we can uh do some of those things28:41 that we've discussed the fabulous four the other fabulous three panelists have28:47 shared as well right so test for the kidneys at least once a year test the28:53 feet with the monofilament test with with your doctor or your healthcare provider other Healthcare Providers as29:00 well once a year and then um eye test should be done once a year or twice a29:05 year or or depending on on if somebody has a condition it could be it could be29:10 more frequent as well and then for your for your heart uh as well as for the29:15 other complications controlling those risk factors so controlling uh the glucose levels but in addition29:22 controlling the blood pressure cholesterol we've seen uh over the past 20 years two decades complications have29:30 come down so that's the positive news and I think uh if we keep uh you know29:35 the medical advances uh coming and flowing and using it in our clinical practices the complication rates will29:41 even come down further in the next two decades as well beautifully said Thank you do and29:49 Dr Holden I think I've been doing Diabetes Care the longest on the panel here I'm29:55 up to 32 years this disease is totally different than it was when I started there's so much we can do complications30:03 are not inevitable um as everybody's saying there are things to do so keep in30:08 touch with your healthcare provider come in for those regular visits and let us do our30:14 work thank you so much um doctors um for giving your time today and all these30:21 fabulous questions to all of you who have posted them and these are incredible questions unfortunately ran30:27 out of time so I'd like to thank Dr Holden McFarlin Dr Bajaj and Alo for30:34 answering all these amazing questions I mean we could have um this room go going for like another hour because we have so30:40 much to ask but thank you so much for your time and uh my name is CA Swami Nathan and thank you all for tuning30:52 in