#41 - Jake Kushner, M.D.: How to thrive with type 1 diabetes and how everyone can benefit from the valuable insights

Feb 18, 2019 2h 7m 17 insights

<div class="gmail_default"> In this episode, Jake Kushner, pediatric endocrinologist specializing in helping people with type 1 diabetes, discusses the best strategies to live and thrive with T1D, especially as it relates to diet and exercise. We also discuss why many patients who control their blood sugar with high amounts of exogenous insulin are at a substantially higher risk than people who can control their blood sugar at lower levels of insulin. This concept has great implications for non-diabetics as well considering the increasing prevalence of diseases related to insulin resistance. We also cover some of the basics, the history, the increasing prevalence of type 1 diabetes, and more importantly, what we can do to help kids with this disease, and their families.</div> <div class="gmail_default"> </div> <div class="gmail_default"> We discuss:</div> <div class="gmail_default"> <ul style="margin-bottom: 0in;"> <li>How Jake became interested in type 1 diabetes [<a dir="ltr" href="">5:30</a>];</li> <li>The pathophysiology of type 1 diabetes, the increase in prevalence, and the role of beta cells [<a dir="ltr" href="">17:00</a>];</li> <li>The role of body weight and BMI in the risk of developing T1D [27:00];</li> <li>Genetics of T1D and the risk of inheritance [32:00];</li> <li>Hemoglobin A1c [36:15];</li> <li>Insulin: the amazing story of its discovery, its effect on cellular metabolism and IGF-1, and why the hell it's so expensive [39:15];</li> <li>Diabetes Control and Complication Trial: blood glucose and the complications associated with diabetes [54:45];</li> <li>Cognitive impairment, epigenetic changes, and other dangers associated with high, peak blood glucose, and big swings in blood glucose levels [1:09:15];</li> <li>Depression, anxiety, and other challenges of living with T1D [1:15:30];</li> <li>Jake's realization that the current standard of care of T1D is inadequate [1:26:15];</li> <li>Managing diabetes with exercise [1:30:15];</li> <li>The Bernstein method, and protein's impact on glucose and insulin [1:36:15];</li> <li>Jake radically changes his approach to treating patients [<a dir="ltr" href="">1:45:00</a>];</li> <li>What other tools are there for controlling T1D? [1:49:45];</li> <li>Is the ketogenic diet appropriate for those with T1D? [1:52:45];</li> <li>The most important lessons that can be applied by the non-diabetic population [<a dir="ltr" href="">1:59:00</a>];</li> <li>The two dream measurements Peter wishes were available [<a dir="ltr" href="">2:04:00</a>]; and</li> <li>More.</li> </ul> Learn more at <a href="http://www.peterattiamd.com/">www.PeterAttiaMD.com</a> Connect with Peter on <a href=""> Facebook</a> | <a href=""> Twitter</a> | <a href=""> Instagram</a>. </div>

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Actionable Insights

1. Optimize Insulin Levels

Aim to control blood sugar with lower levels of insulin, as high circulating insulin (whether from injections or your own body) is linked to higher health risks, including cardiovascular disease.

2. Precise Carb & Protein Management

For Type 1 diabetes, meticulously manage carbohydrate and protein intake to reduce insulin requirements and minimize blood glucose fluctuations, following Dr. Richard Bernstein’s method.

3. Embrace Low-Carb for T1D

Significantly reduce carbohydrate intake, focusing on vegetables and avoiding enriched carbohydrates, to lower insulin needs and stabilize blood glucose, thereby reducing volatility and associated health burdens for Type 1 diabetics.

4. Leverage Continuous Glucose Monitoring

Utilize a Continuous Glucose Monitor (CGM) as an essential tool to gain real-time understanding of your glucose excursions, which is crucial for making informed decisions to stabilize blood sugar and reduce overall insulin exposure.

5. Prioritize Distance Exercise for T1D

Engage in consistent, long-duration exercise like walking 6-10 miles daily, as this can dramatically reduce insulin requirements and improve glucose control for individuals with Type 1 diabetes by promoting insulin-independent glucose uptake.

6. Seek T1D Education & Community

Actively seek out educational resources like Dr. Bernstein’s ‘Diabetes Solution’ book, the ‘Type 1 Grit’ Facebook group, and low-carb focused media (e.g., Low Carb Down Under, Adam Brown’s ‘Bright Spots and Landmines’) to learn practical strategies for managing Type 1 diabetes.

7. Insulin Dose for Protein (T1D)

Recognize that protein can convert to glucose over several hours (gluconeogenesis), requiring insulin coverage (often regular insulin due to its slower action) to prevent delayed blood sugar spikes in Type 1 diabetes.

8. Avoid Prolonged Fasting (T1D)

Do not engage in prolonged fasting if you have Type 1 diabetes, as it can lead to dangerously high levels of ketones and diabetic ketoacidosis, even if blood glucose appears normal (euglycemic DKA).

9. Boost T1D Early Detection

Be vigilant about the signs and symptoms of Type 1 diabetes in children (e.g., increased thirst, frequent urination, weight loss) and educate others to ensure early diagnosis and prevent life-threatening diabetic ketoacidosis.

10. HCP: Allocate More Patient Time

Healthcare providers should allocate more time for patient appointments, especially for complex conditions like Type 1 diabetes, to foster deeper understanding, build rapport, and provide more effective, personalized care.

11. HCP: Practice Active Listening

As a healthcare provider, make a conscious effort to listen more and ask open-ended questions to patients, especially those with chronic and complex conditions, to build rapport and facilitate deeper understanding.

12. Patience & Empathy for Teenagers

When interacting with teenagers, especially those managing chronic illnesses, offer patience and understanding without judgment, as building trust and rapport is crucial for long-term support and positive outcomes.

13. Minimize Glucose Variability

Strive to minimize both your average blood glucose and its fluctuations (standard deviation), as this serves as an indirect indicator for reducing your body’s overall insulin production or requirement, which is beneficial for health.

14. Practice Quantified Self

Actively monitor and understand your body’s physiological responses to different inputs, using tools like CGMs, to become ‘dialed into your physiology’ and optimize your health.

15. Maintain Child’s Normal BMI

Encourage children to maintain a normal BMI, as there’s a subtle population-level association between higher body weight and an increased risk for Type 1 diabetes.

16. Early Peanut Exposure

Introduce peanuts to children early in life, as current evidence suggests this practice can help prevent the development of anaphylactic peanut allergies.

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