WEBVTT 00:00.440 --> 00:02.607 Yeah maybe it works . And what else in 00:02.870 --> 00:04.920 the A . One C . Test measures the 00:04.920 --> 00:07.040 percentage of hemoglobin in red blood 00:07.040 --> 00:09.270 cells that has been Glick aided or 00:09.270 --> 00:11.860 should arised . The average life cycle 00:11.860 --> 00:15.260 of red blood cell is 100 to 120 days . 00:15.340 --> 00:17.270 Measuring how Glick aided the 00:17.270 --> 00:19.450 hemoglobin is can give an accurate 00:19.460 --> 00:22.060 picture of average blood glucose levels . 00:22.060 --> 00:24.750 Over time . Higher blood glucose levels 00:24.750 --> 00:26.861 will result in a higher percentage of 00:26.861 --> 00:28.694 hemoglobin with sugar attached . 00:28.694 --> 00:31.360 Generally an A . One C level below 00:31.360 --> 00:35.240 5.7% is considered normal and A one 00:35.240 --> 00:39.090 C between 5.7 and 6.4% usually 00:39.090 --> 00:42.600 indicates prediabetes and an a one c of 00:42.600 --> 00:46.320 65% or higher indicates diabetes . 00:46.330 --> 00:49.660 However , there's no one size fits all 00:49.660 --> 00:51.604 A one C target and patients should 00:51.604 --> 00:53.771 discuss an appropriate target for them 00:53.771 --> 00:55.770 with their providers . Normally a 00:55.770 --> 00:57.937 provider will perform this test on two 00:57.937 --> 00:59.840 separate occasions or use it in 00:59.840 --> 01:01.896 combination with other blood glucose 01:01.896 --> 01:04.660 test to confirm a diagnosis of diabetes 01:05.140 --> 01:07.140 because it measures an average over 01:07.140 --> 01:09.140 time . The A . One C . Test doesn't 01:09.140 --> 01:11.590 require fasting beforehand and blood 01:11.590 --> 01:13.701 can be drawn for the test any time of 01:13.701 --> 01:16.260 day . This makes the A . One C test 01:16.260 --> 01:18.120 more convenient than other blood 01:18.120 --> 01:21.000 glucose tests . However , it's 01:21.000 --> 01:23.056 important to note that some people , 01:23.056 --> 01:24.556 such as those of african , 01:24.556 --> 01:27.560 mediterranean or Southeast asia sent 01:27.640 --> 01:29.480 may have a less common type of 01:29.480 --> 01:32.800 hemoglobin called a hemoglobin variant 01:32.810 --> 01:35.810 in these cases and A one C test can 01:35.810 --> 01:38.790 give false results . Other conditions 01:38.790 --> 01:41.520 can also affect A one C results . These 01:41.520 --> 01:45.130 conditions can include anemia , heavy 01:45.130 --> 01:48.160 bleeding , iron deficiency , kidney 01:48.160 --> 01:51.640 failure and liver failure . The time of 01:51.640 --> 01:54.240 year can also affect a person's A one C . 01:54.250 --> 01:57.420 For example during winter A one C test 01:57.420 --> 01:59.790 results might be slightly higher than 01:59.790 --> 02:02.310 in summer providers should all these 02:02.310 --> 02:04.088 factors into consideration when 02:04.088 --> 02:06.143 administering the A . One C test and 02:06.143 --> 02:08.310 may need to rely on other like glucose 02:08.310 --> 02:10.350 tests for accurate diagnosis . 02:11.040 --> 02:15.370 Two 02:15.370 --> 02:17.426 blood glucose tests that may be used 02:17.426 --> 02:19.370 together or separately to diagnose 02:19.370 --> 02:21.700 diabetes are the fasting plasma glucose 02:21.710 --> 02:24.010 or F . P . G . Test . In the random 02:24.010 --> 02:27.070 plasma glucose or RPG test major 02:27.070 --> 02:29.181 spencer . Will you tell us more about 02:29.181 --> 02:31.520 these tests ? Well dr hempstead , the 02:31.520 --> 02:34.180 fasting plasma glucose or F . P . G . 02:34.180 --> 02:36.380 Test has historically been the most 02:36.380 --> 02:39.130 commonly used test to diagnose diabetes . 02:39.740 --> 02:41.760 It measures blood glucose after a 02:41.760 --> 02:43.816 person has fasted for at least eight 02:43.816 --> 02:46.090 hours . A fasting glucose level below 02:46.090 --> 02:48.680 100 mg per deciliter is considered 02:48.680 --> 02:51.110 normal . A fasting glucose level 02:51.110 --> 02:54.500 between 100 and 125 mg per deciliter 02:54.590 --> 02:58.280 indicates prediabetes and when it's 126 02:58.280 --> 03:00.750 mg per deciliter or above , it could 03:00.750 --> 03:03.550 mean diabetes . If a person has a 03:03.550 --> 03:06.900 fasting glucose level of 126 or above , 03:06.910 --> 03:08.800 they will be asked to return on a 03:08.810 --> 03:11.730 different day to repeat the test . If 03:11.730 --> 03:13.830 the second F . P . G . Test confirms 03:13.830 --> 03:16.690 the results that person is diagnosed 03:16.700 --> 03:19.770 with diabetes . The random plasma 03:19.770 --> 03:22.910 glucose or RPG test . Sometimes used to 03:22.910 --> 03:24.960 diagnose diabetes during a regular 03:24.960 --> 03:27.220 health check up . It doesn't require 03:27.220 --> 03:30.440 fasting beforehand . If RPG measures 03:30.440 --> 03:33.540 200 mg per deciliter or above and the 03:33.540 --> 03:35.429 individual also shows symptoms of 03:35.429 --> 03:37.780 diabetes , such as excessive thirst , 03:37.790 --> 03:40.630 excessive urination or excessive hunger . 03:40.670 --> 03:43.250 Then a provider may diagnose diabetes . 03:43.940 --> 03:44.940 Yeah . 03:48.840 --> 03:51.380 Mhm . Having high blood glucose levels 03:51.390 --> 03:53.130 over a long period of time can 03:53.130 --> 03:55.186 eventually cause damage to the small 03:55.186 --> 03:57.408 blood vessels and nerves throughout the 03:57.408 --> 03:59.408 body . When this damage occurs , it 03:59.408 --> 04:01.463 causes other serious conditions that 04:01.463 --> 04:03.797 can be difficult or impossible to treat . 04:03.797 --> 04:05.963 That's why it becomes so important for 04:05.963 --> 04:07.852 people diagnosed with diabetes to 04:07.852 --> 04:09.908 control their blood glucose levels . 04:09.908 --> 04:11.797 Some major complications that can 04:11.797 --> 04:13.797 result from poorly managed diabetes 04:13.797 --> 04:15.963 include cardiovascular disease , nerve 04:15.963 --> 04:18.019 damage , foot damage , problems with 04:18.019 --> 04:20.260 sexual function , kidney damage , I 04:20.260 --> 04:23.460 damage neurological problems and dental 04:23.460 --> 04:25.480 problems , other potential 04:25.480 --> 04:27.702 complications related to diabetes , our 04:27.702 --> 04:29.924 skin conditions , stomach problems such 04:29.924 --> 04:32.170 as gastro paralysis and susceptibility 04:32.170 --> 04:34.281 to viral illnesses such as the common 04:34.281 --> 04:35.560 cold and influenza . 04:42.540 --> 04:44.760 Having deputies basically doubles a 04:44.760 --> 04:46.371 person's risk for developing 04:46.371 --> 04:48.590 cardiovascular disease and makes it 04:48.590 --> 04:50.590 more likely they will develop these 04:50.590 --> 04:52.450 problems at an earlier age . In 04:52.450 --> 04:54.672 addition to the increased likelihood of 04:54.672 --> 04:56.728 cardiovascular disease , people with 04:56.728 --> 04:58.561 diabetes also tend to have heart 04:58.561 --> 05:01.150 attacks that are more serious and more 05:01.150 --> 05:03.830 often results in death . Having a blood 05:03.830 --> 05:05.830 glucose levels is associated with a 05:05.830 --> 05:07.774 condition called atherosclerosis , 05:07.774 --> 05:09.941 which is the clogging and hardening of 05:09.941 --> 05:11.941 blood vest , elevated blood glucose 05:11.941 --> 05:13.941 levels may increase the build up of 05:13.941 --> 05:16.108 fatty materials inside blood vessels , 05:16.108 --> 05:17.774 which is a key contributor to 05:17.774 --> 05:19.997 atherosclerosis , but it also may cause 05:19.997 --> 05:21.997 inflammation inside blood vessels , 05:21.997 --> 05:23.997 which can aggravate the condition . 05:23.997 --> 05:25.997 Doctor Patel , can you tell us what 05:25.997 --> 05:27.997 other complications can result from 05:27.997 --> 05:30.219 diabetes related atherosclerosis ? Sure 05:30.219 --> 05:32.219 thing . Doctor instead , one of the 05:32.219 --> 05:34.163 major types cardiovascular disease 05:34.163 --> 05:36.274 that's common in people with diabetes 05:36.274 --> 05:38.660 is coronary artery disease , or cat . 05:38.730 --> 05:41.340 Cat , is caused by the hardening or 05:41.340 --> 05:43.430 thickening of the walls of the blood 05:43.430 --> 05:45.550 vessels that go to the heart , which 05:45.550 --> 05:47.850 reduces the blood supply to the heart 05:47.860 --> 05:50.170 when fatty deposits block the blood 05:50.170 --> 05:52.710 supply or reduce it too much . The 05:52.710 --> 05:55.020 result is a heart attack . Another 05:55.020 --> 05:57.187 major type of cardiovascular disease , 05:57.187 --> 05:59.290 common in people with diabetes is 05:59.300 --> 06:01.720 cerebral vascular disease , which 06:01.720 --> 06:04.240 results from the narrowing , blocking 06:04.240 --> 06:06.430 or hardening of the blood vessels that 06:06.430 --> 06:09.260 go to the brain . Cerebral vascular 06:09.260 --> 06:11.520 disease can eventually cause transient 06:11.530 --> 06:13.690 ischemic attacks , or T . I . A . S . 06:13.690 --> 06:15.750 And strokes . T . I . A . S . Were 06:15.750 --> 06:17.750 caused by a temporary blockage in a 06:17.750 --> 06:20.130 blood vessel to the brain , and strokes 06:20.130 --> 06:22.130 result from the blood supply to the 06:22.130 --> 06:24.530 brain being suddenly cut off strokes 06:24.530 --> 06:26.697 cause the death of brain cells , which 06:26.697 --> 06:29.040 may cause permanent problems with 06:29.040 --> 06:32.360 speech vision weakness or paralysis . 06:32.740 --> 06:34.684 People with diabetes are also more 06:34.684 --> 06:36.840 likely to have heart failure , a 06:36.840 --> 06:39.062 chronic condition in which the heart is 06:39.062 --> 06:41.680 unable to pump that effectively . High 06:41.680 --> 06:43.791 blood glucose may cause damage to the 06:43.791 --> 06:45.902 heart muscle and to the vessels going 06:45.902 --> 06:48.220 to and from the heart which can lead to 06:48.220 --> 06:51.400 heart failure . Another cardiovascular 06:51.400 --> 06:53.456 condition often found in people with 06:53.456 --> 06:55.780 diabetes is peripheral artery disease , 06:55.780 --> 06:58.610 or P . A . D . A . Person with the A . 06:58.610 --> 07:00.800 D . Has decreased blood flow to the 07:00.800 --> 07:03.150 legs and because the blood vessels in 07:03.150 --> 07:06.090 the legs become narrow or blocked , ph . 07:06.090 --> 07:08.423 D . Increases the risk for heart attack , 07:08.423 --> 07:10.480 stroke and serious infection in the 07:10.480 --> 07:12.800 legs and feet , which can eventually 07:12.800 --> 07:13.967 lead to amputation . 07:16.740 --> 07:17.740 Mhm 07:20.940 --> 07:23.107 Damage to the nervous system caused by 07:23.107 --> 07:25.384 diabetes is called diabetic neuropathy . 07:25.740 --> 07:27.629 Estimates of people with diabetes 07:27.629 --> 07:29.740 suffer from diabetic neuropathy range 07:29.740 --> 07:32.970 from 50 to 70% . Nerve problems can 07:32.970 --> 07:34.914 develop at any time , but the risk 07:34.914 --> 07:36.803 increases the longer a person has 07:36.803 --> 07:39.010 diabetes . Other factors that increase 07:39.010 --> 07:41.066 the risk for diabetic neuropathy are 07:41.066 --> 07:43.232 poorly controlled blood glucose levels 07:43.232 --> 07:45.010 high levels blood fat and blood 07:45.010 --> 07:47.288 pressure and being overweight or obese . 07:47.288 --> 07:49.510 Doctor Patel , can you tell us a little 07:49.510 --> 07:51.566 bit more about diabetic neuropathy ? 07:51.640 --> 07:54.130 Definitely Dr Reynolds having high 07:54.130 --> 07:56.950 blood glucose for many years can cause 07:56.950 --> 07:59.220 damage to nerve coverings and to the 07:59.220 --> 08:01.630 blood vessels that supply nerves with 08:01.630 --> 08:04.610 oxygen , damaged nerves might stop 08:04.610 --> 08:06.970 sending signals altogether or they may 08:06.970 --> 08:09.340 send them too slowly or at the wrong 08:09.340 --> 08:12.040 times . This can cause all sorts of 08:12.050 --> 08:14.880 issues from numbness , pain or weakness 08:14.880 --> 08:16.824 in the limbs , Two problems in the 08:16.824 --> 08:20.140 digestive tract , heart and organs . It 08:20.140 --> 08:22.251 all depends on which nerves are being 08:22.251 --> 08:24.430 affected when the affected nerves are 08:24.430 --> 08:26.970 in the hands , arms , feet or legs . 08:27.100 --> 08:29.290 It's called peripheral neuropathy . 08:29.780 --> 08:31.558 This is the most common type of 08:31.558 --> 08:33.670 diabetic neuropathy , but it is more 08:33.670 --> 08:37.050 common in type two Then type one . 08:37.060 --> 08:39.490 Peripheral neuropathy may manifest in a 08:39.490 --> 08:42.070 number of ways , including numbness or 08:42.070 --> 08:44.292 insensitivity to pain or temperature or 08:44.292 --> 08:46.750 a tingling , burning or prickling 08:46.750 --> 08:49.590 sensation , sharp pains or cramps , 08:49.600 --> 08:53.220 weakness or loss of reflexes , foot 08:53.220 --> 08:56.120 deformities , extreme sensitivity to 08:56.120 --> 08:59.040 touch , even light touch or loss of 08:59.040 --> 09:01.920 balance and coordination . Because 09:01.920 --> 09:03.950 peripheral neuropathy often affects 09:03.960 --> 09:06.770 feet . A person may be more susceptible 09:06.770 --> 09:09.030 to sores and infections that go 09:09.030 --> 09:11.420 unnoticed . If an infection goes 09:11.420 --> 09:14.090 untreated for even a short time , it 09:14.090 --> 09:16.220 could spread to the bone and require 09:16.220 --> 09:18.690 amputation in order to prevent further 09:18.690 --> 09:21.310 spread of the infection . Another kind 09:21.310 --> 09:23.600 of diabetic neuropathy is autonomic 09:23.600 --> 09:25.790 neuropathy , which affects the nerves 09:25.800 --> 09:29.030 in and around internal organs such as 09:29.030 --> 09:31.310 the heart and blood vessels , the 09:31.310 --> 09:34.070 digestive system , the urinary tract , 09:34.580 --> 09:37.940 organs , sweat glands , lungs and eyes . 09:37.950 --> 09:40.590 Consequences of autonomic neuropathy 09:40.600 --> 09:43.550 can include sudden drops in blood 09:43.550 --> 09:45.890 pressure or a heart rate that does not 09:45.890 --> 09:48.900 correspond to activity . Constipation , 09:48.910 --> 09:51.650 diarrhea , nausea , vomiting , bloating 09:51.660 --> 09:54.900 or difficulty swallowing , inability to 09:54.900 --> 09:57.710 control urination , decreased sexual 09:57.710 --> 10:00.650 response , profuse sweating or 10:00.660 --> 10:03.140 difficulty seeing and certain light 10:03.140 --> 10:06.090 levels . Two other kinds of diabetic 10:06.090 --> 10:08.250 neuropathy are proximal neuropathy 10:08.260 --> 10:10.660 which affects thighs , hips , buttocks 10:10.660 --> 10:13.440 or legs . And vocal neuropathy , which 10:13.440 --> 10:15.750 can affect any single nerve or group of 10:15.750 --> 10:17.972 nerves in the body , such as the nerves 10:17.972 --> 10:20.400 in the wrist . Proximal neuropathy is 10:20.400 --> 10:22.810 more common in type two diabetes . 10:22.820 --> 10:25.720 Vocal neuropathy tends to be painful 10:25.730 --> 10:28.860 but temporary mm 10:32.240 --> 10:34.407 high blood glucose can cause damage to 10:34.407 --> 10:36.750 blood vessels and two nerves . Now , 10:36.750 --> 10:38.917 feet seem to be especially susceptible 10:38.917 --> 10:41.083 to the problems that result from blood 10:41.083 --> 10:42.972 vessel and nerve damage and those 10:42.972 --> 10:45.380 problems can be serious major spencer . 10:45.380 --> 10:47.436 Will you tell us more about diabetes 10:47.436 --> 10:49.547 related ? But problems ? Sure thing . 10:49.547 --> 10:52.010 Dr Homestead nerve damage in the feet 10:52.020 --> 10:54.330 is called peripheral neuropathy and 10:54.330 --> 10:56.540 blood vessel damage in the feet leads 10:56.540 --> 10:58.762 will condition called peripheral artery 10:58.762 --> 11:02.060 disease or PhD peripheral neuropathy . 11:02.060 --> 11:04.282 M . P . A . D . Are bad enough on their 11:04.282 --> 11:06.020 own . But in combination the 11:06.020 --> 11:08.520 consequences can be very serious . 11:08.530 --> 11:11.580 Peripheral neuropathy can cause pain , 11:11.590 --> 11:14.370 burning sensations , weakness or 11:14.370 --> 11:17.040 deformities and bones and muscles of 11:17.040 --> 11:18.920 the feet . It can also cause a 11:18.920 --> 11:21.020 condition called shark cuts foot , a 11:21.020 --> 11:23.076 problem in which the joints and soft 11:23.076 --> 11:25.242 tissue in the foot are destroyed . The 11:25.242 --> 11:27.242 bones slip out of place as a result 11:27.242 --> 11:30.020 causing severe deformity . Peripheral 11:30.020 --> 11:32.120 neuropathy can also cause a loss of 11:32.120 --> 11:34.880 feeling in the foot . A person with the 11:34.880 --> 11:37.140 A . D . Has poor blood flow to their 11:37.140 --> 11:39.880 legs and feet means the legs and feet 11:39.890 --> 11:42.057 aren't getting adequate blood supply . 11:42.440 --> 11:44.640 This can make it difficult for a sore 11:44.640 --> 11:47.390 or an infection to heal impaired 11:47.390 --> 11:49.230 healing may increase the risk of 11:49.230 --> 11:51.580 developing gangrene , which is a life 11:51.580 --> 11:53.840 threatening condition resulting from a 11:53.840 --> 11:55.840 critical deficiency of blood to the 11:55.840 --> 11:58.750 tissues . The lack of blood results in 11:58.750 --> 12:01.550 necrotic or dead tissue around sore 12:02.240 --> 12:04.400 gangrenous areas often have to be cut 12:04.400 --> 12:06.730 away in order to prevent the spread of 12:06.730 --> 12:09.430 the infection if the infection does 12:09.430 --> 12:11.620 spread , for instance , to the bone 12:11.630 --> 12:14.140 amputation may be the only way to keep 12:14.150 --> 12:16.372 the infection from reaching the rest of 12:16.372 --> 12:19.340 the body sores that are infected . And 12:19.340 --> 12:21.600 infections that don't feel are more 12:21.600 --> 12:23.656 likely to happen to a person who has 12:23.656 --> 12:25.640 both P . A . D . And peripheral 12:25.640 --> 12:28.180 neuropathy . When a person can't feel 12:28.180 --> 12:30.013 their feet because of peripheral 12:30.013 --> 12:32.180 neuropathy , they may not notice right 12:32.180 --> 12:34.800 away that they even have a sore then 12:34.800 --> 12:36.770 because they also have P . A . D . 12:36.780 --> 12:39.002 There's not enough blood getting to the 12:39.002 --> 12:42.200 sore to fight off infection . Once 12:42.200 --> 12:44.089 infection sets in , it can become 12:44.089 --> 12:45.978 difficult to treat before serious 12:45.978 --> 12:48.910 problem like gangrene arise for this 12:48.910 --> 12:51.100 reason , it's extremely important for 12:51.100 --> 12:53.156 people with diabetes to with them in 12:53.156 --> 12:55.460 their feet at least daily to look for 12:55.460 --> 12:58.000 sores . They should also be alert for 12:58.010 --> 13:00.066 other foot problems that can lead to 13:00.066 --> 13:02.400 open sores , including corns and 13:02.400 --> 13:06.090 calluses . Blisters , ingrown toenails , 13:06.100 --> 13:09.670 bunions , planter warts , hammer toes , 13:09.680 --> 13:13.170 dry and cracked skin , athletes , foot 13:13.180 --> 13:15.980 and fungal infections . If you have 13:15.980 --> 13:18.260 diabetes and any of these foot problems 13:18.260 --> 13:20.760 occur , it's vital to see a provider 13:20.770 --> 13:23.220 right away . Even if these problems 13:23.220 --> 13:25.940 seem mild or small , never try to treat 13:25.940 --> 13:28.200 them on your own as you are more likely 13:28.200 --> 13:29.367 to cause infection . 13:31.440 --> 13:35.750 Kidney 13:35.750 --> 13:37.917 damage . That results from diabetes is 13:37.917 --> 13:39.806 called diabetic kidney disease or 13:39.806 --> 13:42.210 diabetic neuropathy . Diabetic kidney 13:42.210 --> 13:44.710 disease happen slowly with almost no 13:44.710 --> 13:46.960 notice symptoms in the early stages , 13:46.970 --> 13:49.120 but if it goes undiagnosed or 13:49.120 --> 13:51.210 uncontrolled for too long , symptoms 13:51.210 --> 13:53.280 can become severe and even lead to 13:53.280 --> 13:55.650 kidney failure . Doctor Patel , Can you 13:55.650 --> 13:57.594 tell us more about diabetic kidney 13:57.594 --> 14:00.390 disease ? Of course , Dr homestead the 14:00.390 --> 14:02.600 kidneys filter waste out of the blood 14:02.610 --> 14:05.090 and send it on to the bladder as urine . 14:05.100 --> 14:07.550 Having high blood glucose can cause 14:07.550 --> 14:09.790 damage to the vessels and blood vessels 14:09.800 --> 14:12.340 in the kidneys , which makes it harder 14:12.350 --> 14:14.620 for the kidneys to filter properly . 14:14.940 --> 14:17.162 When the kids don't filter the way they 14:17.162 --> 14:19.790 are supposed to waste . And extra fluid 14:19.790 --> 14:22.260 can build up in the blood and cause 14:22.260 --> 14:24.730 serious illness . The kidney's 14:24.740 --> 14:27.270 filtering apparatus may become damaged 14:27.280 --> 14:29.430 and allow certain items , such as a 14:29.430 --> 14:31.900 protein called albumin , that the body 14:31.900 --> 14:34.760 needs to keep to be lost in the urine . 14:35.140 --> 14:37.500 Although the early stages of diabetic 14:37.510 --> 14:39.830 kidney disease don't present any 14:39.830 --> 14:42.800 symptoms as the disease advances . 14:42.810 --> 14:45.150 Parts of the body may begin as well , 14:45.160 --> 14:48.560 such as hands , face , feet or ankles . 14:48.570 --> 14:51.690 Other symptoms may include increased or 14:51.690 --> 14:54.630 decreased urination , feeling drowsy or 14:54.630 --> 14:58.200 tired , feeling itchy or numb . Drop 14:58.200 --> 15:02.060 skin headaches , weight loss , not 15:02.070 --> 15:04.500 feeling hungry , feeling sick to your 15:04.500 --> 15:07.910 stomach , vomiting , sleep problems , 15:07.920 --> 15:11.800 trouble focusing darkened skin and 15:11.810 --> 15:14.730 muscle cramps . If diabetic kidney 15:14.730 --> 15:17.700 disease progresses too far , it can 15:17.700 --> 15:20.360 turn into kidney failure , which means 15:20.360 --> 15:22.470 the kidneys are no longer able to do 15:22.470 --> 15:25.260 their job at all . When this happens , 15:25.260 --> 15:27.482 a person may undergo a treatment called 15:27.640 --> 15:30.330 dialysis , which uses a machine to 15:30.330 --> 15:33.430 filter the blood or may need a kidney 15:33.430 --> 15:35.340 transplant . Yeah , 15:39.640 --> 15:41.770 there are four parts of the eye that 15:41.770 --> 15:44.770 can be affected by diabetes the retina , 15:44.780 --> 15:47.750 the lens , the vitreous gel . The optic 15:47.750 --> 15:50.550 nerve diabetic eye disease can lead to 15:50.550 --> 15:52.661 permanent vision loss , including low 15:52.661 --> 15:54.772 vision and blindness . That cannot be 15:54.772 --> 15:56.717 improved with eyeglasses , contact 15:56.717 --> 15:59.590 lenses , medicine or surgery , Major 15:59.590 --> 16:01.757 spencer . What can you tell us about ? 16:01.757 --> 16:04.020 I damage caused by diabetes ? Well , dr 16:04.020 --> 16:06.076 Reynolds . When diabetes affects the 16:06.076 --> 16:07.742 retina , it's called diabetic 16:07.742 --> 16:10.840 retinopathy . High blood glucose levels 16:10.850 --> 16:13.120 can damage the tiny blood vessels on 16:13.120 --> 16:15.550 retina , causing them to swell and 16:15.550 --> 16:17.772 eventually block or cut off the retinas 16:17.772 --> 16:21.060 oxygen supply . New weak blood vessels 16:21.060 --> 16:23.330 may grow on the retina and the surface 16:23.340 --> 16:25.930 of the ice gel , but these new vessels 16:25.940 --> 16:27.950 tend to break easily and leak blood 16:27.950 --> 16:30.170 into the vitreous gel , which prevents 16:30.170 --> 16:32.890 light from reaching the retina . Over 16:32.890 --> 16:34.890 time , the swollen and weak blood 16:34.890 --> 16:37.300 vessels may form scar tissue and pull 16:37.300 --> 16:39.356 the retina away from the back of the 16:39.356 --> 16:41.940 eye . This is called detached retina , 16:42.070 --> 16:43.792 which can cause vision loss or 16:43.792 --> 16:45.792 blindness if it's not taken care of 16:45.792 --> 16:48.370 quickly . Another aspect of diabetic 16:48.370 --> 16:50.470 retinopathy is a condition called 16:50.470 --> 16:53.390 macular edema or swelling of the macula , 16:53.400 --> 16:55.990 which caused by leaking fluid from the 16:55.990 --> 16:58.090 retinas , damaged blood vessels . 16:58.100 --> 17:00.870 Macular oedema is the most common cause 17:00.880 --> 17:02.769 of diabetes related vision loss . 17:03.340 --> 17:05.660 Someone diabetic retinopathy may 17:05.660 --> 17:08.230 experience few symptoms at first , but 17:08.230 --> 17:10.430 as damaged worsens , symptoms can 17:10.430 --> 17:13.980 include blurry or double vision rings , 17:13.990 --> 17:16.500 flashing lights or blank spots in their 17:16.500 --> 17:19.170 vision , dark or floating spots in 17:19.170 --> 17:22.160 their vision , pain or pressure in one 17:22.170 --> 17:24.710 or both eyes and trouble with 17:24.710 --> 17:27.350 peripheral vision . The new abnormal 17:27.350 --> 17:29.490 blood vessels form on the iris , or 17:29.490 --> 17:31.860 colored party . I . Neo vascular 17:31.860 --> 17:34.670 glaucoma kicker , closing off the flow 17:34.670 --> 17:36.670 of fluid in the eye and raising eye 17:36.670 --> 17:39.550 pressure . The increased eye pressure 17:39.550 --> 17:42.120 can damage the optic nerve and result 17:42.120 --> 17:45.110 in villas and blindness . High blood 17:45.110 --> 17:47.277 glucose levels can also accelerate the 17:47.277 --> 17:50.010 development of cataracts . A cataract 17:50.020 --> 17:52.270 is a clouding of the lens that causes 17:52.270 --> 17:55.100 blurry vision . Cataracts have to be 17:55.100 --> 17:57.170 surgically removed and the eyes . 17:57.180 --> 17:59.069 Natural lens is replaced with the 17:59.069 --> 18:02.070 plastic lens . Finally , high blood 18:02.070 --> 18:04.160 glucose can cause nerve damage or 18:04.160 --> 18:06.740 neuropathy . In the I . A person with 18:06.740 --> 18:08.962 this kind of neuropathy may have double 18:08.962 --> 18:11.550 vision , a drooping eyelid pain over 18:11.550 --> 18:14.670 the eye or paralysis of the eye muscles . 18:15.040 --> 18:17.370 This edition is usually but not always 18:17.370 --> 18:18.460 temporary 18:23.240 --> 18:25.160 diabetes in and of itself causes 18:25.160 --> 18:28.880 nothing poorly managed diabetes . When 18:28.880 --> 18:31.410 your blood sugars are high on a 18:31.410 --> 18:33.870 consistent basis , your body is really 18:33.870 --> 18:35.981 stressed due to my high blood sugar . 18:35.981 --> 18:39.600 My blood flows slower than the 18:39.600 --> 18:41.433 average person because it's more 18:41.433 --> 18:43.544 thicker . Your heart has to work much 18:43.544 --> 18:45.822 harder to pump around the syrupy blood . 18:45.822 --> 18:48.120 It's associated with diabetes and so 18:48.120 --> 18:50.287 your heart is working very , very hard 18:50.340 --> 18:52.396 going through a minor heart attack . 18:52.440 --> 18:54.700 And that's all you know due to me not 18:54.700 --> 18:56.922 taking care of my body , the high blood 18:56.922 --> 18:59.033 sugars . I started to have high blood 18:59.033 --> 19:02.210 pressure , high cholesterol . Then I 19:02.210 --> 19:03.988 problem started recently . I've 19:03.988 --> 19:06.210 actually found out that I was diagnosed 19:06.210 --> 19:08.377 with a with the early stages of a rare 19:08.377 --> 19:10.850 diabetic eye disease , which calls the 19:10.860 --> 19:12.693 black spots in your eyes and can 19:12.693 --> 19:15.080 eventually cause blindness glasses now . 19:15.090 --> 19:17.780 Well for like long distance , trying to 19:17.780 --> 19:19.920 read from afar and I didn't have that 19:19.920 --> 19:22.031 problem before . I had beyond perfect 19:22.031 --> 19:24.950 vision and I was like , oh no , my 19:24.960 --> 19:28.550 vision is not perfect and it 19:28.550 --> 19:32.300 is , it still suffers from the diabetes 19:32.300 --> 19:36.220 symptoms , but it's still there and I'm 19:36.220 --> 19:38.331 thankful for it . The raw empathy can 19:38.331 --> 19:40.820 cause , not just pain and foot sores , 19:40.820 --> 19:42.931 It doesn't cause the foot sores out . 19:42.931 --> 19:44.764 You actually get a sort diabetic 19:44.764 --> 19:47.098 neuropathy is when you're you feel numb . 19:47.098 --> 19:49.320 So you wear a new pair of shoes and you 19:49.320 --> 19:51.376 get a blister , a lot of people that 19:51.376 --> 19:53.487 happens , you get a little blister at 19:53.487 --> 19:53.100 first . But if you have neuropathy , 19:53.100 --> 19:55.100 you may not even realize you have a 19:55.100 --> 19:57.860 blister because you're numb and you 19:57.860 --> 19:59.860 can't feel the blister and might be 19:59.860 --> 20:01.990 hidden from your view . You don't 20:01.990 --> 20:04.430 notice it . Open sores , don't heal 20:04.430 --> 20:06.790 quick . And if you have an open story 20:06.790 --> 20:09.170 could also develop into other further 20:09.170 --> 20:11.226 complications which might even cause 20:11.226 --> 20:14.910 you to amputate your toes or your foot . 20:14.920 --> 20:18.310 And so that's why that's important to 20:18.310 --> 20:21.640 take care of your feet and him 20:21.650 --> 20:24.130 notice source because you may not feel 20:24.130 --> 20:26.241 that when you're diagnosed with being 20:26.241 --> 20:29.060 diabetic having diabetes , you need to 20:29.060 --> 20:31.760 take it serious because no one is 20:31.760 --> 20:33.940 invincible . Don't be a knucklehead 20:33.940 --> 20:36.051 about it , don't be like me and think 20:36.051 --> 20:37.940 you can you can take it on and do 20:37.940 --> 20:39.940 whatever you want . If it's not one 20:39.940 --> 20:41.940 thing , it's another . If you don't 20:41.940 --> 20:43.940 have eye problems , you have kidney 20:43.940 --> 20:43.490 problems . If you don't have kidney 20:43.490 --> 20:45.770 problems , you have other health issues 20:45.770 --> 20:47.937 that complicate everything . So all of 20:47.937 --> 20:50.370 these things are related to the syrupy 20:50.370 --> 20:53.340 blood that's associated with poorly 20:53.340 --> 20:55.562 managed diabetes . If you just approach 20:55.562 --> 20:57.396 the situation from the beginning 20:57.396 --> 20:59.451 correctly , you're just going to get 20:59.451 --> 21:01.750 into a routine and you don't have to 21:01.750 --> 21:03.861 get over this the bumps because there 21:03.861 --> 21:05.861 aren't any if your diabetes is well 21:05.861 --> 21:08.530 managed and you keep your blood sugars 21:08.540 --> 21:10.940 in a healthy level in a healthy range , 21:10.950 --> 21:13.061 you're much less likely to have those 21:13.061 --> 21:15.380 kinds of conditions , much less likely 21:15.380 --> 21:17.324 to experience complications of all 21:17.324 --> 21:17.670 kinds 21:23.740 --> 21:25.851 because there is no cure for type one 21:25.851 --> 21:27.740 diabetes treatment plans focus on 21:27.740 --> 21:29.518 disease management . This means 21:29.518 --> 21:31.629 monitoring glucose levels closely and 21:31.629 --> 21:33.962 working to keep them in a desired range . 21:33.962 --> 21:35.907 Through insulin therapy , diet and 21:35.907 --> 21:38.018 activity . For Children with Type one 21:38.018 --> 21:40.018 diabetes , the parents will need to 21:40.018 --> 21:42.129 help administer insulin . People with 21:42.129 --> 21:44.240 diabetes also need to take extra care 21:44.240 --> 21:43.950 when they get sick since illness can 21:43.950 --> 21:46.080 affect blood glucose levels and make 21:46.080 --> 21:48.191 them more difficult to control . It's 21:48.191 --> 21:50.024 important to get the recommended 21:50.024 --> 21:52.191 vaccinations to prevent illnesses such 21:52.191 --> 21:54.630 as influenza pneumonia and hepatitis B . 21:54.870 --> 21:56.981 Routine appointment with primary care 21:56.981 --> 21:59.148 providers . Eye doctors , dentists and 21:59.148 --> 22:01.370 foot specialist are also recommended to 22:01.370 --> 22:02.981 monitor for diabetes related 22:02.981 --> 22:03.981 complications . 22:09.850 --> 22:11.980 In many medical situations , there is 22:11.980 --> 22:14.400 no single right answer about diagnostic 22:14.410 --> 22:16.590 tests and treatments because all the 22:16.590 --> 22:18.860 choices come with pros and cons king 22:18.860 --> 22:21.240 diabetes is one of these situations . 22:21.250 --> 22:23.472 First reason providers are increasingly 22:23.472 --> 22:25.694 engaging with their patients and what's 22:25.694 --> 22:27.806 called shared decision making . Major 22:27.806 --> 22:30.220 spencer . What is shared decision 22:30.220 --> 22:32.780 making ? Well dr him step share 22:32.780 --> 22:34.891 decision making is a process in which 22:34.891 --> 22:37.630 providers and patients work together to 22:37.630 --> 22:39.797 make decisions about selecting tests , 22:39.797 --> 22:42.780 treatments and care plans . The goal is 22:42.780 --> 22:45.650 to balance risks and expected outcomes 22:45.650 --> 22:47.594 with the patient's preferences and 22:47.594 --> 22:50.120 values . If type one diabetes develops 22:50.120 --> 22:52.100 during childhood , shared decision 22:52.100 --> 22:54.211 making will involve parents as well . 22:54.640 --> 22:56.751 When patients with diabetes and their 22:56.751 --> 22:58.862 providers , you share decision making 22:58.940 --> 23:00.884 patients are more likely to follow 23:00.884 --> 23:03.051 through with the treatment plan . They 23:03.051 --> 23:05.107 have a better understanding of their 23:05.107 --> 23:07.329 health and their disease as well as the 23:07.329 --> 23:09.162 pros cons of different treatment 23:09.162 --> 23:11.329 options . Shared decision making helps 23:11.329 --> 23:13.496 patients and their providers determine 23:13.496 --> 23:15.607 the best treatment and for them , for 23:15.607 --> 23:17.662 people with type one diabetes , this 23:17.662 --> 23:19.662 means weighing the pros and cons of 23:19.662 --> 23:21.829 different insulin regimens and finding 23:21.829 --> 23:23.773 the right diet and exercise plan . 23:23.773 --> 23:25.884 Every patient is different . Which is 23:25.884 --> 23:27.718 why shared decision making is so 23:27.718 --> 23:31.440 important . Yeah . Yeah . 23:34.240 --> 23:36.240 Listen it control or trying to keep 23:36.240 --> 23:38.351 blood glucose levels within a desired 23:38.351 --> 23:40.573 range . It's key to managing diabetes . 23:40.840 --> 23:43.062 This means working with the health care 23:43.062 --> 23:45.229 team to set a blood glucose goal or an 23:45.229 --> 23:47.173 A one C . Target . Each patient is 23:47.173 --> 23:49.284 unique . So a one C targets will vary 23:49.284 --> 23:51.451 between individual patients . Doctor . 23:51.451 --> 23:53.618 Tell what else can you tell us about ? 23:53.618 --> 23:55.729 Glycemic control ? Well , dr Reynolds 23:55.729 --> 23:59.300 and A one C target between seven and 8% 23:59.310 --> 24:01.460 has been shown to significantly 24:01.460 --> 24:03.710 decrease the risk of long term 24:03.710 --> 24:06.560 complications for patients younger than 24:06.560 --> 24:08.980 18 and a one c target of 24:08.980 --> 24:12.810 75% or less is recommended 24:12.820 --> 24:15.780 for most adults with diabetes . It's 24:15.780 --> 24:18.710 appropriate to set in A ones target as 24:18.710 --> 24:21.190 close to non diabetic levels as 24:21.190 --> 24:23.770 possible . Which means aiming for an A 24:23.770 --> 24:27.430 one c a 6.5% or less . 24:27.440 --> 24:30.440 However , there are certain conditions 24:30.440 --> 24:32.662 that make us kind of target potentially 24:32.662 --> 24:35.220 more harmful than helpful for some 24:35.220 --> 24:37.400 people . A normal A once level could 24:37.410 --> 24:39.830 increase their risk for severe 24:39.830 --> 24:42.690 hypoglycemia or blood glucose levels 24:42.690 --> 24:46.130 that drop too low mild hypoglycemia . 24:46.140 --> 24:48.600 Can the person feel faint , weak or 24:48.600 --> 24:52.360 shaky and severe hypoglycemia can cause 24:52.370 --> 24:54.980 falls , seizures , accidents with 24:54.980 --> 24:58.110 machinery or vehicles or other injuries . 24:58.840 --> 25:00.510 A person who is experiencing 25:00.510 --> 25:02.510 hypoglycemia should eat or drink 25:02.510 --> 25:05.110 something with fast acting or simple 25:05.110 --> 25:07.750 carbohydrates like glucose tablets , 25:07.760 --> 25:10.750 fruit juice or a simple candy and 25:10.750 --> 25:13.600 recheck their blood glucose in 15 25:13.600 --> 25:16.450 minutes . Should repeat every 15 25:16.450 --> 25:18.800 minutes until the blood glucose within 25:18.800 --> 25:21.760 their desired range . This is known as 25:21.760 --> 25:25.410 the rule of 15 in the case of severe 25:25.410 --> 25:27.560 hypoglycemia , where the person is 25:27.570 --> 25:30.200 unconscious or can't eat or drink . A 25:30.200 --> 25:32.800 glue Kogan injection is necessary . 25:32.810 --> 25:34.990 Glue keegan is a hormone that 25:34.990 --> 25:37.460 stimulates the liver to convert stored 25:37.460 --> 25:40.430 glycogen into glucose and release it 25:40.440 --> 25:42.329 into the blood to raise the blood 25:42.329 --> 25:45.460 glucose rapidly back to normal . A glue 25:45.460 --> 25:48.060 gun kit must be prescribed and the 25:48.060 --> 25:50.040 injection administered by a family 25:50.040 --> 25:53.870 member or friend , severe hypoglycemia 25:53.880 --> 25:55.930 can be an even bigger problem for 25:55.930 --> 25:58.300 someone who's Type one diabetes has 25:58.300 --> 26:00.750 caused damage to autonomic nerves that 26:00.750 --> 26:03.070 let them know they are experiencing 26:03.070 --> 26:05.730 hypoglycemia . This is called 26:05.740 --> 26:08.990 hypoglycemia unawareness with this 26:08.990 --> 26:11.157 condition , the person may not realize 26:11.157 --> 26:13.379 that they need to normalize their blood 26:13.379 --> 26:16.130 glucose until it's too late . It's 26:16.130 --> 26:18.800 critical that an emergency glue gun kit 26:18.800 --> 26:20.970 be prescribed for people who have 26:20.980 --> 26:24.220 hypoglycemic unawareness and a family 26:24.220 --> 26:26.340 member or friend should be trained to 26:26.340 --> 26:28.950 deliver the injection . Parents of 26:28.950 --> 26:31.400 Children with type one diabetes need to 26:31.400 --> 26:33.190 be able to recognize signs of 26:33.190 --> 26:36.240 hypoglycemia and be ready to offer fast 26:36.240 --> 26:39.470 acting carbohydrates or emergency glue 26:39.470 --> 26:42.880 gun if necessary . People have other 26:42.880 --> 26:45.120 extensive conditions in addition to 26:45.120 --> 26:47.540 diabetes and people who have advanced 26:47.540 --> 26:50.130 complications from diabetes such as 26:50.130 --> 26:53.170 cardiovascular disease are at a greater 26:53.170 --> 26:56.370 risk for severe hypoglycemia . These 26:56.380 --> 26:58.102 patients need to talk to their 26:58.102 --> 27:00.580 providers about setting a less rigorous 27:00.590 --> 27:04.140 A one C target , for example , 8% 27:04.150 --> 27:07.840 instead of 6.5 . However , there's no 27:07.840 --> 27:10.740 one size fits all . A one C target and 27:10.750 --> 27:12.820 patients should revisit their target 27:12.820 --> 27:15.380 with their providers often and change 27:15.380 --> 27:16.960 it as needed 27:21.940 --> 27:24.120 In type one diabetes . The beta cells 27:24.130 --> 27:26.241 in the pancreas that normally produce 27:26.241 --> 27:28.408 insulin have been destroyed . Now when 27:28.408 --> 27:30.519 that happens , the body can no longer 27:30.519 --> 27:32.574 produce enough insulin to keep blood 27:32.574 --> 27:34.741 glucose levels normal or in some cases 27:34.741 --> 27:37.280 can't produce any insulin at all . For 27:37.280 --> 27:39.280 this reason , all patients who have 27:39.280 --> 27:41.391 been diagnosed with type one diabetes 27:41.391 --> 27:43.660 must take insulin Major Spencer . Can 27:43.660 --> 27:45.716 you tell us more about treating type 27:45.716 --> 27:47.938 one diabetes with insulin ? Of course . 27:47.938 --> 27:49.882 Dr Homestead , there are different 27:49.882 --> 27:51.604 types of insulin and there are 27:51.604 --> 27:53.716 different methods of taking insulin . 27:53.716 --> 27:55.827 The different types work at different 27:55.827 --> 27:57.827 speeds . For example , rapid acting 27:57.827 --> 27:59.882 insulin starts to work immediately . 27:59.882 --> 28:02.180 Long acting insulin works over many 28:02.180 --> 28:04.960 hours . Many people need to are more 28:04.960 --> 28:07.071 types of insulin to reach their blood 28:07.071 --> 28:09.500 glucose targets . Most people with type 28:09.500 --> 28:12.130 one diabetes need to take insulin to 28:12.140 --> 28:14.510 three or four times a day to reach 28:14.510 --> 28:17.370 their blood glucose targets , patients 28:17.370 --> 28:19.370 should discuss the insulin type and 28:19.370 --> 28:21.890 frequency with their providers to find 28:21.890 --> 28:24.130 a plan works with their daily routine 28:24.140 --> 28:26.890 and unique needs . There are also 28:26.890 --> 28:28.890 several methods of taking insulin . 28:28.890 --> 28:31.720 This again is something each patient 28:31.720 --> 28:34.090 should discuss with provider to decide 28:34.090 --> 28:36.150 what's right for them . Benefits of 28:36.150 --> 28:38.310 taking insulin can include needle and 28:38.310 --> 28:41.730 syringe , pen , injection port 28:41.740 --> 28:45.290 pump and jet injector . People who he's 28:45.290 --> 28:47.290 a needle and syringe draw up the 28:47.290 --> 28:49.401 correct dose of insulin from a bottle 28:49.401 --> 28:51.540 into the syringe and injected into 28:51.540 --> 28:54.380 their body with the needle . An insulin 28:54.380 --> 28:56.491 pen looks like a thick highlighter or 28:56.491 --> 28:59.160 marker , but has a needle for its point . 29:00.040 --> 29:01.900 Disposable pens come filled with 29:01.910 --> 29:05.020 insulin . Non disposable pens come with 29:05.030 --> 29:08.180 insulin cartridges . Both needle and 29:08.180 --> 29:10.460 syringe and pens can be used with an 29:10.460 --> 29:13.410 injection port . An injection port has 29:13.420 --> 29:15.587 a short tube that is inserted into the 29:15.587 --> 29:17.870 tissue beneath the skin . On the skin 29:17.870 --> 29:20.340 surface . An adhesive patch or dressing 29:20.350 --> 29:23.350 holds the port in place . The insulin 29:23.350 --> 29:25.239 is injected through the port with 29:25.239 --> 29:27.294 either a needle and syringe or a pen 29:27.940 --> 29:29.940 ports are replaced every few days , 29:29.950 --> 29:32.061 which make them less painful and more 29:32.061 --> 29:34.420 convenient than a needle and syringe or 29:34.430 --> 29:37.550 in some pain alone , A pump is a small 29:37.550 --> 29:40.080 machine that can worn on a belt in a 29:40.080 --> 29:42.280 pocket or attached to the skin , 29:42.290 --> 29:44.550 depending on which model is chosen . 29:44.560 --> 29:47.600 Most pumps connect with a small plastic 29:47.610 --> 29:50.140 tube to plastic catheter that is 29:50.140 --> 29:52.140 inserted under the skin with a tiny 29:52.140 --> 29:54.840 needle . The needle is removed Once the 29:54.840 --> 29:57.890 catheter in place , a wireless version 29:57.890 --> 30:00.550 of the pump is available as well . The 30:00.550 --> 30:02.580 pump is programmed to administer 30:02.580 --> 30:04.960 insulin into the body in very small 30:04.960 --> 30:08.800 amounts 24 hours a day . The pump site 30:08.800 --> 30:10.856 is typically changed out every three 30:10.856 --> 30:14.160 days . Finally , advice called a jet 30:14.170 --> 30:17.260 injector sends a five spray of insulin 30:17.270 --> 30:20.710 into the skin at a high pressure . This 30:20.710 --> 30:22.900 eliminates the use of any needles that 30:22.910 --> 30:25.510 punctured the skin Pairs of young 30:25.510 --> 30:27.621 Children who have been diagnosed with 30:27.621 --> 30:29.830 type one diabetes will need to assist 30:29.840 --> 30:32.670 with insulin . Administration needles 30:32.670 --> 30:34.930 can be scary for young Children and 30:34.930 --> 30:37.097 they may not yet have the coordination 30:37.097 --> 30:39.430 necessary to give themselves injections . 30:40.040 --> 30:42.040 Parents who do not feel comfortable 30:42.040 --> 30:44.096 giving their child injections should 30:44.096 --> 30:45.929 discuss one of the other insulin 30:45.929 --> 30:48.040 methods with their child's provider . 30:48.040 --> 30:50.096 Mental health professionals can also 30:50.096 --> 30:52.318 help patients with needle phobia . Some 30:52.318 --> 30:54.484 people with type one diabetes may need 30:54.484 --> 30:56.651 to take additional medications here in 30:56.651 --> 30:58.800 the form of pills or other injections 30:58.800 --> 31:01.230 that work with insulin . This is 31:01.230 --> 31:03.620 especially likely if they insulin 31:03.620 --> 31:05.630 resistant or have other health 31:05.630 --> 31:07.370 conditions or diabetes related 31:07.370 --> 31:09.540 complications . Yeah , 31:14.640 --> 31:18.510 I started out taking pills 31:18.520 --> 31:21.820 the oral medications for diabetes , but 31:21.830 --> 31:24.580 um he never really offered the insulin 31:24.590 --> 31:27.630 part of yet . It was later on , maybe 31:27.630 --> 31:30.650 five years later that he was like , 31:30.660 --> 31:32.771 this is uncontrollable and we need to 31:32.771 --> 31:35.010 get on the insulin . Insulin is my life 31:35.010 --> 31:37.270 support . If you will . There is no 31:37.270 --> 31:40.780 cure for type one diabetes . I have to 31:40.780 --> 31:43.330 take insulin . And the very medication 31:43.330 --> 31:46.100 that saves my life could also kill me . 31:46.110 --> 31:48.630 I was um in the hospital for I would 31:48.630 --> 31:50.686 say the first two months after I got 31:50.686 --> 31:52.519 diagnosed because they had to go 31:52.519 --> 31:54.519 through my carbohydrate counts what 31:54.519 --> 31:56.574 kind of incident I had to use . So I 31:56.574 --> 31:58.463 have to take insulin in the right 31:58.463 --> 32:00.960 amount at all times . If I take too 32:00.960 --> 32:03.400 much insulin , my blood sugar goes too 32:03.400 --> 32:05.567 low and I can fall asleep and not wake 32:05.567 --> 32:08.660 up if I don't take enough insulin , my 32:08.660 --> 32:10.730 blood sugar goes too high . And then 32:10.730 --> 32:13.063 I'm at risk for long term complications . 32:13.063 --> 32:15.230 We're learning how to use syringes and 32:15.230 --> 32:17.397 stuff . And my mom like I remember she 32:17.397 --> 32:19.619 like through the syringe and the nurses 32:19.619 --> 32:21.563 arm like a dart . He is who you're 32:21.563 --> 32:23.563 practicing . And she's she's like , 32:23.563 --> 32:23.250 okay you can use my arms . And I was 32:23.250 --> 32:25.472 like that's fine . But after I seen and 32:25.472 --> 32:25.320 I was like , I don't want her to give 32:25.320 --> 32:27.730 me shots . Uh huh . And I started with 32:27.730 --> 32:29.730 injecting and then from there on in 32:29.730 --> 32:32.120 there and we had to kind of switch our 32:32.120 --> 32:34.231 whole lives around to adapt to that . 32:34.231 --> 32:36.420 At first I took nph insulin and I took 32:36.420 --> 32:38.531 that twice a day , first thing in the 32:38.531 --> 32:40.420 morning and then an evening about 32:40.420 --> 32:42.587 mealtime uh that lasted about 12 hours 32:42.587 --> 32:44.809 each shot . And then I also take a once 32:44.809 --> 32:47.390 a week . Um does we should last me for 32:47.390 --> 32:49.680 the whole week Until the next dose . 32:49.690 --> 32:53.410 Then I also took uh are uh about 30 32:53.410 --> 32:55.920 minutes before a meal . I had to take 32:55.930 --> 32:57.930 the are to cover what I was getting 32:57.930 --> 33:00.041 ready to eat . My parents injected me 33:00.041 --> 33:02.430 maybe the first month or two . I think 33:02.430 --> 33:05.200 my mom was kind of scared to do it even 33:05.200 --> 33:07.256 though she knew how to she learned . 33:07.256 --> 33:09.422 But I had also learned that I was kind 33:09.422 --> 33:11.533 of eager to give it to myself because 33:11.533 --> 33:11.080 I'm very independent person . So they 33:11.080 --> 33:13.191 had a little Device that you push the 33:13.191 --> 33:15.247 button and it shoots into your leg . 33:15.247 --> 33:17.191 And that's what I started to do by 33:17.191 --> 33:19.413 myself . And I did that for about seven 33:19.413 --> 33:21.413 years until I was put on an insulin 33:21.413 --> 33:23.580 pump once I was 15 , I believe , maybe 33:23.580 --> 33:25.636 14 . I got introduced to the insulin 33:25.636 --> 33:27.580 pump , went through quite a bit of 33:27.580 --> 33:29.802 training , probably about 10 classes to 33:29.802 --> 33:31.969 learn how to use an insulin pump . And 33:31.969 --> 33:34.191 now all of those numbers are in my pump 33:34.191 --> 33:36.191 and I simply put in what my current 33:36.191 --> 33:38.290 blood sugar is and it calculates how 33:38.290 --> 33:40.346 much I need to correct and bring the 33:40.346 --> 33:42.580 blood sugar into a healthy range and 33:42.580 --> 33:44.636 then how much do I need to cover the 33:44.636 --> 33:46.802 food I'm getting ready to eat and have 33:46.802 --> 33:49.024 a lot more flexibility in my eating . I 33:49.024 --> 33:50.969 can choose to skip a meal or I can 33:50.969 --> 33:53.080 choose to eat more if I want and just 33:53.080 --> 33:54.969 take more insulin at the meal . I 33:54.969 --> 33:54.720 didn't want an insulin pump at first 33:54.730 --> 33:56.841 because they had wires and when I was 33:56.841 --> 33:59.008 playing sports , they would get in the 33:59.008 --> 34:01.119 way that was a problem for me because 34:01.119 --> 34:03.174 then when I wanted to go swimming or 34:03.174 --> 34:05.174 whatnot , you know , there would be 34:05.174 --> 34:07.397 everyone , hey , what's that ? This had 34:07.397 --> 34:07.300 another and I would have to change it 34:07.300 --> 34:09.790 every three days . But that was , I 34:09.790 --> 34:12.012 think that was mainly the biggest issue 34:12.012 --> 34:13.790 for me is that , you know , the 34:13.790 --> 34:15.568 attention and that people would 34:15.568 --> 34:15.250 approach you a different way for 34:15.250 --> 34:17.194 something . They don't know what's 34:17.194 --> 34:19.250 going on . So I played that game all 34:19.250 --> 34:21.472 day long . How do I keep it between the 34:21.472 --> 34:23.940 lines ? How do I keep my blood sugar in 34:23.940 --> 34:25.060 a safe range ? 34:31.840 --> 34:34.007 I don't think that diabetes commitment 34:34.007 --> 34:35.940 me . I think it might close some 34:35.940 --> 34:38.670 opportunities for me for the military 34:38.670 --> 34:40.960 for example . But it has a logical 34:40.960 --> 34:43.260 explanation for it . But I don't think 34:43.260 --> 34:45.260 that diabetes would limit me . I've 34:45.260 --> 34:47.260 been living with it for so long and 34:47.260 --> 34:49.371 I've been doing what I wanted to . So 34:49.371 --> 34:51.482 I'm going to continue doing so well . 34:51.482 --> 34:53.371 If I could tell other people with 34:53.371 --> 34:55.538 diabetes one thing , it would probably 34:55.538 --> 34:55.450 be , there is going to be a passionate 34:55.450 --> 34:57.339 life . That's a little bit hard . 34:57.339 --> 34:59.561 You're gonna wonder why you have it and 34:59.561 --> 35:01.617 why you um why you're different than 35:01.617 --> 35:03.783 everyone else and you have to push you 35:03.783 --> 35:05.450 that patch , You have to keep 35:05.450 --> 35:07.450 maintaining your diabetes . It's so 35:07.450 --> 35:09.450 important to help other people with 35:09.450 --> 35:11.450 diabetes . I've been doing it since 35:11.450 --> 35:13.450 very early on in my diagnosis . For 35:13.450 --> 35:15.783 whatever reason , people would say , oh , 35:16.140 --> 35:19.250 Janna can help you . Jan is doing good . 35:19.250 --> 35:22.010 She'll help you go to her and 35:22.540 --> 35:25.080 I'm happy to help . I want to go into a 35:25.080 --> 35:27.302 field where I can help other Children . 35:27.302 --> 35:29.524 Like my doctors have helped me . I feel 35:29.524 --> 35:31.858 like I have a second chance at life now . 35:31.858 --> 35:34.080 I'm more focused on trying to take care 35:34.080 --> 35:36.191 of myself because I have a three year 35:36.191 --> 35:38.358 old son . I have a wonderful husband . 35:38.640 --> 35:42.190 And uh I just need to 35:42.200 --> 35:45.090 take care of myself more and make sure 35:45.090 --> 35:47.610 that I'm healthy . I enjoy time 35:47.610 --> 35:49.832 spending with my family . That's what , 35:49.832 --> 35:51.999 that's my main concern . That's what I 35:51.999 --> 35:54.332 that's what I find important in my life . 35:54.332 --> 35:56.332 I've dedicated most of my time just 35:56.332 --> 35:58.110 Assisting at the house or doing 35:58.110 --> 36:00.166 whatever I can to make sure that the 36:00.166 --> 36:00.020 people I care about are good living 36:00.020 --> 36:03.310 with it for almost 27 years . I'm 36:03.320 --> 36:05.910 trying to live longer because I have 36:05.910 --> 36:09.250 such a young son to uh , 36:09.640 --> 36:12.270 make my family life better . Anything 36:12.270 --> 36:14.270 that I can do to make life a little 36:14.270 --> 36:16.492 easier to show somebody that you can be 36:16.492 --> 36:18.800 healthy and have diabetes , that it's 36:18.800 --> 36:21.020 possible to live a long , healthy , 36:21.020 --> 36:24.470 happy life matters to me .