Q&A: Talking diabetes with Dr. David McCulloch

Let’s start with the basics. What is diabetes?

In very simple terms, it’s a condition where you have high blood sugar (glucose) because your body isn’t producing enough insulin or not responding properly to the insulin you are producing, or both. 

What’s the difference between type 1 and type 2 diabetes?

Type 1 is a genetic disorder and a type of autoimmune disease where your immune system destroys the cells in your pancreas that make insulin. Only 5 percent of diabetes cases are type 1. It is much more severe than type 2.

Type 2, the more common form of diabetes, is caused by a whole combination of factors. All of us, if we live long enough, will eventually get diabetes. In the same way your joints wear out, your pancreas gradually makes less insulin as you get older.

People can become resistant to insulin, most commonly because they have gained weight and don’t exercise enough. It can also happen if they get stressed or have another illness. The body’s response to these problems is to crank out hormones that blunt the ability of insulin to work.

Are you seeing more children with type 2 diabetes?

Diabetes is definitely increasing in young people, related to the obesity epidemic. Kids are becoming heavier and heavier at a younger age, and less active. There’s not really any difference in the disease in adults and children. We use the same treatment for both. Treatment usually includes medication along with lifestyle changes that involve eating less and exercising more.

What kind of long-term damage does diabetes cause? Is it the same for type 1 and type 2?

 

It’s the same. The biggest long-term complication of diabetes is a significant increase in heart attacks and strokes. In the case of young people, if you get diabetes earlier in life, you have a much higher risk of heart attacks and strokes earlier in life. Other problems are high blood pressure, eye damage that can lead to blindness, kidney failure, and nerve damage. But by far, the biggest cause of death with diabetes is heart attacks and strokes.

What’s changed since you first started working with patients who had diabetes?

When I started practicing medicine in the 1970s, there were so many people who were blind, in kidney dialysis, or who had to have their feet amputated because of the disease. In the early 1980s, when the first technology came out allowing people to prick a finger and get an instant blood sugar reading, it revolutionized diabetes care and empowered people to take control of their condition. Today, there are fewer of these problems because technology allows us to accurately measure blood sugar levels at any moment and then have the ability to make a change in diet, exercise, or medication to respond to that. This minimizes damage to the body.

Is there anything routinely misunderstood about diabetes?

People with type 2 diabetes sometimes initially feel that there’s nothing they can do except take insulin and other drugs. But exercise is incredibly useful and we promote this as vigorously as we can. Within hours of going for a single 30-minute walk, the body immediately begins producing more insulin receptors on their muscle and liver cells, which makes their body respond much better to insulin. This effect of reducing insulin resistance only lasts for about 24 hours, though. That’s the reason we say people with diabetes have to get 30 minutes a day of exercise. It doesn’t help to get three hours of exercise on Saturday and nothing the rest of the week.

Does the term “pre-diabetic” mean that someone is going to develop diabetes?

I don’t find this term all that helpful. It makes it sound as though we know exactly who will get diabetes, how we can delay its onset, or predict exactly when it might happen. We don’t. At best, the term implies that someone is exhibiting some degree of impaired glucose tolerance and is at greater risk of developing diabetes down the road, perhaps because they also have a family history of the disease.

Is there anything on the research horizon that you’re excited about?

Yes. For people with type 1 diabetes, we are getting closer and closer to developing an artificial pancreas. This is a pump that will deliver insulin plus an automatic glucose monitor that will tell the pump how much insulin to give.

What do you like best about practicing at Kaiser Permanente Washington?

We track patients very carefully, and use thoughtful, evidence-based medicine. Because of our wonderful electronic medical record system, we can reach out to patients and remind them when they are overdue for blood tests or other care, such as an eye exam.

Elaine Porterfield

Kaiser Permanente is a proud sponsor of the 35th annual Beat the Bridge fundraiser for the Juvenile Diabetes Research Foundation. Beat the Bridge  features an 8k run, a 3 mile wheelchair race, a 3 mile walk, a 1 mile fun run, and the Diaper Derby for toddlers.

Register onsite at Husky Stadium on May 21 beginning at 6:45 a.m. The event starts at noon.

DAVID MCCULLOCH, MD

Endocrinologist and Kaiser Permanente Washington Diabetes Specialist 

TITLE: Medical Director of Clinical Improvement and Prevention

OFFICE LOCATION: Kaiser Permanente Medical Center Capitol Hill Campus, Seattle WA

AUTHOR: The Diabetes AnswerBook (2008, SourceBooks Inc.)