8/1/2019
Ask the Doctor:
An Insightful Q&A with Dr. Gandica

During a recent program for children with type 1 diabetes (T1D), Berrie Center pediatric endocrinologist, Dr. Rachelle Gandica led a game called “Ask the Doctor.” What follows is an edited transcript of an insightful Q&A filled with everything the kids wanted to know about diabetes and were not afraid to ask. 

Q: How close are we to finding a cure?

A: I answer that question in different ways. Some people define “cure” differently. I have some patients who think that curing their diabetes would actually entail wearing technology that would keep them completely hands off, and other people say, “Oh, no, no. We want a CURE!” I take that to mean no technology, eat whatever you want and your blood sugars would be perfect.

You might have heard about the bionic pancreas, which the Berrie Center is going to help test in 2020. Inside that pump is going to be insulin and glucagon, and it works in conjunction with a continuous glucose monitor (CGM). You do not have to enter carbohydrates with this pump. You tell the pump if you are eating an average amount of carbs, more than usual, or less than usual, and then the CGM provides the blood sugar. This device has the potential to make living with type 1 diabetes (T1D) much easier.

In terms of a total hands-off, no tech cure, the researchers can give you a closer timeline. It is a work in progress, but farther down the road.

Q: How is life as a doctor? What is your favorite part of being doctor?

A: My favorite part is you guys! I love seeing you come to the Berrie Center and succeed in your goals. I come to work each day because I love what I do and I love seeing my patients and helping you succeed in this because it takes teamwork. You guys make it worthwhile.

Q: How many carbs do you eat each day?

A: I’ll answer for myself and I’ll answer for my kids. I have three kids ages 9, 7, and 5. They don’t eat a lot of candy and we don’t have juice in the house. I eat one whole grain waffle with peanut butter every morning, with coffee and almond milk. Lunch is something around the Berrie Center – a salad or a sandwich. When I come home from work I’m really hungry so I eat while I’m making dinner. I snack on chips (which I probably should not do) and then I eat dinner with my family. We have a protein and either quinoa or pasta or brown rice and a vegetable. My kids like broccoli, green beans and carrots. ‘

Q: Do you have a favorite pump brand to recommend to patients?

A: I actually do not have a favorite brand. I’ve had a lot of patients say to me, “Just tell me what to get, I don’t want to have to go to that pump class, just tell me what to get.” It really is a very personal decision. I think what works for one person might not work for somebody else. I have one patient who is a junior Olympian swimmer and he is in the pool twice per day, and he does really well on a wireless pump because he can’t be disconnected from his pump for long. So, it’s really a very personal, and individual decision. I think it’s really cool that pumps are starting to link up with CGMs and closing that loop. What is available now is going to be different than what is available next year. It’s exciting to see so much change!

Q: Can dogs have diabetes?

A: Yes! I actually know people who have dogs and cats with diabetes, and give them insulin shots. Mammals can get diabetes.

Q: Why do blood sugars go low when you exercise?

A: I tell my patients the thing that drives your blood sugars low is a recent bolus or a recent injection of fast acting insulin; it is not usually the background insulin, either the lantus or basaglar or the basals. Going low often occurs when you give an injection or you give a bolus, and then you go and run, jump and play. Some of the biggest culprits are swimming and trampoline jumping. Also, playing on a soccer field in hot weather, or playing basketball – activities that really get your heart rate up and get you sweating. If you have active insulin working, then there is a higher likelihood of going low.

Q: At what age does diabetes normally occur?

A: Two phases of growth tend to have higher rates of diabetes diagnosis. They both are times when children are growing fast. The first is toddlers, ages 1-4. Then growth slows down. Then puberty: for girls it can start as young as 8, for boys it’s one or two years later. When you are growing and developing and changing all the hormones that cause these changes make someone more resistant to insulin. If you are not making enough insulin, which is what is going on in T1D, you might be more likely to develop diabetes sooner in those two phases of life. With that said, we do see new patients who are ages 6, 7, 8.

We recently had an adult patient diagnosed at the age of 72 years old. She is thin and her doctors originally thought she had type 2 diabetes (T2D). She had bloodwork done which showed she had newly diagnosed T1D.

Q: Why can’t I eat candy?

A: Well, you can eat candy (within reason), but timing is essential. Products made from pure sugar and nothing else (no fat or protein to slow down the absorption in the stomach) get absorbed quickly. If you do not make enough insulin, your blood sugar will rise very fast. The insulin that you use in your pumps, or that you inject with your pens, doesn’t actually start to work in your body until 10 to 15 minutes after you press the plunger on the pen or press the button on the pump. Because the insulin that you use is slow to work, it makes it hard to eat sweets without covering for them well in advance.

Q: What advice would you give to a person who has had type 1 diabetes for more than 15 years that can help them better themselves?

A: Usually by the time children with T1D become teenagers it becomes easy to think you can do this all by yourself. I think some of my best advice is really to make sure that you have as much support as you feel you need. If you don’t have that support, ask for it. Your diabetes should be a team approach. Your doctor wants to help, your educator wants to help--we are all part of your team. Always ask for help and get the support that you need.

This is a marathon, not a sprint. We want you to have the kind of lifestyle that gets your blood sugars and your diabetes in the target range that we want for long term. Try to set tiny goals and achieve them, then set other tiny goals for the weeks and months to come and you will do really well.

Q: Which type of diabetes is better to have?

A: That is a tricky question! I think it depends on how you treat the diabetes you have. No matter what kind of diabetes you have, if you can keep your blood sugars in the target range that we want (which is a wide range) then there is little risk of complications in the future. You are going to live a long, healthy life. If you have T1D or T2D and you have lots of high numbers for a long time, then we do worry about complications. It is really about keeping your blood sugars in target range.

 

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