Unveiling Myths: Diabetes & Sleep Disorders

Beverly Yates, ND

Hey, thank you so much, Dr. Wells. I’m so excited. I’m looking forward to our conversation. that you and I are simpatico in our point of view of its critical importance. The essentiality of sleep. We’ve got to have it right. It’s not optional.

Audrey Wells, MD

I like to tell people that, when it comes to your health, you need to get your nutrition right. You need to get your physical activity right, and you need to get your sleep. But they’re not necessarily three pillars. I feel like sleep is the foundation on which nutrition and exercise rest. I just looked up this statistic, and it’s hard to believe, but one out of three Americans has pre-diabetes, and diabetes is also very common. a little less common than obstructive sleep apnea. They both share this problem, and many people have been undiagnosed so far. What do you have to say to that?

Beverly Yates, ND

Oh, my gosh. These are the epidemics and pandemics that are facing the entire planet right now. It has broadened beyond the industrialized world. It just seems to me like humankind is struggling. I agree with you. Sleep is the foundation of all health. Sleeping is healing, and healing is sleep. At this moment, people are having struggles of a variety of kinds. where this interacts with blood sugar issues with type 2 diabetes, prediabetes, type 1 diabetes, type 1.5 diabetes, dementia, Alzheimer’s, all these things that are so sensitive to blood sugar, PCOS, metabolic syndrome, this is a big deal. We have to find practical ways to help people sleep better and untangle any interaction with their blood sugar. Unfortunately, what people don’t know is that people who have disordered sleep or who have sleep apnea or things like that are far more at risk of having type 2 diabetes or pre-diabetes. They are far more at risk, and no one tells them that. When you think about how these two things get going, you realize, how could it not be anything else? It’s not fair to not tell people what they’re at risk for and then help them avoid these things where possible or reverse them where possible.

Audrey Wells, MD

Agree. The bidirectional relationship between sleep problems and diabetes management or risk for diabetes is not on everybody’s tongue. It’s not that intuitive. Can you explain to the audience what the connection is between sleep problems and problems with managing blood glucose?

Beverly Yates, ND

Yes, I’ll be happy to do it. One of the things that happens, is that this will probably be the most direct path. I hope the clarity because we’re speaking both of the general health consumer and other health professionals who are on our summits, is the fact that when you have disordered sleep, when you have struggled to sleep, your body can become awash in catecholamines, that’s awash in adrenaline, awash in cortisol. For those who have watched other things or who are aware of the impact of these hormones on neurotransmitters, we know that those are responses to stress. Your body feels like it’s not sleeping well, whether you have insomnia or whether you’re up a lot at night, which can be an early warning sign. By the way, folks, if you have blood sugar dysregulation and diabetes, your frequent urination. Sometimes these things come together. in that moment, because you are under the influence of all these other chemicals when you should be resting, restoring, and resetting. Remember, sleep is a massive opportunity every night to hit the reset button and start the day afresh. But if your sleep is a hot mess, that doesn’t happen. That restoration is missing. Your gut doesn’t reset, your brain doesn’t reset, and your soul doesn’t reset. Your mental wellness doesn’t reset. all of these things that are simply not getting a chance to hit the pause button. As a result, you become much more likely to gain weight, much more likely to have all kinds of mood issues, whether it’s anxiety or depression, and to irritable and crabby. This can have profound relationship issues because the other person, you are in a partner situation, is probably not interested in your attitude, or at work, your work might be compromised. Your ability to make decisions—all sorts of things—just go gossiping in the toilet bowl because the sleep issue is so fundamental. Your body perceives sleep as a stressor. It’s releasing those catecholamines and those stress chemicals, but you’re not working them off. You’re not in the gym, lifting weights, running, or any of those things. You’re not working off those chemicals. As a result, they’re circulating in your body, and they’re frankly just doing all kinds of harm and setting you up for the increased risk of heart attacks, strokes, and the consequences of that. With that chronic rise in blood sugar, to meet that chronic rise in the catecholamines and the stress chemicals, including cortisol and adrenaline, what happens is that if you were fleeing from a bear or tiger, you would have that clear stressor. You’d be running and working those chemicals off if you had to lift a car off of a loved one. You’d be lifting. You’d be working those chemicals off. But because you’re asleep and you’re in the fight of your life with these difficult sleep problems, you’re not working those chemicals off. When you wake up in the morning, you feel like you ran a marathon and got hit by a truck. This is a bad combination. It does not feel good. It leads to weight problems or a harder time hanging on to a healthy weight. It leads to these mood problems. It also leads, unfortunately, and this is the one, Dr. Wells; it’s a real kicker, so unfair. It leads to a desire to eat all kinds of foods that aren’t healthy. You’re not going to be craving cucumbers and celery. Spinach will not be great. You’re going to crave two kinds of foods very specifically because now other hormones have come to respond to this poor sleep situation. I call them the twin gremlins. They get tangled up. They are leptin and ghrelin. As a result, you’re going to be more hungry. growling, your stomachs are hungry. Think of that as ghrelin, which is well-named because it sounds like growling. The other one is leptin. They will tell you when you have reached satiety, when you’re satisfied, and when you’re full; those are probably going to get disordered too. The result is that you’ll be hungry for either sweets or savory umami foods that are high in calories. This is a problem when you wake up in the morning. Again, you’re going to want this stuff. It’s no good for you, and preferentially, be driven towards something that’s just going to lead to a cycle of potentially bad habits. You must have plans for how you’re going to handle the morning after a bad night’s sleep and lunchtime, too. If you have that plan in place, it’ll help you avoid some problems that inevitably seem to nag people.

Audrey Wells, MD

Yes, and one of the things that I see in my practice is that when people aren’t getting healthy sleep, they stop expecting their sleep to be restorative. When they’re feeling depleted and like they have tiredness and a lack of energy, they start turning to food as a source of energy. Oftentimes, it’s the high-processed foods, the snack foods, and there’s more impulsivity around eating those foods because a sleep-deprived brain is very reward-driven. I love what you said about having the stress hormones increase both night and day as a result of the stress response to sleep loss. There is also a reduced insulin response or even insulin resistance. Can you say more about that?

Beverly Yates, ND

Yes. Part of what’s going on is, if you think about it, that the entire endurance system and all of our hormones are unhappy. We’re not sleeping. Just to add insult to injury or put a little salt on that open wound is what goes on with insulin. so your insulin becomes less and less sensitive. Or another way to say it is increasingly resistant to doing its job of grabbing up that extra glucose, that extra blood sugar that’s in your bloodstream. When you’re stressed, your body’s going to release more glucose. There’s more cortisol present. There’s more glucose present because those two are supposed to go together. Cortisol says we’re stressed. Glucose says, Hey, here’s your energy source. You need to go be a superwoman or a superman. Go get it right. However, in that chronic situation, you’re not working that stuff off. It’s still circulating in your blood. This is a problem. Then insulin comes out. It’s like, Whoa, there’s all this extra blood sugar out there. Let me go get it. After a while, the two are completely mismatched. So when in a chronic situation, the cells are supposed to signal,  stop listening to insulin grab all that extra blood sugar, and bring it inside the cell to make it available for energy. That process gets less and less efficient over time. That means that extra glucose is circulating in your bloodstream. Your blood sugar gets stored instead in your liver. So this is how you’ll get fatty liver. This is how you get extra abdominal fat around your belly, your waist area, and the organs in the abdominal area. That’s where a lot of extra inflammation comes from because, unfortunately, fat stored specifically there tends to put off the kinds of inflammatory cytokines that cause problems, whether it’s heart attacks, strokes, or other aspects of inflammation. the circulatory problems that diabetics are famous for, the issues with gangrene and losing body parts, whether it’s toes and legs, the loss of vision in going blind diabetic retinopathy, the need for kidney support, and eventually dialysis because the kidneys hate extra blood sugar. When it compromises with the immune system, the immune system starts to struggle, and then it just stops doing its job. How else does it heal neuropathies where there’s first shooting, stabbing, and difficult kinds of pain, and then it just goes blank? There’s no signal of pain. People get easily injured. They can’t feel anything. They go numb on and off the list. It’s a terrible list that comes from diabetes. If somebody has disordered sleep, they are at risk of all these things.

Audrey Wells, MD

Yes. It’s a great point to bring up the problems with the microvasculature and the end organ damage that diabetes does because, with sleep apnea in particular, there’s also endothelial dysfunction. I want to underscore what that means. Cardiovascular disease is well associated with untreated sleep apnea. People think about the heart first and foremost. Yes, there’s an increased risk of a heart attack. There’s an increased risk of heart arrhythmia. But when you consider the entire system, there are also the vessels, the blood vessels, from the big blood vessels to the little tiny ones in your organs and your extremities. Untreated sleep apnea, for example, causes inflammation and stress, stress hormone release, and catecholamine damage to that little, tiny layer inside the blood vessels that keeps those vessels nice and open and functioning well. Diabetes also harms this. There’s an overlapping pathology that can accelerate the disease.

Beverly Yates, ND

Definitely. I’m glad you brought that up. When you put those two together, it’s an unfair situation. It’s almost like the blood vessels are under some direct internal assault. When you think about what happens when someone is stressed and supposed to be fleeing from an actual tiger or bear rather than a chronically perceived one, you’re working off the chemicals. I’m going to say it again. When you aren’t in a situation where you are fleeing from a direct threat, You’re not on a European bike; you’re not running at five K. Those things are happening. Those chemicals are circulating in your blood, and they start to do damage to your blood vessels. Let’s talk about that detail a little bit more with the vasculature, right? When we look at that microvasculature,  common sense and I ask people listening here, wouldn’t you think that if you were fleeing or running, you needed to get away from some danger or stay and fight either one? Fight or flight, your big, powerful muscles would probably be engaged. Therefore, the larger blood vessels would be prioritized. Wouldn’t you think that this might compromise the circulation to the smaller blood vessels, the microvasculature? The answer is yes, it does, but that means that they’re not getting their nutrients in and their waste out. There are all sorts of things that aren’t happening at a normal pace. So if you are under 24 hours a day under this threat. Wow. In the case of sleep apolutely throws a monkey wrench in the works and is particularly problematic, whether it’s obstructive sleep apnea or central sleep apnea. Absolutely. It’s a problem.

Audrey Wells, MD

I’m wondering, in your practice, how do you advise people who are trying to control their blood sugars because they’ve been diagnosed with diabetes or even prevent the development of diabetes in the first place? How do you advise them in terms of sleep?

Beverly Yates, ND

I tell people you shouldn’t take it personally, but take it seriously. If you sleep with someone, whether that’s a lover, a partner, or whatever your household arrangement may be because people have a lot of different things going on, however, it, is, right, I’m not a judgmental person. If somebody gives you feedback that you snore, get checked out. You should have a sleep study done, irrespective of other things. You should prioritize that.

Audrey Wells, MD

Snoring is not normal, right?

Beverly Yates, ND

No, snoring is not normal. The other thing is that if someone tells you that you don’t breathe when you sleep, you just go silent. That’s even worse because now your airway is completely closed. You should run, not walk, to go get that sleep study assessment done, whether it’s done in a hospital clinical setting, sleep study at home, or an objective assessment or test; don’t guess; find out because this could be a life-saving difference. I watch people fool around with this. I can say another word, but yes, fool around. Then they found out it wasn’t good. People have lost their lives over this. It’s serious, folks. Serious.

Audrey Wells, MD

One thing that’s hard for people is the slow nature with which things get compromised. The same is true whether you’re talking about diabetes or problems with sleep. These are things that get worse incrementally over a long period like the boiled frog phenomenon. You put a frog in water and you start heating it and the frog becomes much less sensitive to the temperature of the water as it goes up slowly. But if you were to try to put a frog in hot water, it would jump out immediately because it doesn’t have time to acclimate. People are always acclimating to a new low, it seems that’s what you’re trying to say, and also that my message is to just take these things seriously, get them checked out, and get them treated as early as possible.

Beverly Yates, ND

It’s one of the most unfair things about sleep disorders and sleep struggles. Is that a corrosive, ever-present issue around the erosion of health, the erosion of good decisions, the erosion of mood, and the erosion of the will to do things? It becomes even harder. So the best time to start was yesterday, and the next best time to start is today. Please take this seriously because you’re right about the fact that it’s not clear that the house is on fire, that there’s a few embers here and a little smolder there; people don’t take it seriously, whereas the whole thing’s up in an inferno. Here comes all of the attention. much more expensive, and so much more life is compromised. People often make bad decisions about their careers, money, or things simply because they haven’t gotten rest and the train didn’t get a chance to reset. It could help them make good decisions. then, other implications for dementia later on in life: when you’re in your 30s or 40s, 50s or 60s, it’s not too late, even in your seventies, whatever your age may be. Please, people, take this seriously. If you don’t sleep with someone else, that’s fine. There are apps to help you get a sense of whether or not you’re snoring or if you go completely silent. sleep issues have got to be taken care of appropriately. Seriously. But what? Let’s think about this. Another way I’d love to get your thoughts on is how about our colleagues who just tell people, “Oh, we’ll just watch your blood sugar numbers. Oh, you’re okay. Everybody snores.” Normalizing the thinking is the pathology. What are your thoughts about that?

Audrey Wells, MD

It’s common, and it’s unfortunate because people internalize that message. Snoring is okay, or snoring I only snore when I’m tired, is something that I hear a lot. But snoring means that there’s enough narrowing in the airway to cause tissue vibration, which makes the noise. Just a little further down the spectrum, you’re entering a realm of pathology. The snoring may just be the tip of the iceberg. Given how common problems with sleep-disordered breathing are, it’s worth taking it seriously, especially if you have an underlying aggravating or comorbid condition like diabetes. The good thing about making changes to your sleep is that you can claw back some of that lost function you had before. You can optimize your functioning, your moods, your daytime activity, and your performance. It seems the same is true with diabetes. I’m curious to hear from you about the kinds of lifestyle modifications you recommend so that people can gain ground with their diabetes.

Beverly Yates, ND

What a great question! When it comes to diabetes, whether you’ve got type 2 diabetes pre-diabetes right now, you’ve recently been diagnosed, and maybe you’re still in shock about that, or you have a family history and you’re trying to prevent it because you’ve seen what an unpleasant show unfolds with this. There are five steps to the protocol. Nutrition is going to be the bull’s eye of the whole thing because we have to eat healthy food. We want to avoid highly processed, ultra-refined food because that stuff just depletes us of our nutrients. We want to eat nutrient-dense food as freshly prepared as possible, and within whatever the constraints of your budget are, you can eat healthy without having to spend a fortune on it. It is possible. That’s number one. Nutrition is at the center of our focus. The next piece is going to be meal timing. The time of day you eat your food matters for good blood sugar regulation and good sleep. I always recommend that people leave at least three to five hours between their last bite of dinner and before they put their head on their pillow. I’ve seen people push that edge and eat a heavy meal late, and then the next day they feel terrible. Sometimes they develop heartburn and VRD gastroesophageal reflux disease from that, etc. because it’s just bad. The physics alone of a heavy meal right against the sphincter, the stomach, Of course, you’re going to have heartburn because that stomach acid is going to push up into the esophagus because instead of you being upright during the day, you’re like this. We went to sleep after that big meal. Bad idea. It just doesn’t work sometimes. Just explaining how the anatomy is and the time, people are like, Oh, and then they are eating it earlier. There goes the heartburn. There goes the GERD. They’ve sold it. You didn’t have to throw pills at it. You had to change the lifestyle and make people aware of what the difference was. Other things around this that are important to know are making sure that you don’t skip lunch. I’ve seen a lot of type 2 diabetics. They are the most giving people. They are often the rock in their community. Do a lot of things. A lot of people, well, sometimes their self-care isn’t number one on their list. It Is not even on their list. I am not throwing shade at anybody because sometimes they are also in caregiver situations or they work in a profession where they’re expected to be on call and ready to go. Whether they are members of our military, whether they are first responders, or whether they are the person in the family who provides care for an older relative or a younger relative, maybe they have an adult child who has profound issues. Whatever it may be, They’re often sandwiched with life’s responsibilities. So,  they feel like they run out of time in the day. I certainly had a year where my mother was very ill with, let’s say, lung cancer, a small cell, and she lived much longer. We thought she would, but still. Wow. That was my own experience with it, along with other things that I’ve seen. It’s a lot to be able to put together a life that’s in balance. But this makes a difference for good sugar regulation. Make sure you get your meals in. If you’re doing intermittent fasting, that’s fine. But don’t go to bed on a heavy meal three to five hours after dinner. When you go to sleep, that’s one. Another tip for those of you who tend to be habit-based people, brush your teeth after dinner this will keep you away from mindless, unintentional snacking.

Audrey Wells, MD

I agree with that. Brushing your teeth gives you that nice minty feel. I don’t know if you’ve ever had this experience, but there are times when I eat something salty and then I’m craving something sweet, mostly because of the taste in my mouth. If I just went to the bathroom and brushed my teeth, that would go away. It’s true.

Beverly Yates, ND

Yes, definitely. It’s just a way to anchor in another layer of good habits. Then, for the other three folks there, the other three steps for the eighth protocol are going to be your stress management. From the beginning, I thought people should fully understand why stress is not your friend. Stress is necessary sometimes in life; it can motivate us, and we can use it in extremely we want to have healthy ways to relieve it, whether it’s going for a walk, lifting weights, making sure you have consistent exercise, dancing, singing, praying, or meditation. There are lots of ways it could be knitting, crocheting, or talking with friends. There are so many ways to relieve stress. Find the ones that don’t pull you down but instead lift you’d say get different things in the mix so you don’t get bored and you’re rewarding different aspects of your body and your soul to be able to pivot as needed, because sometimes life can hand us some pretty unfair hands, that’s for sure. The fourth member here is going to be Sleep. Our summit is focused here on sleep. I would argue that, in some ways, sleep absolutely should be the number one thing. But if you already have diabetes, I find nutrition, and to start, we’ve got to make sure your food drives it. Sometimes, though, people are already eating healthy food, in which case we can go right to sleep and stress because we know that goes to the twin gremlins, right or left hand, and ghrelin are probably at play and tease that apart with some smart lab tests to focus in so they can have an idea of, Oh, that’s where I have cravings. At 4:00 in the afternoon, or this is why I want to be up at 2 a.m., but I don’t have a lifestyle that supports me being up to it. Now, what do I do? Then, of course, our fifth member is going to be consistent exercise and strength training. I think of them together because, particularly as we age, we have to have muscles. We just do a lot of muscle work for you. Muscles are blood sugar sponges. In the same way, when we talk about nutrition, we say leafy green vegetables are blood sugar sponges because they make a big difference in avoiding blood sugar spikes. The same is true for your musculature. the more that you can lift weights and be ready, your kettlebell, whatever it is, as I will do this when working with my patients. To the clients, you get your kettlebell while we’re sitting here. Come on, you’re working at it. You just have to find a way to work it in. You just do.

Audrey Wells, MD

I agree. It’s a matter of being deliberate with it, isn’t it? Just like putting it at the top of your to-do list and making sure that you prioritize it and execute it. Sometimes, these habits are difficult. Against the backdrop of poor sleep, you’re not going to be able to implement or sustain anything healthy in the long term.

Beverly Yates, ND

That’s true for you.

Audrey Wells, MD

One of the things that people don’t know or that’s not talked about a lot is the power of your new brain, your prefrontal cortex, to inhibit that amygdala, those emotional regulation centers, and that impulsive behavior. So when you lose sleep, the part that’s inhibiting your internal toddler, or what I like to call it, is offline. Your internal toddler comes out and says, I don’t want to do the exercise. I don’t want to eat those healthy foods. I don’t want to do the things that I need to take care of myself. Living that way is exhausting. I wonder if you have specific tips that you can give about forming habits, especially when it comes to managing diabetes. Because I imagine that’s a factor.

Beverly Yates, ND

It is a factor. Habits are a powerful factor. I am also well aware that people can feel overwhelmed. rather than anything to completely blow up everything about their lives, we pick on one or two things. We focus on those things, and we make sure that they’re put together. One way to do it is to make sure that if people know that sleep is also a factor for them, we do something that will support the entirety of this situation, and that’s meal planning. to have it be that specifically for their meal planning, what they’ll do is have a meal that they go to for their breakfast and then a meal that they go to for their lunch, and that’s already set. They can have a piece of paper right on that refrigerator door, or maybe they’ve got a note on their phone. If they travel a lot and say, This is what I’m going to eat for breakfast, this is what I’m going to eat for lunch, “Then, not the morning after a poor night’s sleep. It’s already decided. Because you’re right, if people have to make a lot of decisions and are exhausted, they’re not going to make good ones. We just don’t have a whole lot of capacity. We’re vulnerable, So this is a way to acknowledge it and say this is a moment of self-care or self-love. I’m going to do what I need to to take care of myself, and I’m going to have this all ready and set. with the planning, then they’ve got their meals planned for the week, and from there they can mix and match. They’ll know what the green light options are. They’ll know what the yellow options are. There are no red options in the house. We’ve got rid of those. Those we’ve already identified, particularly if they’re using a glucometer and test strips, or if they regularly use a CGM. We already know where the trouble zones are because sometimes people have odd reactions to otherwise healthy foods. We’ve gotten that figured out. They’ve got their care pack, and this is what they’re doing. I find that if people can get a good breakfast under their belt after a bad night’s sleep and a healthy lunch under their belt after a bad night’s sleep, they’re usually fine to make good decisions for dinner.

Audrey Wells, MD

I agree with that. Sometimes the willpower is down by the evening. If you’re flexing that muscle earlier in the day, Having that group of what you’re going to do and how you’re going to address it takes the load off of somebody’s mind and helps them stick to a plan. I heard you say that meal timing is a factor. Some people do intermittent fasting, but that can be tricky for some people who have diabetes. Can you elaborate more on how you would advise somebody with time-restricted feeding or intermittent fasting when diabetes is in the mix?

Beverly Yates, ND

Yes, there are the things I’ve seen that have worked clinically. Number one is to know whether or not that person has a history of disordered eating. If they have anorexia, bulimia, or any of those other disordered eating situations, then tread carefully because sometimes you’re going to get triggered and they’ll be pushed into relapse. They’re often not a good candidate, in my experience, for intermittent fasting. Fasting of any kind—that’s often just not going to be the strategy that’s going to be successful for that person. If they don’t have a history of disordered eating, then full steam ahead for type 2 diabetes pre-diabetes. Intermittent fasting is a great way to go because, in today’s 24/7 food access world, it’s very different from what any of our ancestors had. No matter what, where we were, the atmosphere, etc. Nobody had 24/7 access to food. Now we do. This is why humanity is having so many struggles with that concept, To put the brakes on that way again with meal planning, it just underscores, Hey, we’re going to eat two to three meals a day. They’re going to be healthy. They’re going to be robust and nourishing, and they’re going to lead to us having an even blood sugar response. The ones that I find most appealing are your green vegetables, often leafy greens. They don’t have to be leafy ones, but they’re easy enough these days. You already have pre-wash prep ready to go. It could not be simpler. Think of an affordable price. For a few dollars, you can have a basket of greens that are already chopped. It’s gotten a lot easier. In addition to that, you’re going to need protein. Protein is a huge help. It’s satisfying. It helps your blood sugar run evenly. If you’ve had a bad night, protein is your friend. It’s going to help kick cravings to the curb because the leptin and ghrelin twin gremlin situation is absolutely in the background. Lurking, waiting for you to mess up? Just know that it’s not that you’re trying to sabotage yourself. This is an actual physiologic response to the abnormal sleep. There’s nothing wrong with you. You aren’t broken. If you’re struggling with cravings, they’re there for a reason. You just have to have a different strategy to deal with them. 

Next on our list would be healthy fats. Fans don’t cause any blood sugar spikes, and they are very satisfying. That could be nuts. Seeds, olive oil, coconut oil, and things like that. There are lots of ways to get healthy fats in you. Avocados. Much of it is very satisfying and creamy. Those are good options. Now we’ve covered three different food groups. We’ve talked about our veggies; we’ve talked about our proteins; we’ve talked about our fats. 

Then finally, the fourth one is going to be a portion of what I call the resistance complex with carbohydrate rates, so resistant starch, complex carbohydrates, slow-burning carbs—that’s going to be your beans, legumes, peas, things of that nature. It’s also going to be in small amounts if you tolerate whole grains. Some people with diabetes do fine with grains; some people do not. With the testing, either with glucometer test strips or with a CGM test, don’t guess. Find out if you’re one of the people who can have whole grains or who needs to limit them and focus on the other sources of resistant starch so you don’t blow up your blood sugar, and then your blood sugar gets into that healthy green zone and stays there. Then you can continue to choose the things that work for you. If you like to have potatoes, I’d say so, but wait, potatoes are a problem. Maybe you do a half-and-half mix of white potatoes with cauliflower, and you can make mashed potatoes. Here in our family for Thanksgiving time, we do that. No, we don’t have anyone here who has type 2 diabetes or pre-diabetes. But in my family, my dad was one of 13 siblings. They all had some diabetes, including type 1. I am well aware that, genetically, I have to be careful. So, far, so good. Knock on wood. But just to put an idea out there, you can easily do swaps and substitutions to get a similar taste and enjoy your food without destroying your blood sugar. But again, if you’re planning your meals, this is much easier. You have to do this spontaneously. Dr. Wells, you’re right. It’s not going to work, is it?

Audrey Wells, MD

It’s not going to work. Yes. I’ve got personal experience doing that; truly, I remember back to the days when I was in residency and doing overnight calls. I did a fellowship in critical care. So the ICU is very demanding. For me in the morning after a call it a night, biscuits and gravy—that’s all I wanted to eat. I had no power to resist it. 

Beverly Yates, ND

You know, it was gravy.

Audrey Wells, MD

Yes. It’s just how we’re programmed as humans. You mentioned CGM, which is a continuous glucose monitor. Can you tell me, do you need a prescription to have a CGM? If not, where can you get one?

Beverly Yates, ND

Okay, so CGM is a fascinating topic and depends on where you are in the world. If you’re in the U.S., they’re considered a medical device, and you will need to get a prescription for one. If you’re in other parts of the world where an over-the-counter device like a thermometer is available and you can just go get one because you want it, people should have access to these things, particularly if they’re trying to monitor their health and get a sense of it. It’s ideal if you’re guided by a professional who understands what it means so that you aren’t panicking unnecessarily. Let me be clear. Someone who has type 1 diabetes, where their body no longer makes insulin, is dependent on insulin as an exogenous pharmaceutical drug for the rest of their lives. Should always have priority for a CGM. A continuous glucometer makes a difference for type one; it’s life-saving. Okay, now from there, for people with type 2 diabetes, particularly those who are looking to improve their situation, we want to get actionable insights. They also should have scripts. I don’t know why doctors withhold that. Medicare may have some silly rule where you have to have an A1C of 9.0 or higher to have a CGM written, which is insane because you get your blood maple syrup by then. Like, who are we kidding? We are just trying to kill people, that’s dumb. That restriction shouldn’t be there. They didn’t ask me, but I’m just saying, So Docs, write the scripts. Okay, just do it. If it’s a person with prediabetes, they too should have access to the scripts for CGM because the actionable insights are precious. You can reward someone, and they can feel more empowered and in control and know, “Hey, that’s a great meal for me.” Or, “Oh, when I exercise, this is what happens. Look at how beautiful my blood sugar control is the next day,” etc. It gives people a lot of positive feedback, and it takes the guesswork out of it rather than leaving people feeling helpless and doomed. The blaming and shaming that goes on with type 2 diabetes and pre-diabetes is terrible. In the same way, we shouldn’t demonize food groups. We shouldn’t demonize people, either. The judgmental attitude that many colleagues have towards their diabetic patients is so bad that it’s not only mean-spirited; it’s ineffective; it’s terrible. It’s just awful. It’s not right. It’s unkind, and it’s unnecessary. People already have a giant bat. Right before we came on, we were talking about that. Their internal critic is already beating them up. They don’t need us, as doctors or any other health professionals, to pile on. It’s not helpful.

Audrey Wells, MD

I agree with you. I’m confused when I see that judgmental behavior in the medical world. It’s another symptom of how our healthcare system is broken in a lot of ways. It’s no longer healthcare. It’s sick care without the steps necessary for people to know how to prevent disease in the first place. Yes, thank you for bringing that up. 

As we close here, I want to say that I’m sure that people who are watching this would like to work with you and engage in all the preventative steps that are necessary to prevent full-blown diabetes. But also, those with diabetes are probably excited to learn that there’s action they can take to improve their condition. How do people find you, and how do people work with you?

Beverly Yates, ND

For those who are interested, you can go to one of the two websites; it’s going to be amazing. It’s launching right now: naturalhealthcare.com, that’s NATURALHEALTHCARE dot com. The other ones. My name is drbeverlyyates.com. DRBEVERLYYATES dot com. You can connect with me there. We have programs for people, including individual one-on-one care as well as group programs. Sometimes people will heal faster and better in a group setting for other people who have maybe more complex needs or who have more privacy concerns; a one-on-one format may be a better fit, but we’re here to serve and to help as we go on this mission to positively impact the lives of at least three million people who have type 2 diabetes and pre-diabetes. 

Audrey Wells, MD

Wow, that’s fantastic. I’m cheering you on. Thank you so much for a productive conversation today, and it was a pleasure to speak with you. 

Beverly Yates, ND

Thank you so much for your work. I appreciate you. I’m delighted you’re doing the work you’re doing, and I wish you continued success with all the lives you’re going to impact. Because sleeping is foundational.

Audrey Wells, MD

I agree. Thank you so much, Dr. Yates. Take good care.