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The Peter Attia Drive

Feb 18, 2019

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

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