Ask the Doctor!

Pediatric endocrinologist Rachelle Gandica took a moment out of her busy schedule to talk about beta cells, genetics, Ozempic and so much more! Check out this list of hot topic questions from our young inquiring minds. 

Kids: Who first discovered and described diabetes?

Dr. Gandica: The first ever depiction of diabetes dates back to ancient Egyptian times thousands of years ago where stories were written about people who urinated a lot and needed to drink a lot of water which we now realize is a reference to diabetes. Insulin was discovered in 1922, over 100 years ago! Doctors Banting and Best were the scientists who discovered insulin and actually started to extract it from dogs and put it into people. One of the first children to receive insulin was across the street at this hospital! He was very sick, but after receiving insulin he started gaining weight and improving. He is the grandfather of one of my former patients who now sees an adult endocrinologist here at the Berrie Center!

Kids: Why do people get diabetes? 

Dr. Gandica: There are different types of diabetes: type 1 (which you all have) and type 2. The way that people get type 1 has to do with the immune system. For reasons we don’t fully understand, your body got a message that the beta cells in your pancreas that make insulin shouldn’t be there and your immune system targets them to the point where they can’t make insulin very well. And why does that start? We truly don’t know. We do know that autoimmune conditions like thyroid disease, gluten/wheat allergies, and certain kinds of arthritis tend to run in certain families. We know that in families that have other autoimmune conditions there is a higher risk of type 1 diabetes. Also, if you have someone in the family with type 1 diabetes there is more of a risk. We are still trying to figure out what causes it to happen in one sibling and not another. There are many more questions to be answered! 

Kids: What is type 2 diabetes and can anyone with diabetes get Ozempic? 

Dr. Gandica: Type 2 diabetes also causes higher blood sugars, but for a whole different reason. It is a result of carrying extra weight, and the way that we treat type 2 diabetes is working on diet and making sure they eat healthy like vegetables, lean proteins, and limiting carbohydrates (especially processed carbs). We also ask them to exercise and move their body. That’s the first thing we do when we meet someone with type 2. Type 2 diabetes is very hereditary. If a child is type 2, they often have a parent who also has type 2. People with type 2 diabetes make insulin, but it does not work properly - this is called insulin resistance. 

There are pills people with type 2 diabetes can take like metformin which helps overcome the insulin resistance that these patients have. There are also some new medicines called GLP-1 receptor agonists (Ozempic is one brand you have probably heard of and seen advertised on television). They are once weekly injections and they help patients use insulin better and helps them to lose weight. In rare situation a patient with type 1 who carries excess weight may use Ozempic, but they also always use insulin as well. 

Kids: Can someone start by having type 2 and then it develops into type 1?

Dr. Gandica: No, type 1 and type 2 are totally different. If you have someone say that they had type 2 and now they have type 1, it means either someone made the wrong diagnosis to start (they could have been type 1 all along since treatment with pills was not working) or sometimes in patients with type 2 diabetes, despite trying diets, exercise, pills, and injections, they still may need insulin as well (they still have type 2 but they also need insulin because other medications are not working). 

Kids: Are there possibly other types of diabetes besides type 1 and type 2?

Dr. Gandica: Yes. This is actually something that I am very interested in and when I was training to be an endocrinologist this was my research focus. In type 1 and type 2 diabetes many genes in our body are playing a role in the development of the diabetes. These other types of diabetes are much more rare and caused by one gene mistake (this is called monogenic diabetes). Usually these are cases where there is diabetes in many relatives. These patients don’t have the blood markers of type 1 or type 2 diabetes. I have a handful of families and patients who have these hereditary forms of monogenic diabetes. There actually is a study called the RADIANT trial which is looking closer at these families to help describe the genetic cause.  Hopefully by describing the genetic cause of the diabetes, we can improve their treatment. 

Kids: Is it true that no two people can have the same diabetes?

Dr. Gandica: It is definitely true! Everyone’s diabetes is different. Not any one of you at the table or any person in general has the same type of diabetes, the same insulin needs and the way that your body responds to insulin, exercise, and food is so different. That's why it is important to talk about your own diabetes with your doctor/educator so you can learn how to treat it best. 

Kids: Why did you want to become a diabetes doctor and for how many years did you go to medical school?

Dr. Gandica: I love treating patients with diabetes- starting them on technology, helping them overcome challenges and learn how to manage their sugars long-term through the phases of childhood and adolescent development. I really enjoy seeing patients regularly, getting to know them and making a difference.  After high school, I went to four years of college, four years of medical school, three years of a pediatric residency, and three years of a pediatric endocrine fellowship, which makes fourteen total years. And guess what- I love my job! I really love the families I take care of, I love making a difference, I love getting to know them and understand how to improve their diabetes, and I wouldn’t change anything about it. I’m super happy and I feel very grateful to be able to do what I do with the fabulous team at the Berrie Center. 

Kids: When I am sick, my blood sugar is super high. Why is that?

Dr. Gandica: When you are sick or stressed, there are hormones like cortisol (made by adrenal glands on top of the kidneys) that rise in your body and make you more insulin resistant. It is very important when you are sick to really be on top of your blood sugars and correct them often. Call us at the Berrie Center- we can help troubleshoot why your blood sugars are high and how to fix them. 
Kids: What is new in diabetes care and research?

Dr Gandica:  There are many trials ongoing that that are related to type 1 diabetes. Here at the Berrie Center we participate in the research network Trialnet. Trialnet has one research arm aiming to screen all family members of type 1 patients to determine if someone is at increased risk of developing type 1. If they are at higher risk, they are closely monitored through Trialnet. There are also trials through Trialnet that newly-diagnosed patients can enroll in that aim to preserve and prolong how the beta cells are able to function. There are also exciting advances being made in stem cell technology where beta cells are being engineered and later tested in adult human subjects. We will learn soon how these cells are able to make insulin in the body through this research. Aside from this, other important advancements in technology are also ongoing: insulins are getting faster, glucose sensors are getting more accurate, and pump technology is getting smarter. The outlook for the future is very good!