Shireen: In today’s episode, we speak with Dr. Nicole Bereolos about different diabetes related skin conditions such as acanthosis nigricans. Dr. Bereolos talks to us about signs and symptoms to recognize diabetes related skin conditions, manage the symptoms, and if these conditions are something that should get checked out by your doctor. Stay tuned.

 Dr. Nicole Bereolos is a clinical health psychologist and a certified diabetes care and education specialist in private practice in North Texas. She specializes in working with individuals living with chronic illness who want to optimize their quality of life. She also does speaking engagements to healthcare professionals and people living with chronic conditions and their families. Welcome, Dr. Bereolos.

Dr. Bereolos: Thank you so much. Thank you Yumlish to having me today.

Shireen: Absolutely. Dr. Bereolos can you share with us your personal experience of living with Type 1 diabetes and how it has impacted your understanding and approach when discussing diabetes with your patients?

Dr. Bereolos: Absolutely. So, I was diagnosed when I was 12 years old. So, I’ve been living with it more than I’ve not been living with it at this point. And I never dreamed that this would be shaping my career, but I really enjoy speaking with people living with diabetes. I think it really has helped me to be very realistic and not have these crazy expectations in living with diabetes.

I tell people living with diabetes all the time, I’ve got variations with my blood sugar just like you do. I share my continuous glucose monitor with them. It doesn’t matter if my blood sugar is 60 or if it’s well over two or even 300 that this is real. This is diabetes. Even though I’ve been living with it for probably longer than the person in front of me has, it doesn’t mean that my blood sugars are any better than theirs.

And so, I think they really appreciate that very matter of fact, very real way. I take a very problem-solving approach to living with diabetes and try to utilize skills that we talk about today and translate that to new experiences. Because I have this motto that we don’t want diabetes to be in the driver’s seat. We want to be in the driver’s seat, the person living with it.

Shireen: And that is so interesting because what you’re saying is don’t let that disease control your life. You are controlling what happens. Right. And it’s such an important element.

Dr. Bereolos: Absolutely. It comes along for the ride.

Shireen: Interesting. And then with that, Dr. Bereolos and really coming to now the topic for this podcast. It’s really talking about skin related conditions for people with diabetes. So first, tell us how common that is.

Dr. Bereolos: People forget the skin is the largest organ in the human body, right? We very much take it for granted because we look at it every day and don’t even think twice about our skin.

But we have to really remember parts of the skin that we don’t see on a daily basis. The tops of our head, the bottom is of our feet are back in particular. We really need to take notice of our skin because I can cause more concerns than we ever realize. Even people without living with diabetes need to take note of their skin.

Shireen: And what are the causes associated with the skin related conditions?

Dr. Bereolos: Typically, it’s when you’re talking about living with diabetes and you’ve got these blood sugars that are kind of not exactly where you want them to be. When your blood sugars are not where you want them to be, you’re not getting adequate nutrients usually to all parts of the body.

You’re not getting adequate blood flow to all parts of the body. You may not be eating adequate nutrition, getting balanced plate method. So, your body’s not getting proper nutrition and not able to get good blood flow to fuel all parts of your body. So, we can get what’s called degradation to the skin, which simply means breaking down.

Well on tops of the head, where the feet touch the ground, you’re going to get a lot more breakdown. Skin is going to be drier because we don’t always look at those parts of the skin. You can get sores that you may not even realize they’re there, and then they can become infected. They can get deeper, and they can maybe even need surgical intervention if they’re not caught in quick enough. Just because they’re not being looked at because blood sugars are not in that narrow range that we talk about that are ideal. Trying to keep blood sugars in that 80 to 180 range, 70% of the time.

And as a certified diabetes specialist, what are the most common diabetes skin conditions that you see in your work with patients?

Dr. Bereolos: So, in people who wear medical devices, so whether that be a continuous glucose monitor or an insulin pump, we often see like an eczema or some type of skin irritation or that adhesive hits the body, so underneath that tape. So, basically eczema as an allergic reaction.

So, we see inflammation, we see swelling. We see itching, we sometimes even see little blisters that develop underneath that skin patch. So that’s become very common in people who wear these devices. We see drying of the skin, like I mentioned earlier, if the elbows or on the knees in particular on the feet.

You hear a lot of dermatologists talk about moisture, moisture, moisture, moisture. Lotioning is your best friend. Keeping areas clean is your best friend. Sunscreen is your best friend, regardless of the type of skin that you have. Very fair skin, very dark skin. It doesn’t matter. Moisture. Keeping skin lush is very important.

Ulcers. So that’s when the skin is really peeling away at a very deep level. Okay. This is where you have to see a physician where they have to really clean out that wound to try to prevent infections. Sometimes they’ll go to what’s called a hyperbaric chamber, where you’re going to a special room.

It’s a lot of oxygen in that room where they’ll try to really heal that wound kind of from the inside out. Get it oxygen rich. So, heal that. So, the skin starts to heal from the inside back out to try to prevent some type of amputation because that can become common unfortunately, in people living with diabetes.

It can start with that tiny ulcer that’s just a pinpoint and just grow and grow and grow until it’s quite large and then it can lead to an amputation. So, we’re trying to prevent that in people with diabetes. But that all starts with skincare, believe it or not. And even acne, who would’ve thought, there’s some research out of Europe about five years ago that has found that people with diabetes have higher levels of acne, and it’s believed that that’s been associated with the food that they eat.

Because more fast-food, foods with higher fat content can lead to certain types of acne.

Shireen: That is so interesting and next I want to get into a difference between if you find a difference in skin conditions for those living with Type 1 diabetes versus Type 2 diabetes.

Dr. Bereolos: Not really. You really don’t see much of a difference per se. It’s just about keeping blood sugars in that range I mentioned that 80 to 180 as much as possible. Limiting those excursions outside of that range, eating a balanced diet, taking care of your body, doing skin checks regardless of the type of diabetes, is what’s going to be the most important.

Shireen: And the basic thing is the hygiene around it. Keeping the area clean. You mentioned specifically for the CGM for instance, what would you tell someone who’s trying to do better by their health by having something like that on their skin? But certainly, is causing some irritation, what would you say to someone like that?

Dr. Bereolos: I’ve struggled with that myself. So, there’s kind of tricks of the trade that are out there. There’s a lot of people out there on Twitter and Instagram who share their tricks. There’s allergy sprays, there’s patches, there’s other adhesive kind of barrier wipes that you can use.

I personally, I kick an over-the-counter allergy pill every day, a generic allergy pill. And that kind, it doesn’t prevent it completely, but it kind of keeps it a bay. I have found that certain parts of my body are more prone to kind of that itchiness than other parts of the body, so I try to minimize where in that area that causes more allergy than the other parts of the body.

But so many people out there talk about this in like their social media accounts as well. So, there’s plenty of tricks out there that people can do to try to make that better. Absolutely.

Shireen: That’s interesting. I do want to go into one specific item, and I feel like I’m going to butcher it as I even mentioned it to you, but can you help us understand what acanthosis nigricans is particularly. And help us understand, can you explain what this is and how it affects the skin specifically for someone with diabetes?

Dr. Bereolos: So, this is common in people, well, number one, it can be genetic. So, it’s really the thickening of the skin. They refer to it as velvety. So that area of the skin can be just very soft, almost like a baby’s butt, believe it or not.

Very smooth. Darkening of the skin within the folds. So typically, you can see it in the back of the. You could also see it in their groin and there’s often skin tags in that area. And you may be asking, well what’s a skin tag? It’s that dark like piece of skin that’s just kind of hanging. Some people may want to pull it off or burn it off with a lighter.

I would not recommend that you see a professional if get skin tags removed, because it is pretty easy to do. But they’ll just say that skin hang call, skin tag. But it can be a sign of insulin resistance. So, a sign that your body’s just not quite making enough insulin. It’s a sign that it’s very common in people who are overweight.

It’s common in people who have darker skin. It can be a sign of some cancer. Not very common, but it can be. Does it mean you have type two diabetes? No, but it can mean that there you are more likely to develop diabetes. So, it’s definitely worth getting checked out. And some people ask, well, can I just get that… some medicine to make that go away?

There are some, there’s some topical, some creams that you can be given. But it’s definitely worth going to your provider and having them do some blood work because some medications that you take, steroids, some other medications can cause that thickening of the skin too. So, it’s definitely worth getting checked out because it can lead to learning other things about your body.

Shireen: Okay. So, if you have this, don’t worry yourself and immediately think the worst. Go to your doctor, go to a provider and get the blood work done so that they can rule out some of the other concerning things.

Dr. Bereolos: Yes. Get the blood work. I think knowledge is power. You don’t want to rush to assumptions.

It can run in your family; it can be nothing. You see it in young children, believe it or not. You know what? I thought it’s interesting. I have a background in public health as well. And there’s a lot of barbers who actually find this, right? Because they’re back there cutting people’s hair, right? And they notice this.

So, they’ve picked this up on people and tell their clients: Hey, you may want to see your doctor cause I’m noticing some skin changes back there. Because you don’t look at the back of your neck. No one does or very rarely do you. I’ve got long hair I can’t see back there, I’m not going to look.

So, when you get your hair cut, it’s really great. I think that’s a great public health kind of prevention. Population health. Get everybody involved. Have your partner, your parents, whoever, everybody can look at each other’s neck. I think that’s a great thing to do.

Shireen: Which really leads me to the next question, which is how can someone with diabetes tell if their skin condition is something that they need to be concerned about?

Dr. Bereolos: Really the only way to know is to have that open conversation. A lot of times people go to their healthcare professional, and they maybe be embarrassed, especially if they are a larger body size, right? Because every time they go to the doctor, they’re just told, well, just lose weight.

Just lose weight. You just need to lose a few pounds. Or just don’t eat bread. Or don’t eat sweets, or take a walk behind, around the block. Well, people get tired of hearing that over and over. So, people avoid going to see their healthcare professional, but I’m such an advocate for find a provider who works well with you, right?

It’s okay to fire your healthcare professional. There are others around. More than likely we’ve got telehealth. You may not be able to cross state lines in finding a telehealth provider that way, but you’ve got the whole state. To find somebody that works better with you. You shouldn’t have to not tell your healthcare professional something out of being ashamed or feel guilty.

You want to have that open dialogue with that person, because you’re going to get the best care by having that open dialogue and being as honest with that person as possible. For myself, I’m never going to give up my diet soda. I don’t care what they say. That’s just something I’m not going to do personally.

So why lie about it? It’s just not worth it. And you’ve got to find somebody who you’re comfortable with as well, who’s going to work with you and truly, truly listen. That way you’re going to get the best care.

Shireen: Which also takes me to sort of looking at skin conditions in people with who aren’t diabetic. Can someone develop some of these can skin conditions that are associated with diabetes if they do not have diabetes?

Dr. Bereolos: Absolutely. 100%. So that thickening of the skin, like I said, that could be caused by medications, by steroids, by birth control pills or other medications.

It can just run in the family. You can develop ulcers on the feet for other reasons. Of course, acne that’s a bacteria that’s also genetic. There’s different types of acne, so it’s caused by different reasons. So, absolutely I think the important thing is skin is an organ.

So, your skin is important to take care or care of just as is your teeth. Just as your heart, your lungs, right, your intestines, your stomach, your eyes. We can’t forget our skin. I think it’s been ingrained in us to wear sunscreen, right? It’s in our plot of makeup.

It’s in other products that we use. We see commercials about it. We need to take it that next step, right? We need to be aware. We need to do checks. We need to look for moles that look suspicious, but we can’t forget about the bottoms of our feet. The tops of our head. Moles can grow there. Skin issues can grow there.

If you have trouble from a physical standpoint and looking in those areas, ask a loved one. Ask your healthcare professional. If you don’t think they’re doing a thorough job. Find somebody that you trust who will do a thorough job because they are out there. See a podiatrist. See a dermatologist who’ve got specific training in this because it’s not something that you want to ignore. Because this can lead to bigger, it can get out of hand, right? If it gets ignored.

Shireen: And if particularly, can you point us to sort of maybe the top three or four things that could be concerning that you should go see a doctor for, especially if you’re someone again with diabetes?

Dr. Bereolos: Any type of cut or sore that’s not healing, anything that’s kind of uneven. What I mean uneven is the sore is like the spot is odd shaped or like one side of the sore is one shaped and another side is another shape, or it’s got an odd color to it. That could be sign of another issue. Or if you’ve got a part of the body where you don’t get a lot of feeling.

Maybe you’ve got some neuropathy. That’s an area that you probably should get looked at, because if you’re not getting a lot of feeling, that means you’re not getting a lot of blood flow. You need good blood flow in order for something to heal, right? So maybe there’s maybe a medication or some type of treatment method or some, especially like I mentioned, the hyperbaric chamber where you can try to help let blood flow to help that area heal.

So, you’re looking at color, you’re looking at shape, you’re looking at pain, you’re looking at time or something is growing, just gets bigger and bigger and bigger. If it’s got an odor to it, it’s very important. If it’s oozy, that’s got some discharge, that’s definitely something you want to get looked at, because it could be some type of infection.

You may need an antibiotic, a pill, or maybe actually some type of IV antibiotics because that infection could get into the blood. So, you can see how this could get really serious really, really quickly, just from a simple wound on the bottom of your foot. That you’ve never even knew you had.

Something I didn’t mention getting your toenails trimmed. Something people don’t always think about. They think it’s a pain, or maybe they have issues reaching, but that’s very important, right? Because if they can grow into the skin, they can cause wounds. They can get infected. I mean, think about where we put our feet. Some people walk outside with no shoes.

Some cultures do that. When I was working in the South Pacific, they would walk everywhere without shoes on or very thin, thin flip flops. That’s not good for foot health, especially if you live with diabetes, because you could walk on rocks or nails or things could get stuck at the bottom of your foot.

And if you don’t have good feelings, could lead to a lot of infection. So, having well fitted shoes with good soles are very important. If you have any type of circulation issues or if you’re living with diabetes and you can get properly fitted for all of these things. And some people say, well, they’re not cute.

Well, you’d be amazed how many well fitted shoes there are these days that give you good support and good sole protection for the bottom of your feet. So, you really want to keep that in mind. If you live in the south, not walking on the sidewalk because the sidewalk can get well over a hundred degrees you can seriously burn your feet, right?

But if you don’t have a lot of feeling, you may not know it. So, these little things people don’t always think about, but you can get third degree burns on the bottom of your feet just by walking out outside to go get your mail in the southern United States in the summer. So just very important things. We all often just take it for granted.

Shireen: Yeah, absolutely. And I think one of the things there is to someone who doesn’t have diabetes, you would think, oh, well if I have a nail stuck in my foot, I would know. But pair that with something like neuropathy and you have no feeling at the bottom of your feet and now you’ve got this infection and you don’t even know it’s getting worse. So, for context, it’s not, not everyone can feel that kind of pain or a scab, or like a wound or something like that.

Dr. Bereolos: Or what if you don’t have diabetes? But if you have a lot of callouses on the bottom of your feet, you’re not necessarily going to know, right? Because that callous usually doesn’t have a lot of feeling to it.

So, it’s good to get in that habit of checking your feet or someone to check your feet nightly when, with bathing practices or changing for bed or things like that. It’s really good to get in that habit every day.

Shireen: Absolutely. And to our listeners, if you are a caregiver for someone, take that time to check the bottom of the feet there.

With that, my next question for you is, do you have any suggestions or recommendations for those with diabetes to prevent these diabetes related skin conditions altogether.

Dr. Bereolos: So, it would be, try to keep your blood sugars in that range, that narrow range as much as you can maintain all your visits with your healthcare professionals.

Monitor your glucose values as you were in your treatment plan. Take your medications or your insulin or whatever your treatment plan is. Try to do that as consistently as possible. I know life gets in the way. Try to minimize stress as much as you can.

Have positive social support in your life. We’re humans. So, we do everything the best that we can and try to, I guess, like you said earlier, my goal with people is trying to optimize quality of life despite living with chronic conditions.

Shireen: Absolutely love that. And on that note, Dr. Bereolos, thank you so very much for your time. Can you tell our listeners how can they connect with you and just learn more about your work?

Dr. Bereolos: Yeah, so I have a Twitter feed. I try to post various articles I find interesting or things I see when I attend conferences. So that’s @DrNBereolos and I also have a website. It’s drbereolos.com

Shireen: Lovely. And with that, thank you once again Dr. Bereolos. So, for our listeners who are tuning in and listening to this episode, if you have experience. Any diabetes related skin conditions, we would just love to hear from you about your journey, how you were able to manage this particular condition. Head over to our Facebook head over to our Instagram at Yumlish.

Find us there. Find this very podcast post and comment below to tell us again. Have you experienced any diabetes related conditions and then how you were able to manage that particular condition. Let’s get the conversation started over there. And with that, Dr. Bereolos thank you so very much again for your time.

Dr. Bereolos: Thank you.

Connect with Dr. Nicole Bereolos:

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