Looking for in-depth information on diabetes management? Look no further than Diabetes Deep Dives, our video series that goes beyond the surface to explore the burning questions you have about diabetes. Our engaging experts, who have knowledge or lived experience on the topic, provide practical tips and tools that you can easily use. Our goal is to share information in ways that will spark continued interest and learning and leave you with practical tips and tools that you can easily use.
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| 1 | Episode 1 | Menopause and Diabetes Dr. Alice Cheng explores the connection between Type 1 diabetes, menopause, and sexual health, including the influence of hormones on blood sugar levels, strategies for managing fluctuations, and options for symptom management. She also addresses additional health considerations during and after menopause, the impact of diabetes on sexual health, and available treatments for related issues. | 0:03 hello and welcome to diabetes deep Dives 0:06 my name is Candice and I am from 0:08 diabetes Canada I'm so pleased that you 0:10 are joining us today 0:13 diabetes deep Dives is a series of 0:15 videos designed to dive deeper and 0:17 Beyond the surface of different areas of 0:19 diabetes management we're exploring 0:21 those burning questions you may have by 0:24 featuring Dynamic and engaging guests 0:26 with knowledge or lived experience on 0:29 the topic 0:30 our goal is to share information in ways 0:33 that will spark continued interest and 0:34 learning and leave you with practical 0:36 tips and tools that you can easily use 0:38 we'll be dropping a new video every 0:40 month so subscribe to our YouTube 0:42 channel and click on the notification 0:44 Bell to be notified about new content 0:46 you can also check us out on social 0:48 media to find out when the next one will 0:50 be posted on our YouTube channel 0:52 just a reminder that the information 0:54 shared in these videos in no way 0:57 replaces the advice and direction that 1:00 you have from your Healthcare team if 1:02 you have questions about your care 1:04 please speak to your healthcare provider 1:06 and team to make sure that you are 1:07 getting the best advice 1:10 in this video we are going to hear from 1:12 Dr Alice Chang about the intersection 1:14 between type 1 diabetes menopause and 1:17 Sexual Health we know that diabetes and 1:19 Sexual Health are not topics that 1:21 everyone talks about so we are happy and 1:23 excited for this discussion 1:26 Dr Chang is an endocrinologist at 1:28 Trillium health partners and Unity 1:30 Health Toronto as well as an associate 1:32 professor at the University of Toronto 1:35 she's been involved in the development 1:36 of the diabetes clinical practice 1:38 guidelines since 2003. 1:41 in this video Dr Chang discusses the 1:43 hormones involved in menstruation 1:45 perimenopause and menopause how these 1:48 hormones affect living with diabetes 1:50 other health concerns related to 1:52 menopause and how that impacts diabetes 1:55 management and tips for living well 1:57 during menopause and Beyond 2:01 we hope that you find this discussion 2:03 enlightening and that it helps you to 2:05 successfully manage your journey with 2:07 diabetes and now over to Dr Chang 2:10 welcome everyone to this presentation 2:12 entitled menopause in type 1 diabetes 2:15 what to expect and what you can do 2:18 presented by diabetes Canada my name is 2:21 Dr Alice Chang an endocrinologist from 2:23 the University of Toronto and it is my 2:25 pleasure today to be sharing this 2:27 information with you 2:29 now if we think about the hormonal 2:31 stages of life particularly in women we 2:34 think about things such as puberty 2:36 pregnancy 2:38 perimenopause and menopause these are 2:41 the hormonal stages that a woman may go 2:44 through over the course of her lifetime 2:47 now in all of these stages a common 2:50 theme is that the hormones are changing 2:53 so the question then becomes how do 2:55 hormones sex hormones in particular 2:57 affect diabetes 3:01 well to answer that let's think about 3:03 the menstrual cycle 3:05 I'm going to take you back to biology 3:07 class from high school to remind you 3:10 about the hormones involved in the 3:12 menstrual cycle occurring in the first 3:14 place 3:15 so here on the diagram on the right 3:17 you'll see on the top two hormones 3:19 listed LH and FSH those are the 3:22 pituitary hormones the hormones that are 3:24 coming from the brain to help sort of 3:27 Mastermind the entire cycle 3:29 the middle chunk is looking at estradiol 3:32 and progesterone which are estrogen and 3:34 progesterone which are hormones that 3:37 come from the ovaries which is also very 3:39 important in the cycling that occurs 3:42 now day one of the cycle is actually the 3:45 first day of bleeding and if we start at 3:48 day one you'll notice in the middle 3:50 panel that the red line the estradiol 3:52 starts to rise over time and that rise 3:56 over time is triggered by changes in FSH 3:59 and LH in the pituitary and that rise in 4:03 estradiol happens slowly over time and 4:05 then suddenly around just before day 14 4:08 there's a surge in the estradiol 4:11 and a surge in LH and that surge results 4:15 in ovulation so ovulation is the popping 4:18 out of the egg 4:19 once the egg has popped out the 4:22 remaining cells where the egg used to be 4:24 in the ovary starts to transform and 4:26 starts making a hormone known as 4:28 progesterone as shown here in the orange 4:30 dotted line and the progesterone levels 4:32 start to rise rise rise after ovulation 4:36 the progesterone hormone is responsible 4:38 for the PMS symptoms that we experienced 4:40 before a period 4:42 now those cells that are making 4:44 progesterone only live for 14 days 4:46 so 14 days after the egg has been 4:49 released and those cells start making 4:51 progesterone 14 days later those cells 4:53 die and when the cells die the 4:55 progesterone level drops and that drop 4:57 in progesterone level is what triggers 4:59 the bleeding to occur 5:01 so in the first phase of the cycle 5:03 what's deemed the follicular phase 5:05 what's happening is that the estrogen 5:07 levels are rising slowly and that's 5:09 building the lining of the uterus in 5:12 preparation for potential pregnancy 5:14 and then once progesterone is made after 5:17 ovulation progesterone doesn't build the 5:19 lining progesterone matures the lining 5:21 prepares it for potential embedding of 5:24 an embryo but then 14 days later if it's 5:27 not used the drop in progesterone allows 5:30 the shedding of that lining to occur so 5:33 this is the menstrual cycle a reminder 5:35 from high school biology class 5:37 follicular phase is the first half of 5:39 the cycle the middle is ovulation for a 5:41 day and then you've got the luteal phase 5:43 which is the phase with high 5:44 progesterone 5:46 okay so therefore how does this impact 5:49 the glucose levels well there's a 5:53 gradual increase in estrogen in that 5:54 follicular phase which actually raises 5:56 insulin resistance so you become more 5:59 resistant to insulin slowly in that 6:01 first half of the cycle but once 6:03 progesterone starts to rise it's a very 6:05 insulin resistant hormone and you find 6:08 that your blood sugars tend to go higher 6:10 and you need to give yourself more 6:11 insulin but once that drop in 6:13 progesterone occurs which triggers 6:15 shedding of the lining or your period 6:17 then that drop in insulin resistance 6:21 means that you suddenly become more 6:22 sensitive to insulin and your insulin 6:24 requirements go down 6:26 so this is what the pattern that I'm 6:29 sure many of you have observed yourself 6:31 with respect to your cycle 6:34 so then therefore the impact on blood 6:36 glucose is obviously different depending 6:38 on what part of the cycle that you're in 6:40 but the time period just before your 6:43 period 6:44 tends to be when your sugars are the 6:46 highest and that could be just three 6:48 days before or for some ladies it's up 6:50 to 10 days or even 14 days before their 6:53 period so as soon as the progesterone 6:55 starts to go up they start to notice an 6:56 impact on their blood sugars 6:58 however once the period starts then 7:02 there's an Abrupt drop in the blood 7:03 glucose levels which of course have to 7:05 be accounted for 7:07 so from an insulin dose adjustment 7:09 perspective during the PMS time which is 7:13 the time when the progesterone levels 7:15 are rising not only is it giving you 7:17 insulin resistance but I think many of 7:19 us can can attest to the fact that there 7:22 are also cravings for food that may 7:24 occur particularly carbohydrates so 7:27 therefore one needs to account for that 7:28 of course when you're carb counting and 7:31 then also there needs to be an increase 7:33 in the insulin and for those who are 7:35 very regular you can actually predict 7:36 that and have a different basal program 7:39 for example for those of you on a pump 7:41 to be able to account for that 7:43 pre-period period of time and then you 7:46 have to change that basal setting once 7:49 the period starts 7:51 so that's when you're cycling regularly 7:54 but what happens in perimenopause and in 7:58 menopause 7:59 so I'm going to direct you to a fabulous 8:02 website called menopause and you dot CA 8:05 which is actually created by the Society 8:07 of Obstetricians and gynecologists of 8:09 Canada so a very credible Source 8:11 well-designed website designed for 8:14 people the general public and gives 8:16 really up-to-date expert advice on 8:20 menopause in terms of definitions and 8:22 potential treatments etc etc so a great 8:25 place to help guide you for any 8:27 questions that you may have 8:29 so what exactly is menopause so 8:32 menopause is technically a clinical 8:35 definition based on not having a period 8:38 for 12 months 8:40 now from a blood test perspective what 8:42 you could identify is an elevated FSH 8:45 which is one of the hormones that comes 8:47 from the pituitary and the FSH is high 8:50 in response to low estrogen from the 8:53 ovaries that are pooping out and no 8:56 longer working because they've run out 8:57 of eggs 8:58 and the official diagnosis of menopause 9:02 though is having no period for 12 months 9:04 and with that can come a high FSH 95 of 9:08 the time it happens after the age of 45 9:10 and the average age is around 51 in 9:13 North America 9:15 but leading up to menopause there is a 9:18 time period known as perimenopause 9:20 perimenopause is usually in your 40s and 9:23 is associated with and this is the 9:25 visual that I use in my head and when 9:27 I'm explaining it to my patients just 9:29 imagine it's like your ovaries are like 9:31 a car running out of gas and it's sort 9:33 of sputtering 9:35 so every now and then it pops out an egg 9:37 but it's not doing it in a in a in a 9:40 regular fashion like it did previously 9:42 and therefore your periods are just 9:45 unpredictable 9:46 they could happen two months later they 9:49 could happen six weeks they could happen 9:51 two weeks so it could be shorter it 9:53 could be longer it's just no longer the 9:56 regular cycle that many of you may have 9:58 had previously which also means that 10:01 during that time it becomes harder to 10:03 predict when a period is going to show 10:05 up and your hormones are doing funny 10:07 things and it's just a potentially 10:10 difficult time for many women and there 10:13 are symptoms associated with those 10:15 changes in hormones so there are 10:18 potential menopausal slash 10:19 perimenopausal symptoms and this is 10:22 taken from the menopause and you website 10:24 and I hate to share this part of the 10:26 information with you but these symptoms 10:27 can last between six months up to 15 10:30 years depending on the individual and 10:33 the symptoms are shown for you here in 10:35 the red block Red Box 10:37 the most common one that we tend to hear 10:39 about of course is hot flashes night 10:41 sweats however there are other things 10:43 such as sleep disturbances which can be 10:45 quite common fatigue is another one that 10:48 people may describe just not thinking as 10:50 clearly as they previously did some 10:52 people can get mood swings joint aches 10:55 and pains I mean there's a variety of 10:56 symptoms that can come with the 10:58 perimenopause slash menopause and it's 11:01 usually a result of just fluctuating 11:03 hormones and that reduction in estradiol 11:06 or estrogen overall as well as the loss 11:08 of progesterone 11:10 now the challenge in diabetes is that 11:14 the irregular menstrual cycles makes it 11:16 very difficult for you to predict what 11:18 your blood sugars are going to do 11:19 whereas when your periods were regular 11:21 you were able to say okay you know 11:23 checking my calendars is about the time 11:24 when I'm going to need to increase my 11:25 insulin but then in the perimenopause 11:28 because you cannot predict when your 11:30 period is going to show up it's going to 11:31 be harder to do that prediction the 11:34 other thing is hot flashes become very 11:36 difficult to differentiate from low 11:39 blood sugar hypoglycemia 11:41 and that becomes a confusing aspect as 11:43 well so what can you do about it 11:46 it's just check a lot frequent 11:49 monitoring of blood glucose is going to 11:50 be your best way certainly to 11:52 differentiate vasomotor symptoms of hot 11:55 flashes with that of the low blood sugar 11:57 continuous glucose monitoring may be 11:59 particularly helpful during this period 12:01 of time when things are just wonky and 12:03 you need to be able to make adjustments 12:05 in a fairly quick manner 12:07 increase insulin doses or reduce insulin 12:10 doses as needed based on what's 12:12 happening with your sugars 12:14 and then living healthy so regular 12:17 physical activity eating healthy all of 12:19 these things can certainly help lessen 12:22 some of those perimenopausal symptoms 12:24 but it definitely is difficult to 12:28 address 12:30 hormone replacement therapy is of course 12:32 on the table for those women who suffer 12:36 a lot from perimenopausal slash 12:38 menopausal symptoms and when I say 12:40 suffer a lot meaning it's affecting 12:41 their quality of life affecting their 12:43 ability to function then hormone 12:45 replacement therapy is something that 12:47 could be discussed with your physician 12:48 and certainly someone living with 12:50 diabetes could still take it this would 12:52 be the same advice we would give any 12:53 woman who's having significant 12:55 perimenopausal symptoms and that could 12:58 come in the form of low-dose birth 12:59 control or it could come in the form of 13:02 low-dose hormone replacement therapy as 13:04 we might use in menopause itself 13:09 and then what about menopause and 13:11 diabetes so that's sort of perimenopause 13:13 and the symptoms that can go with it but 13:15 once it's menopause menopause and 13:16 there's been no period for 12 months the 13:19 only good thing is that the hormonal 13:21 fluctuations of the unpredictable Cycles 13:23 there's no longer an issue so at least 13:25 from that perspective things are stable 13:28 however you may still experience hot 13:30 flashes for many years to come and that 13:33 is still hard to differentiate from 13:35 hypoglycemia and therefore frequent 13:37 testing is necessary as well some women 13:40 may find over the course of 13:42 perimenopause into menopause a weight 13:44 gain or it's harder to lose weight 13:47 so with weight changes that could also 13:49 impact your insulin resistance so again 13:51 the main strategy Is frequent testing of 13:53 the sugars and being aware of what might 13:55 happen 13:57 the other thing with menopause though is 13:59 to remember other health issues that may 14:01 come independent of diabetes with 14:04 menopause so asking about getting your 14:07 bone marrow density testing checking for 14:09 osteoporosis making sure you're getting 14:11 proper mammograms based on approved 14:13 timings to rule out any breast masses or 14:16 breast cancer and also recognizing that 14:18 cardiovascular risk factor control is 14:21 critical throughout your life of 14:22 diabetes but particularly as you enter 14:24 menopause because one is older at that 14:27 time so making sure that things like 14:29 blood pressure and cholesterol are well 14:31 controlled that you're not smoking and 14:33 then of course again the healthy 14:35 lifestyle and the body weight 14:37 but in terms of treatment of menopause 14:39 itself it's no different for those with 14:42 diabetes and without so if hormone 14:44 replacement therapy is right for you and 14:46 it's a discussion you've had with your 14:48 team then by all means you can go ahead 14:50 and use it it may impact your blood 14:52 sugars because again that treatment will 14:55 involve estrogen and progesterone but 14:57 now you know how those two hormones can 14:58 impact your blood sugars and then you 15:00 can just check and adjust your insulin 15:03 requirements accordingly 15:05 but what about sexual function because 15:07 that's the other aspect that can 15:09 certainly change in the context of 15:12 menopause but frankly even before 15:15 menopause sexual function and female 15:17 sexual dysfunction is more common than 15:20 perhaps we realize 15:22 so if we think about female sexual 15:23 dysfunction these are some of the 15:25 statistics that are out there in terms 15:27 of how common it can occur 15:29 and it's common as you can see here and 15:33 these can be grouped into things like 15:34 hypoactive sexual desire disorder female 15:37 arousal disorder orgasmic disorder or 15:40 sexual pain disorder so this is 15:41 referring to the different phases of the 15:44 sexual response that a woman may have 15:47 now specifically in diabetes though 15:49 female sexual dysfunction may be common 15:51 because of other things that can come 15:54 with diabetes that can of course impact 15:56 sexual function so if there are 15:58 blockages and arteries that could affect 16:00 circulation if there is damage to 16:02 nervous system then that could reduce 16:04 sensation 16:06 high blood sugars can reduce lubrication 16:09 can result in yeast infections which of 16:10 course would not be very pleasant from a 16:12 sexual function perspective there may be 16:14 issues around body image or fear of 16:17 hypoglycemia and then of course the the 16:20 mental health aspects are critical in 16:22 diabetes and depression and anxiety can 16:25 obviously impact sexual function and 16:27 then there may be medications that some 16:29 are using not necessarily specific to 16:31 diabetes but other medications that can 16:34 impact sexual function 16:36 but what about specific to menopause 16:38 well specific to menopause the two big 16:40 ones that often come up as vaginal 16:42 dryness or reduced sex drive 16:46 now strategies to address this so 16:49 hormone replacement therapy is probably 16:50 one of the best strategies to address 16:52 the vaginal dryness and that could be 16:54 just local treatment so vaginal creams 16:57 that could then reintroduce some 16:59 estrogen to the vaginal wall which would 17:01 then help with lubrication and avoid the 17:04 dryness or perhaps systemic treatment 17:06 pills if hot flashes and other systemic 17:11 symptoms are a major issue of course 17:14 lubricants would be very useful to make 17:17 the sexual experience more enjoyable and 17:20 again the the usual motherhood 17:21 statements of regular physical activity 17:23 and lifestyle interventions just giving 17:25 you more energy and feeling good about 17:27 yourself and and those endorphins and 17:29 just feeling happy overall is obviously 17:31 going to also be helpful for sexual 17:34 function 17:35 now in terms of the reduced sex drive I 17:37 mean the female sex drive is very 17:39 complicated it would be like looking at 17:41 the cockpit of an airplane and there are 17:44 multiple components there's the 17:45 biological there's the psychological 17:47 there's the social and there's also the 17:50 contextual so it's not as simple as 17:52 replace a hormone and boom the sex drive 17:54 is back so when there is reduced sex 17:57 drive it's important to determine all 17:58 the things that may in fact be affecting 18:00 that 18:01 there could also be a an official 18:04 diagnosis of something called hypoactive 18:07 sexual desire disorder 18:09 which is officially defined as an 18:11 absence of sexual fantasies absence of 18:13 desire for sexual activity but very 18:16 importantly causing distress and a 18:19 minimum of six months 18:21 many women may experience the first two 18:23 but it doesn't really bother them it 18:25 doesn't bother their partner but in that 18:26 case it's not a disorder however if it 18:29 is causing distress and it is chronic 18:32 then this could be defined as hypoactive 18:34 sexual desire disorder and there 18:37 actually is this screener that exists 18:40 online that you could look for where if 18:43 you answer yes to the first four 18:45 questions but more importantly no to the 18:48 question number five then it could be 18:51 diagnosed as generalized hypoactive 18:54 sexual desire disorder and the no to 18:56 number five is important so it needs to 18:58 not be secondary to a recent operation 19:01 mental health considerations medications 19:04 pregnancy 19:06 etc etc etc so it needs to not have 19:08 another explanation then in that case it 19:11 could be defined as hypoactive sexual 19:13 desire disorder 19:16 but what are the strategies to address 19:18 reduced libido whether it's in the form 19:20 of hsdd or just generally speaking 19:22 reduce libido I think discussing it with 19:25 your Healthcare team is important 19:26 because there may be certain tests that 19:28 need to be done to rule out other causes 19:30 if the thyroid is not working properly 19:32 if the blood sugars are very high 19:34 if there are psychosocial things that 19:36 are going on that are impacting it then 19:39 all of those things could potentially be 19:42 treated or reversible so it's important 19:44 to check out other potential causes and 19:46 then if there's not much to find then 19:48 cognitive behavioral therapy can be very 19:51 helpful Sex Therapy can be helpful and 19:53 of course things like vaginal lubricants 19:55 because painful sex is obviously not 19:57 going to be enjoyable and then only in 19:59 those who are post-menopausal women then 20:01 testosterone low dose could be 20:03 considered if it's officially diagnosed 20:05 as hypoactive sexual desire disorder 20:10 so to summarize hormones affect diabetes 20:13 a lot and we went through the menstrual 20:16 cycle and a reminder that there's an 20:18 increase in insulin requirements 20:19 particularly for the up to two weeks 20:21 prior to a period but the perimenopause 20:25 then is that transition time when things 20:27 are fluctuating considerably and that's 20:29 also when symptoms can be quite strong 20:32 and therefore the only strategy you 20:35 really have is to test a lot and then to 20:38 adjust your insulin accordingly to 20:41 smooth things out one can try things 20:43 like low-dose birth control pills or 20:45 low-dose hormone replacement therapy but 20:48 again that's a discussion with your team 20:51 to see if it's appropriate for you it's 20:53 the same discussion we would have with 20:54 any woman even outside of diabetes and 20:57 the presence of diabetes would not 20:59 exclude you so of course you could use 21:01 those if necessary menopause is 21:04 officially No period for 12 months and 21:06 at that point make sure that you're 21:08 considering other things that can come 21:09 with age which would be checking for 21:12 osteoporosis ensuring that your 21:14 cardiovascular health is well managed 21:17 and of course mammograms to screen for 21:19 breast cancer and then finally sexual 21:22 dysfunction is an issue that women may 21:24 have even before menopause but certainly 21:26 with menopause and is an important 21:29 discussion to have with your health care 21:30 team 21:32 so thank you very much for your kind 21:34 attention and I hope that this 21:36 presentation was useful for you 21:38 thank you so much for joining us to dive 21:40 deeper into diabetes and menopause 21:42 please take the opportunity to let us 21:44 know what you learned what you liked and 21:47 how we can do better in the comments 21:48 section below 21:50 if you have ideas for other topics you'd 21:52 like to learn more about you can include 21:54 that in your comments as well 21:56 if you are looking for more resources 21:58 about diabetes management please visit 22:01 our website at diabetes.ca you can also 22:03 email us at info diabetes.ca or call our 22:07 info line at 1-800-benting that's 22:12 1-800-226-8464 and speak to one of our 22:15 information and support Specialists who 22:17 can address your needs thanks again for 22:19 joining us and see you next time |
| 2 | Episode 2 | Diabetes Research In this episode, Dr. Brandy Wicklow discusses diabetes research models, how individuals with diabetes can participate, and expectations as a research study participant. After watching, you will be able to identify research models, access resources for diabetes research, understand participation expectations and rights, and make informed decisions about getting involved in diabetes research. | 0:08 I'm so pleased that you are joining us 0:10 today 0:11 diabetes deep Dives is a series of 0:14 videos designed to dive deeper and 0:16 Beyond the surface of different areas of 0:18 diabetes management we are exploring 0:20 those burning questions that you may 0:22 have by featuring Dynamic and engaging 0:24 guests with knowledge or lived 0:26 experience on the topic our goal is to 0:29 share information in ways that will 0:31 spark continued interest and learning 0:33 and leave you with practical tips and 0:35 tools that you can easily use we'll be 0:37 dropping a new video every month so 0:39 subscribe to our YouTube channel and 0:41 click on the notification Bell to be 0:43 notified about new content you can also 0:45 check us out on social media to find out 0:47 when the next one will be posted on our 0:49 YouTube channel 0:52 just a reminder that the information 0:54 shared in these videos in no way 0:56 replaces the advice and direction from 0:58 your Healthcare team if you have 1:00 questions about your care please speak 1:02 to your health care provider and team to 1:05 make sure that you are getting the best 1:06 advice 1:09 have you ever wondered about what goes 1:11 into the research that informs the 1:13 development of a new diabetes treatment 1:15 or how new technology is tested for 1:18 diabetes management 1:19 are you interested in getting involved 1:21 in the research process 1:24 in this video we will explore the 1:26 different ways of conducting research 1:28 that contributes to helping us prevent 1:30 treat and find a cure for diabetes as 1:33 well as how people affected by diabetes 1:35 can participate 1:37 our guest speaker Dr Brandy Wicklow will 1:40 share her knowledge about commonly used 1:42 research models for diabetes research 1:44 and the ways in which people affected by 1:47 diabetes can get involved 1:49 she'll also tell us a little bit about 1:51 what to expect as a participant in a 1:53 research study 1:55 after watching this video we hope that 1:57 you will be able to 1:59 identify the different types of research 2:01 models and the differences between them 2:04 find the resources to learn more about 2:06 the diabetes research projects happening 2:08 in Canada and internationally 2:11 understand what to expect and what your 2:13 rights are if you participate in a 2:15 research project 2:17 and make an informed decision if you are 2:20 thinking about getting involved in a 2:21 diabetes research project 2:24 Dr Wicklow is an associate professor in 2:27 the department of Pediatrics and child 2:29 health at the University of Manitoba and 2:31 a clinical investigator at the 2:33 Children's Hospital Research Institute 2:34 of Manitoba 2:36 Dr micklow's research is focused on the 2:39 determinants of type 2 diabetes and its 2:41 renal complications in children with a 2:43 particular interest in the Indigenous 2:45 population of Northern Manitoba 2:49 we hope that you will find this video 2:50 informative and that it will spark your 2:52 interest in learning more about diabetes 2:55 research and about getting involved and 2:57 now over to Dr Wicklow 3:00 researching clinical trials is the basis 3:03 of everything we know about diabetes 3:05 that's how we learn how to diagnose 3:07 diabetes how to screen for diabetes and 3:09 its complications how to treat and 3:12 manage blood sugars and how to prevent 3:14 complications 3:16 and support people living well with 3:18 diabetes as a physician all of the 3:20 clinical practice guidelines that I 3:22 follow in my clinical practice 3:24 are informed by this clinical research 3:28 just like there are many different types 3:31 of diabetes in many different 3:32 populations of people affected by 3:34 diabetes so the research is quite Broad 3:37 in this area 3:41 researchers cover anything from what are 3:44 the most important and relevant 3:46 questions to people living with diabetes 3:49 how do we support people in terms of 3:51 their mental health their nutrition and 3:54 their physical activity when living with 3:56 diabetes 3:57 how to prevent diabetes 4:00 and perhaps most importantly to those 4:02 living with diabetes how to find a cure 4:07 because all of these questions are very 4:09 different and very important there are a 4:12 multitude of different studies and 4:14 different study types that someone 4:16 living with diabetes can get involved 4:18 with we're going to go through a few of 4:20 those today on this deep dive looking at 4:23 Clinical Research in diabetes 4:25 when people think about research and 4:28 specifically Research into diabetes they 4:30 often think about two things 4:32 the research that's looking into a cure 4:34 and the research to prevent diabetes 4:39 many of these research trials are 4:41 clinical trials and often the randomized 4:44 clinical trials 4:46 a randomized clinical trial is a 4:48 clinical trial that looks at a new 4:51 medication 4:52 a new preventative measure 4:56 a new treatment for prevention of 4:58 complications 5:00 a new way to monitor or screen and it 5:04 Compares these new Innovations to common 5:07 practice 5:09 or the current standard of clinical 5:11 practice that you would experience when 5:12 you go to see your doctor on a regular 5:14 basis 5:16 these new treatments or therapies have 5:19 often been trialed in cellular models or 5:22 animal models and at some point those 5:24 same therapies need to be trod and 5:26 humans with diabetes so that we can 5:30 ensure that they're safe they're 5:32 tolerable and they're efficacious or 5:35 they work well 5:37 oftentimes these types of Trials are 5:39 what we call randomized randomization is 5:43 really just like a flip of the coin 5:45 if you're enrolled in a trial and you're 5:48 going to be randomized what that means 5:51 is you are going to be randomly selected 5:54 to be either in the treatment group 5:56 trying the brand new drug the brand new 5:59 method of dosing the brand new way of 6:03 screening 6:04 and if you are randomized into the 6:06 control group you'll be getting your 6:09 usual Care by your usual clinician 6:12 through usual means 6:15 occasionally control groups will also 6:17 experience additional testing screening 6:20 or questionnaires that are given to the 6:23 group that is receiving the intervention 6:25 in order to compare things like 6:28 vulnerability side effects quality of 6:31 life 6:33 these trials are incredibly important 6:36 and they're a way to get a new 6:38 medication such as empathoglobin 6:42 closed-loop insulin pump system 6:45 from Discovery and development 6:49 to the market 6:51 and only when these types of research 6:53 Studies have shown that a medication or 6:57 an innovation is safe is effective and 7:01 oftentimes it's Superior to what we 7:04 currently have and can recommend for 7:05 people living with diabetes will it be 7:08 made available through Health Canada for 7:10 all people with living living with 7:12 diabetes to be able to use 7:15 prevention trials are often similar the 7:18 randomized trials but they're performed 7:21 in a population of people who have not 7:23 yet developed diabetes or who have not 7:27 yet developed complications of diabetes 7:30 and these new Innovative treatments are 7:33 used to prevent the develop or 7:36 development or progression of diabetes 7:38 in a population 7:41 this is the discovery of insulin in 7:43 Toronto over a hundred years ago 7:45 Canadian researchers have been at the 7:47 Forefront of many of these research 7:49 projects 7:50 often centers throughout Canada are 7:53 recruiting people with diabetes to 7:55 participate in these International 7:56 research studies looking at new 7:59 medications to prevent or treat Type 1 8:03 Diabetes Type 2 diabetes gestational 8:06 diabetes or other types of diabetes 8:09 in addition to randomized control trials 8:12 there are several other types of 8:13 research that you can get involved in 8:16 some of these different types of 8:17 research studies include focus groups 8:19 observational trials and occasionally 8:22 it's just a single sample of blood in 8:25 order for fundamental scientists who do 8:27 cell cellular modeling or stem cell 8:29 therapy to look at potentials for 8:32 prevention or a cure 8:34 focus groups are often just that they're 8:38 groups of individuals with lived 8:39 experience 8:41 with either Type 1 Diabetes Type 2 8:43 diabetes gestational diabetes or other 8:47 they're asked a set of questions to 8:49 inform what is the priority for research 8:52 for people living with diabetes what are 8:54 the important and relevant questions to 8:57 you to your loved ones and to other 8:59 families living and or affected by 9:02 diabetes 9:04 often these priority setting exercises 9:06 are the basis of some of the largest 9:09 networks of research there are in Canada 9:11 including 9:13 the patient-oriented research networks 9:16 uh diabetes action Canada and cancel CKD 9:21 for more about those two organizations 9:23 in a minute 9:25 personal interviews focus groups or 9:29 questionnaires that look at how one 9:32 lives with diabetes 9:34 what's a barrier to living well with 9:36 diabetes 9:37 what has been found to be supportive of 9:40 living well with diabetes and where 9:42 people find there's not enough advice or 9:45 information 9:46 these are the places where researchers 9:48 are going to focus their efforts in the 9:51 future 9:53 currently research at sites across 9:55 Canada are looking at what's important 9:58 to people living with diabetes in the 10:01 research Realm 10:03 how do we deliver care in the best 10:05 possible way 10:06 how do we screen for and prevent 10:08 complications of diabetes 10:11 how do we transfer transition patients 10:14 from a pediatric diabetes Clinic to an 10:16 adult diabetes clinic in the safe and 10:19 most effective way 10:21 researchers are looking to partner with 10:24 persons affected or living with diabetes 10:26 and their families or caregivers in 10:29 order to do important and relevant 10:31 research to those who are affected by 10:34 diabetes 10:36 as I mentioned previously there are 10:38 several organizations which have 10:40 information for patients and families 10:42 which outlines some of the different 10:45 projects that are happening in Canada 10:47 and how you might be able to get 10:48 involved one of those is diabetes action 10:52 Canada 10:54 if you Google diabetes action Canada 10:56 you'll come to a face page which 10:58 includes an area for patients or persons 11:02 living with diabetes it also includes an 11:05 outline of all of the researchers in 11:07 Canada who belong to the organization 11:09 and some of the work that they are doing 11:12 through diabetes action in Canada there 11:15 is a project called connect 1D 11:19 connect 1D Canada is an interface on the 11:23 computer which allows patients and 11:25 people living with diabetes to register 11:28 online to be contacted or considered for 11:31 different clinical trials or research 11:34 programs that come up 11:37 other websites with useful information 11:39 to look at research being done in 11:41 diabetes across Canada include diabetes 11:44 Canada 11:45 the juvenile diabetes Research 11:47 Foundation or JDRF and can solve CKD 11:51 which looks specifically at kidney 11:54 outcomes of people living with diabetes 11:57 in addition to these websites they're 12:00 also International websites that outline 12:03 some of the projects where Canadians are 12:05 included 12:07 this includes trial net 12:09 trial net is a type 1 diabetes screening 12:12 and prevention platform 12:15 is looking specifically at the genetic 12:17 risks of diabetes and also the 12:20 environmental risks of diabetes 12:24 trial net is an international research 12:26 organization that runs prevention trials 12:29 and diabetes and also screening for 12:31 diabetes 12:33 specific research projects include 12:35 looking at the genetic basis and risk of 12:37 diabetes early detection of diabetes in 12:40 order to use preventative novel 12:43 therapies to delay the onset of diabetes 12:47 or prevent it altogether 12:49 other research programs can be found on 12:52 the government website called 12:54 clinicaltrials.gov This is where 12:56 clinical trials register all of their 12:59 inclusion criteria exclusion criteria 13:02 what the study questions are and who 13:05 they're looking for in terms of 13:06 participation 13:07 oftentimes if you type in the search 13:11 type 1 diabetes type 2 diabetes 13:14 gestational diabetes or whatever it is 13:18 that is relevant to you into the search 13:20 box up top you will also allow you to 13:23 search by country 13:25 if there's a Canadian site that is 13:27 recruiting for one of those studies that 13:30 you are interested in there's often 13:32 times a contact information at the 13:34 bottom of the page which allows you to 13:36 connect with the researchers directly 13:39 finally there's your local Health Care 13:42 practitioners 13:43 often although as a physician myself I 13:46 don't always know about every new 13:48 clinical trial or every research project 13:51 that's happening in Canada if there are 13:54 specific ones that are of interest to 13:56 you with respect to exercise and 13:58 hypoglycemia closed loop insulin pump 14:03 systems 14:04 or mental health supports for diabetes 14:07 distress or diabetes burnout I can often 14:11 find those projects for you by using my 14:14 own Connections in the field 14:17 and now I know you're asking how can I 14:19 get involved 14:20 you can start by talking to your health 14:22 care provider about what speaks to you 14:25 what are the most important research 14:27 questions that you think there are in 14:29 the field of diabetes what's relevant to 14:32 you and to your family 14:34 then often your physician Allied Health 14:37 care provider diabetes educator can lead 14:40 you to a website like one of the ones we 14:43 spoke of above which will allow you to 14:45 see what current projects are happening 14:47 within Canada North America or 14:50 internationally 14:53 often times with the help of your 14:55 physician your diabetes educator or 14:57 another Allied Health professional you 15:00 will be able to get connected to the 15:01 primary researcher of those projects to 15:04 look to see if you're eligible to 15:06 participate 15:07 if you're deemed eligible to participate 15:10 then there you go you've started your 15:12 research Journey 15:14 oftentimes I'm asked what about my 15:17 privacy my confidentiality 15:20 who's going to know that I'm 15:21 participating in this trial who gets to 15:24 look at my a1cs over time 15:26 how many people are going to see what my 15:29 BMI is over time or how much physical 15:33 activity I do on a regular basis or what 15:36 I eat 15:38 all research projects are reviewed and 15:41 overseen by an Institutional ethics 15:43 review board the purpose of that board 15:46 is to make sure that you're safe in a 15:49 trial and also that your data is 15:51 protected and it protects your privacy 15:53 and confidentiality 15:56 every trial that you enroll in will give 15:59 you a unique study identification number 16:02 most trials will not have any 16:05 information about you including name 16:07 address birth date attached to either 16:11 your questionnaire answers your food 16:15 Diaries your blood samples or your urine 16:18 samples 16:20 these are all what we call anonymized or 16:23 given a code so that even if someone 16:26 were to see the results of your blood 16:28 test they would have no idea that they 16:30 belong to you 16:34 your rights as a patient are to expect 16:37 that the researchers follow their 16:40 institutional ethics review board 16:42 suggestions in terms of privacy and 16:45 confidentiality 16:46 that they keep all of your data safe in 16:49 a secure network that is not hackable by 16:52 outside sources and as password 16:54 protected 16:55 that your data does not leave 16:57 institutional software 17:00 and is not placed on personal equipment 17:03 it's not shared with other individuals 17:06 in the researchers family or friends 17:09 circle 17:10 and it is specific to This research 17:12 project 17:14 and the data is anonymized for analysis 17:18 your data is often kept for several 17:21 years within a locked facility on a 17:25 secured 17:27 computer hard drive within an 17:30 institution just in case there are 17:32 questions about data quality the data 17:36 analysis or the outcomes of the data 17:39 when the study or trial is ended 17:42 after that mandatory period of time on 17:46 which the files are capped they will be 17:48 destroyed entirely 17:50 or in some cases if the data is capped 17:53 anonymized 17:55 each individual who signs consent to 17:58 belong to that study will be informed 18:01 and consented again if that data is to 18:04 be used for any other future analyzes 18:06 that were not outlined in the original 18:08 consent the risks of being involved in a 18:11 clinical trial really depend on the type 18:13 of trial that you get yourself involved 18:15 with 18:16 some clinical studies that are looking 18:18 at priority setting what are the most 18:21 relevant questions to people living with 18:23 diabetes to inform what researchers 18:25 actually research 18:27 to how does mental health support or 18:32 exercise advice or nutrition advice 18:36 impact the lives of people with diabetes 18:39 and finally there are clinical trials 18:42 that are looking at novel medications or 18:46 new ways to give insulin therapy 18:50 in terms of management or prevention of 18:53 diabetes 18:56 in the former often those studies 18:59 involve focus groups or interviews some 19:02 questionnaires sometimes observational 19:05 or longitudinal follow-up of blood work 19:07 or 19:09 complication screening 19:12 there's often little risk associated 19:14 with these types of studies as there's 19:17 no novel intervention or drug being 19:19 introduced 19:22 when getting involved in a treatment 19:24 trial then there is the possibility that 19:27 you'll be randomized to a drug that 19:30 currently either isn't licensed or isn't 19:32 standard of care for people who are 19:34 living with diabetes 19:36 with that consumerous that the newer 19:39 type of drug or medication either will 19:42 have a side effect that you don't 19:44 tolerate or perhaps won't work as well 19:47 in you with respect to glycemic 19:50 management 19:51 complication management or prevention of 19:54 complications 19:56 oftentimes the risks that are associated 19:59 with clinical trials that are trying new 20:01 medications uh or new technology these 20:07 risks are decreased because these have 20:09 been either tried in a population 20:11 without diabetes prior to being tried in 20:15 a larger population of people with 20:16 diabetes or they've been tried in other 20:19 animal models in terms of safety and 20:23 efficacy 20:25 oftentimes the trial methodology 20:28 includes very close follow-up more 20:32 frequent blood work and more frequent 20:34 contact with your physician or the study 20:36 physician to ensure that you are safe 20:39 that you are tolerating the intervention 20:42 or the new treatment and that things are 20:44 going well for you within the study 20:46 trial as always if you're not doing well 20:50 in the study the medication doesn't 20:52 appear to be working or you're having 20:54 significant side effects you might be 20:56 withdrawn from The Trial by the study 20:58 doctor who doesn't think it's in your 21:00 best interest or you're always able to 21:03 withdraw yourself from any clinical 21:05 trial at any time 21:07 if you decide to stop participation in 21:10 any trial that's okay you'll still get 21:14 clinical Care by your clinical team it 21:16 won't impact how your doctors care for 21:19 you it also doesn't impact whether or 21:21 not you will be eligible to participate 21:24 in a trial in the future 21:26 as a physician at a clinical researcher 21:28 I can tell you that we understand that 21:31 participating in a clinical trial at any 21:33 given time isn't the right thing for 21:36 everybody and sometimes even though you 21:38 start a clinical trial it doesn't 21:41 benefit you to continue 21:43 and perhaps in the future there will be 21:45 a better clinical trial for you 21:48 during a clinical trial it's difficult 21:50 to give feedback on the trial design or 21:56 the child protocol meaning what you have 21:58 to do during the trial 22:01 um in terms of changing the trial 22:04 protocol 22:06 oftentimes clinical trials have very 22:09 standard and set protocols that every 22:12 participating site follows across Canada 22:15 North America or internationally 22:18 depending on where the trial is being 22:21 rolled out 22:22 so often if you don't think that the 22:25 visits are timed right or that you 22:29 should be answering that many 22:30 questionnaires there's often not an 22:33 option at that point to make a change to 22:36 that clinical trial however 22:38 researchers are always looking for input 22:42 of people who are participants in their 22:44 trials on people with lived experience 22:46 in order to make these trials uh more 22:49 approachable for participation to make 22:52 it easier and less burdensome on people 22:55 who have agreed to participate in these 22:57 trials and also 23:00 to inform how to make future clinical 23:02 trials better for people living with 23:04 diabetes 23:06 oftentimes researchers are looking for 23:09 participants in their trial to help them 23:11 decide whether or not what happens in a 23:14 clinical trial is actually possible or 23:16 it can be translated into real life and 23:19 real day-to-day living and this is 23:21 important because once a new treatment 23:24 or a new motive therapy or a new 23:27 screening protocol is put into place 23:29 then it will become a standard of 23:31 practice with the expectation that this 23:34 will be useful and non-burdensome to 23:37 people living with diabetes 23:39 sometimes at the end of the trial or 23:42 near the end of the trial the 23:44 researchers will have an exit interview 23:45 this is one of the formal ways to give 23:47 feedback with respect to your experience 23:49 in the trial what measures you thought 23:52 were most important what measures you 23:55 thought were more or less relevant to 23:58 you and your lived experience all of 24:00 these things are incredibly important to 24:03 designing the next clinical trial 24:06 if there isn't a formal exit interview 24:09 or way to provide feedback you're always 24:12 welcome to provide feedback by asking to 24:14 speak to this study principal 24:16 investigator or a member of the research 24:19 team 24:21 you won't always know of the feedback 24:23 you get give gets incorporated into the 24:25 next clinical trial or is incorporated 24:29 into the next trial of that same 24:31 medication with a different population 24:33 you can always ask for feedback you can 24:36 go on 24:37 clinicaltrials.gov to look up the 24:40 clinical trial that you were a part of 24:41 oftentimes that will show you the 24:43 preliminary results or the results of 24:46 the study thus far that you participated 24:48 in it often will also show you the edits 24:51 or changes that are made to the protocol 24:53 of research which oftentimes people 24:57 living with diabetes have informed 24:59 finally if you're interested in clinical 25:02 trials and you want to get involved 25:04 please reach out to any of the 25:07 organizations that I discussed earlier 25:09 to your local health care provider 25:12 to the group of diabetes act in Canada 25:14 or diabetes Canada 25:17 there is so much incredible research 25:19 that's going on right now with Canadian 25:22 researchers here locally nationally and 25:26 internationally that you could be a part 25:28 of I hope you found this helpful 25:31 thank you so much for joining us to dive 25:33 deeper into diabetes research and how 25:35 people affected by diabetes can 25:37 participate and contribute to this very 25:39 important work 25:41 please take the opportunity to let us 25:43 know what you learned what you liked and 25:45 how we can do better 25:47 you can do that by posting a comment in 25:49 the comment section below or by clicking 25:51 the link to the feedback survey in the 25:53 description box 25:54 if you have ideas for other topics you'd 25:57 like to learn more about you can include 25:58 that in the comments or feedback survey 26:01 as well 26:02 you will find the website links to the 26:04 organizations that Dr Wicklow mentions 26:07 in the video in the description box as 26:09 well as some additional helpful 26:11 resources on this topic from diabetes 26:13 Canada 26:14 if you are looking for more resources 26:16 about diabetes management please visit 26:18 our website at diabetes.ca you can also 26:22 email us at info diabetes.ca or call our 26:26 info line at 1-800-banting that's 26:31 1-800-226-8464 and speak to one of our 26:33 information and support Specialists who 26:36 can address your needs thanks again for 26:38 joining us and see you next time 26:40 thank you |
| 3 | Episode 3 | Carb Counting (Tips & Tricks) On this episode of Diabetes Deep Dives, our guest speaker Gabrielle Schmid, a registered dietitian and certified diabetes educator who lives with Type 1 herself, will offer her practical advice on navigating counting carbs when enjoying your meals with different ingredients all mixed together. | 0:08 I'm so pleased that you're joining us 0:11 today 0:12 diabetes deep Dives is a series of 0:14 videos designed to dive deeper and 0:16 Beyond the surface of different areas of 0:18 diabetes management we are exploring 0:20 those burning questions that you may 0:22 have by featuring Dynamic and engaging 0:24 guests with knowledge or lived 0:26 experience on the topic our goal is to 0:29 share information in ways that will 0:30 spark continued interest and learning 0:32 and leave you with practical tips and 0:35 tools that you can easily use 0:37 we'll be dropping a new video every 0:39 month so subscribe to our YouTube 0:41 channel and click on the notification 0:42 Bell to be notified about new content 0:44 you can also check us out on social 0:47 media to find out when the next one will 0:49 be posted to our YouTube channel 0:51 just a reminder that the information 0:53 shared in these videos in no way 0:55 replaces the advice and direction from 0:57 your Healthcare team if you have 0:59 questions about your care please speak 1:01 to your healthcare provider and team to 1:03 make sure that you are getting the best 1:04 advice 1:06 in this episode our guest speaker 1:08 Gabrielle Schmid will offer her 1:10 practical advice on navigating the 1:12 complex world of counting carbs when 1:14 enjoying your meals with different 1:16 ingredients all mixed together 1:18 Gabrielle will walk us through the key 1:19 learnings that we hope you will get from 1:21 this video 1:23 Gabrielle is a registered dietitian 1:25 certified educator and pump trainer she 1:28 currently works at LMC Healthcare as a 1:31 diabetes educator and clinical 1:33 coordinator for the diabetes education 1:35 program 1:36 she has been living with type 1 diabetes 1:38 for 25 years and ultimately she is 1:40 passionate about driving change in the 1:42 healthcare provider approach to help 1:44 Empower all people living with diabetes 1:49 we hope that you will find this video 1:50 informative and that it will support you 1:52 in managing your blood sugar while 1:54 enjoying your favorite mixed dishes and 1:56 now over to Gabrielle Welcome 1:59 hi everyone and welcome to diabetes 2:01 Canada deep Dives today's topic is tips 2:03 and tricks on carb counting my name is 2:06 Gabrielle Schmid I'm a registered 2:07 dietitian and certified diabetes 2:10 educator in Ottawa 2:11 so let me first start by saying that 2:13 curb counting is a very difficult skill 2:15 to learn you may have learned this early 2:17 on in your diagnosis or maybe you're 2:19 learning this for the first time but 2:21 when we learn crowd counting we learn 2:22 about food labels looking at the grams 2:24 of carbs subtracting our fiber for a 2:26 total amount of carbs or maybe learning 2:29 how to use a food scale but what if our 2:31 environment changes right we don't have 2:32 access to these food scales and food 2:34 labels in a restaurant out with friends 2:36 Etc so today I want to help teach you 2:39 some tips and tricks to help you learn 2:41 more about practical skills so we're 2:43 going to learn practical carb counting 2:45 methods how fat protein and the glycemic 2:47 affects carb Counting hidden sources of 2:50 carbs how to make a best guess when carb 2:53 counting using technology to help and 2:56 Insulin strategies Practical Methods 2:58 so here we're looking at practical 3:00 methods so you'll see on the left hand 3:02 side actually two in one so we're 3:04 looking at both the plate method and 3:06 also a visual like using your hand so if 3:09 you're looking at the plate method here 3:11 you'll see that in the plate you're 3:13 divided in three you have your grains 3:15 and starches in one quart of the plate 3:17 protein in the other quarter of your 3:19 plate and half your plate is vegetables 3:21 although this might not be new to you 3:24 you can actually use this method let's 3:26 say in a restaurant right you can order 3:27 a dish that might mimic this and it 3:29 might help you look at it and understand 3:31 more about your 3:32 carbohydrate portions 3:34 um so looking at your corner of your 3:36 plate now maybe the restaurant plate is 3:37 much bigger but at least you have a 3:39 better understanding of how much 3:41 carbohydrate is in your plate versus a 3:43 mixed dish or something like that 3:45 at the same time you can see the hand so 3:48 beside the graves and starches you have 3:50 a fist so that once this tier you're 3:52 looking about a cup of food so if you 3:54 have a big plate at the restaurant and 3:56 you think you have about two fifths of 3:58 food that's approximately two cups so 4:00 then you can do the math in terms of 4:01 what you think the carb count is 4:04 another practical method that I like to 4:06 use is actually using a dry measuring 4:08 cup to actually serve the food on 4:10 someone's plate or my own plate so 4:12 instead of using like a ladle or a big 4:14 spoon I don't know how much that later 4:16 that spoon is actually going to give me 4:17 in terms of the amount of food but if I 4:20 actually use 4:21 um a one cup measuring cup I know that 4:23 I'll be serving myself one cup of food 4:25 and I can do my curb counting a little 4:27 easier that way so using a dry measuring 4:29 cup is actually quite useful for 4:31 actually serving the food on someone's 4:32 plate same thing for liquids if you 4:35 actually want to measure the amount of 4:38 liquid going into a smoothie for example 4:39 maybe pouring it up in a measuring cup 4:42 to see how much milk you're getting or 4:44 fruit Etc to give you a better sense of 4:47 the amount of carbohydrate Hand Visuals 4:51 here's another document to show you more 4:54 visuals so just understanding more 4:56 household objects versus your hand but 4:59 certainly you may not have access to 5:00 these things if you're at a restaurant 5:01 but you have your hand right so looking 5:04 in at your fist was again one cup the 5:07 palm of your hand is about a quart or 5:09 half a cup sorry 5:11 um the Palm here 5:13 is about three ounces a handful another 5:17 ounce so looking at different ways to 5:18 use your hand to look at you know uh how 5:21 much I may be eating in my plate of food 5:23 you could even maybe print this off and 5:25 have it handy for the first couple of 5:26 times just because you may not be sure 5:29 um but you'll get used to it so if you 5:30 start using this now even at home when 5:32 you're in a restaurant or someone else's 5:34 house to eat it might get easier over 5:36 time 5:37 so looking at both household objects and 5:39 also your hands could be another 5:40 practical tip to help you with your carb 5:42 counting a little more accurately Non Carbs 5:46 so what about non-carbs so we know that 5:48 when we eat carbohydrate if we just eat 5:50 the carbohydrate alone it's pretty 5:52 predictable how it might act in the body 5:54 but if I have something that's high fat 5:56 and high protein with the carb food it's 5:59 actually going to slow down the 6:00 absorption of the carb so if I take 6:02 insulin for my carb counting and I think 6:05 you know when I eat it alone and I think 6:07 that it's going to work within two hours 6:09 Etc it might not be the same thing when 6:12 we're actually adding something like 6:13 cheese or something that's deep fried or 6:15 something of that sort you may have that 6:17 experience yourself when you in 6:19 something like pizza or nachos right the 6:22 spaghetti or the noodle itself or the 6:24 chip itself uh maybe the chip because 6:26 it's higher in fat but let's say the 6:28 noodle itself is pretty predictable in 6:30 terms of how it affects your sugar but 6:32 when you add a lot of that cheese or a 6:34 lot of that meat sauce it might change 6:36 the way that it works so looking at 6:38 strategies to help you with that could 6:39 be either using the extend bolts feature 6:42 if you're using an insulin pump if 6:44 you're on injections you might want to 6:45 split urine injection in two and of 6:48 course discussing this with your 6:49 diabetes team to help you learn more 6:51 about those features and understanding 6:53 how to split your injection 6:55 but just understanding the fact that you 6:57 know if I have a plate of food and it 6:59 seems to be quite high fat high protein 7:01 the outcome is going to be different 7:02 than if you're just having a 7:04 carbohydrate with more predictable food 7:05 on the plate like a side salad and a 7:08 small piece of fish or something like 7:10 that Glycemic Index 7:12 and what about the glycemic index so the 7:15 glycemic index is a way to look at how 7:17 carbohydrate is going to impact the 7:19 sugar just the carbohydrate alone so an 7:21 example would be let's say bread if I'm 7:24 eating a white uh bread or one slice of 7:26 white bread my blood sugar might Spike 7:28 fast versus if I have something like 7:31 sourdough bread or rye bread 7:33 surprisingly even though they are still 7:35 white by visually looking at it the way 7:38 that it's made and fermented actually 7:40 it's quite different and so the outcome 7:42 or the absorption of the carbohydrate 7:44 may look differently than just having 7:45 that white bread so if I have to 7:48 pre-bull this let's say for my sandwich 7:49 with white bread I may not need to 7:51 pre-bull this if I'm having something 7:53 with sourdough bread or rye bread 7:55 because the carb even though the carb 7:57 count might be similar it's how the 7:58 carbohydrate is actually behaving in my 8:00 body once I've eaten it so again it's 8:03 not all about carb counting learning the 8:05 grams of carbohydrate but understanding 8:07 kind of what foods do what and when we 8:09 pair it on top of fat and protein again 8:11 right understanding of that there might 8:13 be a change in the outcome of your sugar Hidden Carbs 8:18 and what about those hidden sources of 8:20 carbohydrate so certainly if you're at a 8:22 restaurant right this is my this might 8:24 be where you might come to face this 8:26 challenge just because if you're at home 8:28 you have more control in terms of what 8:30 you're putting into your recipes 8:32 Etc so if I'm at a restaurant remember 8:34 to look at the sauces the salad 8:36 dressings the condiments the breaded or 8:40 crispy options right those are going to 8:41 be more or higher in carbohydrates so if 8:45 you're having let's say chicken fingers 8:46 right sure the chicken is protein it may 8:49 not be counted but if it's breaded then 8:52 you'll look at not only maybe higher fat 8:54 but also looking at carbohydrate because 8:56 of that breading 8:58 milk Alternatives so not all milk is 9:01 created equally so one cup of cow's milk 9:03 for example is not the same thing as one 9:05 cup of oat milk or if you're looking at 9:08 almond milk so looking at the food label 9:10 because that's often um available to you 9:12 when you are purchasing the milk 9:13 Alternatives but be mindful of that as 9:17 well 9:17 and some nuts and seeds so usually when 9:20 we learn about carb counting we say you 9:22 know don't count your nuts and seeds but 9:24 that's not true not all nuts are created 9:26 equally so looking at cashews for 9:28 example those are actually kind of high 9:31 in carbohydrate depending on the amount 9:32 that you're having but I would actually 9:34 count that towards your carb amount if 9:36 you are eating let's say about a third 9:38 of a cup of cashews compared to if 9:41 you're eating peanuts or almonds 9:43 so here are some examples right so 9:46 ketchup for example a quarter of a cup 9:48 of ketchup often very common when we're 9:50 eating especially during the summer time 9:52 right that can add about 15 grams of 9:54 carbohydrate to your meal but often we 9:57 might forget about it because it doesn't 9:58 visually look like a carbohydrate that 10:00 we might usually count for like the 10:02 bread or a fruit example as example Technology 10:07 so technology so we're lucky today that 10:10 we live in a world where you know we 10:12 have access to lots of things that are 10:13 fingertips in terms of information and 10:15 that includes carb counting not only 10:18 just carbohydrate but all nutrition and 10:20 nutrients found in our Foods so I often 10:23 tell my patients you know start Maybe by 10:25 Googling it so if you don't have access 10:26 to a food label or a food scale or 10:28 really you're just looking at a plate of 10:30 food and you're not sure but you have 10:31 access to it to your phone you could 10:33 Google it you go in your search bar and 10:35 you just type in something like I don't 10:36 know um strawberries right and then you 10:39 can actually choose the amount of 10:40 strawberries that you're going to be 10:41 eating and it will come up with the carb 10:43 count for that amount of food all as 10:46 well as the fiber and all the other 10:48 nutrition for that food 10:50 the other thing I like to teach my 10:52 patients is the fast foods restaurants 10:54 nutrition information so if you actually 10:56 go on Google and do a quick search I can 10:59 actually do a live demonstration here to 11:01 show you how easy it is so let me just 11:03 stop sharing my screen 11:06 if I go to Google and let's say I'm 11:08 going to Subway for lunch 11:11 okay and then I'm going to click on 11:14 subway 11:24 let's see if I can find it somewhere 11:26 else here 11:28 um 11:31 okay 11:34 so nutrition 11:39 I go down to nutrition data tables 11:41 it's a PDF so you can actually print 11:43 this if you're often going to Subway uh 11:46 you can print this keep this handy ready 11:47 to go you can actually find this in your 11:49 phone as well okay so PDF comes up and 11:52 in the PDF I'll make this a bit bigger 11:54 here you see here the carbohydrate and 11:57 the dietary fiber 11:58 so you can do the math 12:00 okay so if I'm looking at perhaps 12:05 the turkey 12:06 43 minus five so I'm looking at about 38 12:10 grams of carbs first my six inch 12:13 sandwich okay so you can literally like 12:15 I said like I said print this off have 12:17 it handy uh take a picture with your 12:20 phone uh but again keeping track of the 12:22 things that you're often ordering can be 12:24 very helpful and maybe it's once or 12:25 twice a need to look it up and then 12:27 after that you'll know it by heart so 12:29 that's just an information how easy it 12:31 is to find nutrition information your 12:33 carb counting online 12:36 so let me just reshare my screen 12:44 okay perfect the other thing that we can 12:46 do as well is if you again look online 12:48 are Canadian nutrient file has a huge 12:51 array of different foods that we've come 12:53 up with over the years in terms of the 12:54 nutrition available to us so again just 12:57 looking up a certain food you'll find 12:59 all the nutrients related to that food 13:01 including the carb count 13:04 another thing that we all use these days 13:05 for multiple reasons are apps on our 13:08 phone so for example carbs and cows carb 13:11 manager MyFitnessPal Calorie King these 13:14 are examples of carb counting apps so 13:16 you might be already using a diabetes 13:18 app or um not for anything right so 13:21 downloading another app on your phone to 13:23 help with this it's not that you need to 13:25 use it every time that you need to card 13:26 count I mean you can but it could be for 13:29 those things that you're just really not 13:30 sure about there's often big databases 13:32 of different types of foods ethnicities 13:34 all types of foods available to you 13:36 different restaurants even if you travel 13:39 to a different country you'd be 13:40 surprised what you can see there or 13:42 different chains so again using these 13:44 apps uh when you want can really help 13:46 and like I said if you often visit these 13:49 restaurants or have these meals over and 13:52 over again you might need to look it up 13:53 once or twice a few times and then 13:56 you'll know it off by heart after after 13:58 a few times of looking it up 14:00 so these are some of many apps available 14:02 to you these are the most popular that I 14:04 see but certainly looking on your phone 14:06 and looking either in your app store to 14:09 see what's available to you when you 14:10 type in carbohydrate counting you'd be 14:12 surprised what you can see there so take 14:14 a look Strategies 14:17 so of course when we're carb counting 14:19 we're often doing that to take our 14:20 insulin with our carb ratio or perhaps 14:23 just looking at learning more about 14:24 carbohydrates so we can come up with the 14:26 carb ratio for you so here are some 14:29 strategies to help you with your insulin 14:31 but also to help your insulin work 14:33 better especially when there's a 14:34 situation where you're not sure about 14:35 the carb count 14:36 so consider taking your correction if 14:38 you're a little high before eating so at 14:41 least get some insulin circulating in 14:43 your system if you're really not sure if 14:45 you can't pre-bull this for your meal 14:46 making sure that you have at least a 14:48 correction going in so that you can be 14:50 maybe less above Target when you're 14:53 eating your food again if you can and 14:55 you can remember 14:57 if you're at a restaurant don't pre-bull 14:59 this at a restaurant you don't know 15:00 what's happening in the kitchen there 15:02 might be a fire there someone might be 15:04 delayed whatever it is so really make 15:06 sure that you're only bullisting when 15:08 your plate of food arrives at your table 15:09 then you can take a look at it do some 15:11 calculation maybe looking at your hands 15:14 to see if it mimics the plate method or 15:15 whatever it is and then bolus when you 15:18 have a better understanding of your card 15:19 count and again when it's in front of 15:21 you 15:22 use your extend Bulls feature on your 15:24 pump like we talked about in terms of 15:26 high fat high protein certainly a 15:28 situation that would happen more often 15:29 in a restaurant and if there's something 15:31 that you're often eating in a restaurant 15:33 that you really want to get correct in 15:35 terms of bolusing maybe discussing this 15:37 with your diabetes team taking notes so 15:40 maybe the first time you're not actually 15:42 using extendable list you just take a 15:43 you take your insulin as you usually 15:45 would and see what happens to your sugar 15:47 and then maybe you'll see that maybe in 15:49 four hours or six hours you need more 15:51 insulin well we can use the extend Bulls 15:53 feature to help you with that 15:56 be careful it's better to underestimate 15:59 than to overestimate when we're looking 16:00 at our carb count I would say if you're 16:02 really not sure give it a guess but try 16:05 to guess a little lower than maybe what 16:07 you think is actually in your plate 16:09 um so better to do that than to overdo 16:11 it and then have too much insulin on 16:12 board and cause a low 16:15 if you're really not sure bullets for 16:17 some right or half if you think of an 16:19 idea of how much it is Monitor and 16:22 adjust as needed we can always give 16:24 Corrections later on but certainly you 16:26 want to give it enough time you don't 16:27 want to give a correction half an hour 16:29 after eating you want to at least wait 16:31 two three four hours to give your 16:33 correction 16:34 um so just keep that in mind just give 16:36 some before if you can 16:39 um and if you have no idea you can eat 16:42 your plate of food think of how much you 16:44 ate and go from there right some insulin 16:46 is better than no insulin Summary 16:50 so I hope that today we learned about a 16:53 few things ultimately we know carb 16:55 counting is hard work we never expect 16:56 Perfection you shouldn't as well right 16:59 that is a lot of work to just do that 17:01 um so be mindful of that skill use your 17:04 hands or visuals to help you understand 17:06 your portions like we talked about those 17:08 household items if you have them around 17:09 but certainly using your hand is good 17:11 enough 17:12 model the plate method at a restaurant 17:14 when possible so if you're at a 17:16 restaurant and you want to order 17:18 something if you can see if it fits more 17:20 into that plate method versus a mixed 17:22 dish certainly you know it might 17:24 increase your chances of getting a more 17:26 accurate carb counting but don't make 17:27 that your deciding factor for what 17:29 you're going to order but it could be a 17:31 helpful strategy for sure 17:33 look out for those hidden sources of 17:35 carbohydrate like we said in those 17:37 sauces and the condiments pay attention 17:39 to how high fat and high protein meals 17:42 affect your sugars and discuss with your 17:44 team so maybe you won't use the extended 17:46 bolus or give insulin a different way 17:48 you'll just see how your sugar reacts to 17:50 a certain food take note of that and see 17:52 what happens and you can discuss that 17:54 with your diabetes team 17:56 a best guess is better than no guests 17:58 and use technology to help with your 18:00 carb Counting 18:02 I hope today's presentation helped you a 18:04 little more with your curb counting 18:05 skills and like I said please reach out 18:07 to your diabetes team if you need more 18:09 uh review or skills or practical 18:11 knowledge on learning how to carb count 18:13 thank you so much Outro 18:16 thank you so much for joining us to dive 18:18 deeper into how card counting can help 18:20 support your diabetes management please 18:22 take the opportunity to let us know what 18:24 you learned what you liked and how we 18:26 can do better 18:27 you can do that by posting a comment in 18:29 the comments section below or by 18:31 clicking the link to the feedback survey 18:33 in the description box 18:35 if you have ideas for other topics you'd 18:37 like to learn more about you can include 18:39 that in the comments or feedback survey 18:41 as well 18:43 you can also find the website linked to 18:45 the Canadian nutrient file mentioned in 18:47 the video in the description box as well 18:49 as some additional helpful resources on 18:52 this topic from diabetes Canada 18:54 if you are looking for more resources 18:56 about diabetes management please visit 18:58 our website at diabetes.ca you can also 19:01 email us at info diabetes.ca or call our 19:05 info line at 1-800banting that's 19:10 1-800-226-8464 and speak to one of our 19:12 information and support Specialists who 19:14 can address your needs thanks again for 19:17 joining us and see you next time 19:19 foreign |
| 4 | Episode 4 | DIY Automated Insulin Delivery In this episode, Dr. Ilana Halperin explains AID, its devices, and the concept of do-it-yourself AID. She also discusses highlights from an upcoming Diabetes Canada position statement on DIY AID, along with the associated research. After watching the video, viewers will understand the difference between commercial and DIY AID systems, the benefits and risks, and know where to find additional information on the topic. | 01:27:23:04 - 01:27:49:14 Candace Aqui Hello and welcome to Diabetes Deep Dives. My name is Candace and I am from Diabetes Canada. If you are new to our video series, thank you for joining us. If you have been enjoying the series. Welcome back. This video series is designed to go beyond the surface of general diabetes information. We are diving deeper into different areas of diabetes management by featuring dynamic and engaging guests with knowledge or lived experience on the topic. 01:27:50:01 - 01:28:09:11 Candace Aqui We hope to spark continued interest and learning and leave you with practical tips and tools that you can easily use. A new video is shared every month, so subscribe to our YouTube channel and click on the notification below to be notified about new content. You can also check us out on social media to find out when the next one will be posted on our YouTube channel. 01:28:10:01 - 01:28:38:08 Candace Aqui Thanks to those who have subscribed and for your support of our video series. In this episode, we're going to shine a light into the world of automated insulin delivery. Also known as AID for short. Specifically, the conversation will focus on a hot topic in the world of AID better known as doing it yourself or DIY AID. You will hear from Dr. Ilanna Halperin, who will take us through an explanation of AID, what devices are involved and what it means to do it yourself. 01:28:39:03 - 01:29:07:16 Candace Aqui She will share some highlights from an upcoming Diabetes Canada position statement on DIY AID, as well as the research that has informed the position statement. After watching this video, we hope that you will understand what AID is and recognize what devices are involved. Understand the differences between commercial AID systems and DIY AID, know the benefits and risks of commercial and DIY AID systems. 01:29:08:19 - 01:29:31:18 Candace Aqui Feel comfortable with approaching your health care provider with questions about DIY AID and know where to find more information about DIY AID. While this is a very interesting and emerging topic, we recognize that the content in this video may not be relevant for everyone and will depend on what your experience with diabetes is and what devices are available to you where you live. 01:29:32:07 - 01:29:58:13 Candace Aqui If you have specific questions about AID please reach out to your health care team. These videos are for educational purposes only. The content discussed in this video is not intended to be medical advice. And to the extent that medical advice is required, you should consult with a qualified medical professional. The information discussed in this video cannot replace consultations with a qualified health care professional to meet your individual medical needs. 01:29:59:14 - 01:30:27:12 Candace Aqui The views and opinions expressed in this video are those of the speakers and do not necessarily reflect the views or positions of Diabetes. Canada. Dr. Halperin is a staff physician at Sunnybrook Hospital and an assistant professor at the University of Toronto. As the Quality and Innovation lead for the Division of Endocrinology. She leads a group of physicians committed to improving quality and safety for inpatient and outpatient for diabetes and other endocrine diseases. 01:30:28:01 - 01:30:48:06 Candace Aqui Dr. Halperin has a large Type one diabetes practice and believes strongly in the potential for continuous glucose monitoring to improve diabetes related outcomes and the experience of living with diabetes. As always, they hope that this video sparks your interest in learning more about diabetes management. And now over to Dr. Halperin. 01:30:49:11 - 01:31:32:21 Dr. Ilana Halperin Hey, I'm Dr. Ilana Halperin, and I'm really excited to be here today to talk about our new Do It Yourself automated insulin delivery position statement that will be out in the July 2023 issue of the Canadian Journal of Diabetes. So let's start by talking about what is automated insulin delivery. Automated insulin delivery utilizes two advanced diabetes technologies, continuous glucose monitoring and an insulin pump, and then a control algorithm which can be embedded within the pump itself or on an app on a smartphone, is used to have the insulin modulated based on the glucose sensor, and it's different from using regular injections or just the pump and open loop. 01:31:33:03 - 01:32:06:07 Dr. Ilana Halperin Because if you live with diabetes, you know that no two days are the same. And as much as you can fine tune your settings, there's still days where your glucose are going to go high and low because of all the variability in your day to day activities. But when you have a control algorithm modulating their insulin delivery, you can stay in range more often and long before we had commercial systems available, there was a community of individuals living with diabetes or caring for people living with type one diabetes who decided to not wait and they got together and did it themselves. 01:32:06:15 - 01:32:33:15 Dr. Ilana Halperin And that's what DIY automated insulin delivery is using a commercially available insulin pump and continuous glucose monitor. But a open source control algorithm which is available on the internet to help modulate your insulin delivery. This is a screenshot from one of my patients using a commercial automated insulin delivery system. And so I'll orient you because I think it's very illustrative to what I'm talking about. 01:32:34:03 - 01:32:59:16 Dr. Ilana Halperin This is the target range of glucose between four and ten, and this is the sensor glucose. You can appreciate that this person is spending over 90%25 of their day in the Green Zone, where we want to be not too high, not too low. In order to do that, the insulin pump is continuously adjusting the basal insulin and when it looks like the person's glucose is going to drop below our desired range, the pump suspends. 01:32:59:16 - 01:33:16:13 Dr. Ilana Halperin That's what these pink lines are. And then in order to as the glucose levels start to climb, that basal insulin delivery goes back up. Then the person wakes up and decides to eat breakfast. And this is where a person living with diabetes still has to interact with the pump and say, I'm going to eat approximately 30 grams of carbs. 01:33:16:23 - 01:33:37:20 Dr. Ilana Halperin It tells the pump it's eating carbs and the pump delivers a bolus of insulin. But that wasn't quite right. Maybe the person underestimated their insulin or took it a little too late. And so the pump delivers small correction doses without the person having to do anything. And the glucose comes back into range. Then lunchtime the next time a person living with diabetes should have to think about their diabetes bolus again. 01:33:37:20 - 01:33:55:17 Dr. Ilana Halperin This time the bolus is bang on and the glucose barely rises until about four in the afternoon when maybe you had a stressful event at work or you grabbed a cookie with your coffee and forgot to bolus. It's no big deal. The pump delivers a correction bolus and you're back in range. Dinner goes well, but as you get closer to bedtime, the glucose starts to drop. 01:33:55:17 - 01:34:23:16 Dr. Ilana Halperin Maybe there was an after dinner walk or you over bolus for dinner. Either way, the pump suspends and keeps the person living with diabetes in range. And we know the Diabetes Canada wants most adults living with type one diabetes to spend about 70%25 of their time in that target range of 3.9 to 10 millimoles per liter. But with automated insulin delivery, it's very possible to achieve goals above this with greater than 70%25 time in range and much less than 4%25 hypoglycemia. 01:34:25:21 - 01:34:57:23 Dr. Ilana Halperin So when we talk about DIY systems, they're part of a larger way of thinking about insulin delivery options. We have multiple daily injections, continuous subcutaneous insulin, otherwise known as insulin pumps and automated insulin delivery. And automated insulin delivery comes in different forms. Commercial and DIY. And we should be thinking that our patients should have choices along this various spectrum, from the yellow to the blue to the teal here, and that whatever makes sense for you and how you want to manage your diabetes, your team should be supporting you in. 01:35:00:15 - 01:35:36:12 Dr. Ilana Halperin So what automated insulin delivery systems are available in Canada today. The first is the Medtronic 670G system, which we're going to see less and less of because now the Medtronic 780G system has been approved and this system is used with a medtronic sensor and allows for individualized targets between 5.6 and 6.7 millimoles per liter. There's also the Control IQ system, which allows people to use a Dexcom and a tandem pump and has a control algorithm that adjusts to a range between 6.2 and 8.9. 01:35:36:21 - 01:36:02:19 Dr. Ilana Halperin But then we have the do it yourself automated insulin delivery systems, and these systems are meant to be a little bit more flexible. People have different options in terms of which pump and CGM they want to use and they can build the system right off of their phone. And of course the targets are also much more personalized. Of course there is no licensing. 01:36:04:10 - 01:36:28:08 Dr. Ilana Halperin So as I mentioned before, there's at least three different DIY automated insulin delivery options out there for you today. And these are the ones that we discuss in detail in the position statement. So why are people with diabetes choosing to use DIY? This is a survey from a colleague of mine named Kate Farnsworth, who surveyed people using DIY automated insulin delivery systems across Canada. 01:36:28:14 - 01:36:50:19 Dr. Ilana Halperin And what she found was that people choose to use these systems because of transparency and interoperability. They like the idea of open source software that can be quickly iterated without having to wait for regulators. In addition it. For many people, it's the only kind of automated insulin delivery available where they live due to barriers related to insurance coverage. 01:36:51:09 - 01:37:20:17 Dr. Ilana Halperin And some people believe it's safer than other systems because it's built by people living with diabetes who really understand and what it's like to experience hypoglycemia. And for many it's an issue of affordability. So although people are choosing to do it themselves, they're rarely doing it alone because the DIY community is quite established. And when I recommend these systems to my patients, I direct them to a trusted online resources like the DIY Facebook groups called Looped. 01:37:20:19 - 01:37:58:17 Dr. Ilana Halperin And I know that they will get good information there because the Facebook group is moderated by somebody I know and trust, and that will help them on their journey to starting to use their own insulin. Automated insulin delivery systems. So what about evidence? There is evidence supporting DIY AID use, and this was an article published in the New England Journal about a New England Journal of Medicine back in the fall of 2022, which was showed that people were randomized to either using just an insulin pump and a CGM or the open source automated insulin delivery system. 01:37:59:08 - 01:38:21:12 Dr. Ilana Halperin And what happened was, not surprisingly, the people using the automated insulin delivery system spent about 10%25 time more in range across the study compared to the control group, which had no improvements in their time in range. That resulted in more 3 hours and 21 minutes a day in the optimal range, which means more time doing other things and less time worrying about your diabetes. 01:38:24:15 - 01:38:50:13 Dr. Ilana Halperin So where can I find more information? As I mentioned, I often direct patients to trusted online resources like the Looped Facebook group, or if you're more interested in understanding things about the Android APS system because perhaps that's the type of smartphone you use, you can find information about their systems as well here, and all of this will be available in the publication that's coming out in the in the next month. 01:38:52:14 - 01:39:15:23 Dr. Ilana Halperin So another thing you might be wondering is what should I ask my health care team? So we know that one of the reasons people don't use DIY AID is because they're worried their health care team doesn't support them. Our Diabetes Canada position paper makes a strong statement that for diabetes professionals who support AID, meaning they're comfortable enough with insulin pumps and continuous glucose monitors. 01:39:16:02 - 01:39:40:20 Dr. Ilana Halperin And so they're ready to prescribe commercial systems. They should also be supporting patients using DIY. They're actually quite similar and we should support our patients autonomy and their ability to choose the system that's best for them in managing their complex chronic disease. But if your health care professional does not support DIY AID, maybe they can make a referral to a team that does. 01:39:41:17 - 01:40:03:00 Dr. Ilana Halperin Perhaps they haven't had a patient before, but they're willing to learn with you. Certainly I learned the most from my patients who were using DIY AID even before there were commercial systems available such that once the commercial systems came along and became available in Canada, I was able to take some of my early learnings and apply those to my patients using commercial systems. 01:40:03:08 - 01:40:24:18 Dr. Ilana Halperin And there's more similarities and differences between these different control algorithms. So usually a practitioner who's comfortable with the general automated delivery system will be comfortable. You can also let them know because maybe they don't know that the Diabetes Canada Position Paper and Health Care User's Guide has been published in CJD and that they can get lots of useful tips and tricks to help support you. 01:40:27:21 - 01:40:53:16 Dr. Ilana Halperin It's important to recognize that it's not the job of the health care professional to build the app for you. That is why it's called DIY. If you're using a commercial system, you can call 1-800 number. If you're having technical support. If you're using a DIY system, the technical support is your online community. However, these online communities have grown so significantly that sometimes you can get better support at three in the morning because there's someone from Australia who happens to be on Facebook. 01:40:53:24 - 01:41:14:04 Dr. Ilana Halperin Then you can from the 1-800 numbers. I'm not recommending one system over the other, I'm just recommending that our patients with living with type one diabetes should have the choice to choose between the DIY and the commercial systems. But it is really important that the health care team continue to support you in optimizing your settings to help meet your personal goals and decrease the diabetes burden. 01:41:15:09 - 01:41:39:09 Dr. Ilana Halperin So education remains an important part of all AID systems, and having an AID system doesn't mean you don't need to know the basics because technology fails, whether it's commercial or the DIY systems, insulin pump sites can fail and you need to know how to go back. How do you troubleshoot for ketones? How do you calculate the doses that you need If your pump has failed and you need to go back to manual injections? 01:41:39:15 - 01:42:21:15 Dr. Ilana Halperin Those are important learning points that are universal and should be reviewed regularly with your health care team. So when it comes to navigating DIY AID to optimize settings, there's tons out there and way outside the scope of this short video. But it's important to know that there are lots of growing resources. There's a full hour and 20 minute webinar that I put together for our health care practitioners to learn more about this, but we talk in general about understanding how the system calculates insulin, how the system adjusts insulin, what to do when the system stops working, educating on essential management points like I already mentioned, and how to share the data. 01:42:21:15 - 01:42:44:22 Dr. Ilana Halperin And that's actually a really important point for you. If you're somebody living with type one or a family member of someone living with type one is your health care team does want to have a look at the data, so figure out what system works for them. There's more than one. But that way, when you get back together in clinic, if you've started using one of these systems, they can review how the insulin delivery systems are working for you and help you to make changes to your settings to optimize your glucose outcomes. 01:42:46:12 - 01:43:13:11 Dr. Ilana Halperin As with all insulin delivery systems, whether they be injections or automated insulin delivery, there's a risk. We know that insulin is a high alert medication and when given in excess can result in hypoglycemia. But with DIY, there's less parameters than with the commercially available systems. So it is important to work with your health care team to set the right max basal maximum bolus and suspend threshold. 01:43:14:10 - 01:43:42:13 Dr. Ilana Halperin These are detailed settings that you will learn more about if you want to watch our longer webinar and or if you want to dive into loop docs and start building the system for yourself. In general, however, continuous glucose monitoring, which is recommended by Diabetes Canada for all adults living with type for all people, actually children and adults living with type one diabetes are very helpful to prevent significant hypoglycemia because alerts and alarms will prompt you before you've gone to low. 01:43:45:02 - 01:44:21:19 Dr. Ilana Halperin So in summary, there are four key messages I'd like to leave you with. We feel that DIY AID can be effective to help individuals with T1D improve glycemic outcomes while reducing the burden of day to day diabetes self-management. We also feel strongly that diabetes health care team has an obligation to discuss all available treatment options that have evidence of benefits, and that includes DIY AID. Health care practitioners should connect interested people with diabetes to trusted online social media and in-person resources, but they're not obligated to build the systems for the patients. 01:44:21:19 - 01:44:46:21 Dr. Ilana Halperin In fact, it's best when patients build these systems on their own or using the support of the online community community so they know how to troubleshoot it when things go wrong. Health care practitioners should continue to provide ongoing support and education to people with diabetes who choose to use the DIY AID systems, including assisting with optimizing pump settings and coaching on the behaviors that are linked to decreasing glucose variability. 01:44:47:15 - 01:44:58:20 Dr. Ilana Halperin All of this is the so that people with diabetes can live full and enjoyable lives and minimize the burden of managing T1D. Thanks so much for joining me on this deep dive video today. 01:45:00:02 - 01:45:20:22 Candace Aqui Thank you so much for joining us to dive deeper into the world of DIY automated insulin delivery and how it can support diabetes management. Again, this topic may not be relevant to everyone living with diabetes, but we do hope that you've found it interesting and learned something new. Please take the opportunity to let us know what you learned, what you liked, and how we can do it better. 01:45:21:14 - 01:45:40:20 Candace Aqui You can do that by posting a comment in the comments section below or by clicking the link to the feedback survey in the description box. If you have other ideas for other topics you'd like to learn more about, you can include that in the comments or feedback survey as well. Dr. Halperin mentioned that other educational resources will be available soon. 01:45:41:09 - 01:46:07:14 Candace Aqui If you are interested in the upcoming position statement and webinar, please stay tuned to the Diabetes Canada website and the description box on YouTube for this video. As we will post links to those resources when they are available. In the meantime, you can check out some additional helpful resources related to this topic from Diabetes Canada. If you are looking for more resources about diabetes management, please visit our website at diabetes.ca. 01:46:07:16 - 01:46:24:16 Candace Aqui You can also email us at info@diabetes.ca or call our info line at 1-800-BANTING. That's 1-800-226-8464 and speak to one of our information and support specialists who can address your needs. Thanks again for joining us and see you next time. |
| 5 | Episode 5 | Exercise, Sport and Diabetes In this episode, Chris Jarvis, a Former Canadian Olympian, discusses his journey in creating a practical guide to effectively manage diabetes during sports challenges. The episode covers various exercise types, their physiological effects, the advantages of exercise, diabetes management hurdles during training/competition, technological aids for exercise-related diabetes care, and how sports training can foster resilience against diabetes stigma. | 01:52:29:08 - 01:52:31:21 Hello and welcome to Diabetes Deep Dives. 01:52:31:21 - 01:52:32:23 My name is Candace 01:52:32:23 - 01:52:34:16 and I'm from Diabetes Canada. 01:52:34:16 - 01:52:36:08 If you are new to our video series, 01:52:36:08 - 01:52:37:18 thank you for joining us. 01:52:37:18 - 01:52:39:10 If you have been enjoying the series 01:52:39:10 - 01:52:40:19 welcome back! 01:52:40:19 - 01:52:42:02 Our Diabetes Deep Dives 01:52:42:02 - 01:52:43:10 video series is designed 01:52:43:10 - 01:52:44:21 to go beyond the surface 01:52:44:21 - 01:52:45:24 of general diabetes 01:52:45:24 - 01:52:47:17 education information. 01:52:47:17 - 01:52:48:22 We hope to spark continued 01:52:48:22 - 01:52:49:24 interest and learning 01:52:49:24 - 01:52:50:13 and leave you 01:52:50:13 - 01:52:52:07 with practical tips and tools 01:52:52:07 - 01:52:54:00 that you can easily use. 01:52:54:00 - 01:52:55:16 We drop a new video every month, 01:52:55:16 - 01:52:57:01 so subscribe to our Youtube 01:52:57:01 - 01:52:58:18 channel and click on the notification 01:52:58:18 - 01:53:01:04 bell to be notified about new content. 01:53:01:04 - 01:53:03:04 You can also check us out on social media 01:53:03:04 - 01:53:04:09 to find out when the next one 01:53:04:09 - 01:53:06:19 will be posted on our YouTube channel. 01:53:06:19 - 01:53:08:06 Thanks to those who have subscribed 01:53:08:06 - 01:53:10:05 and supported our video series. 01:53:10:11 - 01:53:13:00 For this episode on Exercise, 01:53:13:01 - 01:53:14:15 Sport and Diabetes, I’m 01:53:14:15 - 01:53:16:05 very excited to share with you 01:53:16:05 - 01:53:18:09 that our guest speaker is Chris Jarvis, 01:53:18:09 - 01:53:19:21 a Former Olympian Rower 01:53:19:21 - 01:53:20:16 who has been living 01:53:20:16 - 01:53:22:17 and competing with diabetes. 01:53:22:17 - 01:53:23:19 He is also the founder 01:53:23:19 - 01:53:25:17 and executive director of I Challenge 01:53:25:17 - 01:53:26:14 Diabetes, 01:53:26:14 - 01:53:28:04 a non-profit that focuses 01:53:28:04 - 01:53:29:15 on creating opportunities 01:53:29:15 - 01:53:30:11 for people with Type 01:53:30:11 - 01:53:32:04 1 diabetes of all ages 01:53:32:04 - 01:53:35:13 to overcome challenges and find support. 01:53:36:03 - 01:53:38:00 Chris will be sharing his experiences 01:53:38:00 - 01:53:40:00 of developing a playbook of sorts 01:53:40:00 - 01:53:40:14 that helped him 01:53:40:14 - 01:53:41:20 manage his diabetes 01:53:41:20 - 01:53:43:18 while competing and participating 01:53:43:18 - 01:53:45:18 in his sports and adventure challenges. 01:53:47:17 - 01:53:48:23 After watching this video, 01:53:48:23 - 01:53:50:07 we hope that you will understand: 01:53:50:07 - 01:53:52:08 The different types of exercise 01:53:52:08 - 01:53:53:09 involved in fitness 01:53:53:09 - 01:53:55:10 as well as training for sport, 01:53:55:10 - 01:53:56:21 How the body’s physiology 01:53:56:21 - 01:53:58:11 is impacted by exercise, 01:53:58:11 - 01:54:00:23 The potential benefits of exercise 01:54:00:23 - 01:54:01:20 and the challenges 01:54:01:20 - 01:54:03:05 with managing diabetes 01:54:03:05 - 01:54:06:03 while training or competing in sport, 01:54:06:03 - 01:54:07:13 How technology can support 01:54:07:13 - 01:54:09:17 your diabetes management during exercise 01:54:09:17 - 01:54:10:23 and what to look out for, 01:54:10:23 - 01:54:13:01 and How training for a sport 01:54:13:01 - 01:54:14:03 can build resilience 01:54:14:03 - 01:54:17:03 in the face of diabetes stigma. 01:54:17:06 - 01:54:19:04 While this is a very interesting topic, 01:54:19:04 - 01:54:19:20 we recognize 01:54:19:20 - 01:54:21:09 that the content in this video 01:54:21:09 - 01:54:22:05 may not be relevant 01:54:22:05 - 01:54:22:22 for everyone 01:54:22:22 - 01:54:24:02 and will depend on what 01:54:24:02 - 01:54:26:00 your experience with diabetes is, 01:54:26:00 - 01:54:27:21 and what devices are available to you 01:54:27:21 - 01:54:29:03 where you live. 01:54:29:03 - 01:54:30:14 If you have specific questions 01:54:30:14 - 01:54:32:06 about your diabetes management, 01:54:32:06 - 01:54:33:00 please reach out to 01:54:33:00 - 01:54:33:24 your health care team. 01:54:34:23 - 01:54:35:24 These videos are for 01:54:35:24 - 01:54:37:22 educational purposes only. 01:54:37:22 - 01:54:38:10 The content 01:54:38:10 - 01:54:39:12 discussed in this video 01:54:39:12 - 01:54:40:08 is not intended 01:54:40:08 - 01:54:41:19 to be medical advice 01:54:41:19 - 01:54:42:12 and, to the extent 01:54:42:12 - 01:54:44:09 that medical advice is required, 01:54:44:09 - 01:54:45:03 you should consult 01:54:45:03 - 01:54:47:11 with a qualified medical professional. 01:54:47:11 - 01:54:49:04 The information discussed in this video 01:54:49:04 - 01:54:50:20 cannot replace consultations 01:54:50:20 - 01:54:52:23 with a qualified health-care professional 01:54:52:23 - 01:54:55:23 to meet your individual medical needs. 01:54:55:24 - 01:54:57:04 The views and opinions 01:54:57:04 - 01:54:58:08 expressed in this video 01:54:58:08 - 01:54:59:13 are those of the speakers 01:54:59:13 - 01:55:00:17 and do not necessarily 01:55:00:17 - 01:55:01:23 reflect the views 01:55:01:23 - 01:55:04:21 or positions of Diabetes Canada. 01:55:04:21 - 01:55:05:14 As always, 01:55:05:14 - 01:55:06:22 we hope that this video sparks 01:55:06:22 - 01:55:08:03 your interest in learning more 01:55:08:03 - 01:55:09:18 about diabetes management. 01:55:09:18 - 01:55:11:06 And now over to Chris. 01:55:12:00 - 01:55:12:15 My name's Chris 01:55:12:15 - 01:55:14:17 Jarvis and I have been living 01:55:14:17 - 01:55:16:16 with Type one diabetes for 28 years 01:55:16:16 - 01:55:18:17 and gotten into some pretty extreme 01:55:18:17 - 01:55:20:20 exercise myself. 01:55:20:20 - 01:55:22:10 Some of you might think of rowing 01:55:23:18 - 01:55:25:11 as a type of sport 01:55:25:11 - 01:55:27:14 that you float around in a boat. 01:55:27:14 - 01:55:29:08 But I got into the sport 01:55:29:08 - 01:55:31:09 and got pretty competitive 01:55:31:09 - 01:55:33:10 and got pretty fit. 01:55:33:10 - 01:55:34:04 That's me there 01:55:34:04 - 01:55:36:08 training for the Canadian Olympic team. 01:55:36:08 - 01:55:39:08 I have been able to row for Team Canada 01:55:39:08 - 01:55:40:21 as well as bring back 01:55:40:21 - 01:55:43:21 gold from Rio de Janeiro. 01:55:44:16 - 01:55:46:18 And you know, this is a sport 01:55:46:18 - 01:55:47:10 that has 01:55:47:10 - 01:55:49:03 not only pushed me with my diabetes, 01:55:49:03 - 01:55:51:11 but torn my entire body to shreds. 01:55:51:11 - 01:55:53:02 As I trained for 7 hours 01:55:53:02 - 01:55:56:02 a day over 70 kilometers every day. 01:55:56:21 - 01:55:59:06 But I've also done a lot of other things. 01:55:59:06 - 01:56:00:13 I have been lucky enough 01:56:00:13 - 01:56:01:18 to bike across Canada, 01:56:01:18 - 01:56:03:12 raising money for a cure. 01:56:03:12 - 01:56:06:06 I have been able to join a team of type 01:56:06:06 - 01:56:07:21 ones and race in the Canadian death 01:56:07:21 - 01:56:09:05 race, 125 01:56:09:05 - 01:56:11:00 kilometers of running up 01:56:11:00 - 01:56:13:06 and down some mountaintops. 01:56:13:06 - 01:56:15:10 As you can see there, 17,000 feet of 01:56:15:10 - 01:56:16:10 elevation change 01:56:17:18 - 01:56:20:15 all done in 24 hours. 01:56:20:15 - 01:56:20:24 I have 01:56:20:24 - 01:56:22:09 also been able to do 01:56:22:09 - 01:56:25:09 lots of leisurely fun trips 01:56:25:14 - 01:56:27:03 with our adventure team 01:56:27:03 - 01:56:29:12 with I Challenge diabetes. 01:56:29:12 - 01:56:30:18 And some of those adventures 01:56:30:18 - 01:56:32:18 have led to some extreme places 01:56:32:18 - 01:56:34:01 like the West Coast Trail, 01:56:34:01 - 01:56:36:02 which I've hiked eight times, 01:56:36:02 - 01:56:38:00 completed with a group of Type 01:56:38:00 - 01:56:40:08 one diabetics as well. 01:56:40:08 - 01:56:43:08 I have pushed my own boundaries, 01:56:43:19 - 01:56:46:19 completing some mountaineering with 01:56:47:17 - 01:56:48:10 a role model 01:56:48:10 - 01:56:51:04 that I've looked up to with my diabetes, 01:56:51:04 - 01:56:52:09 and that pushes our bodies 01:56:52:09 - 01:56:53:12 in so many different ways 01:56:53:12 - 01:56:53:24 when we're doing 01:56:53:24 - 01:56:56:00 different types of sport. 01:56:56:00 - 01:56:56:24 And so I just thought I'd give you 01:56:56:24 - 01:56:57:23 a little bit of a background 01:56:57:23 - 01:57:00:23 on some of the things that I have done. 01:57:01:23 - 01:57:03:16 So getting back into it. 01:57:03:16 - 01:57:05:15 If you're pushing your body, 01:57:05:15 - 01:57:08:03 it doesn't need to be something extreme, 01:57:08:03 - 01:57:09:08 but doing intense 01:57:09:08 - 01:57:11:17 physical exercise can push our bodies 01:57:11:17 - 01:57:12:23 and we need to learn about 01:57:12:23 - 01:57:14:05 how to manage our diabetes 01:57:14:05 - 01:57:15:08 in the midst of that. 01:57:15:08 - 01:57:16:21 And our bodies are the best way 01:57:16:21 - 01:57:18:17 to give us feedback on that. 01:57:18:17 - 01:57:20:03 So I've got a few topics 01:57:20:03 - 01:57:21:17 for you to speak to today 01:57:21:17 - 01:57:22:22 in our deep dive, 01:57:22:22 - 01:57:24:20 and I wanted to speak to you about 01:57:26:08 - 01:57:26:19 a training 01:57:26:19 - 01:57:28:10 playbook, something that I've learned 01:57:28:10 - 01:57:31:10 to use to adjust from play to play 01:57:31:13 - 01:57:32:24 on how to make a quick change 01:57:32:24 - 01:57:34:19 in my diabetes management. 01:57:34:19 - 01:57:35:24 And that all stems back 01:57:35:24 - 01:57:37:24 from how sport affects our blood sugars 01:57:37:24 - 01:57:39:15 and the physiology that we're looking at. 01:57:39:15 - 01:57:42:15 So we'll give a little dive into that. 01:57:42:16 - 01:57:44:06 We're also going to look at the pros 01:57:44:06 - 01:57:45:22 of how exercise has helped, 01:57:45:22 - 01:57:47:03 but also some of the challenges 01:57:47:03 - 01:57:48:23 that we face, 01:57:48:23 - 01:57:51:02 the stigma and the mindset 01:57:51:02 - 01:57:53:02 and the resiliency that we gain 01:57:53:02 - 01:57:54:11 and the technology 01:57:54:11 - 01:57:55:07 and the tips and tricks 01:57:55:07 - 01:57:56:20 that I have for that. 01:57:56:20 - 01:57:58:10 Now, as we dive on in here, 01:57:58:10 - 01:58:01:10 talking about intense exercise, 01:58:01:10 - 01:58:02:13 there's four main components 01:58:02:13 - 01:58:04:13 that we're addressing: physiology, 01:58:04:13 - 01:58:05:23 the technology that supports 01:58:05:23 - 01:58:08:01 us, our mindset 01:58:08:01 - 01:58:09:13 and the pros and cons of doing it. 01:58:11:24 - 01:58:14:24 So the first part here is 01:58:15:11 - 01:58:16:18 to talk about the physiology 01:58:16:18 - 01:58:18:18 and the type of exercise. 01:58:18:18 - 01:58:19:21 And there's been a lot of research 01:58:19:21 - 01:58:20:09 done on this. 01:58:20:09 - 01:58:22:22 We know that there are generally 01:58:22:22 - 01:58:24:14 a few different kinds of exercise. 01:58:24:14 - 01:58:26:09 So you got your strength training 01:58:26:09 - 01:58:27:03 that's building up 01:58:27:03 - 01:58:28:01 your muscle mass 01:58:28:01 - 01:58:29:15 as a general thought, 01:58:29:15 - 01:58:30:23 aerobics that's building up 01:58:30:23 - 01:58:32:02 your your lungs 01:58:32:02 - 01:58:34:10 so that it can handle a lot of 01:58:34:10 - 01:58:35:18 heavy breathing. 01:58:35:18 - 01:58:37:01 And then you're anaerobic 01:58:37:01 - 01:58:38:05 is when you're not actually 01:58:38:05 - 01:58:39:10 using your breathing 01:58:39:10 - 01:58:40:13 to power your exercise. 01:58:40:13 - 01:58:43:09 So it's very short bursts of exercise, 01:58:43:09 - 01:58:44:07 whereas aerobic 01:58:44:07 - 01:58:47:07 could be long hours of exercise, 01:58:47:23 - 01:58:49:02 even in the five minute 01:58:49:02 - 01:58:51:22 range, would still be aerobic exercise. 01:58:51:22 - 01:58:53:09 But your breathing is doing 01:58:53:09 - 01:58:55:07 the most of the energy 01:58:55:07 - 01:58:56:17 component for that. 01:58:56:17 - 01:58:58:01 And then you've got your flexibility 01:58:58:01 - 01:58:59:02 and balance training. 01:58:59:02 - 01:59:01:09 That's still a type of physical exercise 01:59:01:09 - 01:59:02:16 that we want to be doing. 01:59:02:16 - 01:59:04:10 And when we think 01:59:04:10 - 01:59:06:02 about the research into diabetes 01:59:06:02 - 01:59:09:02 and how this impacts us, 01:59:09:02 - 01:59:11:12 mostly we try to associate a type 01:59:11:12 - 01:59:14:04 of exercise with the 01:59:15:10 - 01:59:18:00 the corresponding physical physiology. 01:59:18:00 - 01:59:18:17 So as you see 01:59:18:17 - 01:59:19:12 here, 01:59:19:12 - 01:59:21:01 we're looking at sprinting up 01:59:21:01 - 01:59:22:15 at the very top. 01:59:22:15 - 01:59:24:21 That's going to be an anaerobic exercise. 01:59:24:21 - 01:59:26:20 And what that arrow is trying to say 01:59:26:20 - 01:59:27:10 is that 01:59:27:10 - 01:59:28:13 sprinting might push 01:59:28:13 - 01:59:30:17 your blood sugars up. 01:59:30:17 - 01:59:33:00 Weightlifting is on the up side. 01:59:33:00 - 01:59:33:11 Okay. 01:59:33:11 - 01:59:35:04 And then you've got mixed sports, 01:59:35:04 - 01:59:37:09 which might be more in the middle. 01:59:37:09 - 01:59:39:05 So basketball, soccer, 01:59:39:05 - 01:59:42:05 you're thinking about bursts of exercise 01:59:42:14 - 01:59:44:11 that also have stopping points. 01:59:44:11 - 01:59:47:11 Burst, stop, burst, stop. 01:59:48:00 - 01:59:50:24 So those are 01:59:50:24 - 01:59:53:16 from our hypothetical, 01:59:53:16 - 01:59:55:23 you know, from our research side 01:59:55:23 - 01:59:56:19 might say that 01:59:56:19 - 01:59:59:19 it is a more balanced approach 01:59:59:23 - 02:00:02:08 versus as it shows, 02:00:02:08 - 02:00:05:06 a bicycle ride slowing down 02:00:05:06 - 02:00:08:06 and a jog is going down. 02:00:08:19 - 02:00:09:11 And so that's 02:00:09:11 - 02:00:10:15 because there might be less 02:00:10:15 - 02:00:11:21 stopping and starting 02:00:11:21 - 02:00:14:18 from a hypothetical situation. 02:00:14:18 - 02:00:15:20 Now, I say hypothetical 02:00:15:20 - 02:00:16:19 because 02:00:16:19 - 02:00:18:17 I think all of these exercises 02:00:18:17 - 02:00:20:06 should comprise 02:00:20:06 - 02:00:22:05 all of the types of exercise. 02:00:22:05 - 02:00:23:24 If you want to be a good sprinter, 02:00:23:24 - 02:00:26:02 you don't just do sprints. 02:00:26:02 - 02:00:28:12 If you want to do the maximum push 02:00:28:12 - 02:00:29:24 in your weightlifting, 02:00:29:24 - 02:00:30:18 then you're probably going 02:00:30:18 - 02:00:32:22 to want to do a whole lot of other 02:00:32:22 - 02:00:34:08 strength training activities 02:00:34:08 - 02:00:36:14 than just maximal efforts. 02:00:36:14 - 02:00:37:08 So for example, 02:00:37:08 - 02:00:38:18 when I was weight training, 02:00:38:18 - 02:00:40:20 I would be doing 2 to 3 reps 02:00:40:20 - 02:00:41:20 to try to build up. 02:00:41:20 - 02:00:43:22 How much maximum could I push? 02:00:43:22 - 02:00:45:17 I will also be doing exercises 02:00:45:17 - 02:00:48:08 with 12 reps. 18 reps. 02:00:48:08 - 02:00:50:19 And and so because I was a rower, 02:00:50:19 - 02:00:52:04 I would also do weightlifting 02:00:52:04 - 02:00:53:10 with a lot more reps as well. 02:00:53:10 - 02:00:56:12 Sometimes bursts of of sets where I would 02:00:56:12 - 02:00:58:11 drop down from 20 reps of one, 02:00:58:11 - 02:00:59:22 drop some weight off, 02:00:59:22 - 02:01:01:01 do another 02:01:01:01 - 02:01:04:03 15 reps, drop some weight, etc.. 02:01:04:03 - 02:01:05:00 So there's lots of different 02:01:05:00 - 02:01:06:07 kinds of weight training 02:01:06:07 - 02:01:07:20 as my is my point there. 02:01:08:20 - 02:01:10:03 And so 02:01:10:03 - 02:01:12:02 especially when you get into 02:01:12:02 - 02:01:13:16 different sports, 02:01:13:16 - 02:01:13:22 you know, 02:01:13:22 - 02:01:15:08 hockey would be one of these ones 02:01:15:08 - 02:01:16:10 that is trying to say 02:01:16:10 - 02:01:18:01 a straight line approach 02:01:18:01 - 02:01:20:01 or even a spike approach. 02:01:20:01 - 02:01:20:23 But that's not going to be 02:01:20:23 - 02:01:23:00 every time you play hockey. 02:01:23:00 - 02:01:23:13 In fact, 02:01:23:13 - 02:01:24:06 we often talk 02:01:24:06 - 02:01:25:21 about how practices vary 02:01:25:21 - 02:01:30:08 greatly from a competition or a race 02:01:30:08 - 02:01:33:08 or game, depending on the sport. 02:01:33:08 - 02:01:35:20 And so those psychological components 02:01:35:20 - 02:01:37:21 start to play a factor 02:01:37:21 - 02:01:39:14 and they start to influence 02:01:39:14 - 02:01:40:13 what happens with their blood 02:01:40:13 - 02:01:42:01 sugars as well. 02:01:42:01 - 02:01:45:01 So while this is still a very valid 02:01:45:08 - 02:01:48:08 tool that we can look at here to see what 02:01:48:08 - 02:01:51:08 what is the general concept of a sport? 02:01:51:15 - 02:01:53:22 If we dive into something like cycling, 02:01:53:22 - 02:01:55:10 I have seen many times 02:01:55:10 - 02:01:57:17 when I was to get on a spin bike 02:01:57:17 - 02:01:59:04 that within 15 minutes 02:01:59:04 - 02:02:01:16 my sensor readings would change 02:02:01:16 - 02:02:04:17 from upward arrows to downward arrows. 02:02:05:19 - 02:02:08:18 So when you see something like this, 02:02:08:18 - 02:02:11:04 you know, I would show you 02:02:11:04 - 02:02:13:01 a snack over here 02:02:13:01 - 02:02:13:12 is something 02:02:13:12 - 02:02:15:04 that I would do to try to prepare my body 02:02:15:04 - 02:02:16:05 so that my blood sugars 02:02:16:05 - 02:02:18:02 wouldn't drop into a low. 02:02:18:02 - 02:02:19:05 And then I would wait 02:02:19:05 - 02:02:20:09 until I see those arrows 02:02:20:09 - 02:02:22:15 going up to protect myself. 02:02:22:15 - 02:02:24:00 And then I would start my 02:02:24:00 - 02:02:25:18 cycling exercise. 02:02:25:18 - 02:02:26:12 And then as you can 02:02:26:12 - 02:02:27:22 see, as I finish 02:02:27:22 - 02:02:30:08 my blood sugars start to taper off. 02:02:30:08 - 02:02:32:10 Of course, you can start to perfect this. 02:02:32:10 - 02:02:33:08 So just thinking about 02:02:33:08 - 02:02:36:08 this type of reading and using 02:02:36:11 - 02:02:37:11 your body 02:02:37:11 - 02:02:39:17 and learning about your activity, 02:02:39:17 - 02:02:41:24 this could be any activity for you. 02:02:41:24 - 02:02:44:18 And if we take that snack and we say, 02:02:44:18 - 02:02:46:10 did this snack work? 02:02:46:10 - 02:02:48:21 You can see that my blood sugar rose 02:02:48:21 - 02:02:50:17 and then it also descended. 02:02:50:17 - 02:02:51:11 And if my blood sugar 02:02:51:11 - 02:02:52:10 stayed in the right 02:02:52:10 - 02:02:54:13 target range at the end, 02:02:54:13 - 02:02:55:00 that tells you 02:02:55:00 - 02:02:56:00 I took a right 02:02:56:00 - 02:02:58:01 about the right amount of carbs. 02:02:58:01 - 02:03:00:17 And now if we look at it and say, 02:03:00:17 - 02:03:02:12 could I do any better 02:03:02:12 - 02:03:04:07 than maybe I want to move my 02:03:05:07 - 02:03:07:04 my snack a little bit later in the game. 02:03:07:04 - 02:03:08:15 So the same blood sugar profile, 02:03:08:15 - 02:03:09:24 but just demonstrating that 02:03:09:24 - 02:03:12:14 if I ate that snack 15, 20 minutes later, 02:03:12:14 - 02:03:13:10 maybe my 02:03:13:10 - 02:03:15:06 my spike wouldn't have 02:03:15:06 - 02:03:17:03 gone quite as high. 02:03:17:03 - 02:03:17:24 And so that's a great way 02:03:17:24 - 02:03:19:14 to work within your blood sugars. 02:03:19:14 - 02:03:21:00 Learning your sport 02:03:21:00 - 02:03:21:15 that, yes, 02:03:21:15 - 02:03:23:15 cycling is going to drop my blood sugar 02:03:23:15 - 02:03:25:19 based on what my reading show. 02:03:25:19 - 02:03:28:14 But that snack is a little bit too early 02:03:28:14 - 02:03:30:20 in order to stabilize my blood sugars. 02:03:30:20 - 02:03:32:14 And we can see some very stable 02:03:32:14 - 02:03:33:02 blood sugars 02:03:33:02 - 02:03:34:10 when we get practicing 02:03:34:10 - 02:03:36:03 and doing the same amount of sport. 02:03:36:03 - 02:03:37:19 We should also be a little bit safe 02:03:37:19 - 02:03:39:09 when we're trying a new sport. 02:03:39:09 - 02:03:40:12 And so if you saw your blood 02:03:40:12 - 02:03:43:01 sugars spike up and stay there, 02:03:43:01 - 02:03:43:09 you know, 02:03:43:09 - 02:03:44:10 don't beat yourself up 02:03:44:10 - 02:03:45:12 because that's a safe way 02:03:45:12 - 02:03:47:04 to start a new exercise. 02:03:47:04 - 02:03:48:16 And maybe after a few times, 02:03:48:16 - 02:03:50:12 if you see the same trend, 02:03:50:12 - 02:03:51:20 then you might want to back off 02:03:51:20 - 02:03:53:13 and not eat as many carbohydrates, 02:03:53:13 - 02:03:55:05 which I'll talk about again in a moment. 02:03:56:07 - 02:03:57:23 So getting back into it, this 02:03:57:23 - 02:04:01:11 is hopefully demonstrating to you that as 02:04:01:22 - 02:04:03:07 any athlete, 02:04:03:07 - 02:04:04:04 when you think about somebody 02:04:04:04 - 02:04:05:23 who's competing at the Olympics, 02:04:05:23 - 02:04:06:24 you realize that they're doing 02:04:06:24 - 02:04:07:13 a whole bunch 02:04:07:13 - 02:04:09:00 of different kinds of sport 02:04:09:00 - 02:04:11:13 and adjusting their strategy each time. 02:04:11:13 - 02:04:12:11 It's not as simple 02:04:12:11 - 02:04:13:05 as some of your friends 02:04:13:05 - 02:04:14:18 might think, of course, 02:04:14:18 - 02:04:17:12 But if we keep on working with our tools 02:04:17:12 - 02:04:20:13 and our tips and adjusting our playbook 02:04:21:00 - 02:04:23:09 for each of these types of exercise, 02:04:23:09 - 02:04:25:10 then we might get a more stable approach 02:04:25:10 - 02:04:26:14 in each one of them. 02:04:26:14 - 02:04:28:01 And each one of them are so important 02:04:28:01 - 02:04:31:10 for our health and our in our experience. 02:04:32:12 - 02:04:34:13 So this chart 02:04:34:13 - 02:04:35:12 and this idea 02:04:35:12 - 02:04:37:04 of the different types of exercise 02:04:37:04 - 02:04:37:22 and how they affect 02:04:37:22 - 02:04:39:17 our blood sugars is really helpful 02:04:39:17 - 02:04:41:11 because some of us might be frustrated 02:04:41:11 - 02:04:41:24 that, 02:04:41:24 - 02:04:42:15 you know, we're doing 02:04:42:15 - 02:04:43:19 something really hard 02:04:43:19 - 02:04:45:17 and it doesn't have as much of an impact 02:04:45:17 - 02:04:48:02 as maybe going shopping at the mall 02:04:48:02 - 02:04:50:15 or gardening going for a walk. 02:04:50:15 - 02:04:51:23 These forms of exercise 02:04:51:23 - 02:04:53:03 are really good for us 02:04:53:03 - 02:04:55:03 and they are proving this 02:04:55:03 - 02:04:57:02 by impacting our blood sugars. 02:04:57:02 - 02:04:58:13 While it can be pretty frustrating 02:04:58:13 - 02:04:59:15 to have a low blood sugar 02:04:59:15 - 02:05:01:13 in the midst of one of these activities, 02:05:01:13 - 02:05:02:08 we should note that 02:05:02:08 - 02:05:03:20 the more continuous 02:05:03:20 - 02:05:05:02 forms of exercise 02:05:05:02 - 02:05:07:14 are very helpful for our bodies, 02:05:07:14 - 02:05:08:10 just the same as 02:05:08:10 - 02:05:09:06 as the ones that push 02:05:09:06 - 02:05:10:17 our blood sugars up. 02:05:10:17 - 02:05:12:05 But you shouldn't be frustrated 02:05:12:05 - 02:05:14:00 that a lower form of exercise 02:05:14:00 - 02:05:16:04 that you're not pushing yourself as hard 02:05:16:04 - 02:05:17:18 can still bring your blood sugars down. 02:05:17:18 - 02:05:20:09 It's really about adapting our strategy. 02:05:20:09 - 02:05:21:13 So another component 02:05:21:13 - 02:05:23:10 of adapting our strategy 02:05:23:10 - 02:05:24:16 that came along is 02:05:24:16 - 02:05:27:05 called the ExCarb Factor. 02:05:27:05 - 02:05:28:14 And so a scientist came up 02:05:28:14 - 02:05:29:23 and we've got charts online 02:05:29:23 - 02:05:31:19 that give you some identification. 02:05:31:19 - 02:05:32:11 But as I mentioned, 02:05:32:11 - 02:05:34:05 you really it's your responsibility 02:05:34:05 - 02:05:35:07 to try and figure out 02:05:35:07 - 02:05:37:07 how much carbs are required 02:05:37:07 - 02:05:38:24 for your type of exercise. 02:05:38:24 - 02:05:41:21 So this as a concept is taking in 02:05:41:21 - 02:05:43:12 this chart might be hard to see, 02:05:43:12 - 02:05:45:02 but you can look it up online. 02:05:45:02 - 02:05:47:03 Is that taking your exercise, 02:05:47:03 - 02:05:48:00 say, cycling, 02:05:48:00 - 02:05:49:11 as we just looked at 02:05:49:11 - 02:05:50:05 and determining 02:05:50:05 - 02:05:51:21 how hard are you going 02:05:51:21 - 02:05:53:09 and then identifying a certain 02:05:53:09 - 02:05:54:24 amount of extra carbs. 02:05:54:24 - 02:05:57:24 Excarbs is the short form, 02:05:58:08 - 02:05:59:09 the certain amount of carbs 02:05:59:09 - 02:06:00:07 that you might need 02:06:00:07 - 02:06:03:07 per hour to manage that exercise. 02:06:03:18 - 02:06:05:21 And so you wouldn't take insulin 02:06:05:21 - 02:06:06:21 or you would cut this back 02:06:06:21 - 02:06:08:06 from your medication 02:06:08:06 - 02:06:10:19 to try and balance out your exercise. 02:06:10:19 - 02:06:11:15 That way, you don't need to 02:06:11:15 - 02:06:12:23 treat low blood sugars. 02:06:14:01 - 02:06:16:13 So as an example, 02:06:16:13 - 02:06:17:03 if we are 02:06:17:03 - 02:06:19:15 looking at a light form of cycling, 02:06:19:15 - 02:06:23:09 maybe 20 grams of carbs is the ideal. 02:06:24:08 - 02:06:26:00 As you step it up and you go harder, 02:06:26:00 - 02:06:27:11 maybe it's 30 02:06:27:11 - 02:06:29:00 and if you're going full steam, 02:06:29:00 - 02:06:30:06 maybe it's 40. 02:06:30:06 - 02:06:31:13 And so you kind of come up with that. 02:06:31:13 - 02:06:32:00 And that way 02:06:32:00 - 02:06:34:15 you've got to plan for each exercise 02:06:34:15 - 02:06:35:15 and this is going to change. 02:06:35:15 - 02:06:37:07 It's not just per person, 02:06:37:07 - 02:06:39:16 but it's per exercise. 02:06:39:16 - 02:06:41:09 Now, taking that into account, 02:06:41:09 - 02:06:42:12 we should also remember 02:06:42:12 - 02:06:45:13 that our glycemic index is important. 02:06:45:17 - 02:06:47:12 So if we have a lower range 02:06:47:12 - 02:06:49:07 blood sugar as we're starting, 02:06:49:07 - 02:06:51:03 we're going to want to eat higher 02:06:51:03 - 02:06:52:01 glycemic index. 02:06:52:01 - 02:06:53:19 And I won't get into that 02:06:53:19 - 02:06:54:24 in too much detail here. 02:06:54:24 - 02:06:56:04 But the idea being that 02:06:56:04 - 02:06:57:24 we can look at our blood sugar levels 02:06:57:24 - 02:06:59:23 as they currently are to determine 02:06:59:23 - 02:07:01:07 how fast do we need 02:07:01:07 - 02:07:03:20 the energy to come into our body. 02:07:03:20 - 02:07:05:17 And we can also think about our snacks 02:07:05:17 - 02:07:08:17 if we're doing a long endurance exercise 02:07:08:22 - 02:07:10:08 that we might want to have a meal 02:07:10:08 - 02:07:12:12 that's going to last longer 02:07:12:12 - 02:07:14:00 into our exercise period. 02:07:14:00 - 02:07:14:24 So a lower 02:07:14:24 - 02:07:16:20 glycemic index meal 02:07:16:20 - 02:07:18:22 would help for a long endurance activity 02:07:18:22 - 02:07:20:00 like a hike, 02:07:20:00 - 02:07:22:09 like a long walk that you're going on 02:07:22:09 - 02:07:24:05 or a busy day. 02:07:24:05 - 02:07:25:20 The last big piece of physiology 02:07:25:20 - 02:07:27:01 I want to talk to you about 02:07:27:01 - 02:07:28:01 is about the timing. 02:07:29:02 - 02:07:30:12 Now I 02:07:30:12 - 02:07:31:06 like to 02:07:31:06 - 02:07:32:14 break my workouts 02:07:32:14 - 02:07:34:10 down into different zones. 02:07:34:10 - 02:07:36:10 And so what I notice 02:07:36:10 - 02:07:39:10 is that leading up to my exercise, 02:07:39:24 - 02:07:41:24 as I mentioned in that cycling 02:07:41:24 - 02:07:42:14 shot there, 02:07:42:14 - 02:07:43:16 I want to get my blood sugars 02:07:43:16 - 02:07:46:04 kind of angling up. 02:07:46:04 - 02:07:47:22 Now that's because I usually do 02:07:47:22 - 02:07:49:10 cardio vascular exercise 02:07:49:10 - 02:07:50:24 or aerobic exercise, 02:07:50:24 - 02:07:52:01 so my blood sugars 02:07:52:01 - 02:07:52:23 would trend 02:07:52:23 - 02:07:54:05 on the downward side 02:07:54:05 - 02:07:54:17 if I didn't 02:07:54:17 - 02:07:56:15 do something to counteract it. 02:07:56:15 - 02:07:58:01 So this pre exercise 02:07:58:01 - 02:08:00:01 period is something that you work out 02:08:00:01 - 02:08:00:20 when you know what 02:08:00:20 - 02:08:01:22 your exercise is doing. 02:08:01:22 - 02:08:02:18 If you're doing 02:08:02:18 - 02:08:03:21 a stressful activity 02:08:03:21 - 02:08:06:13 like a game or a race 02:08:06:13 - 02:08:07:19 and you notice that your blood sugars 02:08:07:19 - 02:08:08:12 spike up 02:08:08:12 - 02:08:09:21 during that activity, 02:08:09:21 - 02:08:12:08 then you might want to do the opposite 02:08:12:08 - 02:08:12:18 where you're 02:08:12:18 - 02:08:15:05 being really sensitive about 02:08:15:05 - 02:08:16:04 managing your 02:08:16:04 - 02:08:16:23 your diabetes 02:08:16:23 - 02:08:17:20 so that your blood sugars 02:08:17:20 - 02:08:19:24 don't spike up on race day, 02:08:19:24 - 02:08:22:24 for example, versus training. 02:08:23:08 - 02:08:24:00 In training, 02:08:24:00 - 02:08:25:19 I would be eating my breakfast 02:08:25:19 - 02:08:28:19 about 45 minutes before my exercise 02:08:28:19 - 02:08:30:20 and I would take a very small portion 02:08:30:20 - 02:08:33:12 of insulin for that carbohydrate. 02:08:33:12 - 02:08:35:05 Because of the Excarb factor, 02:08:35:05 - 02:08:35:17 I knew that 02:08:35:17 - 02:08:37:04 I needed more carbs 02:08:37:04 - 02:08:40:03 for the exercise without insulin, so 02:08:40:03 - 02:08:41:02 I would 02:08:41:02 - 02:08:42:05 adjust my ratio 02:08:42:05 - 02:08:43:02 so that I would get 02:08:43:02 - 02:08:44:07 extra carbs 02:08:44:07 - 02:08:46:19 for the exercise, for training 02:08:46:19 - 02:08:48:07 versus on a race day. 02:08:49:06 - 02:08:51:12 There were times where I would be 02:08:51:12 - 02:08:52:16 watching my blood sugars 02:08:52:16 - 02:08:54:07 and taking my insulin 02:08:54:07 - 02:08:55:14 and waiting for that 02:08:55:14 - 02:08:56:18 insulin to take action. 02:08:56:18 - 02:08:57:24 And because of the stress 02:08:57:24 - 02:09:00:24 involved in a race day, 02:09:01:01 - 02:09:01:19 there were times 02:09:01:19 - 02:09:03:17 where I would be waiting for 45 minutes 02:09:03:17 - 02:09:05:12 and my blood sugar would continue to rise 02:09:05:12 - 02:09:07:11 without eating any food. 02:09:07:11 - 02:09:10:03 Yet that morning the stress was pushing 02:09:10:03 - 02:09:13:03 those blood sugars up pre exercise. 02:09:13:12 - 02:09:14:23 And this can make it really tricky 02:09:14:23 - 02:09:15:21 because then as you 02:09:15:21 - 02:09:18:03 get into the exercise, things can change. 02:09:18:03 - 02:09:19:22 And that's why I say the timing. 02:09:19:22 - 02:09:21:20 So when I shift into the next zone 02:09:21:20 - 02:09:24:09 and I start getting active, 02:09:24:09 - 02:09:26:06 as we just spoke about in a race day 02:09:26:06 - 02:09:28:16 format, the 02:09:28:16 - 02:09:31:09 the stress of it could change 02:09:31:09 - 02:09:32:13 based on the activity. 02:09:32:13 - 02:09:33:17 So usually in my warm up, 02:09:33:17 - 02:09:34:07 I'm watching 02:09:34:07 - 02:09:37:14 and I could see those stress hormones 02:09:37:14 - 02:09:38:11 pushing my blood sugars 02:09:38:11 - 02:09:41:11 up, shift very quickly into a drop. 02:09:41:19 - 02:09:44:04 And so that's all I'm trying 02:09:44:04 - 02:09:44:21 to identify here 02:09:44:21 - 02:09:45:02 is that 02:09:45:02 - 02:09:46:13 if you see a shift that might be 02:09:46:13 - 02:09:48:20 because your physiology is changing. 02:09:48:20 - 02:09:50:13 The stress hormones are being abated 02:09:50:13 - 02:09:52:07 because of the activity 02:09:52:07 - 02:09:53:15 now could be opposite to you. 02:09:53:15 - 02:09:54:18 And the idea here 02:09:54:18 - 02:09:55:15 that I want to present 02:09:55:15 - 02:09:58:15 is that you watch the timing of the zones 02:09:58:19 - 02:10:00:15 during your exercise. 02:10:00:15 - 02:10:03:01 You want to watch what that trend is 02:10:03:01 - 02:10:04:09 and then try to come up with 02:10:04:09 - 02:10:06:02 an appropriate counteraction. 02:10:07:21 - 02:10:09:23 So in 02:10:09:23 - 02:10:11:06 most of my exercise, 02:10:11:06 - 02:10:13:05 even in race day for men 02:10:13:05 - 02:10:14:06 during the warm up 02:10:14:06 - 02:10:17:06 period would be a dropping blood
sugar. 02:10:17:07 - 02:10:19:04 Whereas just the race alone, 02:10:19:04 - 02:10:21:05 my races were 5 minutes long. 02:10:21:05 - 02:10:22:12 So they're 02:10:22:12 - 02:10:25:21 a heavy load of anaerobic exercise. 02:10:26:04 - 02:10:29:04 And so that is going to be pushing 02:10:29:05 - 02:10:32:05 all the hormones into that body again 02:10:32:07 - 02:10:34:04 and pushing my blood sugars back up. 02:10:34:04 - 02:10:36:23 So that's a little shift in my warm up 02:10:36:23 - 02:10:39:23 to the race period. 02:10:40:07 - 02:10:40:22 But in general, 02:10:40:22 - 02:10:42:22 we're looking at the type of exercise 02:10:42:22 - 02:10:43:19 and what's happening 02:10:43:19 - 02:10:44:12 with our blood sugars 02:10:44:12 - 02:10:46:04 and then coming up with a plan. 02:10:46:04 - 02:10:47:06 And then 02:10:47:06 - 02:10:48:16 one thing that we noticed 02:10:48:16 - 02:10:50:06 is that not only anaerobic 02:10:50:06 - 02:10:52:03 exercises push our blood sugars up, 02:10:52:03 - 02:10:53:19 but also long cardio 02:10:53:19 - 02:10:55:03 periods can do so too. 02:10:55:03 - 02:10:57:12 In the recovery phase. 02:10:57:12 - 02:10:58:16 So in the recovery phase, 02:10:58:16 - 02:11:00:06 I've got a little wiggly line there. 02:11:00:06 - 02:11:01:10 And a lot of times 02:11:01:10 - 02:11:03:00 people will find that even after 02:11:03:00 - 02:11:04:04 their exercise is over, 02:11:04:04 - 02:11:04:22 their blood sugars 02:11:04:22 - 02:11:06:14 could continue to descend, 02:11:06:14 - 02:11:08:10 it could continue to drop. 02:11:08:10 - 02:11:10:13 And so you want to think about even 02:11:10:13 - 02:11:11:19 in that aftermath, 02:11:11:19 - 02:11:14:00 if you need extra carbs 02:11:14:00 - 02:11:14:18 to balance out 02:11:14:18 - 02:11:16:16 those blood sugars or a reduction 02:11:16:16 - 02:11:18:04 in medication, insulin 02:11:19:11 - 02:11:20:21 could help to balance that. 02:11:20:21 - 02:11:21:23 But in some cases, 02:11:21:23 - 02:11:23:02 like I mentioned, 02:11:23:02 - 02:11:25:19 endurance athletes will find what we now 02:11:25:19 - 02:11:27:01 call the whip. 02:11:27:01 - 02:11:29:00 And I was experiencing this time 02:11:29:00 - 02:11:31:02 and time again after my practices, 02:11:31:02 - 02:11:32:15 especially in the morning 02:11:32:15 - 02:11:35:15 when my blood sugars would go from a 02:11:36:01 - 02:11:37:19 sensitive phase where it was 02:11:37:19 - 02:11:40:19 wanting to drop to a spike phase. 02:11:40:20 - 02:11:42:15 And before I even got a chance 02:11:42:15 - 02:11:43:09 to eat anything 02:11:43:09 - 02:11:45:20 after two or three hour long practice, 02:11:45:20 - 02:11:47:18 my blood sugar would spike up. 02:11:47:18 - 02:11:48:22 And so if you've experienced 02:11:48:22 - 02:11:51:03 something like this, you're not alone. 02:11:51:03 - 02:11:52:03 But that's what we're watching 02:11:52:03 - 02:11:53:11 for, is when we finish 02:11:53:11 - 02:11:54:01 and this 02:11:54:01 - 02:11:55:09 into this recovery phase, 02:11:55:09 - 02:11:57:24 does the trend change? 02:11:57:24 - 02:11:59:04 So if you're watching for that, 02:11:59:04 - 02:12:01:08 that could be in the most immediate time 02:12:01:08 - 02:12:04:08 after your exercise between 02:12:04:08 - 02:12:06:15 right afterwards to an hour and a half 02:12:06:15 - 02:12:07:19 or so 02:12:07:19 - 02:12:09:08 before that recovery 02:12:09:08 - 02:12:10:12 phase starts to shift. 02:12:10:12 - 02:12:11:15 So there's a bit of stubbornness 02:12:11:15 - 02:12:12:21 that can happen there 02:12:12:21 - 02:12:14:11 that can push blood sugars up. 02:12:14:11 - 02:12:16:00 And we want to watch for that phase 02:12:16:00 - 02:12:17:06 and the timing. 02:12:17:06 - 02:12:18:04 And then I've also got 02:12:18:04 - 02:12:20:01 delayed or overnight. 02:12:20:01 - 02:12:21:23 And that's because we should understand 02:12:21:23 - 02:12:23:20 that our bodies are recovering 02:12:23:20 - 02:12:24:22 from all this exercise. 02:12:24:22 - 02:12:26:17 Our muscles need to be replenished 02:12:26:17 - 02:12:28:01 during the activity. 02:12:28:01 - 02:12:29:05 Our muscles are using 02:12:29:05 - 02:12:30:11 all of their storage, 02:12:30:11 - 02:12:32:08 their storage inside of our muscles 02:12:32:08 - 02:12:35:03 for energy, and we need to replace that. 02:12:35:03 - 02:12:36:21 So it's a lot easier for insulin 02:12:36:21 - 02:12:39:03 to get energy into our muscles 02:12:39:03 - 02:12:40:15 during an overnight period 02:12:40:15 - 02:12:41:20 or when we're resting 02:12:41:20 - 02:12:44:09 delayed much after our exercise. 02:12:44:09 - 02:12:45:11 And so that's why a lot of people 02:12:45:11 - 02:12:47:06 have experienced nighttime lows 02:12:47:06 - 02:12:48:05 after exercise 02:12:48:05 - 02:12:49:03 because our body is just 02:12:49:03 - 02:12:50:19 replenishing those muscles. 02:12:50:19 - 02:12:52:01 And so we need to have a little bit 02:12:52:01 - 02:12:55:11 of a careful approach to the overnight 02:12:56:10 - 02:12:57:06 medication that we 02:12:57:06 - 02:13:00:06 take to manage our blood sugars. 02:13:00:10 - 02:13:00:23 One other thing 02:13:00:23 - 02:13:01:13 I wanted to mention 02:13:01:13 - 02:13:03:24 about inside of our exercise period 02:13:03:24 - 02:13:04:22 is that our body 02:13:04:22 - 02:13:06:23 has a physiological shift. 02:13:06:23 - 02:13:08:19 Usually our body is picking up energy 02:13:08:19 - 02:13:10:08 from our intestinal track, 02:13:10:08 - 02:13:11:21 from our digestive track, 02:13:11:21 - 02:13:12:20 and trying to bring that 02:13:12:20 - 02:13:13:24 into the bloodstream 02:13:13:24 - 02:13:16:20 to start to fuel the rest of our body. 02:13:16:20 - 02:13:17:24 And that's when we're eating food. 02:13:17:24 - 02:13:19:15 That's where it's getting picked up. 02:13:19:15 - 02:13:20:21 But when we're exercising, 02:13:20:21 - 02:13:21:17 our body can learn 02:13:21:17 - 02:13:23:02 to shunt the blood away 02:13:23:02 - 02:13:24:21 from that intestinal track. 02:13:24:21 - 02:13:26:06 And so what's happening 02:13:26:06 - 02:13:27:20 there is that the body knows that 02:13:27:20 - 02:13:30:02 it has enough storage in its muscles 02:13:30:02 - 02:13:32:00 as well as in the liver, where it stores 02:13:32:00 - 02:13:32:24 a lot of energy. 02:13:32:24 - 02:13:34:14 Almost 40%25 of our energy 02:13:34:14 - 02:13:36:03 is stored in our liver. 02:13:36:03 - 02:13:38:11 And so our body should be producing 02:13:38:11 - 02:13:40:20 a counter hormone to insulin 02:13:40:20 - 02:13:42:14 called glucagon. 02:13:42:14 - 02:13:44:06 But in most people with diabetes, 02:13:44:06 - 02:13:46:04 that glucagon function is inhibited. 02:13:46:04 - 02:13:48:00 It's not working properly. 02:13:48:00 - 02:13:50:13 So that's why it's so hard to treat a low 02:13:50:13 - 02:13:52:03 blood sugar during exercise 02:13:52:03 - 02:13:55:00 because the body is breaking it down, 02:13:55:00 - 02:13:55:16 but it's being 02:13:55:16 - 02:13:57:05 put into our digestive track 02:13:57:05 - 02:13:59:19 and the blood's not going there. 02:13:59:19 - 02:14:02:14 So this could cause a big challenge 02:14:02:14 - 02:14:03:13 for people who are doing 02:14:03:13 - 02:14:07:07 endurance exercise, who are doing that 02:14:07:10 - 02:14:08:20 aerobic exercise 02:14:08:20 - 02:14:10:03 because the body is trying 02:14:10:03 - 02:14:11:15 to pick it up from the liver. 02:14:11:15 - 02:14:13:03 But there's no glucagon response 02:14:13:03 - 02:14:15:03 to pull that energy out of storage. 02:14:16:07 - 02:14:17:24 So I often suggest to people 02:14:17:24 - 02:14:18:07 to think 02:14:18:07 - 02:14:21:10 about delaying the swallowing 02:14:21:10 - 02:14:22:19 of your low treatment. 02:14:22:19 - 02:14:24:12 And sometimes people will slam back 02:14:24:12 - 02:14:27:03 juice or Gatorade really quickly 02:14:27:03 - 02:14:28:08 and then get right back into it, 02:14:28:08 - 02:14:29:21 and then they end up going low again 02:14:29:21 - 02:14:31:07 or staying low. 02:14:31:07 - 02:14:32:21 And so this is an idea 02:14:32:21 - 02:14:34:05 that I could suggest to you 02:14:34:05 - 02:14:35:21 is to try to keep something either gummy, 02:14:35:21 - 02:14:36:21 even if it is juice 02:14:36:21 - 02:14:38:09 or Gatorade that you want to do. 02:14:38:09 - 02:14:39:21 Try to take it a little bit slower 02:14:39:21 - 02:14:40:13 because the more 02:14:40:13 - 02:14:41:10 you put into your stomach. 02:14:41:10 - 02:14:42:08 I've heard from many people 02:14:42:08 - 02:14:44:12 who have had three, four juice boxes 02:14:44:12 - 02:14:46:01 and still their low hasn't come up 02:14:46:01 - 02:14:48:02 until the end of their exercise. 02:14:48:02 - 02:14:48:23 And then of course, it's 02:14:48:23 - 02:14:49:13 going to spike up 02:14:49:13 - 02:14:51:12 much higher than what we want. 02:14:51:12 - 02:14:53:01 So that's something that we 02:14:53:01 - 02:14:56:19 should be watchful for and aware of to 02:14:56:19 - 02:14:59:07 try to slow down our low treatments 02:14:59:07 - 02:15:01:22 and keep our energy in our in our mouth 02:15:01:22 - 02:15:03:10 so that we can actually pick up 02:15:03:10 - 02:15:05:11 some of that energy from the gums, 02:15:06:11 - 02:15:07:21 which isn't inhibited at all. 02:15:07:21 - 02:15:08:21 So it's a really quick 02:15:08:21 - 02:15:10:10 absorption in our mouth. 02:15:10:10 - 02:15:12:13 So chewing on some gummies, 02:15:12:13 - 02:15:13:16 there's lots of different products 02:15:13:16 - 02:15:14:06 like that. 02:15:14:06 - 02:15:15:11 Energy gels 02:15:15:11 - 02:15:16:11 that work really quickly, 02:15:16:11 - 02:15:17:20 that are designed for athletes 02:15:17:20 - 02:15:19:14 because of this type of symptom, 02:15:19:14 - 02:15:22:14 even those that don't have diabetes. 02:15:22:14 - 02:15:25:00 So that's another idea for you. 02:15:25:00 - 02:15:26:11 But just reinforced 02:15:26:11 - 02:15:27:18 at these different timing 02:15:27:18 - 02:15:29:12 zones can change 02:15:29:12 - 02:15:30:14 and make it pretty complex 02:15:30:14 - 02:15:32:06 for managing your diabetes. 02:15:32:06 - 02:15:34:09 But it certainly 02:15:34:09 - 02:15:35:15 is possible 02:15:35:15 - 02:15:37:22 if we are putting our minds to it. 02:15:37:22 - 02:15:38:10 As I mentioned, 02:15:38:10 - 02:15:40:03 all these little timing pieces 02:15:40:03 - 02:15:41:09 and the physiology pieces 02:15:41:09 - 02:15:42:16 we're tracking with modern day 02:15:42:16 - 02:15:44:12 technology these days. 02:15:44:12 - 02:15:44:24 Here I am 02:15:44:24 - 02:15:46:11 at the top of one of the mountains 02:15:46:11 - 02:15:48:17 in the snowboarding provincial park, 02:15:48:17 - 02:15:51:01 looking at my glucose sensor 02:15:51:01 - 02:15:52:13 and it patches right into a pump. 02:15:52:13 - 02:15:53:06 And I'm not going to get 02:15:53:06 - 02:15:55:06 into all the details of this. 02:15:55:06 - 02:15:55:20 But as you know, there's 02:15:55:20 - 02:15:56:12 multiple different 02:15:56:12 - 02:15:57:02 kinds, as 02:15:57:02 - 02:15:57:24 is Medtronics 02:15:57:24 - 02:16:00:08 with the Smart guard feature 02:16:00:08 - 02:16:01:17 that's going to be balancing 02:16:01:17 - 02:16:04:17 all of the changes in your physiology 02:16:05:00 - 02:16:05:22 from day to day 02:16:05:22 - 02:16:08:06 to adjust your insulin dosages. 02:16:08:06 - 02:16:10:10 There are also self D.I.Y. 02:16:10:10 - 02:16:13:17 versions of this like Loop as well as 02:16:14:18 - 02:16:16:09 the Tandem version with 02:16:16:09 - 02:16:18:06 Dexcom compatibility. 02:16:18:06 - 02:16:20:09 And you see there there's a little bar 02:16:20:09 - 02:16:23:03 right up in this corner and 02:16:23:03 - 02:16:24:11 it's dark red, 02:16:24:11 - 02:16:24:23 and that's 02:16:24:23 - 02:16:26:15 because the pump has shut off 02:16:26:15 - 02:16:28:01 the insulin delivery 02:16:28:01 - 02:16:28:21 during that period 02:16:28:21 - 02:16:30:14 to protect you from a low. 02:16:30:14 - 02:16:30:24 That's what 02:16:30:24 - 02:16:32:01 a lot of this artificial 02:16:32:01 - 02:16:33:11 intelligence is doing 02:16:33:11 - 02:16:34:11 at this point, combined 02:16:34:11 - 02:16:37:11 with the technology of glucose sensing. 02:16:37:11 - 02:16:38:09 And it's something 02:16:38:09 - 02:16:39:11 that we should be all thinking 02:16:39:11 - 02:16:40:06 about in the background 02:16:40:06 - 02:16:43:05 is how much active insulin do we have? 02:16:43:05 - 02:16:44:24 Active insulin is a whole other topic, 02:16:44:24 - 02:16:46:02 but really it's just saying 02:16:46:02 - 02:16:47:06 how much is in our body 02:16:47:06 - 02:16:50:00 and how much is going to be 02:16:50:00 - 02:16:52:16 encouraged by our exercise. 02:16:52:16 - 02:16:54:20 So when our insulin is stimulated 02:16:54:20 - 02:16:56:03 by our exercise, 02:16:56:03 - 02:16:57:21 it's going to do more work 02:16:57:21 - 02:16:59:22 and so we see that little period there 02:16:59:22 - 02:17:02:14 where the insulin is being shut off 02:17:02:14 - 02:17:04:12 because the background insulin 02:17:04:12 - 02:17:06:23 is being too powerful or perhaps 02:17:06:23 - 02:17:08:00 a bolus of insulin 02:17:08:00 - 02:17:10:09 has been become too powerful. 02:17:10:09 - 02:17:12:00 And so that's really where 02:17:12:00 - 02:17:12:16 we're thinking about 02:17:12:16 - 02:17:14:14 with all these timing features, 02:17:14:14 - 02:17:16:15 the excarbs could also be reduced 02:17:16:15 - 02:17:17:11 so you don't have to eat 02:17:17:11 - 02:17:19:05 as much carbohydrate. 02:17:19:05 - 02:17:20:15 You could reduce the insulin 02:17:20:15 - 02:17:21:14 in the same amount. 02:17:21:14 - 02:17:25:04 They're equal as we work through that. 02:17:26:05 - 02:17:27:20 And so one thing that I really wanted 02:17:27:20 - 02:17:29:05 to focus in on here, 02:17:29:05 - 02:17:30:01 because this technology 02:17:30:01 - 02:17:31:21 we could talk about all day, 02:17:31:21 - 02:17:33:10 but one thing that we are seeing 02:17:33:10 - 02:17:35:05 is that the insulin pumps 02:17:35:05 - 02:17:36:05 are being 02:17:36:05 - 02:17:38:01 reduced in their insulin delivery 02:17:38:01 - 02:17:39:19 based on our blood sugars, 02:17:39:19 - 02:17:40:17 which is fantastic, 02:17:40:17 - 02:17:43:17 especially during these aerobic exercises 02:17:43:17 - 02:17:45:02 as we spoke of 02:17:45:02 - 02:17:46:05 during the evening times 02:17:46:05 - 02:17:47:03 when we're going to sleep. 02:17:47:03 - 02:17:48:16 This these technologies are 02:17:48:16 - 02:17:51:11 making our lives so much safer 02:17:51:11 - 02:17:52:07 as we can sleep 02:17:52:07 - 02:17:54:09 peacefully without low blood sugars, 02:17:54:09 - 02:17:56:07 interrupting our nights. 02:17:56:07 - 02:17:59:01 But additionally, I wanted to point out 02:17:59:01 - 02:17:59:13 one thing 02:17:59:13 - 02:18:01:19 that is sometimes a bit of a problem 02:18:01:19 - 02:18:02:24 where we have a correction 02:18:02:24 - 02:18:05:04 ratio built into our 02:18:05:04 - 02:18:06:10 artificial intelligence. 02:18:06:10 - 02:18:07:11 And so if you have a pump 02:18:07:11 - 02:18:09:24 that's using the sensor to adjust 02:18:09:24 - 02:18:11:12 how much insulin you're getting, 02:18:11:12 - 02:18:13:06 certainly it helps protect from lows 02:18:13:06 - 02:18:14:18 during exercise. 02:18:14:18 - 02:18:16:06 As you see here, there's a bit of a low 02:18:16:06 - 02:18:17:13 blood sugar on the screen. 02:18:19:01 - 02:18:20:05 And one thing we 02:18:20:05 - 02:18:20:09 got to 02:18:20:09 - 02:18:21:01 watch out for 02:18:21:01 - 02:18:22:20 is that as we recover from that low, 02:18:22:20 - 02:18:24:06 if we treat the low 02:18:24:06 - 02:18:27:06 and our blood sugar starts to climb up, 02:18:27:10 - 02:18:30:00 then the sensor might indicate 02:18:30:00 - 02:18:30:10 to the pump 02:18:30:10 - 02:18:32:06 that we need a shot of insulin 02:18:32:06 - 02:18:34:20 and it might give us a correction factor. 02:18:34:20 - 02:18:36:05 And so I really encourage you 02:18:36:05 - 02:18:38:07 to check out with your clinician, 02:18:38:07 - 02:18:39:03 your team, 02:18:39:03 - 02:18:40:04 if you're dropping 02:18:40:04 - 02:18:42:06 after one of these spikes 02:18:42:06 - 02:18:43:09 in the middle of your exercise 02:18:43:09 - 02:18:46:00 and having a yo yo effect up and down, 02:18:46:00 - 02:18:49:00 treating low, getting back into exercise, 02:18:49:06 - 02:18:50:22 having a blood sugar climb up, 02:18:50:22 - 02:18:53:09 and then a correction bolus from the pump 02:18:53:09 - 02:18:54:06 to bring you back down. 02:18:54:06 - 02:18:54:19 That's something that 02:18:54:19 - 02:18:56:00 I've seen a lot in our programs 02:18:56:00 - 02:18:57:03 as people are learning 02:18:57:03 - 02:18:58:24 how to use these technologies. 02:18:58:24 - 02:19:00:08 And something that I'd watch out for 02:19:00:08 - 02:19:01:19 because if your blood sugar 02:19:01:19 - 02:19:03:00 is climbing up quickly 02:19:03:00 - 02:19:05:05 as it gets to eight or nine, 02:19:05:05 - 02:19:06:24 the pump will probably respond 02:19:06:24 - 02:19:08:11 with a correction bolus 02:19:08:11 - 02:19:09:13 that could bring you back down 02:19:09:13 - 02:19:10:20 very quickly, 02:19:10:20 - 02:19:13:02 sometimes in as fast as 15 minutes. 02:19:13:02 - 02:19:14:00 Change those arrows 02:19:14:00 - 02:19:15:17 from going up fast 02:19:15:17 - 02:19:17:04 down to a quick descent. 02:19:18:08 - 02:19:20:13 So technology can really help us out. 02:19:20:13 - 02:19:22:15 But there are also little things 02:19:22:15 - 02:19:23:19 that are going to come in 02:19:23:19 - 02:19:25:09 and we got to watch out for those. 02:19:25:09 - 02:19:26:12 And so I want to make sure 02:19:26:12 - 02:19:28:18 we also think about our mindset 02:19:28:18 - 02:19:31:16 now as you think 02:19:31:16 - 02:19:33:04 everything in life, you know, 02:19:33:04 - 02:19:35:09 could affect you up or down. 02:19:35:09 - 02:19:35:21 Diabetes, 02:19:35:21 - 02:19:37:20 a pretty good parallel for that. 02:19:37:20 - 02:19:39:06 So with our technology, 02:19:39:06 - 02:19:41:03 we've come so far in the last 30 years 02:19:41:03 - 02:19:42:21 since I was diagnosed, 02:19:42:21 - 02:19:44:03 far more people that I've met 02:19:44:03 - 02:19:46:07 that had diabetes a lot longer than that. 02:19:46:07 - 02:19:48:08 And so think about that place 02:19:48:08 - 02:19:49:04 that you come to, 02:19:49:04 - 02:19:50:11 and there's going to be 02:19:50:11 - 02:19:52:16 great examples of this. 02:19:52:16 - 02:19:54:03 And I'm going to use rowing. 02:19:54:03 - 02:19:55:22 And so many people 02:19:55:22 - 02:19:57:12 don't know what rowing is. 02:19:57:12 - 02:19:58:18 And it's my sport 02:19:58:18 - 02:20:00:17 and I have people that come across 02:20:00:17 - 02:20:01:20 and interact with me 02:20:01:20 - 02:20:03:20 about my rowing in a negative way 02:20:03:20 - 02:20:05:16 and it can frustrate me. 02:20:05:16 - 02:20:07:14 But the same thing is going to happen 02:20:07:14 - 02:20:08:09 with diabetes. 02:20:08:09 - 02:20:09:02 We're going to have people 02:20:09:02 - 02:20:10:01 that don't quite get it, 02:20:10:01 - 02:20:10:18 that don't realize 02:20:10:18 - 02:20:11:18 how much effort we need 02:20:11:18 - 02:20:12:13 to put in 02:20:12:13 - 02:20:13:04 every day 02:20:13:04 - 02:20:14:11 in order to manage this, 02:20:14:11 - 02:20:16:08 in order to be at our best 02:20:16:08 - 02:20:17:19 or to get up on top of that. 02:20:17:19 - 02:20:18:22 And there's a lot of stigma 02:20:18:22 - 02:20:20:12 around diabetes for sure. 02:20:21:11 - 02:20:22:06 So find 02:20:22:06 - 02:20:23:02 that place that you 02:20:23:02 - 02:20:23:20 can come to 02:20:23:20 - 02:20:25:07 and stay motivated 02:20:25:07 - 02:20:27:02 because sitting on the sidelines 02:20:27:02 - 02:20:28:03 at any point 02:20:28:03 - 02:20:31:01 because of an illness like diabetes 02:20:31:01 - 02:20:33:07 is going to be additional frustration 02:20:33:07 - 02:20:33:21 on top 02:20:33:21 - 02:20:35:22 of all the physiological challenges 02:20:35:22 - 02:20:38:21 that we have. It's the mindset there too. 02:20:38:21 - 02:20:41:04 So that builds in us 02:20:41:04 - 02:20:44:04 determination and resiliency. 02:20:44:21 - 02:20:46:24 And I just encourage you to explore 02:20:46:24 - 02:20:48:18 that and to recognize yourself 02:20:48:18 - 02:20:50:01 for it, too. 02:20:50:01 - 02:20:52:22 Because if you think the top athletes 02:20:52:22 - 02:20:53:08 in the world 02:20:53:08 - 02:20:54:17 with diabetes are going 02:20:54:17 - 02:20:55:24 through the same moments 02:20:55:24 - 02:20:57:20 that are having the same discouragement, 02:20:57:20 - 02:20:58:08 it's actually what 02:20:58:08 - 02:21:00:00 maybe even the most proud of myself 02:21:00:00 - 02:21:02:05 when I looked back from the Olympics, 02:21:02:05 - 02:21:03:17 back on all the days of training 02:21:03:17 - 02:21:04:22 that I put in, 02:21:04:22 - 02:21:05:20 certainly there were lots 02:21:05:20 - 02:21:07:16 of training accomplishments, 02:21:07:16 - 02:21:08:11 but it was really about 02:21:08:11 - 02:21:09:10 having that mindset 02:21:09:10 - 02:21:11:18 to overcome the daily obstacles 02:21:11:18 - 02:21:13:02 that diabetes brought in the way, 02:21:13:02 - 02:21:13:17 in addition 02:21:13:17 - 02:21:14:18 to all the other training 02:21:14:18 - 02:21:15:22 experiences that I had. 02:21:17:06 - 02:21:18:01 So when 02:21:18:01 - 02:21:19:07 I think about the pros and cons, 02:21:19:07 - 02:21:21:20 I think that's a great place to start. 02:21:21:20 - 02:21:22:00 You know, 02:21:22:00 - 02:21:23:04 we might be thinking about 02:21:23:04 - 02:21:26:06 what we're looking for in life, and maybe 02:21:26:06 - 02:21:27:13 it's a beautiful view that you're 02:21:27:13 - 02:21:29:07 trying to hike towards. 02:21:29:07 - 02:21:32:07 Maybe it's a spot on the podium, 02:21:32:08 - 02:21:33:08 or maybe it's just being 02:21:33:08 - 02:21:35:23 with your friends at that stage. 02:21:35:23 - 02:21:38:10 Could be the way you look at yourself 02:21:38:10 - 02:21:39:11 as well. 02:21:39:11 - 02:21:40:04 Looking at yourself 02:21:40:04 - 02:21:41:19 and being proud of yourself. 02:21:41:19 - 02:21:43:03 Those are all big pros, 02:21:43:03 - 02:21:43:23 but sometimes 02:21:43:23 - 02:21:45:14 we're going to think about ourselves 02:21:45:14 - 02:21:47:00 as someone living with diabetes 02:21:47:00 - 02:21:48:10 in a negative way 02:21:48:10 - 02:21:49:12 because we're frustrated 02:21:49:12 - 02:21:50:15 that we can't 02:21:50:15 - 02:21:51:05 do everything 02:21:51:05 - 02:21:52:23 without having a blood sugar 02:21:52:23 - 02:21:54:04 that goes out of control. 02:21:54:04 - 02:21:55:13 Or maybe we're focused 02:21:55:13 - 02:21:57:15 so much on our blood sugars 02:21:57:15 - 02:21:59:24 that we're looking too deeply at that. 02:21:59:24 - 02:22:01:01 And when I say too deeply, 02:22:01:01 - 02:22:03:08 if it's looking at a negative experience 02:22:03:08 - 02:22:03:14 and it's 02:22:03:14 - 02:22:06:11 changing our lives in a negative way, 02:22:06:11 - 02:22:08:04 then there's a problem, right? 02:22:08:04 - 02:22:10:15 And so we have to focus on blood sugars 02:22:10:15 - 02:22:11:21 and the food that we eat 02:22:11:21 - 02:22:13:04 and the way that we manage it 02:22:13:04 - 02:22:15:20 way more than anyone else does. 02:22:15:20 - 02:22:16:11 So that's a 02:22:16:11 - 02:22:18:08 that's a pretty big challenge. 02:22:18:08 - 02:22:20:15 But it can turn into a pro, right? 02:22:20:15 - 02:22:22:12 As we look to overcome that 02:22:23:11 - 02:22:26:11 and find the fun out there, 02:22:26:14 - 02:22:29:14 the more we value those positive moments, 02:22:30:08 - 02:22:31:05 the more energy 02:22:31:05 - 02:22:34:01 we have to come through the challenges. 02:22:34:01 - 02:22:35:08 And so that's been built up in me. 02:22:35:08 - 02:22:36:07 I know looking back 02:22:36:07 - 02:22:37:09 from when I was diagnosed 02:22:37:09 - 02:22:40:23 at 14 years old, having those challenges 02:22:40:23 - 02:22:42:15 present themselves so regularly 02:22:42:15 - 02:22:44:15 and having the right support around me 02:22:44:15 - 02:22:45:21 to get me back up 02:22:45:21 - 02:22:48:03 that I could enjoy the next experience 02:22:48:03 - 02:22:49:07 played a big 02:22:49:07 - 02:22:50:14 component in how strong 02:22:50:14 - 02:22:52:18 I ended up getting. 02:22:52:18 - 02:22:54:14 So I would say one of the biggest pros 02:22:54:14 - 02:22:56:13 is making sure that you can develop 02:22:56:13 - 02:22:57:23 that positive team 02:22:57:23 - 02:22:58:24 relationship, whether or not 02:22:58:24 - 02:23:00:18 that's with your friends on a team, 02:23:00:18 - 02:23:03:09 in a class or your family. 02:23:03:09 - 02:23:04:05 And diabetes 02:23:04:05 - 02:23:05:12 can raise a lot of conflicts 02:23:05:12 - 02:23:07:17 because this can interrupt 02:23:07:17 - 02:23:09:13 not only our sport, 02:23:09:13 - 02:23:12:13 but also a lot of parts of our lives. 02:23:12:14 - 02:23:14:24 But practicing for a sport 02:23:14:24 - 02:23:16:00 is very similar 02:23:16:00 - 02:23:16:16 to what we're doing 02:23:16:16 - 02:23:18:05 with our diabetes management 02:23:18:05 - 02:23:19:20 practice, practice, practice. 02:23:19:20 - 02:23:21:04 So I encourage you 02:23:21:04 - 02:23:22:08 to get out there and to know 02:23:22:08 - 02:23:24:05 that you're not the only one. 02:23:24:05 - 02:23:26:12 So many people out there across 02:23:26:12 - 02:23:27:12 Canada and across 02:23:27:12 - 02:23:29:15 the world are going through this too. 02:23:29:15 - 02:23:30:14 So I thank Diabetes 02:23:30:14 - 02:23:31:07 Canada 02:23:31:07 - 02:23:32:14 for bringing us together in 02:23:32:14 - 02:23:34:11 this deep dives and 02:23:35:13 - 02:23:36:15 remembering that there 02:23:36:15 - 02:23:37:16 are more people out there 02:23:37:16 - 02:23:39:16 that are doing your specific sport. 02:23:39:16 - 02:23:41:00 And so this is just a deep dive 02:23:41:00 - 02:23:44:00 on exercise and intense training. 02:23:44:02 - 02:23:44:24 But there might be somebody 02:23:44:24 - 02:23:46:01 with your specific sport 02:23:46:01 - 02:23:46:22 that you could reach out to. 02:23:46:22 - 02:23:47:23 I know I've talked to rowers 02:23:47:23 - 02:23:49:10 all around the world, 02:23:49:10 - 02:23:51:11 hikers all around the world, 02:23:51:11 - 02:23:53:18 and I have loved those moments. 02:23:53:18 - 02:23:55:10 So I encourage you to get connected 02:23:55:10 - 02:23:56:15 beyond this video, 02:23:56:15 - 02:23:58:22 to use this as a taste test 02:23:58:22 - 02:23:59:24 for what you can learn 02:23:59:24 - 02:24:01:02 and how you can grow. 02:24:01:02 - 02:24:01:17 And I appreciate 02:24:01:17 - 02:24:03:08 spending some time with you today. 02:24:03:08 - 02:24:03:20 Thank you. 02:24:03:20 - 02:24:05:00 And best of luck 02:24:05:00 - 02:24:05:22 to you and your training. 02:24:06:24 - 02:24:08:10 Thank you so much for joining us 02:24:08:10 - 02:24:09:08 in diving deeper 02:24:09:08 - 02:24:10:18 into the world of exercise, 02:24:10:18 - 02:24:12:01 sport and diabetes. 02:24:12:01 - 02:24:12:20 Again, 02:24:12:20 - 02:24:14:03 this topic may not be relevant 02:24:14:03 - 02:24:16:04 to everyone living with diabetes, 02:24:16:04 - 02:24:17:10 but we do hope that you found it 02:24:17:10 - 02:24:19:02 interesting and learned something new. 02:24:19:02 - 02:24:20:21 Please take the opportunity 02:24:20:21 - 02:24:22:10 to let us know what you learned, 02:24:22:10 - 02:24:25:04 what you liked and how we can do better. 02:24:25:04 - 02:24:26:23 You can do that by posting a comment 02:24:26:23 - 02:24:28:15 in the comment section below, 02:24:28:15 - 02:24:29:09 or by clicking 02:24:29:09 - 02:24:30:10 the link to the feedback 02:24:30:10 - 02:24:32:15 survey in the description box. 02:24:32:15 - 02:24:34:05 If you have ideas for other topics 02:24:34:05 - 02:24:35:22 you’d like to learn more about, 02:24:35:22 - 02:24:37:09 you can include that in the comments 02:24:37:09 - 02:24:38:21 or feedback survey as well. 02:24:39:21 - 02:24:40:19 Chris talked about 02:24:40:19 - 02:24:43:06 Excarbs, as well as DIY 02:24:43:06 - 02:24:45:06 automated insulin delivery. 02:24:45:06 - 02:24:45:22 We’ve included 02:24:45:22 - 02:24:47:20 links to a resource on ExCarbs 02:24:47:20 - 02:24:50:10 as well as to our Deep Dive video on DIY 02:24:50:10 - 02:24:52:13 AID in the description box 02:24:52:13 - 02:24:54:08 as well as some additional resources 02:24:54:08 - 02:24:57:02 related to diabetes and exercise. 02:24:57:02 - 02:24:59:00 We also wanted to take this opportunity 02:24:59:00 - 02:25:00:09 to let you know about Lace Up 02:25:00:09 - 02:25:01:16 to End Diabetes 02:25:01:16 - 02:25:03:01 and encourage you to join the Lace 02:25:03:01 - 02:25:04:14 Up Your way challenge, 02:25:04:14 - 02:25:07:07 a great opportunity to get moving, create 02:25:07:07 - 02:25:07:19 or join 02:25:07:19 - 02:25:10:19 a team and support Diabetes Canada. 02:25:10:22 - 02:25:12:20 For more information about Lace Up 02:25:12:20 - 02:25:13:10 or anything 02:25:13:10 - 02:25:15:05 related to diabetes management, 02:25:15:05 - 02:25:18:05 please visit our website at diabetes.ca. 02:25:18:06 - 02:25:21:18 You can also email us at info@diabetes.ca 02:25:21:20 - 02:25:25:04 or call our info-line at 1-800-Banting, 02:25:25:04 - 02:25:28:17 that’s 1-800-226-8464 02:25:28:22 - 02:25:30:11 and speak to one of our information 02:25:30:11 - 02:25:31:20 and support specialists 02:25:31:20 - 02:25:33:00 who can address your needs. 02:25:33:00 - 02:25:34:06 Thanks again for joining 02:25:34:06 - 02:25:35:19 us and see you next time. |
| 6 | Episode 6 | Managing Diabetes in a School Setting In this episode, two parents share their experience supporting their children after a Type 1 diabetes diagnosis, offering a poignant glimpse into their journey. They discuss their child's diagnosis and the lessons they learned while helping them navigate school. By watching, you'll gain insight into the challenges families face and how collaboration with schools is crucial in supporting children with diabetes. | 02:33:13:10 - 02:33:16:00 Hello and welcome to Diabetes Deep Dives. 02:33:16:00 - 02:33:16:22 My name is Candace 02:33:16:22 - 02:33:18:16 and I'm from Diabetes Canada. 02:33:18:16 - 02:33:20:09 If you are new to our video series, 02:33:20:09 - 02:33:21:22 thank you for joining us. 02:33:21:22 - 02:33:23:09 If you have been enjoying the series. 02:33:23:09 - 02:33:25:00 Welcome back. 02:33:25:00 - 02:33:26:10 Our Diabetes Deep Dives 02:33:26:10 - 02:33:27:19 video series is designed 02:33:27:19 - 02:33:29:03 to go beyond the surface 02:33:29:03 - 02:33:31:12 of general diabetes education. 02:33:31:12 - 02:33:32:18 We hope to spark continued 02:33:32:18 - 02:33:34:00 interest and learning 02:33:34:00 - 02:33:34:12 and leave you 02:33:34:12 - 02:33:36:07 with practical tips and tools 02:33:36:07 - 02:33:38:01 that you can easily use. 02:33:38:01 - 02:33:40:03 We drop a new video every month, 02:33:40:03 - 02:33:41:20 so subscribe to our YouTube channel 02:33:41:20 - 02:33:43:08 and click on the notification bell 02:33:43:08 - 02:33:45:15 to be notified about new content. 02:33:45:15 - 02:33:47:20 You can also check us out on social media 02:33:47:20 - 02:33:48:22 to find out when the next one 02:33:48:22 - 02:33:51:01 will be posted on our YouTube channel. 02:33:51:01 - 02:33:51:10 Thanks to 02:33:51:10 - 02:33:52:15 those who have subscribed 02:33:52:15 - 02:33:55:12 and supported our video series. 02:33:55:12 - 02:33:57:01 I'm so excited to share with you 02:33:57:01 - 02:33:58:00 this new episode 02:33:58:00 - 02:34:00:01 featuring the lived experiences 02:34:00:01 - 02:34:02:08 of people affected by diabetes. 02:34:02:08 - 02:34:02:22 In today's 02:34:02:22 - 02:34:04:17 episode on managing diabetes 02:34:04:17 - 02:34:05:24 in the school setting, 02:34:05:24 - 02:34:07:11 you will meet two parents 02:34:07:11 - 02:34:08:20 who will provide a small 02:34:08:20 - 02:34:10:06 but impactful glimpse 02:34:10:06 - 02:34:11:10 into their experience 02:34:11:10 - 02:34:12:22 supporting their children 02:34:12:22 - 02:34:14:04 as they reentered school 02:34:14:04 - 02:34:15:07 after being diagnosed 02:34:15:07 - 02:34:17:02 with Type one diabetes. 02:34:17:02 - 02:34:18:13 They will share some details 02:34:18:13 - 02:34:20:20 about their child's diagnosis story 02:34:20:20 - 02:34:22:02 to set the stage 02:34:22:02 - 02:34:23:11 as well as what they learned 02:34:23:11 - 02:34:24:21 as they supported their child. 02:34:24:21 - 02:34:26:21 with going to school. 02:34:26:23 - 02:34:28:00 We hope after watching this 02:34:28:00 - 02:34:29:12 video that you will gain a greater 02:34:29:12 - 02:34:30:15 understanding of how 02:34:30:15 - 02:34:32:03 families are impacted 02:34:32:03 - 02:34:34:04 by a diabetes diagnosis, 02:34:34:04 - 02:34:35:05 as well as the process 02:34:35:05 - 02:34:36:16 of working with partners, 02:34:36:16 - 02:34:37:18 including schools, 02:34:37:18 - 02:34:40:18 to support children living with diabetes. 02:34:40:21 - 02:34:42:00 We also want to let you know 02:34:42:00 - 02:34:43:18 that the stories shared by our parents 02:34:43:18 - 02:34:45:07 may be difficult to hear 02:34:45:07 - 02:34:47:20 and may trigger some intense emotions. 02:34:47:20 - 02:34:49:17 We encourage you to seek support 02:34:49:17 - 02:34:51:10 and/or stop the video 02:34:51:10 - 02:34:52:07 if you find yourself 02:34:52:07 - 02:34:53:13 reacting to the content 02:34:53:13 - 02:34:55:22 in a distressing way. 02:34:55:22 - 02:34:56:17 We recognize that 02:34:56:17 - 02:34:57:19 the content in this video 02:34:57:19 - 02:34:58:16 may not be relevant 02:34:58:16 - 02:34:59:15 for everyone 02:34:59:15 - 02:35:00:19 and will depend on what 02:35:00:19 - 02:35:02:17 your experience with diabetes is, 02:35:02:17 - 02:35:04:01 as well as what devices 02:35:04:01 - 02:35:06:09 are available to you where you live. 02:35:06:09 - 02:35:07:20 If you have specific questions 02:35:07:20 - 02:35:09:12 about diabetes management, 02:35:09:12 - 02:35:10:06 please reach out to 02:35:10:06 - 02:35:12:02 your health care team. 02:35:12:04 - 02:35:13:03 These videos are for 02:35:13:03 - 02:35:15:01 educational purposes only. 02:35:15:01 - 02:35:17:00 The content discussed in this video 02:35:17:00 - 02:35:19:08 is not intended to be medical advice. 02:35:19:08 - 02:35:20:02 And to the extent 02:35:20:02 - 02:35:21:21 that medical advice is required, 02:35:21:21 - 02:35:22:15 you should consult 02:35:22:15 - 02:35:24:20 with a qualified medical professional. 02:35:24:20 - 02:35:25:12 The information 02:35:25:12 - 02:35:26:17 discussed in this video 02:35:26:17 - 02:35:28:13 cannot replace consultations 02:35:28:13 - 02:35:29:13 with a qualified health 02:35:29:13 - 02:35:30:10 care professional 02:35:30:10 - 02:35:33:10 to meet your individual medical needs. 02:35:33:10 - 02:35:34:13 The views and opinions 02:35:34:13 - 02:35:35:22 expressed in this video 02:35:35:22 - 02:35:37:03 are those of the speakers 02:35:37:03 - 02:35:38:07 and do not necessarily 02:35:38:07 - 02:35:39:04 reflect the views 02:35:39:04 - 02:35:42:18 or positions of Diabetes Canada. 02:35:42:20 - 02:35:43:14 As always, 02:35:43:14 - 02:35:44:04 we hope that 02:35:44:04 - 02:35:45:13 this video sparks your interest 02:35:45:13 - 02:35:46:05 in learning more 02:35:46:05 - 02:35:47:24 about diabetes management. 02:35:47:24 - 02:35:50:05 And now over to our guest speakers, 02:35:50:05 - 02:35:51:24 Christa and Sylvia. 02:35:52:23 - 02:35:53:05 Well, me 02:35:53:05 - 02:35:57:10 and my family we came 2018 to Canada 02:35:57:12 - 02:35:59:11 and for 02:35:59:11 - 02:36:03:21 six years I was trying to avoid 02:36:03:23 - 02:36:06:18 going to emergency room 02:36:06:18 - 02:36:09:08 because before we immigrated to Canada, 02:36:09:08 - 02:36:12:08 we've heard a lot of terrifying stories 02:36:12:14 - 02:36:14:22 about emergency rooms in North America, 02:36:14:22 - 02:36:17:23 how you can spend like 7 or 8 hours or 02:36:17:23 - 02:36:19:22 even more. 02:36:19:24 - 02:36:22:12 So I'm a nurse. 02:36:22:12 - 02:36:24:10 I think that's important to share. 02:36:24:10 - 02:36:26:08 I'm a nurse back home, 02:36:26:08 - 02:36:30:04 and I was very prepared when we decided 02:36:30:06 - 02:36:31:08 to move to Canada. 02:36:31:08 - 02:36:34:24 I took everything I can take 02:36:35:01 - 02:36:38:00 so I can check my kids and deal 02:36:38:00 - 02:36:40:05 with everything by myself. 02:36:40:05 - 02:36:45:08 But the other thing, since I have kids 02:36:45:10 - 02:36:48:22 and I have all this knowledge, 02:36:48:24 - 02:36:50:06 I have two. 02:36:50:06 - 02:36:54:11 I have two big fears Anaphylaxis 02:36:54:13 - 02:36:57:10 and DKA. 02:36:57:10 - 02:37:00:01 So that's why 02:37:00:01 - 02:37:02:06 probably I called my son 02:37:02:06 - 02:37:05:06 immediately at the very beginning. 02:37:05:07 - 02:37:09:05 And this happened last year in October. 02:37:09:07 - 02:37:10:24 It was Saturday morning. 02:37:10:24 - 02:37:13:05 We had breakfast 02:37:13:05 - 02:37:18:00 and my son asked me for water. 02:37:18:02 - 02:37:20:20 And I realized that the whole week 02:37:20:20 - 02:37:23:20 this guy was asking me for water. 02:37:24:01 - 02:37:27:11 My kids don't ask for water here because 02:37:27:13 - 02:37:31:02 I am that parent who 02:37:31:04 - 02:37:33:01 ask them to drink water all the time. 02:37:33:01 - 02:37:34:03 Drink water, drink water, 02:37:34:03 - 02:37:36:13 and they never been thirsty. 02:37:36:13 - 02:37:38:16 But when he asked me again on Saturday, 02:37:38:16 - 02:37:41:10 I had this flashback 02:37:41:10 - 02:37:43:09 for the previous whole week. 02:37:43:09 - 02:37:44:21 He was asking for water. 02:37:44:21 - 02:37:48:18 I need water when we are outside, 02:37:48:20 - 02:37:50:14 when we are at home. 02:37:50:14 - 02:37:51:19 And I was like, 02:37:51:19 - 02:37:53:02 you know, buddy, let's check 02:37:53:02 - 02:37:54:23 your blood sugar. 02:37:54:23 - 02:37:56:04 I have glucometer. 02:37:56:04 - 02:37:57:10 I check my kid's blood 02:37:57:10 - 02:37:58:01 sugar, 02:37:58:01 - 02:38:01:11 let's say three times per year randomly, 02:38:01:13 - 02:38:05:20 because that's that's huge fear for me. 02:38:05:22 - 02:38:07:04 And I checked, 02:38:07:04 - 02:38:11:07 it was 24. 02:38:11:09 - 02:38:12:13 The nurse in me 02:38:12:13 - 02:38:14:11 knew immediately, 02:38:14:11 - 02:38:17:07 but the mom in me was like, no way. 02:38:17:07 - 02:38:20:04 Like, this is not happening to this guy. 02:38:20:04 - 02:38:21:22 It's very strange moment. 02:38:21:22 - 02:38:23:04 You know it's true, 02:38:23:04 - 02:38:27:05 but the same time you cannot believe it. 02:38:27:07 - 02:38:28:16 And I 02:38:28:16 - 02:38:30:00 changed the Lancet, 02:38:30:00 - 02:38:31:23 and I check my blood sugar 02:38:31:23 - 02:38:32:18 cause I thought, 02:38:32:18 - 02:38:35:08 this glucometer is not right. 02:38:35:08 - 02:38:38:03 But it was. 02:38:38:05 - 02:38:40:01 And it was Saturday morning. 02:38:40:01 - 02:38:43:06 He’s very happy, active, the same. 02:38:43:09 - 02:38:44:03 Nothing. 02:38:44:03 - 02:38:45:24 He doesn't feel bad. 02:38:45:24 - 02:38:48:07 He's not in discomfort anything. 02:38:48:07 - 02:38:51:05 He's the same boy. 02:38:51:05 - 02:38:51:21 And I was like, 02:38:51:21 - 02:38:53:20 okay, I didn't know how the things 02:38:53:20 - 02:38:54:22 work in Canada. 02:38:54:22 - 02:38:55:16 Back home, 02:38:55:16 - 02:38:58:21 you go to your family physician. 02:38:58:23 - 02:39:00:13 He immediately prescribe 02:39:00:13 - 02:39:02:09 you the medication you need 02:39:02:09 - 02:39:05:11 and refers you to endocrinologist 02:39:05:11 - 02:39:06:11 like immediately, 02:39:06:11 - 02:39:09:07 not after months or days. 02:39:09:07 - 02:39:10:21 And I thought, it's the same. 02:39:10:21 - 02:39:11:20 And I said to my husband, 02:39:11:20 - 02:39:14:00 It's Saturday, let's wait for Monday. 02:39:14:00 - 02:39:15:00 I will call up, 02:39:15:00 - 02:39:16:24 call our family physician, 02:39:16:24 - 02:39:20:09 and we will go from there. 02:39:20:11 - 02:39:23:21 But he was worried. 02:39:23:23 - 02:39:26:12 And we have this 02:39:26:12 - 02:39:29:02 this option for 02:39:29:02 - 02:39:32:18 face timing with the nurse practitioners 02:39:32:23 - 02:39:34:06 from his work. 02:39:34:06 - 02:39:36:22 We have this, which is awesome. 02:39:36:22 - 02:39:37:15 And I said, okay, 02:39:37:15 - 02:39:39:10 let's call nurse practitioner 02:39:39:10 - 02:39:42:14 and we will go and enjoy the weekend. 02:39:42:16 - 02:39:45:22 When the guy heard the number, he said, 02:39:45:24 - 02:39:48:13 Take your son immediately 02:39:48:13 - 02:39:50:11 to the emergency room. 02:39:50:11 - 02:39:52:19 And I said, But he's fine. 02:39:52:19 - 02:39:54:04 And emergency rooms 02:39:54:04 - 02:39:57:01 maybe will stay for 8 hours for my son, 02:39:57:01 - 02:39:58:01 not only for my son, 02:39:58:01 - 02:40:01:00 I assume for every seven year old kid. 02:40:01:00 - 02:40:02:16 It's a torture. 02:40:02:16 - 02:40:04:04 And with this blood sugar, 02:40:04:04 - 02:40:06:08 his immune system is not good. 02:40:06:08 - 02:40:07:06 Staying there 02:40:07:06 - 02:40:09:01 for seven, 8 hours in this room 02:40:09:01 - 02:40:10:13 with people sneezing, coughing. 02:40:10:13 - 02:40:12:05 In October, I was like, 02:40:12:05 - 02:40:14:08 Can we avoid that? 02:40:14:08 - 02:40:16:05 And the guy was, 02:40:16:05 - 02:40:16:22 the second 02:40:16:22 - 02:40:18:10 they hear that number, 02:40:18:10 - 02:40:20:17 they gonna admit you immediately. 02:40:20:17 - 02:40:22:17 And I was, okay, I'm going. 02:40:22:17 - 02:40:27:03 No, we stay for a terrible 7 hours 02:40:27:03 - 02:40:29:07 in the emergency room with 02:40:29:07 - 02:40:31:02 people with fever, with. 02:40:31:02 - 02:40:31:16 He was 02:40:31:16 - 02:40:34:12 he became so nervous and so irritated. 02:40:34:12 - 02:40:35:23 And he's such a sweet 02:40:35:23 - 02:40:38:12 and calm and relaxed guy. 02:40:38:12 - 02:40:39:24 And the worst part was 02:40:39:24 - 02:40:43:16 I was asking three or four times 02:40:43:18 - 02:40:46:11 the staff tell me what is going on? 02:40:46:11 - 02:40:46:21 Tell me 02:40:46:21 - 02:40:48:19 how much we going to wait and they’re 02:40:48:19 - 02:40:50:18 like everyone is doing their best. 02:40:50:18 - 02:40:53:17 I know I don't blame anyone. 02:40:53:17 - 02:40:55:11 I know people are working hard, 02:40:55:11 - 02:40:57:22 but I need to know whether I will wait 02:40:57:22 - 02:41:00:13 like 2 hours, 5 hours, or 7 hours. 02:41:00:13 - 02:41:02:20 No one's saying anything 02:41:02:20 - 02:41:04:22 and we're staying there. 02:41:04:22 - 02:41:08:12 So yeah, they admitted us 02:41:08:12 - 02:41:12:13 and the diagnosis was there, 02:41:12:15 - 02:41:15:16 which was not surprise at that point 02:41:15:16 - 02:41:16:09 for me. 02:41:16:09 - 02:41:18:01 I was. I was sure is this. 02:41:18:01 - 02:41:20:09 It can be. 02:41:20:09 - 02:41:24:23 And our adventure start. 02:41:25:00 - 02:41:25:17 My youngest 02:41:25:17 - 02:41:26:22 son was diagnosed 02:41:26:22 - 02:41:29:15 last year in March 2022. 02:41:29:15 - 02:41:31:04 I had noticed in earlier in the year 02:41:31:04 - 02:41:32:24 when he was seven years old, 02:41:32:24 - 02:41:34:06 something was going on with him. 02:41:34:06 - 02:41:35:02 He hadn't been feeling 02:41:35:02 - 02:41:37:04 well in general, was losing weight. 02:41:37:04 - 02:41:38:16 He was not as active 02:41:38:16 - 02:41:41:04 and full of energy is usually was. 02:41:41:06 - 02:41:43:05 Then my oldest son got COVID 02:41:43:05 - 02:41:45:04 and while we tried to isolate at home, 02:41:45:04 - 02:41:46:18 inevitably my youngest 02:41:46:18 - 02:41:48:09 and I got it as well. 02:41:48:09 - 02:41:50:22 It was relatively mild at first, 02:41:50:22 - 02:41:53:13 but then my youngest got really sick. 02:41:53:13 - 02:41:54:16 He wasn't getting better. 02:41:54:16 - 02:41:57:16 He was vomiting and tired and thirsty. 02:41:57:22 - 02:41:59:20 And I'm never one to rush to the hospital 02:41:59:20 - 02:42:00:13 right away. 02:42:00:13 - 02:42:02:10 I try to focus on fluids and rest, 02:42:02:10 - 02:42:04:00 but with no improvement. 02:42:04:00 - 02:42:04:15 I had to take him 02:42:04:15 - 02:42:06:10 to the emergency department. 02:42:06:10 - 02:42:08:18 He was taken in right away 02:42:08:18 - 02:42:11:09 as he was in rough shape at this time. 02:42:11:09 - 02:42:12:04 And I'm 02:42:12:04 - 02:42:13:00 so thankful 02:42:13:00 - 02:42:13:22 that the doctor seemed 02:42:13:22 - 02:42:16:00 to recognize the signs and symptoms. 02:42:16:00 - 02:42:18:08 He moved directly passed the COVID 02:42:18:08 - 02:42:19:17 into testing 02:42:19:17 - 02:42:20:08 and shortly 02:42:20:08 - 02:42:21:16 after confirmed a Type 02:42:21:16 - 02:42:23:22 one diabetes diagnosis. 02:42:23:22 - 02:42:24:17 Looking back, 02:42:24:17 - 02:42:25:24 his diagnosis makes sense 02:42:25:24 - 02:42:27:10 now with his symptoms. 02:42:27:10 - 02:42:28:20 But until you actually hear 02:42:28:20 - 02:42:30:03 from the doctor, 02:42:30:03 - 02:42:31:09 he has diabetes, 02:42:31:09 - 02:42:34:02 you just don't put it together. 02:42:34:02 - 02:42:36:01 I remember saying out loud, 02:42:36:01 - 02:42:37:15 I didn't know, 02:42:37:15 - 02:42:40:14 and the nurse immediately gave me a hug. 02:42:40:14 - 02:42:41:14 I've heard since that 02:42:41:14 - 02:42:43:15 that's how a lot of parents find out 02:42:43:15 - 02:42:46:01 in the emergency department. 02:42:46:03 - 02:42:47:22 I was devastated. 02:42:47:22 - 02:42:49:14 I was overwhelmed. 02:42:49:14 - 02:42:52:05 And honestly, I felt defeated. 02:42:52:05 - 02:42:53:04 Eight months earlier, 02:42:53:04 - 02:42:54:16 my wonderful husband 02:42:54:16 - 02:42:55:22 died in a very tragic 02:42:55:22 - 02:42:57:21 car accident that we were both in. 02:42:57:21 - 02:42:58:06 So my 02:42:58:06 - 02:42:59:20 two boys and I were as a family, 02:42:59:20 - 02:43:02:12 going through intense grieving process. 02:43:02:12 - 02:43:04:11 So once again, I'd say 02:43:04:11 - 02:43:05:04 I went through the same 02:43:05:04 - 02:43:06:03 types of questions 02:43:06:03 - 02:43:07:10 I'd been through before. 02:43:07:10 - 02:43:08:21 Why us? Why now? 02:43:08:21 - 02:43:09:24 How am I going to figure this out 02:43:09:24 - 02:43:12:14 and take care of of my boys? 02:43:12:14 - 02:43:14:08 I learned very quickly 02:43:14:08 - 02:43:17:05 how intense a diagnosis of t1d is. 02:43:17:05 - 02:43:20:05 It is all consuming from day one. 02:43:20:07 - 02:43:22:21 We stayed in pediatrics for two nights 02:43:22:21 - 02:43:23:23 as they give him insulin. 02:43:23:23 - 02:43:25:12 Things got more settled. 02:43:25:12 - 02:43:26:11 We were immediately 02:43:26:11 - 02:43:27:19 connected to the Charles H. 02:43:27:19 - 02:43:28:20 Best Centre, 02:43:28:20 - 02:43:29:22 an amazing 02:43:29:22 - 02:43:31:09 not for profit organization 02:43:31:09 - 02:43:31:18 in Durham 02:43:31:18 - 02:43:34:02 region dedicated to t1d 02:43:34:02 - 02:43:35:23 and supporting patients and families. 02:43:35:23 - 02:43:38:16 I am so thankful for the Best Centre, 02:43:38:16 - 02:43:41:03 especially being a solo parent now. 02:43:41:03 - 02:43:42:10 It was my life support 02:43:42:10 - 02:43:43:24 for t1d at the time. 02:43:43:24 - 02:43:46:06 I relied on them so much 02:43:46:06 - 02:43:48:06 the doctors, nurses, dietitians, 02:43:48:06 - 02:43:49:24 especially as he had some sick days 02:43:49:24 - 02:43:51:13 early on, I trusted 02:43:51:13 - 02:43:53:11 they would help me keep them safe. 02:43:53:11 - 02:43:54:21 Remember, we both had COVID, 02:43:54:21 - 02:43:56:09 so we were in isolation. 02:43:56:09 - 02:43:58:11 So we did a lot of our education 02:43:58:11 - 02:43:59:11 over Zoom. 02:43:59:11 - 02:44:00:24 I learned how to use the devices 02:44:00:24 - 02:44:02:05 with the nurse at the hospital 02:44:02:05 - 02:44:04:19 and nurse at Zoom. It was crazy. 02:44:04:19 - 02:44:05:23 There was not a lot of sleep 02:44:05:23 - 02:44:07:18 in those early days. 02:44:07:18 - 02:44:09:07 I received supplies 02:44:09:07 - 02:44:11:05 from the Best Centre initially 02:44:11:05 - 02:44:12:12 and we were sent home 02:44:12:12 - 02:44:13:17 to continue our education, 02:44:13:17 - 02:44:15:23 to live day to day with the diagnosis. 02:44:15:23 - 02:44:17:23 My son had missed a few days of school. 02:44:17:23 - 02:44:20:06 He went back after March break, 02:44:20:06 - 02:44:20:23 the Best Centre 02:44:20:23 - 02:44:21:21 hosted an online 02:44:21:21 - 02:44:22:22 education session 02:44:22:22 - 02:44:25:03 with a few key people at his school: 02:44:25:03 - 02:44:26:13 the teacher, a gym teacher, 02:44:26:13 - 02:44:28:07 principal, VP, 02:44:28:07 - 02:44:29:10 and provided resources 02:44:29:10 - 02:44:30:18 and details about t1d. 02:44:30:18 - 02:44:32:16 So then I worked with this teacher 02:44:32:16 - 02:44:33:19 to make a plan 02:44:33:19 - 02:44:37:04 for my son to get back to class safely. 02:44:37:06 - 02:44:41:00 Family was a definite support to me. 02:44:41:02 - 02:44:42:11 I have some family close by 02:44:42:11 - 02:44:43:21 and some family further away. 02:44:43:21 - 02:44:46:18 But just to talk, listen, 02:44:46:18 - 02:44:49:09 you know, support me when I needed 02:44:49:09 - 02:44:50:24 help, needed a break, 02:44:50:24 - 02:44:53:03 needed some time away, 02:44:53:03 - 02:44:55:13 and just to support my son as well 02:44:55:13 - 02:44:56:23 and someone for him to talk 02:44:56:23 - 02:45:00:07 to, just share his new story, 02:45:00:09 - 02:45:02:14 the new requirements. 02:45:02:14 - 02:45:03:22 It's it was just helpful 02:45:03:22 - 02:45:05:18 to really have family around 02:45:05:18 - 02:45:08:10 and others to just talk to about this. 02:45:08:10 - 02:45:09:13 A lot of people said, 02:45:09:13 - 02:45:10:06 you know, 02:45:10:06 - 02:45:13:06 hasn't this family been through enough? 02:45:13:08 - 02:45:15:22 But we had showed them that, you know, 02:45:15:22 - 02:45:17:07 we could figure things out. 02:45:17:07 - 02:45:19:24 So with their help, 02:45:19:24 - 02:45:22:21 it was it was doable. 02:45:22:21 - 02:45:25:21 I'll never forget my son's teacher. 02:45:25:22 - 02:45:27:16 I messaged him from the hospital 02:45:27:16 - 02:45:29:06 about the diagnosis, 02:45:29:06 - 02:45:32:02 and right away he said, well, 02:45:32:02 - 02:45:33:22 it takes a village to raise a child 02:45:33:22 - 02:45:35:22 and consider me part of that village, 02:45:35:22 - 02:45:38:12 and I'll never forget that. 02:45:38:14 - 02:45:41:14 I needed that. 02:45:41:18 - 02:45:44:24 My personality is like this. 02:45:45:01 - 02:45:46:09 I don't 02:45:46:09 - 02:45:48:13 I don't overthink 02:45:48:13 - 02:45:50:23 when the problem is there. 02:45:50:23 - 02:45:53:08 And I would say I'm a fighter, 02:45:53:08 - 02:45:55:03 so I'm not like, 02:45:55:03 - 02:45:58:13 I know this moment is very 02:45:58:15 - 02:46:02:10 has very huge mental impact on people. 02:46:02:10 - 02:46:04:12 But my thinking 02:46:04:12 - 02:46:05:23 is, okay, the problem 02:46:05:23 - 02:46:07:18 is there how to solve it. 02:46:07:18 - 02:46:08:20 The second 02:46:08:20 - 02:46:10:12 the pediatrician came and said, 02:46:10:12 - 02:46:14:03 Your son has type one, 02:46:14:05 - 02:46:18:05 I said, Did you run all the tests? 02:46:18:05 - 02:46:19:21 Are you sure? 02:46:19:21 - 02:46:22:09 And she said, Hundred percent. 02:46:22:09 - 02:46:24:06 And that was it for me. 02:46:24:06 - 02:46:27:02 From that point I started thinking, 02:46:27:02 - 02:46:29:07 What can I do? 02:46:29:07 - 02:46:32:17 But it's not a common experience 02:46:32:17 - 02:46:34:05 and it's not fair, 02:46:34:05 - 02:46:36:14 I think, toward other families, 02:46:36:14 - 02:46:39:03 because I knew what type one is. 02:46:39:03 - 02:46:42:20 I had a very good knowledge of type one. 02:46:42:22 - 02:46:44:18 Some people, 02:46:44:20 - 02:46:45:16 as we say, that 02:46:45:16 - 02:46:48:19 type one doesn't discriminate. 02:46:48:21 - 02:46:50:00 It's not necessary 02:46:50:00 - 02:46:51:24 for you to know what the insulin is 02:46:51:24 - 02:46:55:18 or what pancreas is, and I cannot imagine 02:46:55:19 - 02:46:59:03 parents receiving this, 02:46:59:05 - 02:47:01:05 your son has type one. What is this? 02:47:01:05 - 02:47:02:05 What is. 02:47:02:05 - 02:47:03:22 I heard about pancreas. 02:47:03:22 - 02:47:06:01 But what exactly of this is. 02:47:06:01 - 02:47:11:02 For these families, I feel very, very bad 02:47:11:04 - 02:47:13:19 and I cannot imagine how hard 02:47:13:19 - 02:47:17:20 that is like mentally and physically and 02:47:17:22 - 02:47:19:02 I educate myself, 02:47:19:02 - 02:47:20:20 even if even people 02:47:20:20 - 02:47:23:00 with the medical background, 02:47:23:00 - 02:47:27:10 when they face this 02:47:27:12 - 02:47:30:04 type of diabetes in their life, 02:47:30:04 - 02:47:33:20 they have to continue 02:47:33:22 - 02:47:35:24 learning about it. 02:47:35:24 - 02:47:37:02 Because it's one thing 02:47:37:02 - 02:47:38:24 learning about this in school 02:47:38:24 - 02:47:40:03 from the books. 02:47:40:03 - 02:47:42:17 One thing to live with it. 02:47:42:17 - 02:47:44:22 And it's very different experience 02:47:44:22 - 02:47:47:06 for every family. 02:47:47:06 - 02:47:51:18 Diabetes is not one size fits everyone. 02:47:51:20 - 02:47:53:08 I remember, 02:47:53:08 - 02:47:55:09 it's very hard to make me cry. 02:47:55:09 - 02:47:59:02 I don't know why it's me, but I remember 02:47:59:02 - 02:48:02:19 I cried a lot. 02:48:02:21 - 02:48:05:21 I picked up the prescription. 02:48:05:23 - 02:48:09:16 It was a big bag with insulin, 02:48:09:20 - 02:48:13:16 with Baqsimi glucagon, with everything. 02:48:13:18 - 02:48:16:15 And I went in my bathroom. 02:48:16:15 - 02:48:17:23 I look at this, 02:48:17:23 - 02:48:19:20 I look at this medications, 02:48:19:20 - 02:48:22:06 and I just start crying 02:48:22:06 - 02:48:25:01 because I realize, what 02:48:25:01 - 02:48:28:01 if this guy, when he grows, now we good. 02:48:28:03 - 02:48:29:20 I'm so happy. We good. 02:48:29:20 - 02:48:32:20 We have a nice insurance, a very good 02:48:32:23 - 02:48:34:18 everything is 02:48:34:18 - 02:48:36:11 good now at that point. 02:48:36:11 - 02:48:37:15 But what 02:48:37:15 - 02:48:39:13 if this guy, when he grows up, 02:48:39:13 - 02:48:41:20 he doesn't have a nice insurance? 02:48:41:20 - 02:48:43:17 He struggled to have this. 02:48:43:17 - 02:48:46:12 He has to have this 02:48:46:12 - 02:48:47:22 to live. 02:48:47:22 - 02:48:49:06 He has to have insulin. 02:48:49:06 - 02:48:52:16 He has to have the glucose monitor 02:48:52:18 - 02:48:56:02 system to have a good management. 02:48:56:03 - 02:49:00:05 What, that's when it hits me. 02:49:00:07 - 02:49:01:05 I cried. 02:49:01:05 - 02:49:03:01 I grieved. And that was all. 02:49:03:01 - 02:49:06:24 Because diabetes is like life, 02:49:07:00 - 02:49:09:08 to be honest. You never know. 02:49:09:08 - 02:49:11:05 You take day by day. 02:49:11:05 - 02:49:12:05 It's hard. 02:49:12:05 - 02:49:14:05 It's a challenge. 02:49:14:05 - 02:49:15:20 You cannot do anything 02:49:15:20 - 02:49:18:11 except do your best. 02:49:18:11 - 02:49:19:13 We decided, well, 02:49:19:13 - 02:49:22:07 I will finish college here 02:49:22:07 - 02:49:23:22 while my son is at home. 02:49:23:22 - 02:49:27:20 And when he starts JK, I will go and 02:49:27:22 - 02:49:28:21 find something. 02:49:28:21 - 02:49:32:09 And everything was according to plan. 02:49:32:11 - 02:49:34:04 I start working part time. 02:49:34:04 - 02:49:36:10 After that, I start full time. 02:49:36:10 - 02:49:40:04 Everything is perfect. 02:49:40:06 - 02:49:42:13 And when this happened, 02:49:42:16 - 02:49:44:21 My son is 02:49:44:21 - 02:49:46:00 he was seven. 02:49:46:00 - 02:49:48:18 He was in grade two in October. 02:49:48:18 - 02:49:50:09 Now he's eight 02:49:50:09 - 02:49:51:22 and he's gonna be grade 02:49:51:22 - 02:49:53:12 three in September. 02:49:53:12 - 02:49:56:18 My reaction was like, What are we 02:49:56:18 - 02:49:58:12 going to do? 02:49:58:14 - 02:49:59:18 I'm working full time. 02:49:59:18 - 02:50:02:00 My husband is working full time at home, 02:50:02:00 - 02:50:04:12 We live very close to the school. 02:50:04:18 - 02:50:07:13 And he said that the beginning. 02:50:07:13 - 02:50:10:01 I can go 02:50:10:01 - 02:50:12:04 during the two nutritional break, 02:50:12:04 - 02:50:14:01 I can go and administer 02:50:14:01 - 02:50:15:17 insulin and check on him. 02:50:15:17 - 02:50:18:17 But how long is gonna continue? 02:50:18:19 - 02:50:20:18 I found out then 02:50:20:18 - 02:50:22:14 that there is no full time 02:50:22:14 - 02:50:24:05 nurse in the Canadian schools. 02:50:24:12 - 02:50:27:18 But our nurse told us, You know what? 02:50:27:18 - 02:50:28:15 There is an option 02:50:28:15 - 02:50:29:20 I can connect you 02:50:29:20 - 02:50:32:00 with the agency, nurse agency. 02:50:32:00 - 02:50:33:19 And they can send a nurse 02:50:33:19 - 02:50:35:12 during the nutritional break 02:50:35:12 - 02:50:37:17 to administer the insulin. 02:50:37:17 - 02:50:40:06 According to the doses 02:50:40:06 - 02:50:42:08 from the pediatrician. 02:50:42:12 - 02:50:44:07 We spoke with the agency. 02:50:44:07 - 02:50:46:09 They said there is a shortage of nurses. 02:50:46:09 - 02:50:47:19 That was October. 02:50:47:19 - 02:50:48:20 There is a shortage. 02:50:48:20 - 02:50:50:16 A shortage of nurses. 02:50:50:16 - 02:50:54:19 I, I don't know how long this will take 02:50:54:21 - 02:50:57:06 for the nurse to be available for you, 02:50:57:06 - 02:50:58:22 but you have to know 02:50:58:22 - 02:51:01:07 if there is a shortage in the future. 02:51:01:07 - 02:51:04:07 Even if you have a nurse at some point 02:51:04:07 - 02:51:06:00 they will not be able to come 02:51:06:00 - 02:51:07:09 or if she's sick 02:51:07:09 - 02:51:09:06 and they cannot find a replacement. 02:51:09:06 - 02:51:13:09 So we said, okay, let's let's see. 02:51:13:11 - 02:51:14:24 And I was working and 02:51:14:24 - 02:51:17:21 in December before Christmas break, 02:51:17:21 - 02:51:18:24 they contacted us. 02:51:18:24 - 02:51:21:02 They said there is a nurse who will come 02:51:21:02 - 02:51:22:18 during the nutritional breaks 02:51:22:18 - 02:51:24:00 to administer insulin 02:51:24:00 - 02:51:26:02 and after that she's gone. 02:51:26:02 - 02:51:29:13 That's only for the insulin. 02:51:29:15 - 02:51:34:14 But I already had two months experience 02:51:34:16 - 02:51:37:12 and my son still, thank God. 02:51:37:12 - 02:51:38:13 I know some people 02:51:38:13 - 02:51:40:06 don't like honeymooning period. 02:51:40:06 - 02:51:40:24 I love it. 02:51:40:24 - 02:51:42:01 This is the period 02:51:42:01 - 02:51:45:04 in which their pancreas still producing 02:51:45:04 - 02:51:48:04 some insulin and it's very unpredictable. 02:51:48:10 - 02:51:51:17 And I saw if the nurses coming administer 02:51:51:17 - 02:51:53:20 the insulin according to the insulin 02:51:53:20 - 02:51:57:07 to carb ratio and he go hypo 02:51:57:09 - 02:52:00:18 hypoglycemic, where is the nurse? 02:52:00:20 - 02:52:04:06 We have approximately 600 kids 02:52:04:06 - 02:52:07:06 in our school 02:52:07:07 - 02:52:09:04 situation happens. 02:52:09:04 - 02:52:11:09 You don't have a nurse. 02:52:11:09 - 02:52:15:18 So that was very surprising to us. 02:52:15:18 - 02:52:21:03 And I after all, me and my husband decide 02:52:21:05 - 02:52:22:24 that I have to 02:52:22:24 - 02:52:26:18 stay at home and 02:52:26:20 - 02:52:30:17 manage my son's blood glucose levels. 02:52:30:19 - 02:52:33:11 I never thought it never crossed my mind 02:52:33:11 - 02:52:37:03 because I never, we never 02:52:37:05 - 02:52:39:01 needed for anything. 02:52:39:01 - 02:52:41:20 And I'm very, 02:52:41:20 - 02:52:42:22 very grateful 02:52:42:22 - 02:52:45:15 because our school is amazing. 02:52:45:15 - 02:52:50:24 We have amazing support from our office 02:52:51:01 - 02:52:52:19 staff, from the principal, 02:52:52:19 - 02:52:54:00 from the teachers. 02:52:54:00 - 02:52:55:24 Our experience is super positive, 02:52:55:24 - 02:52:58:09 but they work with me. 02:52:58:09 - 02:52:59:13 I'm available. 02:52:59:13 - 02:53:01:02 He doesn't feel good. 02:53:01:02 - 02:53:04:01 I'm right there for within a minute. 02:53:04:01 - 02:53:06:04 I watch his Dexcom. 02:53:06:04 - 02:53:07:21 I follow the Dexcom. 02:53:07:21 - 02:53:10:06 The second I see he's going down, 02:53:10:06 - 02:53:12:13 I called them. They react. 02:53:12:13 - 02:53:13:07 But this 02:53:13:07 - 02:53:15:13 and this is working super great 02:53:15:13 - 02:53:18:10 because I'm available and this can't. 02:53:18:10 - 02:53:19:09 Because of that, 02:53:19:09 - 02:53:21:07 my son doesn't have any 02:53:21:07 - 02:53:23:19 any negative experience 02:53:23:19 - 02:53:26:19 and that that that is my goal 02:53:26:19 - 02:53:30:01 cause he's gonna live with this forever. 02:53:30:03 - 02:53:32:09 I want him at least to have a 02:53:32:09 - 02:53:36:00 nice and carefree childhood. 02:53:36:02 - 02:53:39:23 I wish I had known and truly believed 02:53:40:00 - 02:53:41:06 that it is possible 02:53:41:06 - 02:53:43:02 to incorporate diabetes management 02:53:43:02 - 02:53:44:24 into our everyday lives, 02:53:44:24 - 02:53:47:06 including at school. 02:53:47:06 - 02:53:49:05 I heard this from people, 02:53:49:05 - 02:53:49:20 but I didn't know 02:53:49:20 - 02:53:51:22 really understand how that could be true. 02:53:51:22 - 02:53:52:21 I didn't see it 02:53:52:21 - 02:53:54:13 when I joined online communities 02:53:54:13 - 02:53:56:14 or spoke to other parents. 02:53:56:14 - 02:53:58:23 It all seemed like a lot of conversations 02:53:58:23 - 02:54:01:12 of overwhelm and stress, 02:54:01:12 - 02:54:03:03 the constant rhythm of blood 02:54:03:03 - 02:54:04:24 glucose graphs and alarms. 02:54:04:24 - 02:54:05:22 And considering 02:54:05:22 - 02:54:07:07 my son was in grade three, 02:54:07:07 - 02:54:08:17 I just didn't understand how I could 02:54:08:17 - 02:54:11:01 manage the demands of this condition 02:54:11:01 - 02:54:11:19 and live our lives 02:54:11:19 - 02:54:13:17 without this taking over. 02:54:13:17 - 02:54:15:05 And I have two boys, 02:54:15:05 - 02:54:16:06 so I want to be present. 02:54:16:06 - 02:54:18:20 We focused on both of them, 02:54:18:22 - 02:54:19:16 so I had 02:54:19:16 - 02:54:21:03 learned through our tragedy 02:54:21:03 - 02:54:22:18 we could
do hard things. 02:54:22:18 - 02:54:24:01 So I guess I just decided 02:54:24:01 - 02:54:24:17 that things were now 02:54:24:17 - 02:54:25:22 going to be even harder. 02:54:25:22 - 02:54:27:24 I needed to figure that out. 02:54:27:24 - 02:54:29:22 So pray for strength and keep going. 02:54:29:22 - 02:54:31:23 It's what I do. 02:54:31:23 - 02:54:33:01 I was fortunate 02:54:33:01 - 02:54:34:14 that my son's school administration 02:54:34:14 - 02:54:35:13 and teaching 02:54:35:13 - 02:54:38:08 staff were so supportive of my family 02:54:38:08 - 02:54:39:11 and wanted to do anything 02:54:39:11 - 02:54:41:21 they could to have my son back in class. 02:54:41:21 - 02:54:44:15 He's amazing social athletic students. 02:54:44:15 - 02:54:46:20 We really wanted him to see him 02:54:46:20 - 02:54:49:00 thrive and be back with his friends 02:54:49:00 - 02:54:50:01 and he was feeling 02:54:50:01 - 02:54:53:19 and looking so much healthier and active 02:54:53:21 - 02:54:54:19 and back to my fun 02:54:54:19 - 02:54:56:08 energetic eight year old. 02:54:56:08 - 02:54:58:01 And it's so important 02:54:58:01 - 02:54:59:05 to partner in your child's 02:54:59:05 - 02:55:00:23 care together with the school 02:55:00:23 - 02:55:02:01 and as a parent 02:55:02:01 - 02:55:03:05 to really be a driver 02:55:03:05 - 02:55:05:05 of setting them up for success. 02:55:05:05 - 02:55:06:12 You're both still learning, 02:55:06:12 - 02:55:09:11 but there are key ways to get ready. 02:55:09:13 - 02:55:10:03 The first is 02:55:10:03 - 02:55:13:03 open communication is a priority. 02:55:13:04 - 02:55:14:17 You have to discuss with the teacher 02:55:14:17 - 02:55:16:15 the easiest way to get in touch with you. 02:55:16:15 - 02:55:17:19 What requires a check 02:55:17:19 - 02:55:19:14 in, when snacks and juice 02:55:19:14 - 02:55:22:13 need to be restocked and so much more. 02:55:22:13 - 02:55:23:10 My son's teacher 02:55:23:10 - 02:55:25:21 actually spoke to his class about t1d 02:55:25:21 - 02:55:27:12 before my son returned, 02:55:27:12 - 02:55:29:16 so they were aware of what he had, 02:55:29:16 - 02:55:29:23 you know, 02:55:29:23 - 02:55:30:22 what he was dealing with 02:55:30:22 - 02:55:31:23 and how they could support him 02:55:31:23 - 02:55:33:15 when he returned, 02:55:33:15 - 02:55:35:08 our principal through a colleague, 02:55:35:08 - 02:55:36:13 found out that our school board 02:55:36:13 - 02:55:38:00 has a care plan 02:55:38:00 - 02:55:39:10 document for t1d 02:55:39:10 - 02:55:41:12 So we used that and completed it 02:55:41:12 - 02:55:43:04 to outline his diabetes management 02:55:43:04 - 02:55:45:05 at school. 02:55:45:05 - 02:55:47:18 Next, preparing for lunch and snacks 02:55:47:18 - 02:55:49:12 is really important. 02:55:49:12 - 02:55:52:06 In absence of a nurse coming to school, 02:55:52:06 - 02:55:53:17 we didn't have a nurse. 02:55:53:17 - 02:55:54:12 There's a shortage. 02:55:54:12 - 02:55:55:21 So I started going into the school 02:55:55:21 - 02:55:56:17 every day 02:55:56:17 - 02:55:57:17 to administer insulin 02:55:57:17 - 02:55:59:16 for a few minutes before lunch. 02:55:59:16 - 02:56:02:02 It is not practical when you're working. 02:56:02:02 - 02:56:04:07 I had a bit of flexibility at the time. 02:56:04:07 - 02:56:06:15 Fortunately, my son felt comfortable 02:56:06:15 - 02:56:07:20 giving himself injections 02:56:07:20 - 02:56:09:07 within a few months 02:56:09:07 - 02:56:10:10 after his diagnosis 02:56:10:10 - 02:56:12:22 and that was a game changer. 02:56:12:24 - 02:56:14:02 I give him cards in the 02:56:14:02 - 02:56:15:19 same range every lunch, 02:56:15:19 - 02:56:16:02 so he 02:56:16:02 - 02:56:17:23 uses chart with its carb 02:56:17:23 - 02:56:21:03 range, his blood glucose and administers 02:56:21:03 - 02:56:21:19 what he needs. 02:56:21:19 - 02:56:23:09 So again, I'd set up a process 02:56:23:09 - 02:56:25:06 with the school 02:56:25:06 - 02:56:25:24 where they could have 02:56:25:24 - 02:56:27:00 an adult supervise him 02:56:27:00 - 02:56:28:11 and they would text me 02:56:28:11 - 02:56:29:08 the dose and I would just know 02:56:29:08 - 02:56:30:16 it was done. 02:56:30:16 - 02:56:32:15 More recently, he has a nurse now 02:56:32:15 - 02:56:33:18 come to the school 02:56:33:18 - 02:56:35:21 and they often let me know how empowered 02:56:35:21 - 02:56:36:13 and knowledgeable 02:56:36:13 - 02:56:38:01 my son is about his condition, 02:56:38:01 - 02:56:41:01 which makes me so proud. 02:56:41:01 - 02:56:42:12 You also need to ensure office 02:56:42:12 - 02:56:43:12 and classroom 02:56:43:12 - 02:56:45:22 have stopped emergency kits, 02:56:45:22 - 02:56:48:13 extra snacks, and also the clear 02:56:48:13 - 02:56:51:17 process of who's going to take those 02:56:51:19 - 02:56:53:11 when they have fire 02:56:53:11 - 02:56:54:08 drills or school 02:56:54:08 - 02:56:56:21 trips outside all going to work. 02:56:56:21 - 02:56:58:05 There's going to be kinks 02:56:58:05 - 02:57:00:00 to work out as you're learning. 02:57:00:00 - 02:57:01:12 But with good communication 02:57:01:12 - 02:57:04:17 and staff like I have at this school 02:57:04:17 - 02:57:06:05 that go beyond, 02:57:06:05 - 02:57:07:18 I'm going through the motions 02:57:07:18 - 02:57:09:18 and genuinely caring about my child. 02:57:09:18 - 02:57:11:03 We're such a good team 02:57:11:03 - 02:57:13:10 supporting my son together. 02:57:13:10 - 02:57:14:04 I really felt 02:57:14:04 - 02:57:15:13 it was important to prioritize 02:57:15:13 - 02:57:17:20 this sense of belonging in the classroom. 02:57:17:20 - 02:57:18:14 You can ask 02:57:18:14 - 02:57:20:01 teachers to give you a heads up 02:57:20:01 - 02:57:21:07 if there's special snacks, 02:57:21:07 - 02:57:24:03 parties, activities and sports at school. 02:57:24:03 - 02:57:25:18 You can, as a parent, make a choice 02:57:25:18 - 02:57:26:24 if you want to participate, 02:57:26:24 - 02:57:27:17 If you want them to have 02:57:27:17 - 02:57:30:03 the snack, participate in sports, 02:57:30:03 - 02:57:31:06 you can make it happen. 02:57:31:06 - 02:57:33:10 It just takes some planning. 02:57:33:10 - 02:57:34:20 And then finally, remember, 02:57:34:20 - 02:57:36:04 your child is at the center 02:57:36:04 - 02:57:38:22 of all this initial swirl 02:57:38:22 - 02:57:40:24 while we all work to monitor blood sugars 02:57:40:24 - 02:57:42:10 ensure is cared for, 02:57:42:10 - 02:57:43:06 we need to remember he's 02:57:43:06 - 02:57:45:22 so much more than this condition. 02:57:45:22 - 02:57:46:21 The first questions 02:57:46:21 - 02:57:48:09 at the end of the school day. 02:57:48:09 - 02:57:50:08 They need to be about the silly thing 02:57:50:08 - 02:57:51:07 you did at recess, 02:57:51:07 - 02:57:53:01 the new sport he learned in gym. 02:57:53:01 - 02:57:55:12 It's got to be about the kids stuff 02:57:55:12 - 02:57:57:14 and then the diabetes stuff. 02:57:57:14 - 02:57:59:19 I say my best piece of advice 02:57:59:19 - 02:58:00:10 for parents 02:58:00:10 - 02:58:03:24 is beware of analysis paralysis 02:58:04:01 - 02:58:05:12 that term. 02:58:05:12 - 02:58:06:14 The more information 02:58:06:14 - 02:58:07:21 and data you have, 02:58:07:21 - 02:58:09:16 it can sometimes lead to questioning 02:58:09:16 - 02:58:11:17 what to do, or even worse, 02:58:11:17 - 02:58:12:23 or doing nothing at all. 02:58:12:23 - 02:58:15:12 T1d is overwhelming. 02:58:15:12 - 02:58:17:04 There's so much information out there 02:58:17:04 - 02:58:18:09 and you have so many data 02:58:18:09 - 02:58:21:10 points of blood glucose figures taken 02:58:21:10 - 02:58:22:06 every few minutes 02:58:22:06 - 02:58:24:19 you can obsess over and react to. 02:58:24:19 - 02:58:27:07 So if you've educated yourself, 02:58:27:07 - 02:58:28:19 if you're learning about how activity 02:58:28:19 - 02:58:30:11 and food affect your child, 02:58:30:11 - 02:58:32:17 you prepared key people to support them. 02:58:32:17 - 02:58:34:19 Their blood sugars are in target range. 02:58:34:19 - 02:58:35:01 You know, 02:58:35:01 - 02:58:35:09 you don't 02:58:35:09 - 02:58:36:15 necessarily need to keep 02:58:36:15 - 02:58:37:18 seeking out new ways 02:58:37:18 - 02:58:39:24 of doing things every day. 02:58:39:24 - 02:58:40:23 Be compassionate 02:58:40:23 - 02:58:42:22 with yourself, be patient. 02:58:42:22 - 02:58:43:03 You know, 02:58:43:03 - 02:58:44:18 trust the process in education 02:58:44:18 - 02:58:46:11 that you've been given. 02:58:46:11 - 02:58:47:08 Obsessing over 02:58:47:08 - 02:58:47:22 the numbers 02:58:47:22 - 02:58:48:15 can really lead 02:58:48:15 - 02:58:51:09 to lack of sleep, over treating 02:58:51:09 - 02:58:52:16 and just a general sense 02:58:52:16 - 02:58:53:22 that our lives revolve around 02:58:53:22 - 02:58:55:06 diabetes instead of 02:58:55:06 - 02:58:56:05 we take it with us 02:58:56:05 - 02:58:57:17 as we go about our life. 02:58:57:17 - 02:58:58:18 And so me, 02:58:58:18 - 02:58:59:18 I really 02:58:59:18 - 02:59:02:13 can align it with grief and sadness. 02:59:02:13 - 02:59:02:22 You know, 02:59:02:22 - 02:59:04:06 I take that with me 02:59:04:06 - 02:59:05:05 every day, 02:59:05:05 - 02:59:07:10 and yet I'm living my life with my boys 02:59:07:10 - 02:59:09:13 the best I can right now, 02:59:09:13 - 02:59:11:14 my focus on day one was for my son 02:59:11:14 - 02:59:13:03 and I to be in this together. 02:59:13:03 - 02:59:16:00 He learned everything along with me, 02:59:16:00 - 02:59:17:07 counting carbs, insulin 02:59:17:07 - 02:59:19:18 delivery, advocating for himself, 02:59:19:18 - 02:59:21:11 how activity affects him. 02:59:21:11 - 02:59:22:22 I want him to be comfortable 02:59:22:22 - 02:59:24:12 understanding his condition 02:59:24:12 - 02:59:26:08 and not have complete reliance 02:59:26:08 - 02:59:28:14 that Mommy will do everything. 02:59:28:14 - 02:59:30:00 I often ask him, you know, 02:59:30:00 - 02:59:30:18 how many carbs 02:59:30:18 - 02:59:32:15 do you think that is at restaurants? 02:59:32:15 - 02:59:33:16 Ask him how much insulin 02:59:33:16 - 02:59:34:15 he should be getting. 02:59:34:15 - 02:59:35:20 What we could do next 02:59:35:20 - 02:59:37:12 if his blood sugars lower, high, 02:59:37:12 - 02:59:39:00 they're great teaching moments 02:59:39:00 - 02:59:40:24 to empower your child. 02:59:40:24 - 02:59:42:04 And finally, 02:59:42:04 - 02:59:42:21 for your child's 02:59:42:21 - 02:59:43:16 well-being, it's 02:59:43:16 - 02:59:45:16 really important to model as a parent 02:59:45:16 - 02:59:46:18 what calmly 02:59:46:18 - 02:59:48:07 going about diabetes management 02:59:48:07 - 02:59:49:08 looks like 02:59:49:08 - 02:59:50:06 so they're confident 02:59:50:06 - 02:59:51:09 you can take care of them 02:59:51:09 - 02:59:53:04 and that you know how to respond. 02:59:53:04 - 02:59:54:13 That's really the key. 02:59:54:13 - 02:59:56:16 Knowing how to respond to highs, lows, 02:59:56:16 - 02:59:58:21 sick days, unexpected events, 02:59:58:21 - 03:00:00:19 they are going to happen. 03:00:00:19 - 03:00:02:08 Your child will be looking to 03:00:02:08 - 03:00:04:07 you and we'll start to model 03:00:04:07 - 03:00:06:00 how you present yourself. 03:00:06:00 - 03:00:08:02 The language you use is important. 03:00:08:02 - 03:00:09:22 It's not about good or bad numbers. 03:00:09:22 - 03:00:11:00 It's not about blame. 03:00:11:00 - 03:00:11:10 And looking 03:00:11:10 - 03:00:13:17 back, it's really not responding 03:00:13:17 - 03:00:15:09 and moving forward with your child, 03:00:15:09 - 03:00:16:12 especially in dealing 03:00:16:12 - 03:00:17:17 with whatever you face 03:00:17:17 - 03:00:19:24 and learning as you go together. 03:00:19:24 - 03:00:21:10 There are times, of course, 03:00:21:10 - 03:00:23:10 when I am just done. 03:00:23:10 - 03:00:26:06 I'm tired of injections, tired of alarms, 03:00:26:06 - 03:00:27:13 so I need to take a deep breath 03:00:27:13 - 03:00:28:07 or a break 03:00:28:07 - 03:00:29:06 and then focus again 03:00:29:06 - 03:00:30:19 on what matters, 03:00:30:19 - 03:00:33:10 that he is healthy and safe. 03:00:33:10 - 03:00:35:20 And that's what matters most. 03:00:37:06 - 03:00:39:22 So we are now almost 03:00:39:22 - 03:00:43:21 a year into this in like ten months. 03:00:43:21 - 03:00:45:23 Yeah, ten months into this. 03:00:45:23 - 03:00:51:18 And I think it's very important 03:00:51:20 - 03:00:53:06 for parents 03:00:53:06 - 03:00:54:12 at the very beginning 03:00:54:12 - 03:00:57:02 when they're receiving this diagnosis, 03:00:57:02 - 03:01:01:23 grieve, cry, 03:01:02:00 - 03:01:04:06 be mad, be sad, 03:01:04:06 - 03:01:05:03 but just do it 03:01:05:03 - 03:01:07:09 at the beginning and move on. 03:01:07:09 - 03:01:08:16 Don't keep it. 03:01:08:16 - 03:01:15:00 Don't, don't, don't try to be strong. 03:01:15:02 - 03:01:16:23 Don't, grieve. 03:01:16:23 - 03:01:18:16 Accept it. 03:01:18:16 - 03:01:20:17 Go to the grieving. 03:01:20:17 - 03:01:22:03 Do this at the beginning 03:01:22:03 - 03:01:23:11 because if you don't do it, 03:01:23:11 - 03:01:25:13 it will come later for sure. 03:01:25:13 - 03:01:27:03 Hundred percent. 03:01:27:03 - 03:01:31:15 And after that, focus on the focus 03:01:31:15 - 03:01:34:14 on educating yourself, 03:01:34:14 - 03:01:36:01 start reading books. 03:01:36:01 - 03:01:38:12 There are amazing books out there. 03:01:38:12 - 03:01:40:10 It's not necessary for them 03:01:40:10 - 03:01:42:05 to be a medical professional. 03:01:42:05 - 03:01:43:24 There are amazing books out there. 03:01:43:24 - 03:01:46:02 Can I share amazing 03:01:46:02 - 03:01:49:22 podcasts like this for me 03:01:49:24 - 03:01:52:24 was a life changer. 03:01:53:04 - 03:01:54:22 Game changer. 03:01:54:22 - 03:01:58:02 If you want to have a great management, 03:01:58:04 - 03:02:00:08 if you want to 03:02:00:10 - 03:02:02:10 have the understanding of 03:02:02:10 - 03:02:06:03 the real life management of type one, 03:02:06:05 - 03:02:10:12 go and listen to the Juice Box podcast. 03:02:10:14 - 03:02:12:04 This I did. 03:02:12:04 - 03:02:13:09 I was listening 03:02:13:09 - 03:02:15:04 like crazy at the beginning 03:02:15:04 - 03:02:17:02 to wrap my mind 03:02:17:02 - 03:02:20:23 because you have your team behind you, 03:02:21:00 - 03:02:24:04 but you gonna be the best 03:02:24:04 - 03:02:25:16 and endocrinologist 03:02:25:16 - 03:02:29:02 in your kid’s management. 03:02:29:04 - 03:02:31:06 People with the best knowledge of this 03:02:31:06 - 03:02:34:11 disease are people that are living it. 03:02:34:11 - 03:02:37:03 Follow, they have Facebook group, 03:02:37:03 - 03:02:38:21 this Facebook group. 03:02:38:21 - 03:02:39:14 It's not 03:02:39:14 - 03:02:42:09 only great resource of information 03:02:42:09 - 03:02:44:14 like real life information, 03:02:44:14 - 03:02:46:17 but also you can vent, 03:02:46:17 - 03:02:49:11 you can share your victories, 03:02:49:11 - 03:02:51:04 you can share your 03:02:51:04 - 03:02:52:17 your sadness, 03:02:52:17 - 03:02:55:00 you can share your struggle. 03:02:55:00 - 03:02:56:17 They gonna support you. 03:02:56:17 - 03:03:00:10 And this is huge cause some people, 03:03:00:12 - 03:03:02:08 some people, they feel 03:03:02:08 - 03:03:03:24 they feel very 03:03:03:24 - 03:03:04:19 depressed 03:03:04:19 - 03:03:06:22 and they struggle when they receive this. 03:03:06:22 - 03:03:09:09 And this is so, so normal. 03:03:09:09 - 03:03:13:09 You cannot wait months to see a 03:03:13:11 - 03:03:14:15 some therapist. 03:03:14:19 - 03:03:18:19 After months, you're gonna be a problem. 03:03:18:21 - 03:03:21:06 Of course you will need therapists 03:03:21:06 - 03:03:24:16 during the way, but it's different 03:03:24:18 - 03:03:25:17 at the beginning. 03:03:25:17 - 03:03:28:01 You need the help right away 03:03:28:01 - 03:03:29:07 you need to see that 03:03:29:07 - 03:03:31:08 someone is dealing with this. 03:03:31:08 - 03:03:32:20 You need someone to give 03:03:32:20 - 03:03:34:17 you real life advice 03:03:34:17 - 03:03:36:10 how to deal with this. 03:03:36:10 - 03:03:37:14 You need to see someone 03:03:37:14 - 03:03:38:15 that you're not crazy, 03:03:38:15 - 03:03:40:13 that you're not failure. 03:03:40:13 - 03:03:41:23 You receive type 03:03:41:23 - 03:03:44:01 one diagnosis for your kids. 03:03:44:01 - 03:03:45:24 Every healthcare professionals 03:03:45:24 - 03:03:50:08 start telling you oh it's okay. 03:03:50:10 - 03:03:52:00 He can eat whatever, 03:03:52:00 - 03:03:53:21 he can eat everything he wants. 03:03:53:21 - 03:03:56:02 Just count the carbs. 03:03:56:02 - 03:03:58:22 Dose insulin go and you go 03:03:58:22 - 03:04:02:19 and you go back home with this insulin, 03:04:02:21 - 03:04:04:02 which is amazing 03:04:04:02 - 03:04:07:13 habit also is very dangerous thing. 03:04:07:15 - 03:04:10:14 And you don't have medical background. 03:04:10:14 - 03:04:14:10 And as I always like to share 03:04:14:10 - 03:04:15:12 this example, 03:04:15:12 - 03:04:17:00 some kids like to start 03:04:17:00 - 03:04:19:11 the day with cereal. 03:04:19:13 - 03:04:21:07 Only people that live with type 03:04:21:07 - 03:04:25:04 one knows how tricky to dose for cereal. 03:04:25:06 - 03:04:27:20 And imagine this mom, super stress 03:04:27:20 - 03:04:31:02 or dad or whatever caregiver 03:04:31:04 - 03:04:34:04 the doctor told me he can eat whatever. 03:04:34:04 - 03:04:37:10 I just count the carbs and I dose insulin 03:04:37:12 - 03:04:39:15 and they eat cereal. 03:04:39:15 - 03:04:41:14 The care giver dose insulin 03:04:41:14 - 03:04:43:24 and everything goes in a very, 03:04:43:24 - 03:04:45:14 very wrong direction. 03:04:45:14 - 03:04:50:06 How the caregiver feels like a failure. 03:04:50:08 - 03:04:54:01 So I really, really wish people to start 03:04:54:01 - 03:04:56:05 to stop telling 03:04:56:05 - 03:04:58:07 caregivers of newly diagnosed, 03:04:58:07 - 03:04:59:12 go eat, go. 03:04:59:12 - 03:05:01:05 Let let them be kids. 03:05:01:05 - 03:05:02:07 Let them eat whatever. 03:05:02:07 - 03:05:04:03 Yes, you can do that. 03:05:04:03 - 03:05:06:24 You need time, you need knowledge. 03:05:06:24 - 03:05:08:00 So that's why 03:05:08:00 - 03:05:11:22 my huge and very friendly advice 03:05:11:24 - 03:05:13:09 to caregivers, 03:05:13:09 - 03:05:15:14 educate yourself, read books, 03:05:15:14 - 03:05:17:03 listen to the podcast. 03:05:17:03 - 03:05:18:06 I'm telling you, 03:05:18:06 - 03:05:22:05 this will give you the whole knowledge 03:05:22:07 - 03:05:25:20 and you can do it slowly, slowly, slowly. 03:05:26:00 - 03:05:27:02 You will do it. 03:05:27:02 - 03:05:29:21 And automatically, mentally 03:05:29:21 - 03:05:34:10 you're going to be okay for the school. 03:05:34:12 - 03:05:36:23 The other motto I have 03:05:36:23 - 03:05:40:08 and my son has now 03:05:40:08 - 03:05:45:21 also always be prepared. 03:05:45:23 - 03:05:47:09 Nothing is scary 03:05:47:09 - 03:05:49:01 when you are prepared, 03:05:49:01 - 03:05:51:08 always be prepared. 03:05:51:08 - 03:05:55:08 Hypos happens hyperglycemia 03:05:55:08 - 03:06:00:21 happens, be prepared. 03:06:00:23 - 03:06:03:11 What I did, I can share what I did 03:06:03:11 - 03:06:04:12 with my school 03:06:04:12 - 03:06:07:01 and I really hope all the parents 03:06:07:01 - 03:06:11:02 have this support from their school. 03:06:11:04 - 03:06:12:08 After the diagnosis, 03:06:12:08 - 03:06:14:02 I immediately called the principal. 03:06:14:02 - 03:06:15:08 She was amazing. 03:06:15:08 - 03:06:18:22 She was like so supportive and she said, 03:06:18:24 - 03:06:21:11 You know, it's very hard 03:06:21:11 - 03:06:24:14 to have all the staff together 03:06:24:14 - 03:06:25:18 at the same time 03:06:25:18 - 03:06:27:18 so we can have a meeting with you, 03:06:27:18 - 03:06:29:02 but I will do my best. 03:06:29:02 - 03:06:31:13 And she did it. 03:06:31:13 - 03:06:33:15 All the teachers were there, 03:06:33:15 - 03:06:37:13 the admin staff, and we sit in a room. 03:06:37:16 - 03:06:39:08 My son was with us 03:06:39:08 - 03:06:42:05 and I start educating them. 03:06:42:05 - 03:06:43:23 They were so supportive, 03:06:43:23 - 03:06:46:17 but also I can see how stressed they are. 03:06:46:17 - 03:06:47:13 The second, 03:06:47:13 - 03:06:49:04 the second I start 03:06:49:04 - 03:06:53:10 sharing what can happen if he 03:06:53:12 - 03:06:55:07 if he's hypo. 03:06:55:07 - 03:06:56:20 And I saw you know, they were 03:06:56:20 - 03:06:59:20 they're genuinely 03:07:00:01 - 03:07:03:15 very worried and that's okay 03:07:03:16 - 03:07:04:19 but they said 03:07:04:19 - 03:07:06:02 and they were so relaxed 03:07:06:02 - 03:07:08:12 when they said we will be there 03:07:08:12 - 03:07:10:07 my husband or me, 03:07:10:07 - 03:07:12:10 you can rely on us all the time. 03:07:12:10 - 03:07:14:22 We going to follow his Dexcom 03:07:14:22 - 03:07:17:05 and we going to work together. 03:07:17:05 - 03:07:18:16 But they were in after that 03:07:18:16 - 03:07:20:00 with the office staff, 03:07:20:00 - 03:07:22:01 with the office admin, which are 03:07:22:01 - 03:07:22:23 who are great. 03:07:22:23 - 03:07:27:20 Also, we start writing medical care plan 03:07:27:22 - 03:07:30:05 and we decide every September 03:07:30:05 - 03:07:33:08 we will change the medical care 03:07:33:08 - 03:07:37:00 plan as needed if the changes are there. 03:07:37:03 - 03:07:38:03 And the other thing 03:07:38:03 - 03:07:39:20 I very much appreciate, 03:07:39:20 - 03:07:40:22 I told them, don't 03:07:40:22 - 03:07:44:01 treat my son differently. 03:07:44:03 - 03:07:47:03 If you have to push him 03:07:47:03 - 03:07:49:16 hard through something, push him, 03:07:49:16 - 03:07:52:16 don't feel sorry about him 03:07:52:18 - 03:07:54:18 and they’re doing it. 03:07:54:18 - 03:07:56:12 And I love this. 03:07:56:12 - 03:07:59:05 People need to be educated 03:07:59:05 - 03:08:01:17 more in school and everywhere. 03:08:01:17 - 03:08:04:19 People have to hear more about type one. 03:08:04:19 - 03:08:06:11 Honestly, organizations 03:08:06:11 - 03:08:08:02 like Diabetes Canada, 03:08:08:02 - 03:08:11:16 they play a huge role 03:08:11:18 - 03:08:14:10 in educating people and 03:08:14:10 - 03:08:18:01 raising awareness. 03:08:18:03 - 03:08:18:16 Thank you so 03:08:18:16 - 03:08:19:22 much for joining us for 03:08:19:22 - 03:08:21:19 this very important topic, 03:08:21:19 - 03:08:23:16 and thank you to Sylvia and Christa 03:08:23:16 - 03:08:25:01 for sharing their stories 03:08:25:01 - 03:08:25:24 and shining a light 03:08:25:24 - 03:08:26:18 on the experience 03:08:26:18 - 03:08:29:01 of raising a child with diabetes. 03:08:29:01 - 03:08:30:19 Again, this topic may not be relevant 03:08:30:19 - 03:08:32:18 to everyone living with diabetes, 03:08:32:18 - 03:08:34:01 but we do hope that you found it 03:08:34:01 - 03:08:36:10 interesting and learn something new. 03:08:36:10 - 03:08:37:14 Please take the opportunity 03:08:37:14 - 03:08:38:15 to keep the conversation 03:08:38:15 - 03:08:39:06 going 03:08:39:06 - 03:08:40:07 by posting a comment 03:08:40:07 - 03:08:42:11 in the comments section on YouTube. 03:08:42:11 - 03:08:43:18 You can provide this feedback 03:08:43:18 - 03:08:44:15 about the video 03:08:44:15 - 03:08:45:16 by clicking on the link 03:08:45:16 - 03:08:47:00 to the feedback survey 03:08:47:00 - 03:08:48:20 in the description box. 03:08:48:20 - 03:08:50:16 If you have ideas for other topics 03:08:50:16 - 03:08:52:05 you'd like to learn more about, 03:08:52:05 - 03:08:53:14 you can include that in the comments 03:08:53:14 - 03:08:55:24 or feedback survey as well. 03:08:56:17 - 03:08:57:15 For more information 03:08:57:15 - 03:08:58:24 about diabetes management, 03:08:58:24 - 03:09:02:02 please visit our website at diabetes.ca. 03:09:02:04 - 03:09:05:17 You can also email us at info@diabetes.ca 03:09:05:19 - 03:09:08:17 or call our info line at 1-800-BANTING. 03:09:08:17 - 03:09:13:15 That's 1-800-226-8464 and speak 03:09:13:15 - 03:09:15:04 to one of our information and support 03:09:15:04 - 03:09:17:07 specialists who can address your needs. 03:09:17:07 - 03:09:18:05 Thanks again for joining 03:09:18:05 - 03:09:19:19 us and see you next time. |
| 7 | Episode 7 | Unpacking Caregiving In this episode, Pina Barbieri, social worker and a mother of a young adult who lives with Type 1 diabetes will share with us her experiences raising her daughter, unpack and what it means to be a caregiver, and reframe the concept of “caregiver burnout”. She will also provide tips and strategies to thrive in the face of supporting loved ones with diabetes, using both her personal and professional perspectives. This video is supported by an unrestricted educational grant from Sanofi. | 0:00 [Music] 0:03 hello and welcome to diabetes deep Dives 0:06 my name is Candace and I am from 0:07 diabetes Canada if you are new to our 0:10 video series thank you for joining us if 0:12 you have been enjoying the series 0:13 welcome back our diabetes deep Dives 0:17 video series is designed to go beyond 0:18 the surface of General diabetes 0:20 information we hope to spark continued 0:22 interest and learning and leave you with 0:24 practical tips and tools that you can 0:26 easily use we drop a new video every 0:29 month so subscribe subcribe to our 0:30 YouTube channel and click on the 0:31 notification Bell to be notified about 0:33 new content you can also check us out on 0:36 social media to find out when the next 0:38 one will be posted on our YouTube 0:39 channel thanks to those who have 0:41 subscribed and supported our video 0:44 series in this episode we will hear from 0:46 Pina Barbieri a mother of a young adult 0:49 who lives with type 1 diabetes she's 0:51 also a social worker an educator and 0:54 diabetes Canada was very fortunate to 0:56 have her as a volunteer for our decamps 0:58 program not only not only will Pina 1:00 share with us her experiences raising 1:02 her daughter but she'll also unpack what 1:04 it means to be a caregiver and reframe 1:06 the concept of caregiver burnout she 1:09 will also provide tips and strategies to 1:11 thrive in the face of supporting loved 1:13 ones with diabetes using both her 1:15 personal and professional perspectives 1:18 this video is supported by an 1:19 unrestricted educational grant from copi 1:23 we hope after watching this video that 1:24 you will gain a greater understanding of 1:26 how families are impacted by a diabetes 1:29 diagnosis 1:30 and a deeper appreciation of what 1:32 contributes to caregivers experiencing 1:34 stress and burnout as well as strategies 1:36 for dealing with all that being a 1:38 diabetes caregiver entails we also want 1:41 to let you know that some of the content 1:43 in this video may be difficult to hear 1:46 and may trigger some intense emotions we 1:48 encourage you to seek support and or 1:50 stop the video If you find yourself 1:52 reacting to the content in a distressing 1:54 way we recognize that the content in 1:57 this video may not be relevant for 1:58 everyone and will depend on what your 2:00 experience with diabetes is and what 2:02 devices are available to you where you 2:04 live if you have specific questions 2:06 about diabetes management please reach 2:08 out to your Healthcare team these videos 2:11 are for educational purposes only the 2:14 content discussed in this video is not 2:16 intended to be medical advice and to the 2:18 extent that medical advice is required 2:20 you should consult with a qualified 2:22 medical professional the information 2:24 discussed in this video cannot replace 2:26 consultations with qualified Healthcare 2:28 professionals to meet your individual 2:30 medical needs the views and opinions 2:33 expressed in this video are those of the 2:34 speakers and do not necessarily reflect 2:36 the views or positions of diabetes 2:39 Canada as always we hope that this video 2:41 Sparks your interest in learning more 2:43 about diabetes management and now over 2:45 to our guest speaker Pina welcome to 2:49 unpacking caregiving um this is a 2:52 recording for caregivers of children 2:54 living with type 1 diabetes I think you 2:56 can see beside me a list of words 3:00 and wow those are a lot of words these 3:03 are words that describe a journey that 3:05 some of us are on as caregivers to our 3:07 children or siblings or grandchildren or 3:09 whichever way you come by providing care 3:11 for someone who lives with type 1 3:13 diabetes some of the words are actually 3:15 opposites like balancing and juggling 3:19 being proactive but also reactive 3:21 grieving but also holding hope being sad 3:25 and proud smiling and crying keeping 3:29 things stable 3:30 while everything around you is changing 3:33 do any of these words resonate with 3:35 you now I'd like you to imagine a world 3:38 where your role as a caregiver suddenly 3:41 changed almost overnight to include all 3:44 these new job descriptions added to your 3:46 already full plate new roles like 3:48 mathematician working out those isfs do 3:51 I increase insulin sensitivity do I 3:53 decrease it to make it stronger I still 3:56 have to take a minute and walk myself 3:57 through that one new roles like a 4:00 pharmacist learning about new 4:01 medications a doctor making dosing 4:03 decisions a nurse administering insulin 4:06 injection a therapist helping curb 4:09 anxieties and supporting your kids 4:10 through some really really sad times an 4:14 IT expert building your own webites and 4:16 apps a data manager combing over 4:18 thousands of blood sugars looking for 4:20 patterns an EMT running to crisis calls 4:24 I'm not sure I'd sign up for this job it 4:26 actually sounds pretty 4:28 hard 4:30 my child's name is Laura and she's been 4:32 living with type 1 diabetes for the past 4:34 10 years Her diagnosis was lifechanging 4:37 for her and real changing for me my 4:40 name's Pina and I'm the caregiver of a 4:42 child living with type one I'd like to 4:45 spend some time with you today unpacking 4:47 the caregiver experience as it relates 4:50 to type 1 diabetes in my spare time I'm 4:53 also a social worker so I'd like to 4:54 share some strategies and tips that can 4:56 help us navigate the everchanging 4:58 landscape of of caring for someone that 5:01 we love who lives with type 5:04 one if you're the caregiver of a child a 5:07 young adult or even an adult living with 5:09 type one you may have experienced a 5:10 variety of what I like to call ages and 5:12 stages of the diabetes Journey that 5:15 first year that was a tough one I'm sure 5:18 a lot of us remember diagnosis some of 5:21 us may have that day emblazoned in our 5:22 memory others may remember it in bits 5:25 and pieces and others may even struggle 5:27 to bring some of those difficult 5:28 memories to the surface 5:31 Switching gears from that freedom that 5:32 came with the working pancreas to being 5:34 aware of every single carbohydrate that 5:37 your child put in their mouth and all 5:40 those carbohydrates those countless carb 5:42 counts changed how we viewed food and 5:45 meals those first few days then months 5:48 and maybe even years for some of us the 5:50 day-to-day stress that lasted year to 5:52 year packing the diabetes bag making 5:54 sure you have juice or glucagon or 5:56 insulin extra pods extra meters 5:59 navigating healthare systems and 6:00 appointments for some the added stress 6:03 of other autoimmune ill illnesses just 6:05 compounded the caregiver 6:08 role having a child diagnosed at two 6:11 versus a child diagnosed as a teen 6:12 through different spins into how some of 6:14 us had to Pivot with diagnosis and with 6:16 life so many variables and factors 6:19 affected us too many to list 6:22 actually and just like no two person's 6:25 diabetes is the same no two caregivers 6:27 will have the same experience they is no 6:29 way we can cover every single experience 6:32 and emotion in these 20 minutes but what 6:35 I hope to leave you with here is the 6:37 safety to start the discussion of what 6:39 it means to be a t1d caregiver to bring 6:43 awareness and unpack this journey that 6:45 we're on and highlight some strategies 6:47 to help us find balance within our own 6:49 selves but most of all most of all I 6:52 hope you leave here with the reminder to 6:54 be kind to yourself as a caregiver in 6:56 the world of type 6:58 one so remember that word cloud with all 7:01 the added jobs and new expectations that 7:03 came with the type 1 diagnosis well this 7:05 is us in our house 24 hours after our 7:07 daughter's diagnosis where we went from 7:10 a healthy child to a child with a 7:11 lifelong disease we were trying to 7:14 balance all that had changed in our 7:16 daughter's life and all our new roles 7:18 with some normaly so we thought why not 7:20 have a Friday night just dance party on 7:22 day two of 7:25 diabetes putting our child's needs 7:27 before our own needs to grieve that was 7:29 important to us I remember our Clinic 7:32 telling us kid first diabetes second and 7:35 that really resonated with me absolutely 7:38 this made 7:39 sense but at the same time I thought how 7:42 in the world was I going to fit diabetes 7:45 and everything that came with it into a 7:48 childhood and so here begins that 7:50 Journey that we as caregivers feel 7:52 compelled to go on taking on the 7:54 physical mental emotional and social 7:56 impacts of type one on top of everything 7:59 else we 8:01 do a type 1 diagnosis is life-changing 8:04 and it brings with it so many stressors 8:06 and worries the stress and anticipation 8:09 of blood work appointments worries about 8:11 school and educating School staff on 8:13 your child's diabetes working with 8:14 Community organizations to put nursing 8:17 staff in place to help our youngest kids 8:19 stay safe at school or helping our older 8:22 kids navigate this lifechanging event by 8:24 putting IEP accommodations in 8:26 place as life keeps moving and you start 8:29 to figure out what used to be easy like 8:32 birthday parties kids sports family 8:34 vacations and sleepovers and gosh I 8:37 remember heck even just putting your 8:38 child to bed became stressful with 8:40 worries about nighttime blood 8:43 sugars then in her life stages like 8:45 puberty driver's licenses first jobs 8:48 transitioning from pediatric to adult 8:50 diabetes care and moving away to college 8:52 or university life can get very bumpy 8:56 with diabetes and while you're working 8:58 hard to juggle care in for your child 9:00 you often do this at your own expense oh 9:02 and did I mention 9:04 sleep you're doing all of this on less 9:06 sleep than the average person needs 9:08 because diabetes doesn't go away at 9:09 night and lack of sleep correlates with 9:12 decreased focusing decreased 9:15 productivity increased depression 9:17 symptoms increased irritability and 9:19 increased physical health problems not 9:22 what we type 1 caregivers 9:24 need and then just when you think you've 9:26 got the hang of things boom something 9:28 else happens a really bad low blood 9:30 sugar ketones from high blood sugar or 9:33 even just a reminder that sometimes 9:34 diabetes takes precedence over being a 9:36 kid and that sends you back into the 9:39 reality and grief of this disease 9:41 there's actually a term called chronic 9:43 sorrow that's described as an 9:45 intermittent grief reaction that can 9:47 happen with certain triggers even years 9:49 after a type 1D diagnosis for both kids 9:52 and 9:54 caregivers and our kids are heroes 9:57 everyday Heroes absolutely absolutely no 10:00 debate but we caregivers are pretty 10:02 awesome too kind of are every superhero 10:05 we're Batman jumping in action when we 10:07 see that dexc combat signal pop up in 10:09 the middle of the night we're Wonder 10:11 Woman deflecting those low blood sugars 10:13 with juuice boxes in hand and we're the 10:15 Hulk rage bising those stubborn highs 10:18 and we're Superman whose Kryptonite is 10:21 the unpredictability that comes with 10:23 diabetes and renders us feeling 10:25 powerless at times we are Spider-Man 10:28 prepared to scale a building if we have 10:31 to get to our child having a blood sugar 10:32 emergency I know I've driven a little 10:34 too fast trying to get to my daughter at 10:37 school we're Iron Man equipped with 10:39 every Tech Gadget known to man and even 10:41 some DIY and we are even full-time blood 10:45 sugar ninjas only because type 1D mom is 10:49 not an official job 10:52 title yes we're all these superheroes 10:54 but we're also human and frankly being 10:57 even just one superhero can leave us 10:59 feeling 11:01 exhausted actually we're not just 11:03 exhausted caregiving can leave us with a 11:05 lot of other feelings as well a lot of 11:07 us have seen the iceberg analogy in 11:09 relation to anger or even diabetes but 11:12 has anyone ever thought what it would 11:13 look like for us the type 1D caregivers 11:16 I took a shot at creating one since I 11:17 couldn't find one based on my own 11:20 experiences notice what's above the 11:22 surface what everyone sees or what we 11:24 want everyone to see us as calm 11:27 confident coping and control 11:30 and then what's below the surface maybe 11:32 what we don't want anyone to see what we 11:33 try to hide the tough stuff like fear 11:36 and guilt and anger sadness anxiety and 11:40 loss of 11:42 control the reality is that managing 11:45 your child's chronic illness and 11:47 potentially caring for other children 11:48 and managing your own physical and 11:50 mental health managing your family and 11:52 your relationships in your career is a 11:54 recipe for what is often described as 11:56 caregiver burnout burnout is defined in 11:59 the Webster's Dictionary as exhaustion a 12:02 physical or emotional strength or 12:04 motivation usually as a result of 12:06 prolonged stress or 12:09 frustration boy that doesn't sound great 12:11 does it there are so many associations 12:14 with that term burnout for a lot of us I 12:16 know there are for me especially when 12:18 we're talking about caring for our kids 12:20 are we even allowed to feel exhausted or 12:23 does that mean we failed or we're not 12:25 good enough some of us may even end up 12:27 feeling more guilt and May even shame so 12:29 much so that we end up not reaching out 12:31 and asking for 12:32 help I wish we could find another name 12:35 for this burnout term I've thought of 12:36 this long and hard some of these words 12:39 fit 12:40 fatigue uh overload depletion drain 12:44 exhaustion but there really isn't one 12:46 word that captures it adequately 12:48 diabetes is after all a disease and that 12:51 term dis ease literally means the 12:54 absence of ease it's not meant to be 12:57 easy we're going to have ups and downs 12:59 kind of like blood sugar and some days 13:01 boy some days I know I felt like a rock 13:03 star hitting those blood sugar targets 13:05 getting boluses on point and then boom 13:08 diabetes threw one of its everpresent 13:10 curveballs and left me feeling defeated 13:12 deflated and 13:14 incompetent remember that burnout 13:16 definition from earlier the one about 13:17 being exhausted because of prolonged 13:19 stress and frustration well this makes 13:21 sense doesn't it prolonged stress and 13:23 frustration can go hand inand with 13:26 diabetes that's another word we should 13:28 consider prolonged or chronic add that 13:31 to disease and you have chronic lack of 13:34 ease it never 13:37 relents so what can we do how do we 13:39 navigate it and notice I didn't say 13:41 prevent it because burnout is real it's 13:45 normal it's almost expected but most of 13:48 all most of all it's okay so since 13:51 burnout is real and expected how can we 13:55 cope well and here come the strategies 13:58 and tips 13:59 some of us become Advocates and allies 14:01 jumping into those areas where we can 14:03 support our children in the type 1 14:04 community Through walks rides 14:07 fundraisers we try to create meaning and 14:09 become part of the change we want to see 14:12 kind of like what we do with grief work 14:14 after all aren't we all grieving to some 14:16 extent the life we thought we'd have or 14:18 our kids would 14:20 have we also keep doing what we were 14:23 doing routine becomes important 14:25 especially because diabetes took away so 14:28 much so we keep taking our kids to 14:30 hockey or LaCrosse or synchronized 14:32 skating and slowly yes ever so slowly 14:36 diabetes becomes a part of our routine 14:39 is that new normal they talked about 14:40 early on in diagnosis that made no sense 14:42 to you then where I work we often do 14:45 exposure therapy to help us confront 14:47 that which is causing us anxiety it's 14:50 not until we confront our stressors 14:52 through habituation doing something over 14:54 and over again that we can collect 14:56 evidence that disconfirms our initial 14:59 beliefs and fears kind of like what 15:01 happens with diabetes every day is an 15:04 exposure that tells us that we can live 15:07 with diabetes that we can cope with 15:10 diabetes I remember our very first low 15:12 blood sugar our whole house stopped we 15:15 all sat and watched our daughter drink 15:18 her juice waiting for her blood sugar to 15:20 come back up not knowing exactly what 15:22 was going to happen in trying to manage 15:25 those worst case scenario thoughts that 15:27 were swirling in our heads so we waited 15:31 exactly 15 minutes retested and sure 15:34 enough everything turned out okay blood 15:37 sugar was back up then over time you 15:40 have another low and another low and 15:42 another low and it's not long before 15:44 you're taking these lows in stride 15:46 that's habituation doing something over 15:49 and over again and collecting that 15:51 evidence that your worst case scenario 15:53 didn't always have to come true and that 15:55 you could 15:57 cope this helped helps with that anxiety 15:59 and worry that comes with 16:02 diabetes another way to alleviate some 16:04 of the burden and stress caused by 16:06 caregiving in a diabetes world is to 16:08 build connections find your community 16:11 and boy are there ever a bunch of type 16:14 one communities to choose from diabetes 16:17 Facebook groups DIY groups like Loop and 16:20 night Scout organizations like I 16:22 challenge diabetes friends for life 16:24 connected in motion desate decamps and 16:27 even just in formal local Friendly 16:30 coffee clubs where type one caregivers 16:32 meet once a 16:33 month I think the best impact that 16:36 finding your type one Community has is 16:38 that it leaves you knowing that you're 16:39 not alone this goes a long way in 16:42 helping navigate burnout being around 16:44 people who just get it and big bonus 16:47 from your new community is that you can 16:49 make some of the best friends you'll 16:50 ever have in life I know I 16:55 did this next strategy is a tough tough 16:59 one as far as navigating burnout goes 17:02 letting 17:03 go for a disease that came in and 17:05 required us to stick to our kids like 17:07 glue letting go can be really tough for 17:10 some so tough that you may avoid it I 17:13 think what worked best for us was to let 17:15 go a little bit at a time over the 17:18 years one of the ways we can let go a 17:20 little bit at a time is sending our kids 17:23 to diabetes Canada 17:25 decamps it's good for us yes it's okay 17:28 for us caregivers to get a break from 17:30 diabetes I know that thought took me a 17:32 while to get over but it can be super 17:35 fun for our kids to get a break from us 17:37 too teaching our kids how to manage 17:39 their diabetes and sending them to 17:41 places like Camp is a life skill that 17:43 will pay dividends in the long run for 17:45 them and for us too and our kids get to 17:48 make some of their best friends at 17:50 camp and we have fun wow diabetes and 17:53 fun in the same sentence who would have 17:55 thought yes yes we have fun with diabet 17:58 diabetes they say that laughter is the 18:00 best medicine okay well maybe in our 18:02 house insulin is the best medicine but 18:04 laughter is definitely a close second 18:07 see those shoes in the picture they're 18:08 real Jelly Bellies they must have been 18:11 at least a thousand carbs each shoe and 18:14 bonus they gave us easy access to low 18:16 treatments on 18:18 Halloween get creative with this here 18:20 too we started a blood work Buddy system 18:22 at our hospital where we booked blood 18:24 work appointments with other kids living 18:26 with type one who wants to get blood 18:28 work alone it also helped kids who were 18:31 struggling and scared to build their own 18:32 capacity and resilience we even booked 18:35 endoc Clinic appointments together with 18:37 my daughter's diabesity from Camp what 18:39 better way to spend the time waiting for 18:41 your Endo team than catching up with 18:43 your Camp friend and celebrate the 18:45 successes and accomplishments we 18:47 celebrate the Milestones like Diaries 18:50 and pump start days diabetes came into 18:52 our lives and created a lot of losses so 18:55 it's important that you take the moments 18:57 and celebrate the winds and the 18:59 resiliency that you see in your child 19:01 and in yourself too I call this PDG post 19:05 diagnosis growth and it is incredible to 19:08 witness but you have to be open to 19:10 looking for 19:11 it so I'm a realist and I recognize that 19:14 it's not always rainbows and butterflies 19:17 sometimes things go wrong and sometimes 19:19 that can be scary terrifying even 19:23 sickness or pump site failures happen 19:25 low blood sugars happen high blood sugar 19:28 happen remember this is part of the 19:31 disease and it will pass and you will 19:35 cope when you're focused on caregiving 19:38 it might be hard to remember to take 19:39 time for yourself to care for yourself 19:42 self-care can be high level I remember 19:45 after we dropped my daughter off at 19:47 diabetes Camp um my husband and I drove 19:50 straight to the airport for a holiday 19:53 boy was that tough it was really hard to 19:58 trust other people to take care of my 20:00 child with 20:01 diabetes but what better group of 20:04 caregivers can you find for your child 20:07 than a medical team that's on 247 at a 20:10 diabetes 20:13 camp now self-care can also be micr 20:15 level doesn't need to be big doing the 20:18 little things to help offset the burden 20:20 and distress that diabetes can bring 20:21 into your life getting your haircut 20:24 going to dinners going to sporting 20:25 events taking naps spend spending time 20:28 doing something anything other than 20:31 Diabetes Care 20:33 counts now this part is important while 20:35 selfcare absolutely includes taking time 20:38 for things you enjoy and that provide 20:40 restorative rest and relaxation for you 20:43 did you know that self-care is also 20:45 about knowing your own limits setting 20:47 your own boundaries and knowing when you 20:49 need to reach out and ask for help be it 20:52 informal support through family and 20:54 friends or more formalized through 20:56 individual counseling services 20:59 it's okay to speak up and say I'm not 21:01 okay no one to get help for diabetes 21:04 management through your clinics and no 21:06 one to get help for your own mental 21:07 Wellness or your child's JDRF has 21:11 created a mental health and diabetes 21:13 directory that provides a list of 21:15 trained therapists or clinicians 21:16 specializing in type 1 and diabetes 21:19 distress check them out remember my hope 21:22 for you was to leave here being kind to 21:24 yourself well there's a theory that says 21:26 that we decompensate in our skills when 21:29 we're overworked and 21:30 overwhelmed well doesn't this make sense 21:32 for us as type 1D caregivers we are 21:35 tasked with being our best version of 21:37 ourselves during some of our most 21:39 stressed times let's try not to judge 21:43 ourselves when we're at our most 21:45 stressed practicing self-compassion can 21:48 go a long way in navigating 21:50 burnout next we're going to move to some 21:52 Concepts that may not be easy to wrap 21:54 our heads around but are necessary for 21:56 us to move through the Ang anger 21:58 avoidance and denial that may come with 22:01 diabetes distress and caregiver burnout 22:04 we'll start with 22:05 gratitude this is a big ask but it's oh 22:08 so significant in navigating burnout 22:11 find your gratitude in this journey it 22:14 can be gratitude for new technologies 22:16 that have made diabetes management so 22:18 much easier like my Pebble watch back in 22:20 the day when we couldn't see remote 22:22 blood sugars it can be gratitude for new 22:25 friends made through the diabetes 22:26 communities or or it can simply be 22:29 gratitude for getting through another 22:30 day the trick here is that you have to 22:33 be willing to look for it we can 22:35 sometimes get stuck in everything that 22:37 has changed that's become harder or that 22:39 we've lost take some time reflect on the 22:42 good that you still have another tough 22:44 but necessary process acceptance we 22:48 accept that diabetes is a part of our 22:50 Lives it's a part of our children's 22:52 lives this doesn't mean giving in or 22:54 giving up this means choosing to live 22:56 the best life you can with diabetes you 22:59 can see in the picture we made our 23:01 daughter a birthday cake one year with 23:02 her avatar on it actually we ordered it 23:04 in a wonderful talented Baker made it 23:07 but we made sure to include her insulin 23:09 pump it is after all a part of her and 23:12 we love every bit of 23:14 her P.S I still don't like the word 23:16 acceptance I still secretly cringe when 23:19 I hear it but it is liberating to stop 23:22 fighting it and to lean into it so that 23:25 we can adapt and grow remember that PD 23:29 and most of all we adapt our kids adapt 23:33 and we figure out how to keep going like 23:35 how to test blood sugar while you're 23:36 hula hooping that takes 23:40 skill adapting takes time don't rush it 23:43 don't rush any of the processes go at 23:46 your own pace and take care of yourself 23:48 just like they tell us on airplanes to 23:50 put the oxygen mask on yourself first so 23:52 that you can help others you see none of 23:55 the strategies to navigate burnout Focus 23:57 focus on alleviating the work that comes 24:00 with diabetes that work is real and 24:03 necessary to keep our kids alive rather 24:06 navigating burnout starts with you and 24:08 what you can 24:10 do and then sit back and watch as they 24:15 soar we uh dropped my daughter off at 24:18 University a week after she spent the 24:19 summer up at diabetes 24:24 camp that was a tough 24:26 one and while my role wasn't finished it 24:29 was time to let go and 10 years ago I 24:32 never would have thought I'd be ready 24:34 for this moment but I 24:37 was and if I can give my tenure younger 24:40 self one piece of advice it would be to 24:43 let go of the future worries they tend 24:45 to work themselves 24:46 out today my daughter is living on her 24:49 own in her first year of University 24:50 we've had ups and downs we've had 24:52 bumps but we could not be more prouder 24:55 or more grateful and no it wasn't wasn't 24:57 easy but that was never part of the deal 24:59 with diabetes remember the absence of 25:02 ease now our story is not unique there 25:05 are a lot of families like ours whose 25:07 children have done very well and if 25:09 you're watching this you might be one of 25:10 those families and if you're not that's 25:13 okay too remember those ages and stages 25:15 we talked about I wasn't always in a 25:18 good place with diabetes there were 25:19 highs and there were some really low 25:21 lows and I'm not talking about blood 25:23 sugar but if I can encourage you to hold 25:27 on to hope 25:28 what worked for me was reaching out and 25:30 connecting things will get better but 25:32 you don't have to go this 25:34 alone I just spent part of my summer at 25:37 diabetes camp and I can vouch that there 25:39 are superstars out there kids who grew 25:42 up with diabetes who have and continue 25:44 to overcome so much who are exceptional 25:47 and extraordinary look for the success 25:50 stories they'll take away some of your 25:52 stress and worries and fears and build 25:55 your hope that despite the bumps and all 25:57 of our roads we can navigate and come 26:00 out of some of the darkest tunnels in 26:02 ways we never would have imagined living 26:05 our best lives thank 26:08 you thank you so much for tuning into 26:10 this very enlightening episode of 26:12 diabetes deep Dives and thank you to 26:15 Pina for sharing her story and bringing 26:17 to light the experience of raising a 26:19 child with diabetes again this topic may 26:21 not be relevant to everyone living with 26:23 diabetes but we do hope that you found 26:25 it interesting and learned something new 26:28 please take the opportunity to keep the 26:30 conversation going by posting a comment 26:32 in the comment section on YouTube you 26:34 can provide us feedback about the video 26:36 by clicking on the link to the feedback 26:38 survey in the description box if you 26:40 have ideas for other topics you'd like 26:42 to learn more about you can include that 26:44 in the comments or feedback survey as 26:46 well Pina talked about other 26:48 organizations that support people living 26:50 with type 1 diabetes we've included 26:52 links to those organizations in the 26:54 description box as well as some 26:56 additional diabetes can can resources 26:58 related to caregiving and diabetes for 27:01 more information about diabetes 27:03 management please visit our website at 27:07 diabetes.com 27:10 diabetes.com line at800 Banting that's 1 27:15 18226 27:16 8464 and speak to one of our information 27:19 and support Specialists who can address 27:21 your needs thanks again for joining us 27:23 and see you next 27:26 time 27:27 [Music] |
| 8 | Episode 8 | Time to Talk Time in Range In this episode, we will hear from Michelle Chrisp, a registered nurse and community-based Certified Diabetes Educator in Winnipeg, Manitoba with 20 years of experience. Michelle will explain what time in range is and what it means, what the recommended goals for using time in range are, and why time in range is useful and who would benefit from using it. She’ll also walk us through some strategies to work towards achieving the recommended goals for time in range | 03:50:25:19 - 03:50:28:06 Hello and welcome to Diabetes Deep Dives. 03:50:28:06 - 03:50:29:05 My name is Candace 03:50:29:05 - 03:50:31:03 and I am from Diabetes Canada. 03:50:31:03 - 03:50:32:21 If you are new to our video series, 03:50:32:21 - 03:50:34:15 thank you so much for joining us. 03:50:34:15 - 03:50:36:04 If you have been enjoying the series, 03:50:36:04 - 03:50:38:01 welcome back. 03:50:38:01 - 03:50:39:07 Our Diabetes Deep Dives 03:50:39:07 - 03:50:40:14 video series is designed 03:50:40:14 - 03:50:40:21 to go 03:50:40:21 - 03:50:42:24 beyond the surface of general diabetes 03:50:42:24 - 03:50:44:19 education information. 03:50:44:19 - 03:50:46:10 We hope to spark continued interest 03:50:46:10 - 03:50:47:08 and learning 03:50:47:08 - 03:50:47:19 and leave you 03:50:47:19 - 03:50:49:04 with practical tips and tools 03:50:49:04 - 03:50:50:21 that you can easily use. 03:50:50:21 - 03:50:52:10 Subscribe to our YouTube channel 03:50:52:10 - 03:50:53:24 and click on the notification bell 03:50:53:24 - 03:50:56:09 to be notified about new content. 03:50:56:09 - 03:50:58:10 You can also check us out on social media 03:50:58:10 - 03:50:58:23 to find out 03:50:58:23 - 03:50:59:18 when the next one 03:50:59:18 - 03:51:02:04 will be posted to our YouTube channel. 03:51:02:04 - 03:51:03:17 Thanks to those who have subscribed 03:51:03:17 - 03:51:06:02 and supported our video series. 03:51:06:02 - 03:51:06:24 In this episode, 03:51:06:24 - 03:51:08:22 we will hear from Michelle Chrisp, 03:51:08:22 - 03:51:09:22 a registered nurse 03:51:09:22 - 03:51:10:22 and community based, 03:51:10:22 - 03:51:11:24 certified diabetes 03:51:11:24 - 03:51:14:02 educator in Winnipeg, Manitoba. 03:51:14:02 - 03:51:16:07 With over 20 years of experience, 03:51:16:07 - 03:51:17:20 she provides support to people 03:51:17:20 - 03:51:18:18 with type one, 03:51:18:18 - 03:51:19:18 type two 03:51:19:18 - 03:51:21:18 and diabetes in pregnancy 03:51:21:18 - 03:51:23:10 at the Winnipeg Clinic. 03:51:23:10 - 03:51:24:11 Michelle is also 03:51:24:11 - 03:51:25:18 a certified pump trainer, 03:51:25:18 - 03:51:27:03 as well as a research nurse 03:51:27:03 - 03:51:28:24 with the University of Manitoba, 03:51:28:24 - 03:51:29:11 where she is 03:51:29:11 - 03:51:30:08 currently focusing 03:51:30:08 - 03:51:32:00 on automated insulin delivery 03:51:32:00 - 03:51:34:12 technology in pregnancy. 03:51:34:14 - 03:51:35:11 Michelle will walk us 03:51:35:11 - 03:51:37:02 through what time range is 03:51:37:02 - 03:51:38:11 and what it means, 03:51:38:11 - 03:51:39:17 what the recommended goals 03:51:39:17 - 03:51:41:20 for using time in range are 03:51:41:20 - 03:51:43:14 and why time in range is useful 03:51:43:14 - 03:51:45:20 and who would benefit from using it. 03:51:45:20 - 03:51:47:00 She'll also walk us through 03:51:47:00 - 03:51:47:18 some strategies 03:51:47:18 - 03:51:48:13 to work towards 03:51:48:13 - 03:51:50:00 achieving the recommended goals 03:51:50:00 - 03:51:52:01 for time in range. 03:51:52:01 - 03:51:52:22 We recognize that 03:51:52:22 - 03:51:53:24 the content in this video 03:51:53:24 - 03:51:54:20 may not be relevant 03:51:54:20 - 03:51:55:18 for everyone 03:51:55:18 - 03:51:56:22 and will depend on what 03:51:56:22 - 03:51:59:02 your experience with diabetes is 03:51:59:02 - 03:52:01:01 and what devices are available to you 03:52:01:01 - 03:52:02:09 where you live. 03:52:02:09 - 03:52:03:19 If you have specific questions 03:52:03:19 - 03:52:05:09 about diabetes management, 03:52:05:09 - 03:52:06:11 please reach out to your health 03:52:06:11 - 03:52:07:22 care team. 03:52:07:22 - 03:52:09:24 These videos are for educational purposes 03:52:09:24 - 03:52:10:21 only. 03:52:10:21 - 03:52:11:09 The content 03:52:11:09 - 03:52:12:12 discussed in this video 03:52:12:12 - 03:52:14:18 is not intended to be medical advice. 03:52:14:18 - 03:52:15:13 And to the extent 03:52:15:13 - 03:52:17:08 that medical advice is required, 03:52:17:08 - 03:52:18:03 you should consult 03:52:18:03 - 03:52:20:09 with a qualified medical professional. 03:52:20:09 - 03:52:22:00 The information discussed in this video 03:52:22:00 - 03:52:23:16 cannot replace consultations 03:52:23:16 - 03:52:25:16 with a qualified health care professional 03:52:25:16 - 03:52:28:17 to meet your individual medical needs. 03:52:28:19 - 03:52:29:21 The views and opinions 03:52:29:21 - 03:52:31:00 expressed in this video 03:52:31:00 - 03:52:32:05 are those of the speakers 03:52:32:05 - 03:52:33:07 and do not necessarily 03:52:33:07 - 03:52:34:06 reflect the views 03:52:34:06 - 03:52:37:06 or positions of Diabetes Canada. 03:52:37:11 - 03:52:38:04 As always, 03:52:38:04 - 03:52:39:10 we hope that this video sparks 03:52:39:10 - 03:52:40:14 your interest in learning more 03:52:40:14 - 03:52:42:06 about diabetes management. 03:52:42:06 - 03:52:44:02 And now over to our guest speaker 03:52:44:02 - 03:52:44:19 Michelle. 03:52:45:14 - 03:52:46:20 Hi, everyone, 03:52:46:20 - 03:52:48:08 and welcome to another Diabetes 03:52:48:08 - 03:52:50:05 Canada Deep Dives. 03:52:50:05 - 03:52:52:23 Today's topic is time in range. 03:52:52:23 - 03:52:54:15 My name is Michelle Chrisp, 03:52:54:15 - 03:52:56:03 and I'm a diabetes nurse 03:52:56:03 - 03:52:57:07 educator, coming to you 03:52:57:07 - 03:53:01:16 from snowy Winnipeg, Manitoba. 03:53:01:18 - 03:53:03:14 So what we're going to discuss today 03:53:03:14 - 03:53:04:19 is time in range. 03:53:04:19 - 03:53:06:16 What is time in range, 03:53:06:16 - 03:53:08:04 recommended time in range 03:53:08:04 - 03:53:10:24 goals, the usefulness of time in range 03:53:10:24 - 03:53:13:20 and who might benefit the most from it, 03:53:13:20 - 03:53:18:23 and steps to increasing time in range. 03:53:19:00 - 03:53:20:15 Time in range is defined 03:53:20:15 - 03:53:21:24 is the percentage of time 03:53:21:24 - 03:53:23:17 a person spends with their blood 03:53:23:17 - 03:53:26:14 glucose levels in a set range. 03:53:26:14 - 03:53:28:08 It's commonly generated 03:53:28:08 - 03:53:31:00 using 14 days of glucose data, 03:53:31:00 - 03:53:33:10 and it's a practical metric 03:53:33:10 - 03:53:34:00 for showing 03:53:34:00 - 03:53:35:05 where your blood glucose levels 03:53:35:05 - 03:53:40:09 sit through the day and from day to day. 03:53:40:11 - 03:53:41:23 If you're using a continuous 03:53:41:23 - 03:53:42:24 glucose monitor, 03:53:42:24 - 03:53:44:20 that is probably the most accurate way 03:53:44:20 - 03:53:46:14 to capture time in range. 03:53:46:14 - 03:53:49:05 However, it can also be captured manually 03:53:49:05 - 03:53:51:16 by using a blood glucose meter. 03:53:51:16 - 03:53:54:00 In that situation for about two weeks 03:53:54:00 - 03:53:55:09 you would test your blood glucose 03:53:55:09 - 03:53:57:10 before and after meals 03:53:57:10 - 03:53:59:06 and occasionally through the night, 03:53:59:06 - 03:54:01:08 and then you take all those results 03:54:01:08 - 03:54:02:03 and calculate 03:54:02:03 - 03:54:03:09 how many of them are add up, 03:54:03:09 - 03:54:06:02 how many of them are in your time, 03:54:06:02 - 03:54:07:11 your target range 03:54:07:11 - 03:54:08:22 divided by how many of them 03:54:08:22 - 03:54:12:11 you've done in total and times by 100. 03:54:12:13 - 03:54:14:20 This is a lot of work, and we know that 03:54:14:20 - 03:54:16:10 when we test our blood glucose, it's 03:54:16:10 - 03:54:19:09 our capturing a single point in time. 03:54:19:09 - 03:54:21:05 And we also know that 03:54:21:05 - 03:54:23:22 our glucose can vary every 5 minutes 03:54:23:22 - 03:54:25:13 and it's impossible to test your blood 03:54:25:13 - 03:54:26:18 glucose that frequently. 03:54:26:18 - 03:54:30:14 Time in range can also be calculated 03:54:30:20 - 03:54:32:02 by blood glucose meters 03:54:32:02 - 03:54:34:06 that Bluetooth over two different apps. 03:54:34:06 - 03:54:35:01 So the 03:54:35:01 - 03:54:37:06 the Contour app or mySugr 03:54:37:06 - 03:54:38:23 or OneTouch Verio, 03:54:38:23 - 03:54:39:23 these are Bluetooth apps 03:54:39:23 - 03:54:41:14 that can actually automatically 03:54:41:14 - 03:54:42:20 generate your time in range 03:54:42:20 - 03:54:43:19 every time a glucose 03:54:43:19 - 03:54:45:23 level is put into there. 03:54:46:00 - 03:54:47:02 There are also 03:54:47:02 - 03:54:50:03 Tidepool and other types of software 03:54:50:03 - 03:54:50:14 and apps 03:54:50:14 - 03:54:52:24 that can automatically generate time 03:54:52:24 - 03:54:53:21 in range. 03:54:53:21 - 03:54:55:04 And again, by far though, 03:54:55:04 - 03:54:57:04 the most accurate way to calculate 03:54:57:04 - 03:54:58:04 time in range 03:54:58:04 - 03:54:59:20 is by using a continuous 03:54:59:20 - 03:55:02:05 glucose monitoring CGM 03:55:02:05 - 03:55:03:08 and these devices have 03:55:03:08 - 03:55:04:20 their own software apps 03:55:04:20 - 03:55:06:05 that will automatically generate 03:55:06:05 - 03:55:10:13 that data. 03:55:10:15 - 03:55:12:04 When we think about time in range, 03:55:12:04 - 03:55:16:00 it's most commonly shown as a bar graph. 03:55:16:02 - 03:55:16:22 And that bar graph 03:55:16:22 - 03:55:17:10 you can see 03:55:17:10 - 03:55:18:19 there is stratified 03:55:18:19 - 03:55:19:21 into different color 03:55:19:21 - 03:55:22:23 ranges with the red being the time 03:55:22:23 - 03:55:24:02 below range, 03:55:24:02 - 03:55:25:19 the green area being the time 03:55:25:19 - 03:55:27:17 you spend in your target range 03:55:27:17 - 03:55:31:01 and the yellows being time above range. 03:55:31:03 - 03:55:32:18 Depending on the device you use, 03:55:32:18 - 03:55:34:20 you may also see your time in range 03:55:34:20 - 03:55:41:22 as a pie chart like the one on the right. 03:55:41:24 - 03:55:44:02 In 2019, a panel of 03:55:44:02 - 03:55:45:07 experts got together 03:55:45:07 - 03:55:46:04 and published 03:55:46:04 - 03:55:47:20 recommendations 03:55:47:20 - 03:55:49:12 about where time in range 03:55:49:12 - 03:55:51:02 goals should be set, 03:55:51:02 - 03:55:52:21 not only the target ranges 03:55:52:21 - 03:55:54:18 but also the amount of time 03:55:54:18 - 03:55:55:23 or percent of your day 03:55:55:23 - 03:55:57:05 that you should be spending 03:55:57:05 - 03:55:59:12 in those target ranges. 03:55:59:12 - 03:56:00:21 So you can see on the left 03:56:00:21 - 03:56:02:13 that for most individuals, 03:56:02:13 - 03:56:03:22 healthy individuals with type 03:56:03:22 - 03:56:05:24 one and type two diabetes, 03:56:05:24 - 03:56:08:07 the goal is to have the target range 03:56:08:07 - 03:56:10:10 of about 3.9 to 10 03:56:10:10 - 03:56:13:03 and to spend about 70%25 of your time 03:56:13:03 - 03:56:14:03 there. 03:56:14:03 - 03:56:16:00 No more than 4%25 of your data 03:56:16:00 - 03:56:18:04 should be below range 03:56:18:04 - 03:56:20:12 and about 25%25 acceptable 03:56:20:12 - 03:56:21:23 to be above range. 03:56:21:23 - 03:56:23:11 For older, high 03:56:23:11 - 03:56:26:14 risk type one and type two individuals, 03:56:26:17 - 03:56:27:15 the time in range 03:56:27:15 - 03:56:30:15 target goes down a little bit to 50%25. 03:56:30:17 - 03:56:31:21 We don't want these individuals 03:56:31:21 - 03:56:33:24 having a lot of hypoglycemia. 03:56:33:24 - 03:56:35:10 It's more dangerous, 03:56:35:10 - 03:56:37:03 so less hypoglycemia 03:56:37:03 - 03:56:37:15 the better, 03:56:37:15 - 03:56:38:11 less low blood 03:56:38:11 - 03:56:39:21 glucose or time below 03:56:39:21 - 03:56:41:14 range, 50%25 03:56:41:14 - 03:56:44:24 within that target range of 3.9 to 10 03:56:45:01 - 03:56:47:20 and acceptable to have 50%25 above. 03:56:47:20 - 03:56:49:17 For pregnancy, 03:56:49:17 - 03:56:51:09 we know that outcomes for baby 03:56:51:09 - 03:56:52:13 are improved 03:56:52:13 - 03:56:54:16 when we have a tighter time in range. 03:56:54:16 - 03:56:56:09 And so for those individuals, 03:56:56:09 - 03:56:59:21 the target range is between 3.5 to 7.8 03:56:59:23 - 03:57:01:20 and to spend about 70%25 03:57:01:20 - 03:57:06:20 of your time there. 03:57:06:22 - 03:57:07:18 When we talk about 03:57:07:18 - 03:57:08:14 time in range, 03:57:08:14 - 03:57:10:00 it's good to talk about it 03:57:10:00 - 03:57:12:07 I find in time itself 03:57:12:07 - 03:57:15:01 sometimes the percentages are hard to 03:57:15:01 - 03:57:16:03 to grasp, 03:57:16:03 - 03:57:18:24 and so putting it into that timeframe of 03:57:18:24 - 03:57:22:03 was 70%25 of your day is about 17 hours. 03:57:22:03 - 03:57:23:09 So you want to be spending 03:57:23:09 - 03:57:25:18 about 17 hours of your day 03:57:25:18 - 03:57:27:16 between 3.9 to 10. 03:57:27:16 - 03:57:30:08 1%25 of every time in range 03:57:30:08 - 03:57:32:01 percentage is 15 minutes. 03:57:32:01 - 03:57:33:01 So that's where we get 03:57:33:01 - 03:57:35:02 those numbers from. 03:57:35:02 - 03:57:37:19 Less hypoglycemia, the better 03:57:37:19 - 03:57:39:20 and the less hyperglycemia, 03:57:39:20 - 03:57:41:01 the higher, higher 03:57:41:01 - 03:57:42:14 over 13.9, 03:57:42:14 - 03:57:45:07 the less of that the better as well. 03:57:45:07 - 03:57:46:03 Even though we have 03:57:46:03 - 03:57:47:17 these recommendations, it's 03:57:47:17 - 03:57:49:17 really important to remember that 03:57:49:17 - 03:57:51:16 they need to be individualized. 03:57:51:16 - 03:57:54:10 So not everyone may have time 03:57:54:10 - 03:57:55:17 in range targets that fit 03:57:55:17 - 03:57:57:01 these guidelines. 03:57:57:01 - 03:57:58:23 You may have an individual 03:57:58:23 - 03:58:01:05 who's at more risk for hypoglycemia 03:58:01:05 - 03:58:02:22 or a younger individual 03:58:02:22 - 03:58:04:21 or a more frail individual 03:58:04:21 - 03:58:06:11 or someone with really complex 03:58:06:11 - 03:58:07:12 health needs 03:58:07:12 - 03:58:08:11 where their time in range 03:58:08:11 - 03:58:10:22 targets need to be different. 03:58:10:22 - 03:58:12:05 And that's okay 03:58:12:05 - 03:58:13:24 if you're starting off with higher blood 03:58:13:24 - 03:58:15:00 glucose control 03:58:15:00 - 03:58:17:06 and bringing your glucose control down, 03:58:17:06 - 03:58:18:09 you may also want to 03:58:18:09 - 03:58:20:05 expand your time in range 03:58:20:05 - 03:58:21:23 so that you're gently starting 03:58:21:23 - 03:58:27:11 to bring things down closer to target. 03:58:27:13 - 03:58:28:00 So how 03:58:28:00 - 03:58:31:01 is time in range different from A1C? 03:58:31:03 - 03:58:32:10 You know, we go to the lab 03:58:32:10 - 03:58:33:18 every 3 to 6 months 03:58:33:18 - 03:58:35:11 to take a look at that A1C 03:58:35:11 - 03:58:37:14 and what is the A1C? 03:58:37:14 - 03:58:39:04 It is the amount of glucose 03:58:39:04 - 03:58:40:09 that stuck on 03:58:40:09 - 03:58:43:06 to the red blood cells in our blood. 03:58:43:06 - 03:58:44:13 It's a gold standard. 03:58:44:13 - 03:58:46:00 It has been a gold standard 03:58:46:00 - 03:58:47:14 for many years 03:58:47:14 - 03:58:49:00 and we have a lot of research 03:58:49:00 - 03:58:50:00 to support 03:58:50:00 - 03:58:53:10 that A1C can both prevent and predict 03:58:53:12 - 03:58:54:14 complications. 03:58:54:14 - 03:58:57:12 A1C doesn't match 03:58:57:12 - 03:59:00:21 average glucose in a 1 to 1 kind of way. 03:59:00:23 - 03:59:03:04 And so when you get your A1C 03:59:03:04 - 03:59:05:07 to turn it into an average glucose, 03:59:05:07 - 03:59:06:13 you might look at a chart 03:59:06:13 - 03:59:08:05 like we have on the right there 03:59:08:05 - 03:59:09:03 where, okay, 03:59:09:03 - 03:59:12:10 an A1C of 7 is about an average glucose 03:59:12:10 - 03:59:16:16 of 8.3, 03:59:16:18 - 03:59:17:01 but we 03:59:17:01 - 03:59:20:01 know that there are limitations of A1C 03:59:20:02 - 03:59:21:19 and this is a great, 03:59:21:19 - 03:59:24:13 great pictorial from Diatribe 03:59:24:13 - 03:59:28:22 that shows us the many faces of a 7%25 A1C. 03:59:28:24 - 03:59:30:04 So you can see that 03:59:30:04 - 03:59:32:03 the individual on the left 03:59:32:03 - 03:59:35:03 has a 100%25 time in range 03:59:35:08 - 03:59:37:18 and A1C of 7%25, 03:59:37:18 - 03:59:40:09 but they have very flat and narrow 03:59:40:09 - 03:59:41:21 in in range blood 03:59:41:21 - 03:59:43:07 glucose control from day to day. 03:59:43:07 - 03:59:45:00 So they don't have a lot of peaks 03:59:45:00 - 03:59:46:00 and valleys. 03:59:46:00 - 03:59:47:00 And you can imagine that 03:59:47:00 - 03:59:50:00 that individual probably feels 03:59:50:02 - 03:59:53:03 less exhausted or maybe emotionally 03:59:53:03 - 03:59:54:19 or physically less exhausted 03:59:54:19 - 03:59:56:03 from all the peaks and valleys 03:59:56:03 - 03:59:56:24 that can happen 03:59:56:24 - 03:59:58:00 when you live with type, 03:59:58:00 - 03:59:59:02 with with diabetes, 03:59:59:02 - 04:00:01:03 both type one and type two. 04:00:01:03 - 04:00:02:22 The person in the middle 04:00:02:22 - 04:00:06:22 has also a 7%25 A1C, but they are 70%25 04:00:07:00 - 04:00:08:02 in range, 04:00:08:02 - 04:00:11:12 with 25%25 as a result over their target 04:00:11:12 - 04:00:12:02 range 04:00:12:02 - 04:00:13:19 and 5%25 of the results 04:00:13:19 - 04:00:15:10 below their target range. 04:00:15:10 - 04:00:17:18 And you can see more peaks and valleys 04:00:17:18 - 04:00:19:12 in that graph. 04:00:19:12 - 04:00:21:05 And the person on the right 04:00:21:05 - 04:00:23:17 also has a 7%25 A1C, 04:00:23:17 - 04:00:24:11 but they're spending 04:00:24:11 - 04:00:26:16 about 40%25 of their time 04:00:26:16 - 04:00:28:04 in their target range, 04:00:28:04 - 04:00:32:10 40%25 above their target range and 20%25 04:00:32:10 - 04:00:33:22 of their time low 04:00:33:22 - 04:00:37:07 and 20%25 of time with every percent is 04:00:37:08 - 04:00:38:09 15 minutes. 04:00:38:09 - 04:00:41:08 That's a lot of hypoglycemia. 04:00:41:08 - 04:00:43:24 So you can see how there are limitations 04:00:43:24 - 04:00:44:06 in A1C 04:00:44:06 - 04:00:44:16 in terms of 04:00:44:16 - 04:00:47:22 showing us the day to day variability 04:00:47:24 - 04:00:49:20 that is living with diabetes, 04:00:49:20 - 04:00:51:15 the highs and the lows 04:00:51:15 - 04:00:52:17 and those highs and lows 04:00:52:17 - 04:00:54:16 can be exhausting. 04:00:54:16 - 04:00:58:00 So an A1C of seven doesn't always reflect 04:00:58:02 - 04:00:58:19 all of that. 04:00:58:19 - 04:01:00:15 And that is why time in range 04:01:00:15 - 04:01:04:12 can be so much more useful as a metric. 04:01:04:14 - 04:01:08:11 We have research to support A1C 04:01:08:11 - 04:01:10:00 and for preventing 04:01:10:00 - 04:01:12:07 and the risk of complications. 04:01:12:07 - 04:01:14:05 But now we're starting to see research 04:01:14:05 - 04:01:16:08 for time in range as well. 04:01:16:08 - 04:01:18:19 So there are emerging studies 04:01:18:19 - 04:01:19:20 for neuropathy 04:01:19:20 - 04:01:21:12 as well as eye damage 04:01:21:12 - 04:01:23:21 retinopathy and kidney damage. 04:01:23:21 - 04:01:25:10 Micro albuminuria. 04:01:25:10 - 04:01:27:15 In terms of your time in range, 04:01:27:15 - 04:01:30:01 the more time you spend in range, 04:01:30:01 - 04:01:31:08 the lower your risk 04:01:31:08 - 04:01:33:14 for these types of complications. 04:01:33:14 - 04:01:35:17 We also know in pregnancy 04:01:35:17 - 04:01:38:05 that higher amounts of time in range 04:01:38:05 - 04:01:44:24 also lead to better outcomes for baby. 04:01:45:01 - 04:01:45:22 When we're looking at 04:01:45:22 - 04:01:47:11 time in range reports, 04:01:47:11 - 04:01:49:18 it can be really overwhelming. 04:01:49:18 - 04:01:51:01 So I think one of the 04:01:51:01 - 04:01:52:09 first things we can do 04:01:52:09 - 04:01:53:24 is take a look at that 04:01:53:24 - 04:01:55:08 that bar graph 04:01:55:08 - 04:01:58:06 and take a look at the percentages there. 04:01:58:06 - 04:02:00:05 Every time we increase our time in range 04:02:00:05 - 04:02:01:11 by 5%25, 04:02:01:11 - 04:02:02:20 that's another hour 04:02:02:20 - 04:02:05:10 that we're spending in our target zone. 04:02:05:10 - 04:02:06:10 And there's clinically 04:02:06:10 - 04:02:08:08 meaningful significance 04:02:08:08 - 04:02:11:08 with every 5%25 increase. 04:02:11:14 - 04:02:12:07 Other metrics 04:02:12:07 - 04:02:13:15 that we might want to look at 04:02:13:15 - 04:02:14:08 other than that 04:02:14:08 - 04:02:15:04 bar graph 04:02:15:04 - 04:02:16:18 is something called the ambulatory 04:02:16:18 - 04:02:18:04 glucose profile, 04:02:18:04 - 04:02:20:05 which takes 24 hours of data 04:02:20:05 - 04:02:21:14 over two weeks 04:02:21:14 - 04:02:23:23 and puts it into a nice line. 04:02:23:23 - 04:02:25:18 And then we can really see 04:02:25:18 - 04:02:28:00 where on average our patterns might be. 04:02:28:00 - 04:02:31:21 The software and apps will also 04:02:31:23 - 04:02:32:22 sometimes highlight 04:02:32:22 - 04:02:34:03 if they can find patterns 04:02:34:03 - 04:02:35:19 of where your time above range 04:02:35:19 - 04:02:37:17 is or where your time below range is. 04:02:37:17 - 04:02:39:10 So also bring that out 04:02:39:10 - 04:02:41:05 and highlight it for your attention, 04:02:41:05 - 04:02:42:09 which is useful when you're 04:02:42:09 - 04:02:45:11 staring at a sea of data. 04:02:45:13 - 04:02:47:09 So another example of an ambulatory 04:02:47:09 - 04:02:48:22 glucose profile, 04:02:48:22 - 04:02:50:12 you can see that green line 04:02:50:12 - 04:02:52:06 that kind of goes through in that darker 04:02:52:06 - 04:02:55:06 line, that's your mean or average glucose 04:02:55:09 - 04:02:56:23 and then the cloud around that, 04:02:56:23 - 04:02:58:10 that's a little bit darker. 04:02:58:10 - 04:03:02:04 It's sort of your 25 to 75%25 of data. 04:03:02:06 - 04:03:03:14 And then the larger cloud around 04:03:03:14 - 04:03:04:21 that is encompasses 04:03:04:21 - 04:03:05:20 more like your 10 04:03:05:20 - 04:03:08:03 to 90%25 of all your data. 04:03:08:03 - 04:03:09:18 When we're looking at an ambulatory 04:03:09:18 - 04:03:11:00 glucose profile, 04:03:11:00 - 04:03:12:10 we're looking at what that mean 04:03:12:10 - 04:03:13:07 line does. 04:03:13:07 - 04:03:13:20 Does it go 04:03:13:20 - 04:03:14:07 up, does it 04:03:14:07 - 04:03:16:20 go down at a specific time of day? 04:03:16:20 - 04:03:19:06 And how expansive is the data 04:03:19:06 - 04:03:20:02 in other words, 04:03:20:02 - 04:03:21:22 how much variability does 04:03:21:22 - 04:03:29:03 your glucose have from day to day? 04:03:29:05 - 04:03:29:13 Daily 04:03:29:13 - 04:03:31:10 reports is another nice way 04:03:31:10 - 04:03:32:16 to look at data. 04:03:32:16 - 04:03:34:17 And this too can be overwhelming. 04:03:34:17 - 04:03:36:14 But if you're trying to tease out, 04:03:36:14 - 04:03:38:07 are my weekends different 04:03:38:07 - 04:03:39:24 from my weekdays? 04:03:39:24 - 04:03:42:07 When I'm babysitting my grandchildren 04:03:42:07 - 04:03:44:16 do I have more hypoglycemia? 04:03:44:16 - 04:03:46:08 These are really nice things to go in 04:03:46:08 - 04:03:47:07 and take a look at. 04:03:47:07 - 04:03:48:16 Okay, 04:03:48:16 - 04:03:49:21 these are the things that happen 04:03:49:21 - 04:03:50:17 those days 04:03:50:17 - 04:03:51:20 and this is what happened 04:03:51:20 - 04:03:57:02 to my blood glucose. 04:03:57:04 - 04:03:57:13 There are 04:03:57:13 - 04:03:58:23 other really useful 04:03:58:23 - 04:04:00:22 time in range metrics, 04:04:00:22 - 04:04:02:13 so some of the things that those apps 04:04:02:13 - 04:04:04:02 and software will generate 04:04:04:02 - 04:04:04:15 is an 04:04:04:15 - 04:04:05:22 estimated A1C 04:04:05:22 - 04:04:06:03 or what 04:04:06:03 - 04:04:08:23 we call a glucose management indicator, 04:04:08:23 - 04:04:09:19 which is that 04:04:09:19 - 04:04:12:19 if you have two weeks of data 04:04:12:22 - 04:04:15:08 and you extrapolate it over three months, 04:04:15:08 - 04:04:18:20 your A1C may be estimated to be. 04:04:18:22 - 04:04:19:21 We also have 04:04:19:21 - 04:04:20:10 something called 04:04:20:10 - 04:04:23:10 a coefficient of variation which shows us 04:04:23:13 - 04:04:24:16 the variability 04:04:24:16 - 04:04:27:04 of your glucose from day to day. 04:04:27:04 - 04:04:29:15 A larger coefficient of variation 04:04:29:15 - 04:04:30:16 means that your risk for 04:04:30:16 - 04:04:34:20 hypoglycemia is greater. 04:04:34:22 - 04:04:36:10 You can also see events that we talk 04:04:36:10 - 04:04:37:24 about time in range, 04:04:37:24 - 04:04:40:11 but we also talk about time below range. 04:04:40:11 - 04:04:41:11 And the other important term 04:04:41:11 - 04:04:47:03 to talk about is time above range. 04:04:47:05 - 04:04:48:07 In 2019, 04:04:48:07 - 04:04:49:08 I watched a really good talk 04:04:49:08 - 04:04:49:19 by Adam 04:04:49:19 - 04:04:51:09 Brown from Diatribe 04:04:51:09 - 04:04:53:13 and I loved his analogy 04:04:53:13 - 04:04:56:11 about time in range as a highway. 04:04:56:11 - 04:04:58:05 What keeps me on the road more 04:04:58:05 - 04:04:59:21 so if your time in range 04:04:59:21 - 04:05:01:06 is on the left side of the highway, 04:05:01:06 - 04:05:03:00 is that time below range? 04:05:03:00 - 04:05:04:12 And on the right side of the highway 04:05:04:12 - 04:05:06:21 is that time above range? 04:05:06:21 - 04:05:08:08 And then staying on the highway, 04:05:08:08 - 04:05:10:04 that's your target zone. 04:05:10:04 - 04:05:11:17 So when you're looking at your data, 04:05:11:17 - 04:05:14:05 reflecting on what keeps me on the road, 04:05:14:05 - 04:05:15:12 what sorts of things 04:05:15:12 - 04:05:17:02 that I do in my daily life 04:05:17:02 - 04:05:19:01 that keeps me on the road 04:05:19:01 - 04:05:24:05 and how can I do more of those things? 04:05:24:07 - 04:05:25:10 What drives me off the 04:05:25:10 - 04:05:26:07 road in either 04:05:26:07 - 04:05:27:23 direction, driving me low 04:05:27:23 - 04:05:29:08 or driving me high? 04:05:29:08 - 04:05:31:07 And how can I recover 04:05:31:07 - 04:05:31:24 quickly 04:05:31:24 - 04:05:35:17 when those things start to happen? 04:05:35:19 - 04:05:37:10 And do I have guardrails 04:05:37:10 - 04:05:39:01 to prevent extreme off 04:05:39:01 - 04:05:43:04 roading So guardrails might look like 04:05:43:06 - 04:05:44:19 more meal planning? 04:05:44:19 - 04:05:46:07 Maybe when you go out 04:05:46:07 - 04:05:47:17 to eat at restaurants, 04:05:47:17 - 04:05:48:04 you're looking 04:05:48:04 - 04:05:49:19 those menu items up to find 04:05:49:19 - 04:05:51:13 the ones that are 04:05:51:13 - 04:05:52:15 maybe a better load 04:05:52:15 - 04:05:55:15 of carbohydrate for your blood glucose 04:05:55:20 - 04:05:57:19 snacking before you exercise 04:05:57:19 - 04:05:58:08 to prevent 04:05:58:08 - 04:06:02:01 hypoglycemia or low blood sugar or 04:06:02:03 - 04:06:03:19 taking a snack before bed 04:06:03:19 - 04:06:05:12 when your glucose is at a certain level 04:06:05:12 - 04:06:06:19 to make sure that you glucose 04:06:06:19 - 04:06:09:09 stay steady through the night. 04:06:09:09 - 04:06:10:19 Those are the types of guardrails 04:06:10:19 - 04:06:12:10 that when you're staring at your data, 04:06:12:10 - 04:06:14:04 you can start to formulate 04:06:14:04 - 04:06:15:22 and have those conversations 04:06:15:22 - 04:06:20:09 with your diabetes care providers. 04:06:20:11 - 04:06:21:15 And so this is why time 04:06:21:15 - 04:06:23:17 in range can be so useful. 04:06:23:17 - 04:06:25:01 It can help you recognize 04:06:25:01 - 04:06:26:19 blood glucose patterns. 04:06:26:19 - 04:06:28:07 It can also be a springboard 04:06:28:07 - 04:06:29:10 for really meaningful 04:06:29:10 - 04:06:31:09 conversations with your diabetes 04:06:31:09 - 04:06:32:20 health care team. 04:06:32:20 - 04:06:36:01 And unlike A1C that looks at data 04:06:36:01 - 04:06:37:09 over three months, 04:06:37:09 - 04:06:38:09 time in range 04:06:38:09 - 04:06:41:09 can be generated on a daily, weekly or 04:06:41:14 - 04:06:43:16 every 14 day level. 04:06:43:16 - 04:06:46:09 So you can really start to see quickly 04:06:46:09 - 04:06:47:16 when you make changes 04:06:47:16 - 04:06:49:08 to evaluate how those changes 04:06:49:08 - 04:06:50:08 made a difference, 04:06:50:08 - 04:06:51:02 either lifestyle 04:06:51:02 - 04:06:57:00 changes or medication changes. 04:06:57:02 - 04:06:58:00 So let's talk about 04:06:58:00 - 04:07:01:22 how can I improve my time in range? 04:07:01:24 - 04:07:03:09 I think one of the first things 04:07:03:09 - 04:07:04:24 is to look at your data. 04:07:04:24 - 04:07:06:00 We know that 04:07:06:00 - 04:07:07:16 if we don't look at the data, 04:07:07:16 - 04:07:09:02 it is meaningless. 04:07:09:02 - 04:07:10:09 So looking at your data 04:07:10:09 - 04:07:11:03 and sharing it 04:07:11:03 - 04:07:12:20 with your health care team, 04:07:12:20 - 04:07:15:09 a lot of the CGM devices 04:07:15:09 - 04:07:17:13 can actually load data up to the cloud. 04:07:17:13 - 04:07:19:06 So your diabetes care team, 04:07:19:06 - 04:07:19:21 if you give them 04:07:19:21 - 04:07:21:23 permission, can go in and remotely 04:07:21:23 - 04:07:23:21 look at data for virtual visits 04:07:23:21 - 04:07:24:22 and things like that, 04:07:24:22 - 04:07:26:00 which is really useful 04:07:26:00 - 04:07:28:04 and was very useful around COVID 04:07:28:04 - 04:07:29:02 when a lot of people weren't 04:07:29:02 - 04:07:32:03 comfortable coming into the office. 04:07:32:05 - 04:07:33:13 The first thing when we look at data 04:07:33:13 - 04:07:35:05 is always assessing for safety 04:07:35:05 - 04:07:37:03 because hypoglycemia can be 04:07:37:03 - 04:07:39:07 so problematic. 04:07:39:07 - 04:07:40:11 It's really important 04:07:40:11 - 04:07:42:17 for health care providers like myself 04:07:42:17 - 04:07:43:18 and for individuals 04:07:43:18 - 04:07:45:14 living with diabetes to focus on 04:07:45:14 - 04:07:47:09 how much time below range 04:07:47:09 - 04:07:49:10 are we spending. 04:07:49:10 - 04:07:50:16 Then taking a look at 04:07:50:16 - 04:07:51:21 how much time are we spending 04:07:51:21 - 04:07:53:08 in our target range? 04:07:53:08 - 04:07:54:12 And one of the best questions 04:07:54:12 - 04:07:55:19 you can do with your health care 04:07:55:19 - 04:07:56:16 provider is 04:07:56:16 - 04:07:58:17 talk about where my time in range 04:07:58:17 - 04:08:00:10 target should be. 04:08:00:10 - 04:08:01:24 It doesn't always have to reflect 04:08:01:24 - 04:08:03:10 what those international consensus 04:08:03:10 - 04:08:04:15 guidelines recommend, 04:08:04:15 - 04:08:05:24 certainly right away 04:08:05:24 - 04:08:06:20 or even depending 04:08:06:20 - 04:08:09:20 on the complexity of your health, 04:08:09:23 - 04:08:11:23 then we want to look at areas to improve. 04:08:11:23 - 04:08:14:20 So how much time did I spend above range 04:08:14:20 - 04:08:16:09 and then discussing ways 04:08:16:09 - 04:08:18:20 like those guardrails, ways 04:08:18:20 - 04:08:21:12 to reduce that time above range 04:08:21:12 - 04:08:23:06 and coming up with an action plan 04:08:23:06 - 04:08:25:10 that's simple and achievable 04:08:25:10 - 04:08:26:14 and something that you can take 04:08:26:14 - 04:08:28:00 a look at and evaluate 04:08:28:00 - 04:08:30:20 if it was effective. 04:08:30:22 - 04:08:31:16 Now let's talk about 04:08:31:16 - 04:08:33:15 improving time in range. 04:08:33:15 - 04:08:34:18 We know the first thing 04:08:34:18 - 04:08:36:09 is that wearing CGM 04:08:36:09 - 04:08:38:21 or checking your blood glucose more often 04:08:38:21 - 04:08:40:20 is a way to get more in tune 04:08:40:20 - 04:08:42:22 with your numbers. 04:08:42:22 - 04:08:44:17 Talking to your diabetes health care team 04:08:44:17 - 04:08:46:09 about where your time in range 04:08:46:09 - 04:08:49:03 target should be is really important. 04:08:49:03 - 04:08:50:05 If you're going to sit down 04:08:50:05 - 04:08:51:13 and look at time in range. 04:08:51:13 - 04:08:52:19 I think that's a great question 04:08:52:19 - 04:08:53:24 to start off with, 04:08:53:24 - 04:08:57:08 where should my time in range be 04:08:57:10 - 04:08:59:02 observing the data first 04:08:59:02 - 04:09:00:12 and then adding notes 04:09:00:12 - 04:09:02:11 about what you did that day? 04:09:02:11 - 04:09:03:11 That's really useful. 04:09:03:11 - 04:09:04:12 Was it a day 04:09:04:12 - 04:09:06:10 that I looked after the grandkids? 04:09:06:10 - 04:09:08:17 Was it a day that I went out for supper? 04:09:08:17 - 04:09:09:07 Was it a day 04:09:09:07 - 04:09:12:09 that I forgot my lunch dose of insulin? 04:09:12:09 - 04:09:15:10 Watching and learning about your trends, 04:09:15:10 - 04:09:17:20 and sometimes those apps and software 04:09:17:20 - 04:09:20:08 can identify those trends for you, 04:09:20:08 - 04:09:22:11 but am I more consistently high 04:09:22:11 - 04:09:23:11
after dinner? 04:09:23:11 - 04:09:26:15 Am I more consistently low before lunch? 04:09:26:15 - 04:09:29:10 Making one change at a time 04:09:29:10 - 04:09:29:22 and seeing 04:09:29:22 - 04:09:31:15 if that impacts your time in range 04:09:31:15 - 04:09:34:03 for that time of day. 04:09:34:03 - 04:09:35:14 Focusing on habits 04:09:35:14 - 04:09:37:11 versus the percentages, 04:09:37:11 - 04:09:38:23 we can get very number 04:09:38:23 - 04:09:40:06 focused with diabetes. 04:09:40:06 - 04:09:42:08 It is a numbers game so much, 04:09:42:08 - 04:09:44:24 but focusing on when I did this, 04:09:44:24 - 04:09:46:09 this was the outcome. 04:09:46:09 - 04:09:47:16 I like that outcome. 04:09:47:16 - 04:09:50:12 Maybe I'm going to do that more often 04:09:50:14 - 04:09:51:22 and talking about what's 04:09:51:22 - 04:09:53:00 going well, 04:09:53:00 - 04:09:54:15 we get really focused on 04:09:54:15 - 04:09:55:23 what isn't going well. 04:09:55:23 - 04:09:57:19 That's human nature. 04:09:57:19 - 04:09:59:05 But talking about what's going 04:09:59:05 - 04:10:01:01 well is so important, 04:10:01:01 - 04:10:02:11 especially from 04:10:02:11 - 04:10:05:12 prevention of diabetes distress. 04:10:05:14 - 04:10:06:20 So remember to do that. 04:10:06:20 - 04:10:08:00 And oftentimes 04:10:08:00 - 04:10:10:20 those apps will generate your best time 04:10:10:20 - 04:10:12:07 in range day wise, 04:10:12:07 - 04:10:13:23 and you can reflect on that. 04:10:13:23 - 04:10:15:13 Sometimes it's good to take that, 04:10:15:13 - 04:10:20:05 print it and put it on the wall. 04:10:20:07 - 04:10:22:21 Remember that you're not your numbers 04:10:22:21 - 04:10:25:09 when we’re testing blood sugars, 04:10:25:09 - 04:10:27:16 when we're looking at our time in range, 04:10:27:16 - 04:10:28:24 you're just a number. 04:10:28:24 - 04:10:30:00 It's a fuel gauge 04:10:30:00 - 04:10:31:05 and it's telling you 04:10:31:05 - 04:10:32:17 how much of the time 04:10:32:17 - 04:10:34:11 do you have the fuel in the right amount? 04:10:34:11 - 04:10:35:17 How much of the time is 04:10:35:17 - 04:10:37:00 with too much fuel 04:10:37:00 - 04:10:38:02 and how much of your time is 04:10:38:02 - 04:10:40:18 spent with too little fuel, 04:10:40:20 - 04:10:42:02 high levels of emotional 04:10:42:02 - 04:10:44:09 distress from trying to achieve 04:10:44:09 - 04:10:46:05 that perfect time in range 04:10:46:05 - 04:10:48:02 is also not healthy. 04:10:48:02 - 04:10:50:23 So it's really important to be realistic 04:10:50:23 - 04:10:52:11 and kind to yourself 04:10:52:11 - 04:10:54:13 when you're looking at your time in range 04:10:54:13 - 04:10:56:07 and celebrating small gains. 04:10:56:07 - 04:10:59:03 Again, even 5%25 increases in 04:10:59:03 - 04:10:59:23 time in range, 04:10:59:23 - 04:11:02:11 that's another hour of your day 04:11:02:11 - 04:11:03:07 that you're spending 04:11:03:07 - 04:11:07:06 in your target range. 04:11:07:08 - 04:11:10:07 Also, remember, diabetes can happen. 04:11:10:07 - 04:11:12:05 This was taken by a good friend of mine 04:11:12:05 - 04:11:13:21 who lives with type one diabetes 04:11:13:21 - 04:11:16:21 and she does a little bit of art on her 04:11:16:21 - 04:11:19:21 on her CGM screens 04:11:19:21 - 04:11:21:22 so that we can kind of like, yup, 04:11:21:22 - 04:11:24:02 we can have our best intentions 04:11:24:02 - 04:11:26:02 for the day or do the exact same thing 04:11:26:02 - 04:11:27:06 we did yesterday. 04:11:27:06 - 04:11:30:15 And a results can be very different. 04:11:30:17 - 04:11:31:16 So sometimes just 04:11:31:16 - 04:11:35:09 diabetes can happen. 04:11:35:11 - 04:11:36:13 And Brown also talks 04:11:36:13 - 04:11:38:24 about over 42 factors 04:11:38:24 - 04:11:41:08 that affect our blood glucose. 04:11:41:08 - 04:11:43:19 This is also very overwhelming 04:11:43:19 - 04:11:44:23 and many of these things 04:11:44:23 - 04:11:48:24 we can do very little about. 04:11:49:01 - 04:11:50:19 So it's important to focus 04:11:50:19 - 04:11:52:14 on the things that we can change 04:11:52:14 - 04:11:55:14 or that we do have control over. 04:11:55:18 - 04:11:57:17 Some of the practical tips for improving 04:11:57:17 - 04:11:59:21 time in range might be exercise, 04:11:59:21 - 04:12:01:06 going for a walk. 04:12:01:06 - 04:12:04:06 Even just 10 to 15 minutes can help lower 04:12:04:06 - 04:12:05:09 that blood glucose 04:12:05:09 - 04:12:08:02 and bring those levels back down. 04:12:08:02 - 04:12:09:17 Getting more sleep. 04:12:09:17 - 04:12:11:05 We know that too little sleep 04:12:11:05 - 04:12:13:10 can increase insulin resistance 04:12:13:10 - 04:12:15:07 and worsen our mood 04:12:15:07 - 04:12:16:06 and all of those things 04:12:16:06 - 04:12:18:13 can affect our blood glucose. 04:12:18:13 - 04:12:21:13 Staying hydrated is really important. 04:12:21:19 - 04:12:24:01 Your diet, trying new foods 04:12:24:01 - 04:12:26:11 or looking at carbohydrate amounts 04:12:26:11 - 04:12:28:06 and speaking with the dietitian 04:12:28:06 - 04:12:29:06 or choosing foods 04:12:29:06 - 04:12:31:10 that trickle into the bloodstream 04:12:31:10 - 04:12:33:01 versus gush, 04:12:33:01 - 04:12:33:19 those are foods 04:12:33:19 - 04:12:36:13 that are lower on the glycemic index. 04:12:36:13 - 04:12:38:05 All of those things can help, 04:12:38:05 - 04:12:41:02 especially those after meal curves, 04:12:41:02 - 04:12:43:18 building strategies to reduce stress. 04:12:43:18 - 04:12:46:02 So we know that stress often raises 04:12:46:02 - 04:12:47:03 blood glucose. 04:12:47:03 - 04:12:50:00 So how can we work things into our day 04:12:50:00 - 04:12:52:07 that help us to manage stress better 04:12:52:07 - 04:12:53:19 so there's less impact 04:12:53:19 - 04:12:56:24 on our blood glucose? 04:12:57:01 - 04:12:57:08 If you're 04:12:57:08 - 04:12:58:20 taking rapid insulin, 04:12:58:20 - 04:13:00:11 consider insulin timing. 04:13:00:11 - 04:13:02:04 I work with a lot of people 04:13:02:04 - 04:13:04:03 who are on multiple daily injections 04:13:04:03 - 04:13:05:20 or on insulin pumps 04:13:05:20 - 04:13:07:10 and even not even 04:13:07:10 - 04:13:08:21 changing the insulin dose. 04:13:08:21 - 04:13:11:10 But just the timing of that rapid insulin 04:13:11:10 - 04:13:12:12 before you eat 04:13:12:12 - 04:13:14:03 can make a huge difference 04:13:14:03 - 04:13:16:24 in that post-meal curve. 04:13:16:24 - 04:13:18:00 Being patient 04:13:18:00 - 04:13:19:22 with your blood glucose levels. 04:13:19:22 - 04:13:20:15 A lot of times 04:13:20:15 - 04:13:22:05 when people start to see data 04:13:22:05 - 04:13:24:23 that they never saw before, they panic 04:13:24:23 - 04:13:27:10 and they start to take too much action 04:13:27:10 - 04:13:29:08 to bring that blood glucose down. 04:13:29:08 - 04:13:30:03 If you're on insulin, 04:13:30:03 - 04:13:32:00 that can result in a lot of time 04:13:32:00 - 04:13:33:09 below range. 04:13:33:09 - 04:13:34:16 So being patient, 04:13:34:16 - 04:13:36:20 just watching that data first 04:13:36:20 - 04:13:39:20 and then starting to formulate a plan, 04:13:39:20 - 04:13:41:11 being aware of environmental factors 04:13:41:11 - 04:13:42:11 that can affect your blood 04:13:42:11 - 04:13:43:06 glucose levels. 04:13:43:06 - 04:13:45:03 So not unusual to hear 04:13:45:03 - 04:13:46:10 you know, summer heat. 04:13:46:10 - 04:13:47:16 It increases 04:13:47:16 - 04:13:49:00 or makes my insulin absorbed 04:13:49:00 - 04:13:50:21 faster and more active. 04:13:50:21 - 04:13:51:23 And these are the reasons 04:13:51:23 - 04:13:53:19 why I'm having more time below range. 04:13:53:19 - 04:13:56:14 So being aware of those kinds of things, 04:13:56:14 - 04:13:58:19 getting into a routine, 04:13:58:19 - 04:13:59:20 it's really difficult 04:13:59:20 - 04:14:02:12 to establish patterns with blood glucose, 04:14:02:12 - 04:14:04:03 whether you're testing them 04:14:04:03 - 04:14:05:20 or whether you're wearing a monitor, 04:14:05:20 - 04:14:07:13 a continuous glucose monitor. 04:14:07:13 - 04:14:09:03 It's difficult to find patterns 04:14:09:03 - 04:14:09:24 if your day to day 04:14:09:24 - 04:14:12:14 routines are radically different. 04:14:12:14 - 04:14:15:01 So trying to develop some kind of routine 04:14:15:01 - 04:14:16:00 helps us to better 04:14:16:00 - 04:14:17:12 see the patterns, 04:14:17:12 - 04:14:19:03 the things that are working, 04:14:19:03 - 04:14:22:07 the things that we need to work on. 04:14:22:09 - 04:14:23:11 And talking with your 04:14:23:11 - 04:14:24:13 diabetes care team 04:14:24:13 - 04:14:25:23 for continue strategies 04:14:25:23 - 04:14:27:12 to improve your time in range. 04:14:27:12 - 04:14:28:05 So 04:14:28:05 - 04:14:29:14 and remember that 04:14:29:14 - 04:14:31:14 time in range is a moving target 04:14:31:14 - 04:14:32:12 in terms of 04:14:32:12 - 04:14:34:02 you're going to have good days, 04:14:34:02 - 04:14:35:23 you're going to have good weeks 04:14:35:23 - 04:14:36:24 and you may have days. 04:14:36:24 - 04:14:38:12 I don't go so well, days 04:14:38:12 - 04:14:39:24 that aren't as good. 04:14:39:24 - 04:14:42:13 So time in range is going to be flexible. 04:14:42:13 - 04:14:44:17 We're looking for overall trends 04:14:44:17 - 04:14:45:21 towards increasing 04:14:45:21 - 04:14:50:09 your time spend in target. 04:14:50:11 - 04:14:51:22 Who would benefit most 04:14:51:22 - 04:14:56:18 from looking at time in range. 04:14:56:20 - 04:14:57:16 We know that 04:14:57:16 - 04:14:59:04 people with type one diabetes, 04:14:59:04 - 04:15:01:02 including those 04:15:01:02 - 04:15:02:23 who are on multiple daily injections 04:15:02:23 - 04:15:04:03 and those with type two 04:15:04:03 - 04:15:06:03 who are own multiple daily injections, 04:15:06:03 - 04:15:07:15 These people are at greater 04:15:07:15 - 04:15:09:16 risk for both time above range 04:15:09:16 - 04:15:11:04 as well as time below range. 04:15:11:04 - 04:15:12:01 And we also know, 04:15:12:01 - 04:15:13:12 we know that these individuals 04:15:13:12 - 04:15:14:16 would benefit 04:15:14:16 - 04:15:17:02 from from looking at time in range more 04:15:17:02 - 04:15:19:09 and the data supports that. 04:15:19:11 - 04:15:21:22 I think really any person with diabetes 04:15:21:22 - 04:15:23:11 who wants to take a more detailed 04:15:23:11 - 04:15:25:01 look at what impacts their blood 04:15:25:01 - 04:15:26:06 glucose levels 04:15:26:06 - 04:15:27:13 with the goal of improving 04:15:27:13 - 04:15:28:18 their time in range 04:15:28:18 - 04:15:31:08 would also benefit from that. 04:15:31:08 - 04:15:34:20 But it does, you know, rely on coverage 04:15:34:20 - 04:15:36:18 in terms of your insurance coverage 04:15:36:18 - 04:15:38:15 as well as your provincial coverage 04:15:38:15 - 04:15:39:16 as to whether you can go 04:15:39:16 - 04:15:41:12 on devices like CGM 04:15:41:12 - 04:15:41:20 that would 04:15:41:20 - 04:15:44:20 accurately capture time in range. 04:15:44:23 - 04:15:46:22 And remember that time in range data 04:15:46:22 - 04:15:48:04 is meaningless 04:15:48:04 - 04:15:49:15 unless people with diabetes 04:15:49:15 - 04:15:51:03 and their diabetes care team 04:15:51:03 - 04:15:56:13 take the time to check it. 04:15:56:15 - 04:15:58:01 According to the clinical practice 04:15:58:01 - 04:15:58:15 guidelines. 04:15:58:15 - 04:16:01:00 With the new update in 2021, 04:16:01:00 - 04:16:02:13 those people who would benefit from 04:16:02:13 - 04:16:03:19 CGM are 04:16:03:19 - 04:16:04:14 people with type 04:16:04:14 - 04:16:05:13 one diabetes 04:16:05:13 - 04:16:07:19 using multiple daily injections, 04:16:07:19 - 04:16:09:06 people with diabetes 04:16:09:06 - 04:16:11:09 who cannot feel their hypoglycemia 04:16:11:09 - 04:16:12:10 or have had severe 04:16:12:10 - 04:16:14:01 low blood glucose, 04:16:14:01 - 04:16:15:14 adults with type two diabetes 04:16:15:14 - 04:16:17:13 using multiple daily injections 04:16:17:13 - 04:16:18:10 and pregnant women 04:16:18:10 - 04:16:23:16 with type one diabetes. 04:16:23:18 - 04:16:24:09 Access to 04:16:24:09 - 04:16:27:09 CGM varies across Canada widely, 04:16:27:10 - 04:16:28:15 and so if it's something 04:16:28:15 - 04:16:29:23 you're interested in looking at, 04:16:29:23 - 04:16:30:13 it's important 04:16:30:13 - 04:16:31:23 to talk to your diabetes 04:16:31:23 - 04:16:34:00 care team as well as your insurance 04:16:34:00 - 04:16:35:04 if you have 04:16:35:04 - 04:16:36:15 and your provincial government 04:16:36:15 - 04:16:38:16 to see what sorts of criteria 04:16:38:16 - 04:16:39:13 and eligibility 04:16:39:13 - 04:16:40:11 there are for you, 04:16:40:11 - 04:16:42:01 depending on your age 04:16:42:01 - 04:16:44:17 and the type of diabetes therapy you have 04:16:44:17 - 04:16:50:22 and the type of diabetes you have, 04:16:50:24 - 04:16:52:04 I hope that I've answered 04:16:52:04 - 04:16:53:12 some of your questions 04:16:53:12 - 04:16:55:13 about time in range today, 04:16:55:13 - 04:16:56:19 and I thank you 04:16:56:19 - 04:16:58:00 for having me to talk about 04:16:58:00 - 04:17:00:09 this really important topic. 04:17:00:09 - 04:17:01:17 Thank you so much. 04:17:01:17 - 04:17:02:16 Bye bye. 04:17:03:19 - 04:17:05:12 Thank you so much for tuning into this 04:17:05:12 - 04:17:06:10 very informative 04:17:06:10 - 04:17:08:20 episode of Diabetes Deep Dives, 04:17:08:20 - 04:17:10:13 and thank you to Michelle for a deeper 04:17:10:13 - 04:17:12:10 look into time in range. 04:17:12:10 - 04:17:14:06 Again, this topic may not be relevant 04:17:14:06 - 04:17:16:04 to everyone living with diabetes, 04:17:16:04 - 04:17:17:11 but we do hope that you found it 04:17:17:11 - 04:17:19:22 interesting and learn something new. 04:17:19:22 - 04:17:21:01 Please take the opportunity 04:17:21:01 - 04:17:22:00 to keep the conversation 04:17:22:00 - 04:17:23:12 going by posting a comment 04:17:23:12 - 04:17:26:00 in the comments section on YouTube. 04:17:26:00 - 04:17:27:07 You can provide us feedback 04:17:27:07 - 04:17:28:03 about the video 04:17:28:03 - 04:17:30:00 by clicking on the link in the feedback 04:17:30:00 - 04:17:32:02 survey in the description box. 04:17:32:02 - 04:17:33:19 If you have ideas for other topics 04:17:33:19 - 04:17:35:07 you'd like to learn more about, 04:17:35:07 - 04:17:37:00 you can include that in the comments 04:17:37:00 - 04:17:39:14 or feedback survey as well. 04:17:39:16 - 04:17:40:11 Michelle mentioned 04:17:40:11 - 04:17:41:03 that access 04:17:41:03 - 04:17:42:03 and financial coverage 04:17:42:03 - 04:17:44:07 to medical devices for diabetes, 04:17:44:07 - 04:17:45:18 such as continuous glucose 04:17:45:18 - 04:17:47:23 monitors, varies by province. 04:17:47:23 - 04:17:49:03 In the YouTube description 04:17:49:03 - 04:17:50:17 box below the video, 04:17:50:17 - 04:17:51:11 we have included 04:17:51:11 - 04:17:53:15 a link to a Diabetes Canada document 04:17:53:15 - 04:17:54:08 that outlines 04:17:54:08 - 04:17:56:12 the coverage for CGMs by province 04:17:56:12 - 04:17:59:03 as of March 2022. 04:17:59:03 - 04:18:00:02 For more information 04:18:00:02 - 04:18:01:17 about diabetes management, 04:18:01:17 - 04:18:04:14 please visit our website at diabetes.ca. 04:18:04:14 - 04:18:08:02 You can also email us at info@diabetes.ca 04:18:08:04 - 04:18:10:23 or call our info at 1-800-BANTING. 04:18:10:23 - 04:18:14:18 That's 1-800-226-8464 04:18:14:24 - 04:18:16:14 and speak to one of our information 04:18:16:14 - 04:18:17:22 and support specialists 04:18:17:22 - 04:18:19:09 who can address your needs. 04:18:19:09 - 04:18:20:04 Thanks again for joining 04:18:20:04 - 04:18:21:12 us and see you next time. |
| 9 | Episode 9 | What to Expect When Expecting In this episode, we will hear from Kimberley Hanson, who was diagnosed with type 1 diabetes in 1997. Kim will walk us through her experience of managing her diabetes while pregnant. She will share was she learned about getting prepared, navigating her healthcare team and medication needs during pregnancy, and what to expect in the post-partum period. She will share practical tips and resources for people who live with diabetes and are considering having a baby. | |
These videos are for educational purposes only. The content discussed in this video is not intended to be medical advice and, to the extent that medical advice is required, you should consult with a qualified medical professional. The information discussed in this video cannot replace consultations with a qualified health-care professional to meet your individual medical needs.
The views and opinions expressed in this video are those of the speakers and do not necessarily reflect the views or positions of Diabetes Canada.
Please take the opportunity to let us know what you learned, what you liked and how we can do better in the comment section on our Deep Dives YouTube videos. If you have ideas for other topics you’d like to learn more about, you can include that in your comments as well. Email us at info@diabetes.ca or call our info-line at 1-800-Banting and speak to one of our information and support specialists who can address your needs.