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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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 |
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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. |
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| 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. |
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