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.
Diabetes Research
foreign
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I'm so pleased that you are joining us
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today
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diabetes deep Dives is a series of
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videos designed to dive deeper and
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Beyond the surface of different areas of
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diabetes management we are exploring
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those burning questions that you may
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have by featuring Dynamic and engaging
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guests with knowledge or lived
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experience on the topic our goal is to
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share information in ways that will
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spark continued interest and learning
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and leave you with practical tips and
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tools that you can easily use we'll be
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dropping a new video every month so
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subscribe to our YouTube channel and
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click on the notification Bell to be
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notified about new content you can also
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check us out on social media to find out
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when the next one will be posted on our
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YouTube channel
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just a reminder that the information
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shared in these videos in no way
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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
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make sure that you are getting the best
1:06
advice
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have you ever wondered about what goes
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into the research that informs the
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development of a new diabetes treatment
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or how new technology is tested for
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diabetes management
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are you interested in getting involved
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in the research process
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in this video we will explore the
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different ways of conducting research
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that contributes to helping us prevent
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treat and find a cure for diabetes as
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well as how people affected by diabetes
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can participate
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our guest speaker Dr Brandy Wicklow will
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share her knowledge about commonly used
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research models for diabetes research
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and the ways in which people affected by
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diabetes can get involved
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she'll also tell us a little bit about
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what to expect as a participant in a
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research study
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after watching this video we hope that
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you will be able to
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identify the different types of research
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models and the differences between them
2:04
find the resources to learn more about
2:06
the diabetes research projects happening
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in Canada and internationally
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understand what to expect and what your
2:13
rights are if you participate in a
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research project
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and make an informed decision if you are
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thinking about getting involved in a
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diabetes research project
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Dr Wicklow is an associate professor in
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the department of Pediatrics and child
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health at the University of Manitoba and
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a clinical investigator at the
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Children's Hospital Research Institute
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of Manitoba
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Dr micklow's research is focused on the
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determinants of type 2 diabetes and its
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renal complications in children with a
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particular interest in the Indigenous
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population of Northern Manitoba
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we hope that you will find this video
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informative and that it will spark your
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interest in learning more about diabetes
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research and about getting involved and
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now over to Dr Wicklow
3:00
researching clinical trials is the basis
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of everything we know about diabetes
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that's how we learn how to diagnose
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diabetes how to screen for diabetes and
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its complications how to treat and
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manage blood sugars and how to prevent
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complications
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and support people living well with
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diabetes as a physician all of the
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clinical practice guidelines that I
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follow in my clinical practice
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are informed by this clinical research
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just like there are many different types
3:31
of diabetes in many different
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populations of people affected by
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diabetes so the research is quite Broad
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in this area
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researchers cover anything from what are
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the most important and relevant
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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
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diabetes
3:57
how to prevent diabetes
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and perhaps most importantly to those
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living with diabetes how to find a cure
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because all of these questions are very
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different and very important there are a
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multitude of different studies and
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different study types that someone
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living with diabetes can get involved
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with we're going to go through a few of
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those today on this deep dive looking at
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Clinical Research in diabetes
4:25
when people think about research and
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specifically Research into diabetes they
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often think about two things
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the research that's looking into a cure
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and the research to prevent diabetes
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many of these research trials are
4:41
clinical trials and often the randomized
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clinical trials
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a randomized clinical trial is a
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clinical trial that looks at a new
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medication
4:52
a new preventative measure
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a new treatment for prevention of
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complications
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a new way to monitor or screen and it
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Compares these new Innovations to common
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practice
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or the current standard of clinical
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practice that you would experience when
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you go to see your doctor on a regular
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basis
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these new treatments or therapies have
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often been trialed in cellular models or
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animal models and at some point those
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same therapies need to be trod and
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humans with diabetes so that we can
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ensure that they're safe they're
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tolerable and they're efficacious or
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they work well
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oftentimes these types of Trials are
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what we call randomized randomization is
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really just like a flip of the coin
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if you're enrolled in a trial and you're
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going to be randomized what that means
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is you are going to be randomly selected
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to be either in the treatment group
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trying the brand new drug the brand new
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method of dosing the brand new way of
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screening
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and if you are randomized into the
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control group you'll be getting your
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usual Care by your usual clinician
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through usual means
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occasionally control groups will also
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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
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vulnerability side effects quality of
6:31
life
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these trials are incredibly important
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and they're a way to get a new
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medication such as empathoglobin
6:42
closed-loop insulin pump system
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from Discovery and development
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to the market
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and only when these types of research
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Studies have shown that a medication or
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an innovation is safe is effective and
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oftentimes it's Superior to what we
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currently have and can recommend for
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people living with diabetes will it be
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made available through Health Canada for
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all people with living living with
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diabetes to be able to use
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prevention trials are often similar the
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randomized trials but they're performed
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in a population of people who have not
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yet developed diabetes or who have not
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yet developed complications of diabetes
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and these new Innovative treatments are
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used to prevent the develop or
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development or progression of diabetes
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in a population
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this is the discovery of insulin in
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Toronto over a hundred years ago
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Canadian researchers have been at the
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Forefront of many of these research
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projects
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often centers throughout Canada are
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recruiting people with diabetes to
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participate in these International
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research studies looking at new
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medications to prevent or treat Type 1
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Diabetes Type 2 diabetes gestational
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diabetes or other types of diabetes
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in addition to randomized control trials
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there are several other types of
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research that you can get involved in
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some of these different types of
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research studies include focus groups
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observational trials and occasionally
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it's just a single sample of blood in
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order for fundamental scientists who do
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cell cellular modeling or stem cell
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therapy to look at potentials for
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prevention or a cure
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focus groups are often just that they're
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groups of individuals with lived
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experience
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with either Type 1 Diabetes Type 2
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diabetes gestational diabetes or other
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they're asked a set of questions to
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inform what is the priority for research
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for people living with diabetes what are
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the important and relevant questions to
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you to your loved ones and to other
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families living and or affected by
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diabetes
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often these priority setting exercises
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are the basis of some of the largest
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networks of research there are in Canada
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including
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the patient-oriented research networks
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uh diabetes action Canada and cancel CKD
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for more about those two organizations
9:23
in a minute
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personal interviews focus groups or
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questionnaires that look at how one
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lives with diabetes
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what's a barrier to living well with
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diabetes
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what has been found to be supportive of
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living well with diabetes and where
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people find there's not enough advice or
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information
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these are the places where researchers
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are going to focus their efforts in the
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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
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research Realm
10:03
how do we deliver care in the best
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possible way
10:06
how do we screen for and prevent
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complications of diabetes
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how do we transfer transition patients
10:14
from a pediatric diabetes Clinic to an
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adult diabetes clinic in the safe and
10:19
most effective way
10:21
researchers are looking to partner with
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persons affected or living with diabetes
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and their families or caregivers in
10:29
order to do important and relevant
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research to those who are affected by
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diabetes
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as I mentioned previously there are
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several organizations which have
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information for patients and families
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which outlines some of the different
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projects that are happening in Canada
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and how you might be able to get
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involved one of those is diabetes action
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Canada
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if you Google diabetes action Canada
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you'll come to a face page which
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includes an area for patients or persons
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living with diabetes it also includes an
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outline of all of the researchers in
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Canada who belong to the organization
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and some of the work that they are doing
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through diabetes action in Canada there
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is a project called connect 1D
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connect 1D Canada is an interface on the
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computer which allows patients and
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people living with diabetes to register
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online to be contacted or considered for
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different clinical trials or research
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programs that come up
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other websites with useful information
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to look at research being done in
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diabetes across Canada include diabetes
11:44
Canada
11:45
the juvenile diabetes Research
11:47
Foundation or JDRF and can solve CKD
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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
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some of the projects where Canadians are
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included
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this includes trial net
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trial net is a type 1 diabetes screening
12:12
and prevention platform
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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
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therapies to delay the onset of diabetes
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or prevent it altogether
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other research programs can be found on
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the government website called
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clinicaltrials.gov This is where
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clinical trials register all of their
12:59
inclusion criteria exclusion criteria
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what the study questions are and who
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they're looking for in terms of
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participation
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oftentimes if you type in the search
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type 1 diabetes type 2 diabetes
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gestational diabetes or whatever it is
13:18
that is relevant to you into the search
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box up top you will also allow you to
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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
26:43
On this episode of Diabetes Deep Dives, our guest speaker Dr. Brandy Wicklow will share her knowledge about commonly used research models for diabetes research, the ways in which people affected by diabetes can get involved and what to expect as a participant in a research study. After watching this video, we hope that you will be able to:
- Identify the different types of research models and the differences between them
- Find the resources to learn more about the diabetes research projects happening in Canada and internationally; - Understand what to expect and what your rights are, if you participate in a research project
- Make an informed decision if you are thinking about getting involved in a diabetes research project.
Menopause & Type 1 Diabetes
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
In this video, we hear from Dr. Alice Cheng on the intersection between Type 1 diabetes, menopause, and sexual health. She discusses the impact of hormones on blood sugar levels, strategies to manage fluctuations in blood sugar levels, and options for managing the symptoms of perimenopause and menopause. Dr. Cheng also covers other health conditions to be aware of during and after menopause, the impact diabetes may have on sexual health, and treatment to address issues that may arise.
At Diabetes Canada, we're committed to empowering individuals affected by diabetes. That's why we created Diabetes Deep Dives – to provide you with the information you need to work with your care team and achieve better outcomes. And remember, the information shared in these videos in no way replaces the advice and direction from your healthcare team. If you have questions about your care, please speak to your healthcare provider and team to make sure you're getting the best advice.
Please take the opportunity to let us know what you learned, what you liked and how we can do better in the comment section below. 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.
Category Tags: Management;