Diabetes Open Hours

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Dr. Dayna Lee-Baggley: Hello.

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Cayla Runka: Hi, there! How are you today? Good. We have someone filling in for our digital manager. And so

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Dr. Dayna Lee-Baggley: the back end that we were going to be sitting in is not really happening. But he's going to give us a heads up before he feeds us to Facebook live. So we have and just to clarify. I don't currently work at the hospital like I did work for almost 15 years as possible just the way it's worded. It kind of sounds like I'm still there, but I'm I left after wave to

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Cayla Runka: II don't blame you for that.

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Dr. Dayna Lee-Baggley: She has. No, says she has worked okay

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Dr. Dayna Lee-Baggley: for almost 15 years. Yeah, no. I think that's okay.

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Check.

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Cayla Runka: Yeah. So Hassan will give us the heads up that we're going to go live, he said. He'll touch base around 1159. And then once he gives the A okay, I'll just start in with the Moderator script, and then I will

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you. You'll know

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Cayla Runka: when we're ready when I say, you know, are you ready to get started and and we can go from there?

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Dr. Dayna Lee-Baggley: Okay, great. And then one of the last. The last question, I think, is.

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Cayla Runka: if someone is finding time, that finding this time overwhelming, where might they find support and for their help. So the links that you provided will you be mentioning those? Because then I will say something like, I think those links are being provided to you in the chat, and then that will queue Hasan to cause we don't see anything that's happening. Oh, he says, perfect! He can hear. We just don't see him, I guess. And

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Cayla Runka: he'll also put the evaluation for this session and when it's queued as well, so

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Cayla Runka: it should be fine.

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Cayla Runka: and, as I said, sometimes we get questions from the audience, and a Sam will feed those tests in the chat. And then sometimes we don't and so if we don't, then we've got this sort of 7 questions that you and I have in the script here, and we'll just go through those, and then I will find a way to say, well, if there are no more questions.

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Cayla Runka: we'll wrap up the session and close sort of from that perspective. So

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Cayla Runka: and thank you again for doing this.

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Cayla Runka: One of our goals next year is to help manage the journey from diagnosis through to, you know, seasoned

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people with diabetes that still have questions and refreshers. So we're looking a lot at how we can

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Cayla Runka: use some of the existing resources, but also build

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Cayla Runka:  sessions like this to help sort of from beginning to sort of end

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Cayla Runka: support people. Better. So.

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Dr. Dayna Lee-Baggley: okay, sounds good.

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Dr. Dayna Lee-Baggley: Yeah, we've done that. We did like a manual for another group on like.

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Dr. Dayna Lee-Baggley: like, when you get a diagnosis kind of thing

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Cayla Runka: that sounds great. Yeah.

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Cayla Runka: I'm sure. Yeah, people. I have a friend who just her teenager was just diagnosed. And I think obviously, it's overwhelming. But certainly, when it's a child, too. It's.

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Cayla Runka: you know, more than just the individual that's impacted. It's the entire family. So

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Cayla Runka: and so where are you based? Are you out West.

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Dr. Dayna Lee-Baggley: I'm in Halifax, actually. Halifax. Yes.

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Cayla Runka: okay, yes, I guess working at Dalhousie and St. Mary's. That would be hard to do from the West Coast.

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Cayla Runka: I I suppose I saw those posts that you can work for a year in Italy if you are not a resident, and I thought that would be quite nice.

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Dr. Dayna Lee-Baggley: not sure how it would go over with Canada. But yeah, you can always dream.

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Dr. Dayna Lee-Baggley: And so it does get record. It does it get recorded. And then you do it does get recorded. Yeah. So typically, we get in fact, we probably won't be doing them broadcast. Live next year. Any webinars we've been doing it because it gives the opportunity for connection. So people that want to attend can ask questions and get their questions answered.

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Dr. Dayna Lee-Baggley: We don't tend to get a ton of questions, which is why we've now developed our own questions. But what we do then is it's recorded and uploaded to our Youtube channel. And it's shared widely on our media, our social media. Platforms. And then we tend to get

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Dr. Dayna Lee-Baggley: a lot of viewership. On. Can you tag me on those social media

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Dr. Dayna Lee-Baggley: host?

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Cayla Runka: Sure, if you like, I can certainly ask for that

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Dr. Dayna Lee-Baggley: cause. We can then like share them again.

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Cayla Runka: Sure

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Dr. Dayna Lee-Baggley: are you on all the platforms, or I think so, I think, and I think it's at Dr. Lee Bagley, like TRLE. E. Like.

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Dr. Dayna Lee-Baggley: but you can feel free to call me Dr. Dana during that

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Cayla Runka: the session. Okay?

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Dr. Dayna Lee-Baggley: Alright, yes. I edited the script. So as I'm reading your your profile and your bio. Okay? No, I definitely can ask to have that happen.

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Cayla Runka: I'm assuming he's gonna put us live any minute.

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Dr. Dayna Lee-Baggley: I'm really hoping my cats stay sleeping, cause they're just over here, and they sometimes like to jump on the table. So I have just in case

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Cayla Runka: alright, he says, just getting ready.

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Cayla Runka: Send me a, we're live. Okay, Hasan.

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Cayla Runka: 1 s, everyone. It just says that I don't have permissions to take it to live. I'm just gonna double check for you. Okay? Hassan. Also, normally, this, we're in Speaker view, so that it's it's on whoever's speaking. And I think you've spotlighted both of us.

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zoom.webinars@diabetes.ca: This better do you get to see?

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Cayla Runka: It's just different than all the other videos. So far, so normally, it goes back and forth. Whoever speaking.

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zoom.webinars@diabetes.ca: I think this should solve it, does, does it not?

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zoom.webinars@diabetes.ca: It says, on my view speak of you, attend to view. Speak of you as well.

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Cayla Runka: Okay. give me a few more seconds. Let me figure this out.

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zoom.webinars@diabetes.ca: Okay, it's almost there

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zoom.webinars@diabetes.ca: we are. Live.

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Cayla Runka: Hello, and welcome to diabetes, open hours. Your live. QA. Opportunity with experts in diabetes, management, and care. My name is Kayla Ranka, and I'll be your moderator, for today.

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Cayla Runka: I would like to start by acknowledging that I'm calling in from Toronto, and that I'm located on the traditional indigenous territory of the Windat, Hoda Nishoni, Anishinabeg, and the Mississaugas of the Credit and that Toronto is now home to many diverse first nations, Inuit and metis peoples

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Cayla Runka: as a health focused organization diabetes. Canada recognizes that there is systemic racism within and throughout our institutions, and that we have the responsibility and power to create culturally safe and appropriate environments of care.

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Cayla Runka: Our topic today is dealing with a diabetes diagnosis and is supported with an unrestricted educational grant from Sinofi.

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Cayla Runka: And while we have an expert on the call today, this webinar is for educational purposes only the content discussed in this webinar is not intended to be medical advice, and to the extent that medical advice is required, you should consult with a qualified medical professional the information discussed in this webinar cannot replace consultations with a qualified healthcare professional to meet your individual medical needs.

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Cayla Runka: and lastly, the views and opinions expressed in this webinar are those of the speaker, and do not necessarily reflect the views or positions of diabetes. Canada having said all that today, we are very lucky to have Dr. Dana Lee Bagley with us.

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Cayla Runka: Dr. Dana is a registered clinical psychologist in British Columbia, Alberta, Ontario, and Nova Scotia.

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Cayla Runka: Her registrations include clinical Psychology, health, psychology and organizational psychology.

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She's the co-founder and chief scientific officer of the impact. Me app. She has worked for almost 15 years in multidisciplinary teams on medical, surgical and cancer care hospital units

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Cayla Runka: and conducts research as an assistant professor in the department of Family medicine with a cross appointment in the Department of psychology and neuroscience at Dalhousie University, and she's an adjunct professor in the Department of Psychology at Saint Mary's University, and if that wasn't enough, she is also the author of the book. Healthy Habit suck

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Cayla Runka: how to get off the couch and live a healthy life, even if you don't want to.

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Cayla Runka: and I certainly feel like that's a book we could all definitely use in our lives

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Cayla Runka: before we get started. Just a few housekeeping things. Please note this event is being recorded and will be shared on our website and Youtube channel for on demand viewing

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Cayla Runka: any questions or comments that you submit via the chat function will be visible to other participants during the event. But we will not share any names or record of the chat in the recording.

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Cayla Runka: We ask that any comments or reactions you share be affirming and positive, and we encourage you to discuss your learnings with your regular healthcare provider prior to making any changes to your current routine.

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Cayla Runka: and with that are you ready to get started, Dr. Dana?

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Cayla Runka: Great! Thank you for joining us today and for all of you participants feel free to start putting your questions into the chat, and while we're waiting

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Cayla Runka: why don't we start with the actual time of diagnosis? So what might some of the emotions that individuals may feel when they hear the word diabetes from their healthcare provider. I'm sure shock probably is one of the top ones on that list.

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Dr. Dayna Lee-Baggley: Yeah, we know that people are going to feel, you know, a variety of emotions when they first get diagnosed. So

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Dr. Dayna Lee-Baggley: that includes things like shock. It includes things like grief. Confusion. I think it's helpful for people to know that there are

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Dr. Dayna Lee-Baggley: like grief is a really normal part of getting a diagnosis, and it's grief over a lot of different things. Right? Grief is just a reaction to loss, and that loss sometimes includes your ideas about the future that might be different now, and includes potentially a loss of your identity loss of certain roles. That there are changes that will happen kind of throughout your life, potentially because of that diagnosis. And so that's very common for people to go through.

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Dr. Dayna Lee-Baggley: Some people have heard of like the 5 stages of grief. I think it's important to know that there aren't actually 5 stages of grief. And so what's helpful about that model is recognize. There's lots of different emotions that show up in response to grief.

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Dr. Dayna Lee-Baggley: All of those emotions are normal and natural. But you don't have to go through a set order of stages of grief to be coping well with a loss

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and and believing that you have to go through a certain stage, you know, model actually can lead to complicated grief. So just about recognizing there's lots of different emotions that show up.

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Dr. Dayna Lee-Baggley: We talk about the 3 n, so notice it, name it and normalize it right? So, recognizing you're feeling different things. You know, naming it, it could be sadness. It could be anger, it could be numbness. It could be you know, a variety of different emotions, and that those are all normal responses to a a big change in your life like this.

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Cayla Runka: Okay, great. Yeah. So so this grieving period, we often do hear about it. And like you mentioned whether it's due to, you know, things changing rapidly or potentially, even worry about their family. And now their family history has changed with the diagnosis of a a chronic medical condition as well.

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Cayla Runka: So do you. Are there specific tactics that people can use, maybe to get through that time of grief and move on to, you know the management stage of of a new diagnosis.

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Dr. Dayna Lee-Baggley: Yes. So one of the main things we do work on with people. With a chronic disease which, you know, starts at diagnosis. Is a term we call psychological flexibility. And that's like your ability to have like a large behavioral repertoire meaning you could do lots of different things.

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Dr. Dayna Lee-Baggley: And it's really important for people experiencing a chronic disease to figure out how to be value driven instead of goal driven. So our culture talks a lot about being goal driven. And you know, those are achievements. You wanna do their outcomes that you wanna have happen. But we don't always control those right. They're often controlled by lots of different things. Not just our own efforts

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Dr. Dayna Lee-Baggley: being value driven is about how you want to show up as a human. So it's not about what you want to get from the world. It's about what you want to contribute to the world. So whether you wanna contribute creativity or kindness or compassion, it's about how you wanna show up. And if we can move to being value driven, it gives us a much larger opportunity to do things that matter to us. It's quite likely that there are things that will have to change in your life about what you can do.

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Dr. Dayna Lee-Baggley: And but that doesn't mean you can't have a meaningful life. You can for sure have a meaningful life. It's just gonna look different. And frankly, that's true for all humans as we grow up right, it very rarely looks the way we thought it was going to look. And so that psychological flexibility about being able and willing to express your values in a different way.

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Dr. Dayna Lee-Baggley: So, for example, you know perhaps it was a part of your role was to like, make meals for everybody right? And now some of the meals that you make are things that you're not supposed to eat because of your diagnosis. Right? So we're trying to find you another way to care about your loved ones that might involve different meals or different activities, but it's still an expression of your care and affection for them. And so that's something that we are trying to work on with people is to be.

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have more options for how to express your values, we can always find them, and the key is your willingness to have it look different and feel different than how you thought it was going to look or feel.

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Cayla Runka: Wow! II love that that actually spoke to me. Incredibly, as you know, a mom and and someone who cares for my family via food. And I can imagine that. That's a big change for people, especially with the diabetes diagnosis.

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Cayla Runka: You know, learning, you have a chronic medical condition. Can be hard to accept and depending on how you move through that stage. Sometimes people move into a period of self blame. So why did this happen to me? How could I have prevented it?

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Cayla Runka: Can you speak to that feeling a little bit. And and you know some tactics, maybe to help people again deal with that concept of of self blame.

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Dr. Dayna Lee-Baggley: So you know, we all wanna recognize that we live in an environment in like, you know, North America, that absolutely does not is not conducive to health. It's not conducive to health behaviors. It encourages unhealthy behaviors, actually incredibly difficult to to do, like to maintain healthy behaviors in our culture. Our environment just does not support that. And it not a neutral environment actually supports

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Dr. Dayna Lee-Baggley: unhealthy habits? Right? So

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Dr. Dayna Lee-Baggley: will you talk about this as like a compassionate reality check, which is like. Certainly there are things that that you've done and that you could continue to do that will impact your condition. And you want to be aware of those. And you want to work on those as much as possible, cause they, you know, are under your control. But there's a whole bunch of other factors that lead to these diagnoses that are absolutely out of our control. Right? There are different rates of diabetes

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Dr. Dayna Lee-Baggley: depending on different like economic classes. Right? There's differences in terms of different ethnicities. There's differences in terms of like where you live, for example, whether rates are higher in, you know, one country versus another country. None of those are things that we chose right? We don't choose where we're born. We don't choose what era we're born in. We don't choose whether we're male or female.

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And all of those things also impact our health. So it's kind of a terrible thing that our culture has done to act like. If you just believe in your dreams, anything is possible, because it sort of conveys that you have some unlimited control over your body. And if you had just tried harder, you could have stopped this from happening right. But most of us are facing an uphill battle when it comes to health, and there are all a whole bunch of factors that influence that. But we actually have no control over.

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Dr. Dayna Lee-Baggley: And so we're balancing the 2 things which is

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Dr. Dayna Lee-Baggley: there's a whole bunch of this that isn't your fault, and it's your responsibility, right? So there's a bunch of things that you can do to help your condition, and even when you're doing everything right, your condition can still be progressive. It can still go up and down. It doesn't mean what you're doing doesn't count doesn't matter. It just means that there are some parts of our bodies we don't have control over, and we live in an environment that does not help us make it

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good choices. So I once I, you know, once worked with this woman who is diagnosed with breast cancer in her fortys. So I know it's a different diagnosis, but kind of relates to the same idea.

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Dr. Dayna Lee-Baggley: which? You know, and she just run a marathon or something like that. So she was like super healthy, and she was so angry right that she'd gotten this diagnosis when she was so healthy, and she was like all my healthy habits, were for nothing, but we don't know that maybe she was destined to get breast cancer in her twenties, and all of her healthy habits delayed the progression until her fortys right. She was definitely gonna go through Chemo a lot better because

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Dr. Dayna Lee-Baggley: because she was healthier. The rest of her body was healthier. And so there's some parts of our bodies we don't have control over. We can't directly, you know, change them. And so you want to control the things you do have control, which is your behaviors, and there are lots of behaviors that will make your condition better or worse. And at the same time there are parts that even when you're doing everything right, you won't have control over it.

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Dr. Dayna Lee-Baggley: So getting into that shame cycle typically isn't good for people usually like goes down a a path that actually doesn't help you make good choices. It doesn't help you live a meaningful life. And so we just want to recognize that again, you can use our 3 ends of notice it, name it, normalize it. Of course, it's normal to feel that way. Is it really gonna help me if I let this be in charge of my day?

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Dr. Dayna Lee-Baggley: Right? And chances are it's not. And so then go do something that's value driven. Go, do something that matters to you. Go take care of yourself in some way, and some, you know, easy kind of thing that you can do to remind yourself that it's an and not a but right, that you can do things that influence your condition. And you should, and you can be doing everything right, and your condition can still progress.

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Cayla Runka: That's a great thought, and also a fantastic segue into the next question. So you know, a a spec specifically with a diabetes diagnosis. There's a lot of things that end up needing to change

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Cayla Runka: changes to the diet changes to your physical activity, treatment, plans, medication, schedules, blood sugar checks.

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Cayla Runka: and all of those details. Take up a number of sort of points throughout a day and for some that additional routine might be a little overwhelming. So are there ways to organize or even wrap one's mind around fitting in all these points of a treatment plan throughout the day, knowing that again, to your point of value, based and and moving forward through doing something positive for yourself.

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Cayla Runka: is now critical to one's life and well-being.

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Dr. Dayna Lee-Baggley: Yeah. So we try to get people to attach a value driven reason for change for making those changes. A lot of people will try to make those changes.

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Dr. Dayna Lee-Baggley: based on kind of a fear model, right? I don't want to have the bad outcomes that people have told me will happen with diabetes. I don't wanna go blind. I don't. Wanna you know, have problems with my feet, and so it becomes driven by distress, and that can get you going at the start. But it will never keep you going, because people humans don't like being in distress. So if you've attached all of those healthy behaviors

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Dr. Dayna Lee-Baggley: to distress, or something bad happening to you. That's what's become linked in your mind, right? It's not a positive thing. It's this dangerous thing that you're trying to prevent. And so values are always about moving towards something that matters not about getting away from something bad. And so health, we actually describe as not a value. It's a means to an end.

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Dr. Dayna Lee-Baggley: What will the health allow you to do so if, being healthy, gives you more energy, you know, taking care of your diabetes makes you more stable or reliable if it helps you. You know. Do your job better. Right? Those are the things we're looking for, not even just like, well, I could live longer. Okay, well, if you live longer, what are you gonna use those extra years, for why does it matter to be here on the planet

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Dr. Dayna Lee-Baggley: and managing diabetes in particular? There are things that will impact your well-being on a daily basis. Right? So managing your blood sugars will help you think more clearly. It'll help you be more productive. It'll help you be more reliable. And so what matters to you, and who? Who and what are the things that are important to you, that you want to be more reliable for that you want to have a more clear headed, you know, ability to think and to be productive.

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Dr. Dayna Lee-Baggley: right? Whether that's your family, your relationships, your work. It's gonna help you on a day-to-day basis, show up as the person you want to be, and so connected to those things that are meaningful important to you. Not a distress model of change.

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Dr. Dayna Lee-Baggley: The second part is, you know, if we think about that, we have sort of a certain capacity, like a battery right? And that battery will get drained. And there's things that like use up that battery. If you suddenly need to add in a whole bunch of health behaviors. It's going to use some of that battery and time in your day.

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Dr. Dayna Lee-Baggley: And so we have to actually start thinking about, what am I gonna give up. What am I going to give to somebody else? What am I not going to do to make space for these health behaviors? Because they take both time and energy.

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Dr. Dayna Lee-Baggley: Right? They again will help you do the things that matter. Think about the things that anyone could do versus the things that only you can do. If anyone could do them, could someone else do them for you? Then do they really require you to do? Can you save your battery for the things that are most important to you, right and managing your diabetes will always help you show up as the person you want to be, not in the future, but today, right now.

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Dr. Dayna Lee-Baggley: right to the people and the things that matter to you. But you need to find that time by giving up other things in your life, so that you have time, because it actually takes, you know, time and energy to properly manage diabetes.

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Dr. Dayna Lee-Baggley: And so, if the whole plan is, I'm just gonna add it on to what I currently do. It's not a good strategy, because most of us don't have extra hours in the day. So you have to figure out what you're going to give up what you're gonna delegate, what you're gonna not do in order to have time to manage diabetes.

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Cayla Runka: sound advice for everyone, really quite frankly, but especially for those with the additional a stress of sort of a chronic medical condition. So we talked a bit about you know the normal feelings, anger, a shock, numbness, kind of things that you would naturally feel following a diagnosis. But we also know that depression

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Cayla Runka: is about twice as common in people with diabetes. So maybe you could share some things to look out for in particular, with depression. And what might indicate the need to get a little extra help.

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Dr. Dayna Lee-Baggley: Yeah. So we know that. Some of these you know, mental health conditions are higher, and people with chronic disease. And that's in part because it's stressful to live with a chronic condition. Another part that we want people to recognize also is diabetes, distress and diabetes. Distress is symptoms of depression, symptoms of anxiety, symptoms of irritability. But that are about the illness, right? So they're about the emotional burden of the illness, the regimen stress.

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Dr. Dayna Lee-Baggley: How it impacts your interpersonal relationships. And that's almost like 50%25 of people with diabetes will experience those kinds of diabetes distress. And so it's actually very normative. And so the people who are more likely to experience depression have had a history of depression prior to diabetes.

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Dr. Dayna Lee-Baggley: And then their risk increases. When you have a chronic condition, almost everybody can experience diabetes distress because it's actually a normal response to this new stressor in your life. And so I generally say that when you feel stuck, that's a good time to get help like when you feel stuck in depression, we feel stuck in anxiety when it's taking over your life, when it's making the decisions about what to do instead of you.

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Dr. Dayna Lee-Baggley: Then that's a good time to get help. It's important for people both to get help about depression, but also about diabetes, distress, because standard treatments for depression will not take into account the fact that you have this chronic condition that is generating a huge amount of stress in your life that you can't make. Go away right. It's not a you know, in in classic therapy they look for like a distortion, and you know overestimation of risk, or, you know, perceptions of feeling hopeless

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about the future. But some of that actually is entirely normative. When you're facing a chronic condition that will, you know, potentially impair the rest of your life, or at least have an impact on your life.

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Dr. Dayna Lee-Baggley: And so we want people to recognize that treating diabetes to stress requires recognition of this stressor in your life.

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Dr. Dayna Lee-Baggley: Right? That is using up some battery. And it's important to think about. And, you know, has a variable progressive course sometimes for people. And and that's typically a different intervention than what people get when they get treatment for major depressive disorder, for example, or an anxiety disorder. And so you know, both can be helpful if you have both. But also, you know, we should probably have more services

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for diabetes, distress embedded within diabetes. Care not something separate that you go to mental health clinic to go get that treated. It should be integrated into diabetes. Care?

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Cayla Runka: Yes, I agree. And the concept of self advocacy is also an important one. I'm just gonna pause for a second and encourage any participants to post questions in the chat, and our digital manual manager will get those over to us.

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Cayla Runka: But back onto the topic of stress and distress, do you have any tips for recharging or letting go of that stress when you're dealing with? A diabetes diagnosis? And

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so we talk about that. There's like 3 main forms of coping. So one form of coping is problem focus coping. And this is very effective when you can get rid of the stressor. Right? So so, for example, lots of us go through our work life using problem focus coping, there's an email you have to send. There's a paper you have to write. Those are technically like solvable stressors. If you work harder at it, you can, you know,

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Dr. Dayna Lee-Baggley: get rid of that stressor. Of course, in modern life something's always there to take its place right? But in theory they're solvable stressors.

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Dr. Dayna Lee-Baggley: that strategy often is helpful when you think about health behaviors about trying harder about health behaviors. But it doesn't I. By definition, your diabetes can't be fixed or made to go away right. And so we actually need a different type of coping called emotion focus coping and emotion focus coping is helpful. When the stressor can't be eliminated. And it's about dealing with the emotions that show up as a result.

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Dr. Dayna Lee-Baggley: a stressor that can't be removed. And so that's an important skill to develop when you have a chronic condition, because by definition it's not going away. It's something we have to continuously manage.

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Dr. Dayna Lee-Baggley: And lots of people don't have that skill set because it's not one. We really teach. Well in our culture, we focus so much on problem focus coping and trying to apply problem focus coping to your chronic disease will actually in some cases make you feel worse because you're trying so hard. And it's still not doing what you wanted to do. It doesn't mean that your efforts don't matter or don't count. But it's just that there's some aspects of our bodies we don't have direct control over.

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Dr. Dayna Lee-Baggley: And so we need to help people learn those emotion focus coping skills. The third form of coping is relationship focus coping that's about managing and maintaining relationships during times of stress. And so we're often trying to help people expand their coping toolbox with emotion, focus coping and relationship focus coping cause. Those are necessary to deal with a chronic disease.

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Cayla Runka: I forgot I was on mute. You think I'd have learnt by now?

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Okay, so

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Cayla Runka: burnout definitely, you know, stress distress. The treatment. Plans for managing diabetes can be very real for both people living with diabetes as well as their care providers in terms of just getting to that point where it's too much so.

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Cayla Runka: how can individuals deal with this burnout related to chronic disease management? And optimally, obviously in a in a positive way.

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Dr. Dayna Lee-Baggley: Yeah. So I mean, we actually know that in general, everyone's really burnt out like any statistic that you look at. Basically, looks sees that the rates of burnout are increasing basically for everybody. Right? This is a bigger concern when you have a chronic disease, because there's an extra demand on your battery. Right? The chronic disease is using up some of your battery, and so you have less battery to play with.

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And so this is one of like the main things we work on with people across the spectrum is managing burnout.

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Dr. Dayna Lee-Baggley: One of the things we want to think about is that that battery. You know that that energy is a fixed amount, and it's it's like a battery. So we will use it up.

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Dr. Dayna Lee-Baggley: So you want to think about recharging activities right? A recharging activity is something that makes you feel more energetic at the end than when you started. So it's not necessarily the same thing as a healthy habit, right? If going for a walk makes you feel angry and irritated, then it's not a recharging activity, even if it's a healthy habit. So some of the ones I've heard people share are things like drumming, gardening, cuddling with a pet right?

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Dr. Dayna Lee-Baggley: And they're really we're looking for opportunities for joy, opportunities for things that make you smile. And so we wanna think about recharging that battery. And again, on a daily basis like, think of how often you charge your cell phone. If you have a chronic disease. That means that part of that battery is being used for your chronic disease. And so you have less battery to play with. And again, in our culture we kinda act like if you just try harder, you can do more, but it's a fixed amount. And so if it's a fixed amount you wanna think about. If I'm spending it on this.

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Dr. Dayna Lee-Baggley: then, you know, means you can't spend it on that right? We can't just plan to have more and more energy.

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Dr. Dayna Lee-Baggley: And so thinking about, where are you spending your battery? Is that how you want to spend your battery. What things are draining your battery, what things are charging your battery! Everyone has things in their lives that are just drains, sometimes people, but sometimes activities right? That are just trains on your battery. And we just need to take that into account. But we wanna make time for the charges. We wanna make time for opportunities, you know, for joy, for opportunities to smile

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and to really think about that battery management. It becomes a big deal in chronic disease when we talk about pacing. So pacing is about recognizing.

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Dr. Dayna Lee-Baggley: how much energy you have and matching your activities to that. And so what often people will kinda do is wake up and decide like, how am I feeling today? And that sort of decides what they can get done or not get done. But when you do it that way you're at the mercy of your illness. Right? It's the illness deciding what you get to do that day. Pacing is about deciding how much activity you can do, even on a bad day, and keeping the activity level constant, even if your condition is going up and down

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Dr. Dayna Lee-Baggley: and so it actually makes us feel more empowered because it doesn't matter how we feel today, we can do this amount of activity. And so it makes us more reliable, more dependable. You don't have to cancel things as often, but you're often having to. You know. It's less than what you would like it to be right. And so, again deciding what you want to spend your battery on. That's most valuable, and often the hardest part of pacing is actually holding back on a good day.

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Dr. Dayna Lee-Baggley: Right? So people, you know, have a good day. And they're like, Oh, who knows when I'm gonna have another good day. I better do everything, but then they overdo it and then they kind of pay for it for a few days right? And so, holding back on a good day when you feel good saving the battery for tomorrow is actually a key skill in pacing. And so

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Dr. Dayna Lee-Baggley: we also talk about adding extra batteries to the system right? When you have a chronic disease, a really important skill is learning to ask for and accept help. And because you have less battery because of your chronic disease. So we often need to add more batteries, meaning we need friends and family. Your your healthcare providers can be part of. You know that village of support. It could be community groups. It could be your church

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could be work friends. But you're gonna need some extra batteries. And so

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Dr. Dayna Lee-Baggley: you know, our culture again, kind of our dominant Western culture kind of says that. It's bad to depend on other people. But actually, that's the highest like functioning human is someone who is connected to a village who is part of, you know, feels connected to safe trusting other people. And so the opposite of independence isn't dependence. It's connection, right? And so it's and we often.

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Dr. Dayna Lee-Baggley: you know, feel lonely. Their loneliness epidemic, right? And that's partly because we've over emphasized independence, and we're sacrificing connection as a result and so figuring out how to ask for an accept help means, how do you add extra batteries to the system, and sometimes people are glad to help you. Right sometimes is actually way more difficult to watch someone you care about, not accept help

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Dr. Dayna Lee-Baggley: right and watch them struggle when they're refusing your help. It's not a 0 sum game. Sometimes both people feel better when you accept help from somebody else.

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Cayla Runka: Yes, yeah. That circle of support is so important in so many ways. Including when you have diabetes.

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Cayla Runka: If someone is finding things overwhelming. Are there places where they can go for further help or to find support?

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Dr. Dayna Lee-Baggley: Yes. So you know, we know that. Basically, there's not enough mental health providers for the need right now, right? Whether we're talking about

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Dr. Dayna Lee-Baggley: mental health support for people with chronic disease or for other, you know, just living in our crazy world we live in now right? So there's not enough resources for that. And so we often are, you know, looking to how we can create scalable options to help people access, you know, more care. And so those are some of the things that we work on. In our company is, how can we offer

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Dr. Dayna Lee-Baggley: better access to science-based information? Right? More scalable. That's like high quality information that people that can help people.

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Dr. Dayna Lee-Baggley: And so there are some of those options now emerging sort of like online tools as well as you know, mobile app tools we have one that's working on burnout, but we will eventually be adding courses on chronic disease as well as special, you know. Add on modules for diabetes and heart disease, and other chronic conditions. And we try to embed this

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Dr. Dayna Lee-Baggley: of behavior change into those apps so that it's actually helping you on a daily basis. Support the difficult, you know. Behaviors of being healthy.

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Dr. Dayna Lee-Baggley: There are, you know, online resources through government of Canada. Sometimes your provincial government, you know, again, has

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Dr. Dayna Lee-Baggley: opted into. You know, mobile or technology solutions for mental health. And so looking into those as options for extra help, if you are working. You might have an employee assistance program that you could access.

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Dr. Dayna Lee-Baggley: So like wellness together is a government based one that people can access for mental health support. And then community groups patient advocacy groups like diabetes, Canada, those kinds of groups as well, because it really helps to have connection with other people who get it right, who know what you're going through. That really can help us cope as well.

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Cayla Runka: No, that's great. And Dr. Dana, provided some links to a few

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Cayla Runka:  organizations and the impact. Me, app that our digital manager will pop into the chat for you. So I don't see any more questions coming in. So maybe we will. We will wrap this up. But before I ask you one last question, we're going to pop a brief evaluation into the chat. If you could kindly take a minute to provide us with some feedback, so we can continue to learn, grow, and better meet your needs. That would be great.

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Cayla Runka: Also, if you have any ideas on future topics, feel free to pop those in the chat as well, we're always open to ideas on how to meet the needs of our group of people living with diabetes.

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Cayla Runka: So the last questions really generic, and just wondering if we haven't covered something in particular, or if you have any parting words of wisdom regarding a new diagnosis.

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Dr. Dayna Lee-Baggley: So in the chat. We also, I think, provided information about a research study that we're doing that lots of people might be eligible for. And so it's about wellness. For people living with chronic disease. And so you can actually access a program for free for the 12 week program that includes psychology support or as well as other supports. If you are, you know, interested in participating in the research. So that's also available.

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Dr. Dayna Lee-Baggley: The last part I'll just talk about is having an elevator pitch about your illness. Or your condition. So an elevator pitch is, you know, if you only had the length of an elevator ride to give somebody information. That's kind of what an elevator pitch is about. And so it's helpful, you know, when you have a new diagnosis, or you go into a new environment to have an elevator pitch about your condition. You don't actually have to give the diagnosis

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right sometimes. What's more meaningful is to give the symptoms that might impact that environment. So, for example, in your workplace, you don't necessarily have to say I have diabetes.

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Dr. Dayna Lee-Baggley: But you could say, I have a health condition. That sometimes means I need to take more breaks, or I need to manage my diet differently. Right? Because those are the things that might impact your work day, for example, right? And then you can always, you know, end the conversation, meaning that people might ask you more questions, and you can simply say, you know, that's all I'd like to share for now. But thanks so much for your concern.

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Dr. Dayna Lee-Baggley: Right? It's a lovely way to end it. Thanks so much for your concern. Right? People often will give you all kinds of tips and suggestions. You should do this. You should do that. And often, you know, they're not appropriate for you, or they're not the nuanced things that individuals need. And again, you just make them for their concern and go about your day. We don't have to get into arguments with them about you know whether that's an appropriate like, course of action or not.

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Dr. Dayna Lee-Baggley: But it's helpful. If you have a chronic condition to let people know, because it will probably impact you. It might impact your relationships and might impact how you show up, and you want people to attribute your behavior to your health condition, and not that you don't care about things, or it's not important in lots of workplaces. There are accommodations that people need to provide. If you have a health condition which can help you manage your

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Dr. Dayna Lee-Baggley: illness better. Often, you know, planning for more breaks. Planning for time off can be helpful

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Dr. Dayna Lee-Baggley: rather than kind of waiting for it to be a crisis, and then, having to go off. And so those are things that you can have conversations with your workplace to talk about those things, and and again, and then, having an elevator pitch with everybody else that you talk to. So again you don't. You don't have to give them all the details. You don't even have to give them the diagnosis, but just to let them know that you have a health condition that like impacts you or impacts. You know.

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Dr. Dayna Lee-Baggley: your daily behaviors or things like that, so that they understand that there's a reason for your behavior. And sometimes you have to remind people of that, even your loved ones right? They'll forget about, you know the condition and not cause they don't care about you right? Just sometimes you need to remind them, and then sometimes we need to give pre permission to people to not talk about it. Right? It's okay to not talk about it. Sometimes they always want to talk about it. Sometimes they'll forget to talk about it.

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Dr. Dayna Lee-Baggley: And so we just have to communicate more and and describe what's happening and be okay with that, because they're not things that we kind of

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Dr. Dayna Lee-Baggley:  are good at at managing. And so we we need some extra help with that sometimes.

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Cayla Runka: That's that's great advice, and also, I think, to them, the more we talk about it, and the more it is open and out there, the less statements associated with it as well, which I know. Is a whole other topic for another day.

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Cayla Runka: Okay, well, no more questions coming in. So I guess we've come to the end of our time. Thank you for taking time out of your busy schedules to join us today. Taking time for ourselves in our personal care is never easy, but so important and definitely worth it. In the long run. If you haven't filled in the evaluation, please consider doing so now the link can be found in the chat.

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and with that a a big thank you. To Dr. Dana, our guest expert today, I know I learned a lot, and I'm sure you did as well. There was a lot of great advice in there for just healthy living in general.

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Cayla Runka: Without the generosity of your time, Dr. Dana, our open hours would not be possible. So thank you again and thanks everyone for joining us today on Facebook, live open hours, runs the last week of every other month with a different topic and guest expert. So be sure to follow us on social or visit the website regularly for updates

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Cayla Runka: to learn more and stay up to date on diabetes, Canada's work and resources. You can visit our website@diabetes.ca, or check out our social media channels. We're on Facebook, Instagram, Linkedin, and the platform formally known as Twitter.

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Cayla Runka: You can also call our info team at 1 800 banting. That's 1 800 BANT, ING, or email info@diabetes.ca, with questions. So join us again for our next diabetes. Open hours. Please stay tuned to our social channels and our diabetes. Canada open Hours website, page for news about the date, time and guest for our next conversation. And with that, thank you. Have a great day, and we'll see you again.

0:02
Hello and welcome to Diabetes Open Hours, your live Q&A opportunity with experts in diabetes management and care. My name is Cayla Runka and I'll be your moderator for today.

0:13
I would like to start by acknowledging that I'm calling in from Toronto and that I'm located on the traditional Indigenous territory of the Wendat, Holden, Ashtoni, Anishinaabeg and the Mississaugas of the Credit, and that Toronto is now home to many diverse First Nations, Inuit and Matty peoples.

0:31
As a health focused organization, Diabetes Canada recognizes that there is systemic racism within and throughout our institutions and that we all have the responsibility and power to create culturally safe and appropriate environments of care.

0:47
Today's topic is making technology work for you and while we have an expert on the call today, this webinar is for educational purposes only. The content discussed in this webinar is not intended to be medical advice and to the extent that medical advice is required, you should consult with a qualified medical professional. The information discussed in this webinar cannot replace consultations with a qualified healthcare professional to meet your individual medical needs. And lastly, the views and opinions expressed in this webinar are those of the speaker and do not necessarily reflect the views

1:20
or positions of Diabetes Canada.

1:22
Having said all of that, today we're very lucky to have Alana Chambers with us. Alana is a registered dietitian and certified diabetes educator from Kelowna, BC Since completing her training at McGill University, she's focused her career on type one diabetes and technology. She has experience working in the insulin pump industry and her local diabetes program. She is now focused on insulin pump and CGM training and education. She's a dynamic speaker known nationwide for blending current evidence with practical pearls of knowledge. Having lived with type one diabetes

1:56
his childhood, she understands that daily management takes just as much creativity and art as science. Her goal is to help life with diabetes feel just a little bit better when she's not in the diabetes space. She loves to spend time outdoors with her husband and three girls. And before we get started, just a few more housekeeping things. Please note this event is being recorded and will be shared on our website and YouTube channel for on-demand viewing. Any questions or comments that you submit via the chat function will be visible to other participants during this event, but we will not share any names or record of the chat.

2:30
In the recording,

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we ask that any comments or reactions you share be affirming and positive, and we encourage you to discuss your learnings with your regular healthcare provider prior to making any changes to your current routine. And with that, Are you ready to get started, Alana?

2:50
Of course, I had myself muted. Yes, now I'm ready. Kayla, thanks for having me today. Very excited to be here and and talk tech for the next hour with everyone. Amazing. Thank you. It's always good to start with though. Perhaps while we're waiting for our first questions to come in, maybe we can chat a bit about some basics. And I know you and I have discussed the lingo and there's a lot of it in the technology space. So why don't we start maybe by reviewing some of the key terms in technology and diabetes management? Yeah, great question. I think that's a very fair starting point.

3:23
There's acronyms for everything right now is CG. What, right. So let's talk about what these key pieces of technology are that I think we're probably going to be diving into throughout this next hour. So first is some people refer to it as BGM or blood glucose monitoring that we are talking about traditional finger sticking. So you poke your finger and we put it in a blood glucose meter and we get that single number blood glucose monitoring, finger prick. And then we're going to be talking about continuous glucose monitoring. There's a lot of buzz out there about this right now. So that is the acronym is CGM,

3:56
continuous glucose monitoring. And that is where we're wearing our glucose sensors. And those either you scan or it sends automatically to either receiver or a smartphone app or an insulin pump. So that's our continuous glucose monitoring. Let me talk about insulin pump therapy. So those are insulin pumps that we use to deliver insulin. And then I'm really excited towards the end here hopefully to get into some things on automated insulin delivery, closed loop therapy, hybrid closed loop therapy, those are all different terms. We used to talk about that, but I think I'll refer to it today as automated insulin delivery just for simplicity.

4:29
Wow, that's a lot in a short period of time. I'm glad we're recording this so we can go back and review that again. OK, great. Let's start with what are the main technology types available for diabetes management.

4:46
So those are kind of the ones that I explained there. So we do see our, our old standard of care was to use blood glucose monitoring, right? That was when I first got diagnosed with diabetes. I was given a blood glucose meter and insulin syringes, right. And that has now evolved. So now we are seeing the highly rec. If you have type one diabetes. We do recommend the use of a continuous glucose monitor because we see those health benefits. So those are those glucose sensors that will get in a little bit more. And then we have all of our insulin pumps and we have insulin pumps that are connected to CGM's. We have insulin pumps that are

5:19
are just standalone insulin pump systems where you do the, the manual controlling of it. And then we have our automated insulin delivery systems where we have some automation happening in the background.

5:29
Wow. Yeah. I can imagine since you were diagnosed, there's been a lot of changes within the technology world and a lot smarter recently as well. So what start with continuous glucose monitors, sort of what are they, how they work and I guess maybe just the benefits to diabetes management. Yeah. So a continuous glucose monitor, it's really cool because you actually see these now out in the public. We're now wearing our diabetes. And you know, there was a time where we thought it would be really wanted to show people that we have diabetes. And yes, you sometimes want to be discreet,

6:03
but to me, nothing makes me smile more than going to the beach or the swimming pool or just being out in a lineup at a store and and seeing somebody else wearing a glucose sensor. And we kind of feel do like a fist pump or something. I remember having a little girl come up to me at my daughter's track meet and she was smiling so big until I realized she was looking at my glucose sensor on my arm and showing me, hey, me too. So it's kind of a cool way for us to identify each other out there. I see that as a big positive. So. So what do we see when we see somebody wearing a glucose sensor on their arm? If this is new to you,

6:35
underneath that, that transmitter that you see on the outside or that sticker that you see on the outside, there's a glucose sensor that's inserted below the skin and it's a tiny little hair like filament. Many people when they take it off for the first time, they're very surprised by how fine that little, like a little wire that's underneath of your skin and that is measuring the glucose in your interstitial fluid, which is just below your skin. It is not inserted into a bloodstream. It's not reading blood glucose, it's reading interstitial fluid. For that reason, some people

7:08
really expect that meter or that glucose or sorry, expect that CGM to be exactly the same blood glucose reading as their meter. But they're never going to be exactly the same because they're measuring a different substance. But the accuracy of this has come a long, long, long ways. So you're going to wear this glucose sensor for anywhere from 7 to 10 to 14 days, depending on which system you're using. And how you get those readings depends on which type of system you're using. So the first category would be a scan or flash glucose monitor and that would be the Freestyle Libre,

7:42
the Freestyle Libre One and the Freestyle Libre Two, which we have here in Canada. And with those, what you do is you take either your smartphone or your reader and you're going to scan it over your sensor to retrieve your data

7:54
with a real time continuous glucose monitor. And this would be the Medtronic and the Dexcom systems that we have here in Canada. There is a Bluetooth capability on that sensor. So there's a transmitter attached on the outside and it's going to automatically Bluetooth that reading over to either your smartphone to your reader or to your insulin pump. So can be used in many ways and there will be a continuous reading sent that way. The bonus with that continuous delivery of data is that you can set different glucose alarms. And so you can say, hey, my blood sugar is coming up or it's low right now

8:27
or it's high right now and then we can get into some predictive alarms as well, which is hugely beneficial. I don't just want to know that I'm low, I would like to have an advanced warning that I'm going to be low. So that's where we really start to see that therapeutic benefit is when we add that in.

8:42
So when you get your reading, no matter what type of glucose monitoring system you're using for CGM, so whether it's a scan one or real-time CGM, you're getting a lot more information than just a blood glucose meter. Where you get a number you get, hey, I'm 8.9 right now, you're going to get, OK, I'm 8.9 and you'll get an arrow. So it will say OK, you're steady, you have a a straight arrow or you're rising or you're double airing up, you're rising quickly or you're falling or you're falling quickly. And that's incredibly powerful data.

9:14
You think about times when you're about to drive your car, you're about to exercise, you're about to go to sleep at night. To know that you're 8.9 and rising or falling is very drastically, probably going to change what you may do in that situation. So that's a huge, huge piece of power that comes with these systems. The other piece of information that you'll see is you'll be able to look back and see a trend graph. So you'll be able to see over the last several hours what's my glucose been doing. And again, that teaches us a lot about what happened after I ate my last meal. What happened when I

9:47
exercise this afternoon overnight, we can actually see, OK, did I steadily climb overnight or did I climb at one time or did I drop it one time? We see a lot more insights as far as what's going on on a day-to-day basis. And really, all the factors that influence our blood sugars, really, we start to see those in real time.

10:07
Wow, sounds like an incredibly powerful tool. Um, even just from a safety perspective. Absolutely. From that aim, it also sounds like a lot of numbers and a lot of data. So what? Really, what, what? I guess

10:24
is most important in terms of people monitoring the numbers and the data that they can in terms of getting knowledge.

10:33
Absolutely. It is very fair to acknowledge that it can be very overwhelming to go from getting a few blood sugar checks throughout the day to seeing a 24 hour glucose profile and potentially a number every minute or every 5 minutes. And so my best piece of advice at the beginning you're starting C Jam is just stop, take a breath, all right. And we are not wanting to watch minute by minute by minute by minute. Let's just take a deep breath, maybe look at it once an hour, right. We still want to live our lives and and at the beginning, really it's about

11:06
just exploring and learning your patterns. We don't want to fix everything right away. So let's say, OK, I I never used to check my blood sugar 45 minutes after I ate breakfast and today I put on a CGM and I'm seeing it soar up to the sky and I want to fix it. Well, wait a second. Let's take a deep breath. Let's see what happens. I never used to fix it, right. And maybe we see that it comes back down. It's it's very, very normal to see a lot of roller coaster ring when you put on a CGM for the first time. And our goal over time is to learn what's causing those roller coasters and what can we do to smooth it out.

11:39
It is almost never going to be completely flat, OK. Even somebody without diabetes does not have a flat CGM line or very few people would if it is normal to have some peaks and valleys. But we just want it to be a little bit of a smoother ride, OK. So we are going to learn a lot there.

11:54
What we're really looking for as far as a target is we're looking at a new, a new piece of information that we call time in range. And if this is a new term to you, what time and range means is how much time you're spending between 3.9 and 10. OK. So that's kind of where we're aiming to be. And the goal is not to be in that 3.9 to 10 range 100%25 of the time, not even 90%25 of the time. This is not going for an A+ in school. The goal is 70%25 and that is set by

12:28
the Canadian guidelines and also international consensus guidelines. We have seen that that time and range of 70%25 correlates very nicely with within A1C of 7%25 which is our goal, A1C and that is where there's been an abundance of research done as far as minimizing the risk of long term care complications and whatnot.

12:49
Now what I'll say though is as much as 70%25 sounds like it should, well maybe it doesn't sound, but if you're new to see Jimmy, we go, I should be able to get 70%25. It is really hard to get 70%25 time in range. So many, many people will start out on a CGM well below that. So what we also know is that even just an improvement by 10%25 is going to have a clinically meaningful impact on your overall health. So if you're starting out at 45%25 and you get up to 55%25 to start, we're moving in the right direction. OK. We just want to keep moving

13:21
forward overtime. We're continuing to add in more technology. When we get into later automated insulin delivery, I start to see it much more achievable and realistic to get that 70%25 without all the burden and the work that may come with that. OK. Now as a side note, there are some people who will not use a 70%25 as a goal. There are certain situations where we do customize that and knowing that you know if there's a risk of hypoglycemia or other health conditions going on, sometimes we will change that. So just be aware of that and talk to your healthcare team about that. The other thing

13:54
that is just as or or even more important actually is we want to pay attention to how much time you're spending in the low range. OK. So those are the two important, we want to be 70%25 or aiming for 70%25 in range and we want less than 4%25 in the low range. And those are unread on all of your CGM reports, all your CGM data and that represents about an hour of the day. We do not want to try to get to that 70%25 and increase our lows. We want to minimize that and get it as as low as possible. For many people, 4%25 in the low range even feels like too much. So we do want to,

14:27
to make sure we look at that your healthcare provider can spend time looking through your GM reports with you to figure out kind of what those patterns are. You can log in no matter what system you're using. You can look into care link if you use a Medtronic Libre view, if you're using a Libre or Dexcom clarity. And you can go back and and look kind of day by day and go, OK, where am I? Where am I? Where are things going well? And you know, here's a day where I was in range 70%25. What did I do that day and maybe learn from our patterns what worked well and can I do more of those things. And then you can look for periods

15:00
where you tend to run higher and tend to run lower and think about maybe what may have caused some of those and and make some action plans around that.

15:09
I I'm fully intrigued. It sounds complicated, but so useful. Amazing, quite frankly. OK doesn't have to be complicated, Kayla. It sounds like it's just take that deep breath. It's supposed to make life easier

15:24
for sure. And and then you mentioned insulin, so why don't we talk a little bit about insulin pumps.

15:33
So an insulin pump, if you're not familiar, I know we probably have some people in here who are newly diagnosed. So let's just kind of compare how insulin is delivered differently at the pump versus if you're on injections. So if you're on injections and multiple daily injections, you'd be using two types of insulin. So you're using a long acting insulin which is just covering those background insulin needs. We need insulin even when we're sleeping, right. So that's what our long acting insulins are covering and between meals and then we have a rapid acting insulin that we use at a meal time.

16:05
So the one drawback to that is well our long acting insulins have improved significantly over the years. They assume that we need a steady amount of insulin 24 hours a day and what we know is that a lot of people don't necessarily have the same insulin requirements 24 hours a day. So with an insulin pump, what we do is we use rapid acting insulin only and it's given like a little continuous drip, just like somebody's normal healthy pancreas where they getting a continuous amount of insulin all the time. And that allows us to

16:38
fine tune and and give different amounts at different times of day to more closely mimic what your insulin requirements are in the background without food. OK. That insulin is delivered through a an infusion set or through a pod and there's a small little cannula that's inserted underneath the skin, very flexible, very comfortable to wear and there are still some other types of sets out there, but those are the most commonly used ones. So not to be intimidated by that. And so it's giving you that continuous drip for that background insulin requirements. The other beauty of that

17:11
background basal drip is because it's only using that fast acting insulin, we can take some away in certain situations. So you can set something called I I'd like to talk about this right away. We consider it an advanced feature, but a temporary basal rate for something like a more active day. I can turn my pump down if I'm going to go out for a walk or go play tennis or go do something this afternoon. I'm not stuck with that long acting insulin that I gave this morning or last night at bedtime and then I can turn it back up. If I have a time period I'm sick or I'm traveling and I want a little bit more, I can temporarily turn that up

17:44
or dial that back. So that's a really nice advantage of insulin pump therapy.

17:48
So then for our bolus, so for our meal time or our correction insulin, we call that all bolus. We're getting one hit at a time that we go in and you program that into the pump. So typically what we do is we enter in our grams of carbohydrate and it has a bolus calculator. You plunk in your blood sugar and it's going to tell you how much insulin you need for that meal or for that correction. And taking into account a number of other factors as well, it makes it really nice and flexible as far as, hey, you can decide you want a second helping of dinner tonight? I can go and give another bowl

18:23
someone's birthday and there's a dessert. I can give an extra bolus. So we do get a lot of flexibility with our meal time dosing when we use an insulin pump and that is a big draw for a lot of people.

18:35
We kind of we can think about our insulin pumps now into into two main categories. So our first one it would be our non connected or our basic insulin pumps and these ones you're completely in the driver seat. So all of our pump, these do not work with our CGM. All of the pumps on the market in Canada today you can use as a basic insulin pump. So just because some of them have all the bells and whistles doesn't mean you can't use it as a bare bones pump. So if you want to be in the driver's seat and you want to be the one programming your basal rates and making all of your

19:07
adjustments and corrections on that fly, then then that's can be a good way to start. So in Canada, we have a Medtronic system, we have the tandem system, we have the Omni pod, which is the patch pump, and then we have the Yips Ahmed insulin pump as well. So those can all be used as a basic insulin pump.

19:24
The newer option or the second option is if you want your insulin pump to work with your continuous glucose monitor. Now we have a connected insulin pump and we can have different levels of automation with that. And right now in Canada, we see that with the Medtronic and the Tandem systems where we have some level of automation or some options for that.

19:45
So is what you just described what is known as a closed loop system exactly. Yeah. So I want to dive into that now.

19:55
Yeah, leaping, leaping the hot word. Yes, we're layering on the text. So those last two options I talked about and actually I I just talked about too. So with both Medtronic and with Tandem, we do have this ability to use a closed loop or automated insulin delivery. And I will say right off the bat, this is not yet completely closed loop. There still are some things we have to do. OK. So I'm going to explain this also. There is 1/3 option out there as well, which I think we're going to, I'm going to save for another question here, but we do have people using do it yourself.

20:28
Automated insulin delivery system. So we'll get into that. But there are some, there's some core similarities between all of these systems. They use their own unique algorithms. So we are going to see some, some, definitely some differences in the way you program it and the way you manage with it. But as a core, let's talk about how they deliver basal and bolus insulin.

20:47
So that basal insulin, that background insulin that I was talking about on an insulin pump, we program a basal rate to be to be set. So this is your insulin needs at this time of day, it's going to be here at this time of day here and it's going to, it's going to do that just on its own. So now if we add in automated insulin delivery, it's looking at the algorithm is looking at your continuous glucose monitoring readings and it's saying, oh, Alana, your blood sugar is running a little bit on the higher range right now. It's rising quickly. I'm going to give you a little bit more

21:20
right now or oh, now you're starting to drop. I'm going to dial back your basal insulin delivery right now or oh, it looks like you're about to be low. I'm going to stop your insulin delivery right now. So it's kind of got this ebb and flow going that's being adjusted continuously throughout the day and throughout the night. And that is incredibly powerful. Does it get rid of all of the lows and all of the highs? No. Diabetes is still difficult, but we see incredible results with people more than I ever could have imagined, usually from night

21:52
one. Almost everybody that I have started on an automated insulin delivery system sees that blood glucose comes room into range overnight. That overnight glucose profile flattens beautifully across the board no matter what system you're using. And we see that in all of the research studies that are done on this. Will there be the odd person who maybe doesn't see that effect? Yes, we do see that happen sometimes, but it's very rare. So that overnight glucose becomes very consistent very quickly. And then during the daytime, things do get a little bit more challenging

22:25
because guess what, we eat, we exercise, we move, we get stressed out some days. And those things, you know, can throw our glucose in different directions. And this system is going to do its best to try to manage that and it certainly will do better than us having to try and stay on top of that all day long. But we do see sometimes a little bit more variability happening during the daytime,

22:45
OK. So that's that's that basal adjustment that's going on all the time

22:49
for bolus, we do still need to to tell the insulin pump systems that we're eating right now. Unfortunately, we are still stuck with rapid acting insulin that is still a little bit too slow. If you've ever worn A continuous glucose monitor and you've eaten and if you dose that insulin a little bit too late, we do see the glucose rise up and there's a lag time between when that insulin action can catch up to our food sometimes. So if we were to allow a system to just dose when it sees our blood sugar go up because our insulin is still not quite fast enough, it's it's going to have a hard time playing catch up.

23:24
So at the moment what we still do need to do is give that pump a heads up, hey, I'm about to eat, I think I'm eating about 30 grams of carbs or whatever it might be. And then you give that bolus and then in that delayed later after the meal, maybe if I made a little bit of a mistake on my carb counting, it's going to be able to to adjust my insulin delivery later and try and help make up for any errors that may have been done there. And we're seeing that as a very positive thing right now.

23:50
What these systems can do though is they can deliver an automatic correction bolus. So like that situation, I just say, let's say at lunch today, I end up under underestimating the carbohydrates I eat and I go a little bit above target after lunchtime. Well, if that system detects that maybe it's been turning out my basil, but it may say Ohana, we need to give you an extra correction bolus and it can go and do that. So we do see that being very beneficial for people and and definitely take some of the weight off of our shoulders for sure.

24:22
All right. I am not sure if you wanted to just jump right into the do-it-yourself system. I know we have a a very in depth deep dive on do it yourself and some new clinical practice guidelines just came out. But would love to hear you give everybody a a sort of an update on that

24:44
the way so do it yourself and diabetes, I mean think about diabetes and we're doing it ourselves pretty much every day, right. It is one of the few conditions where we are in the driver seat having to self manage type one diabetes and type 2 diabetes especially as well. So what what we think about is before the days that we had commercially available automated delivery systems, these are still very new to the market. We had some people saying hey listen, we have insulin pumps on the market and we have continuous glucose monitors on the on the market and it is taking too long

25:17
has to have these two pieces work together. And if you take some of, you know, the most brilliant minds out there in the type one diabetes community, they said let's do something about this and that they did. And you know I will be the first to say when I first heard about this movement, it frightened me a little bit. I went Oh my goodness, like what what is this going to be? But what we've seen is, is really a beautiful thing happened where they've where they've made this work together with some algorithms. You basically will what's missing is, is the algorithm in the middle, right. So they have that openly available online

25:50
with instructions on how you can put this app on your phone. So you have to build an app on your phone which will speak to both your pump and your CGM and doesn't work with all pumps and it doesn't work with every system. So that is something to do some reading on, but and then in some cases we need a connecting device that works to allow these things to speak together. But what I will say about this is that as I said, we were all a little bit nervous about, you know, is this dependable, is this safe? There has actually been an incredible amount of research done by this and we have many, many people

26:23
using these systems and we have seen that indeed it does improve glycemic outcomes incredibly and we have not seen the adverse events. So that has led us to developing a position statement for Canada where we say, yes, this is a viable treatment option for people and as healthcare professionals we need to support people who are willing to use these systems. What I will say is probably the most important take away from this is that if you're using one of these systems or if you want to use one of these systems, yes, you as the user do have to go and and follow those online instructions

26:56
to build your app and to get it up and working. But still definitely involve your healthcare team, especially if you're new to pump therapy, you need help with those initial pump settings and whatnot. And down the road that fine tuning and making some of the adjustments to the settings, you should involve your healthcare team with that for sure as well.

27:13
Really cool stuff though that's for sure very fascinating. Yes. Yeah. I'm just wondering if we can touch for a minute on sort of the risks or challenges associated with this because it does sound very exciting and very powerful in terms of diabetes management. But are there maybe some people that shouldn't be using technology and what are some of the risks associated with it? So the greatest risk with technology is that technology can fail.

27:44
So yes, your CGM could stop working today. Yes, I could leave my phone at home today or I could end up with a power outage and I can't charge my devices. So we absolutely always have to think about what if my technology fails and have a backup plan for that. And so that is where we certainly do say you know, for continuous glucose monitoring you still need to have a blood glucose meter and you know will you need to use it very often. There's there's nowadays with the accuracy there are very few times that you need to confirm a finger stick with a finger

28:17
check, but make sure you have that meter on hand. If you're going out for a day trip, you're going on a holiday, bring a meter with you. For me, I have actually put my blood glucose meter in a neon coloured case right now because I don't use it as often as I used to and I can't find it when I need it. So it's, you know, it lives in a certain spot. It's in a bright pink case so that I can go in and grab that when I need it. Same thing with our insulin pump systems, right, Those if your insulin pump goes down. The manufacturers are incredible at iPhone. That 1800 support line

28:50
in the middle of the night and they get a pump to you as fast as you can. But natural disasters happen. I live in Kelowna. We've just we're in the middle of of this fire season right now and you don't know if you're going to be blocked in somewhere. I've I've heard all sorts of stories of people getting close to being in trouble. So again, you want to have a backup. Keep some insulin pens. I'm a really big fan of keeping some old fashioned insulin syringes. We can always drop insulin and give insulin as we need. So definitely talk with your insulin pump trainer, with your care team. If if you don't know how to replace the insulin manually, you need to have a

29:23
plan for that. And that is incredibly important. Absolutely.

29:27
Now as far as you know, is this too risky to use technology with certain populations? I love that question because for for many years we did, we did wonder about that. And this has been one of the most incredible shifts with the most recent generations of the technology that we have available today is that we do see that people can be successful on an insulin pump or on CGM regardless of your education level, regardless of how long you've had diabetes, regardless of, you know, where you come from,

29:59
what you have access to or where you're where you're where you're starting A1C, is. There are were times we thought, oh, we should probably try and bring things, you know, closer to target before we start you on this. Hang on a second. No, no, no. That is an old way of thinking. We know now that people actually with a higher A1C have a bigger drop and a bigger improvement when they start using some of these devices. So really it's it's, it's open to everyone for sure, as long as you're willing to participate in your care. As I said, none of this is completely plug and play. You do have to engage with it and and be willing to kind of follow

30:32
patterns and whatnot, but I'm certainly accessible. It should be accessible to everyone.

30:38
OK, great. You mentioned, you know some of the more traditional methods like the the syringe and the insulin pens and things like that. So you know, when would it be good for someone to start technology and and how do they know when they're ready? Because it sounds like having that basic foundation upon diagnosis really lasts you throughout your entire sort of diabetes management journey. So can maybe anyone start or is there a sort of a leg time in terms of of of

31:10
kind of a good time to start would be,

31:13
yeah, great question. So you know this really should be a very individual decision. Absolutely. You will. You and you may sometimes think, can I be ready for this? And we may question ourselves, but I think it's worth everyone exploring if they want, if they may be interested in using diabetes technology.

31:35
Especially at diagnosis, things are incredibly overwhelming. You are learning a lot of information and in many cases your world has been completely rocked and it can be like, Oh my gosh, we need to layer on something else. But what? And so our traditional thinking used to be, hey, let's wait, let's teach. As you mentioned, let's teach kind of some of the the basics, the traditional education, let's start slow and we can get to that later.

32:03
What we're seeing now in the research though is that the sooner you start using technology the better. So for example, there was one study done in the US where they took a look at people who started on CGM within the first six months of diagnosis and those who started later or didn't start on it. And they saw that seven years later those people who started on a real time CGM within that first six months had a lower A1C than those who started later or those who didn't start at all. So what we see

32:35
there's this, there's this kind of this theory about the sooner we can get you on track, we get you on this different trajectory over time. And if we can kind of get you on that on that track earlier after diagnosis, it's going to help you stay there. Again, does it mean it's going to be perfect? No, But the sooner the better is what we're starting to see. We're even seeing some research starting to come out where they're looking at even using automated insulin delivery very soon after diagnosis and people doing very well with that and again that having a lasting impact. So we are seeing this start to shift. We are working on updated

33:09
type one diabetes guidelines in Canada right now. So stay tuned for where that official recommendation comes. But that is that is the pattern that we're starting to see. And and it really makes a lot of sense because we get so much power out of learning what our glucose is doing in different situations that why not give us the tool to be able to see that. And the other thing is that we also see a lot of burden left it. It's like, OK, instead of, you know, being newly diagnosed and not being sure, OK, do I feel low? Is this a low or is it not And to be able to just quickly look and go, OK, no, that is what's happening.

33:42
Um, it's it's a really great learning tool as well.

33:47
Perfect. I'm kind of still stuck on the do-it-yourself people building their own app. So on that note, outside of some of the company's, you know, pairing systems with with reading and things, are there other apps and sort of services out there that help to pull it all together or provide education or or help with respect to diabetes management. So there's there's so much available online right now it it can almost become overwhelming, right? So definitely as far as

34:20
information goes, you know all of these technology companies have their own websites. That's a great place to start just to get making sure that you're getting the clear information from the company on what their system does and doesn't do. But it's also nice to look on some third party websites to kind of see a true comparison of some of the less of the marketing messages and more of the what are the actual things that these things do and don't. So Diabetes Canada always has an abundance of information. I as as you mentioned Kayla, there is a another deep dive with Doctor Halpern on the do-it-yourself systems diabetes. wise.org is

34:53
a great resource for going in and looking at different types of systems out there on the market. Many of the health authorities have really great websites with lots of information as well. Another one I'm thinking about good for technology is Waltzing the Dragon out of Alberta. They're very up-to-date and have a lot of information.

35:13
And then as far as third party apps, really what you want to consider is which apps are going to work with the devices that you are using. Not everything is cross compatible. If you're not using any tech at the moment and you're just kind of wanting to explore it, probably a first step for many people is OK, maybe I'm interested in an insulin pump, but I want to start with a bolus calculator. That's what our insulin pumps use. So there's a few systems out there that do that. Diabetes M is a really great little app where you it has a

35:46
goal is calculator. You can start to get a sense of how some of these systems calculate your insulin doses for meal time. So work with the healthcare team to to set that up though because there are some factors you'd have to put in yips amed that insulin pump company. They do have an app that actually works with their pumps that you can use when you're using multiple daily injections. Again to get a sense of kind of how those calculations work. So that could be a starting point. And then there are some apps that do work that can help Mary data together. So usually you will use the apps that work with your system. But what if I'm using, let's say a Medtronic

36:19
Island pump and a Dexcom sensor and I want my reports to feed together. So that would be a system called tide pool. You can actually upload your your pump and your sensor data and it will come together. Many clinics, we use something called Gluco and your diabetes team will use that. So not Google, but Gluco and that does work with many of our insulin pumps and we can get our sensor data in there as well. So lots of information out there, but but definitely talk with your care team about what you choose to use because some clinics are more used to looking at the reports and whatnot on sound systems versus others.

36:52
Thank you for that. So valuable because as you said, there's so much out there, there's so hear from someone like yourself, those are great options for people out there. Just to call out to those people listening in and we'll be taking the last questions now. And before we sort of wrap up to help us learn and grow, we're going to pop an evaluation form into the chat. So if you want to take a minute or two just to fill that out, that would be great. From our end, a few more questions. So I I think we all

37:25
know that people living with type one diabetes obviously take insulin and so this is a very strong conversation for them. But there are some people living with type 2 diabetes that are also taking insulin. So I'm assuming that these technologies work equally well for those people living with type 2 diabetes as well.

37:43
Absolutely. And and this is we're getting, you know, a growing body of evidence to support this. So depending on where you live, your coverage for using these products is likely going to be different. If you live with type 2 diabetes, for example, here in BC, a continuous glucose monitor you have coverage for if you're living with type 2 diabetes and you're using multiple daily injections. So you're not just on long acting insulin, but you're also on rapid acting insulin. Different provinces have different levels of coverage depending on what type of a treatment regimen you're on. So that is something that you're going to want to look at.

38:17
But yes, we're seeing the benefit, especially someone if you're living with type 2 diabetes, that continuous glucose monitoring is incredibly valuable. You're trying to learn how different food impacts your blood sugar. You're trying to minimize those spikes. So we, we can learn so much about what our glucose is doing to facilitate us making some changes to our daily behaviors. And we're going to, we're going to, we see more and more studies coming out on this, but we do see that A1C improvement across the board no matter what type of diabetes you have. So we're just kind of waiting to get that kind of put together

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a little bit more. But you can benefit from that, an insulin pump and getting into those automated insulin delivery systems. Those are going to work. I mean, you could use it in theory, I guess just for that background basal insulin. But really it's if you're using those multiple daily injections, absolutely you can go in and you can bolus through a pump. I've seen many people with type 2 diabetes do incredibly well on insulin pump therapy.

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I thank you for that. Speaking again, still on technology, what about emerging technologies? I think things are changing so rapidly. Is there anything really wonderful on the horizon?

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You know what? I I can't wait to be surprised. I really can't. So you know I think back to you. I was diagnosed as a kid with type one diabetes and I also had an older sister with type 1. So I had the benefit of having someone to banter back and forth with as a kid about our hopes and dreams. And we would talk about, you know, I wish one day I could see my glucose on my watch. Would that be so cool? You wouldn't just have to wonder where you're at. You would actually know. And we have that today. There's smartwatch integration and and things talking to each other. So I was surprised that that

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going to be I I almost can't even imagine what's next but there are some, there's some really cool things that are being looked at it's it's amazing diving into some of this research. I think the biggest race right now is to refine the algorithms that are automated insulin delivery systems are using so that they can tackle our meal time insulin doses.

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Having to figure out how to dose our insulin every time we eat, quite frankly, is not fun for any of us. And so we have this limitation of our slower insulin. But I have listened at some conferences to researchers, you know, battle back and forth on how they're going to tackle this and how these algorithms do it. And I'm very, very excited to see how that comes to a finish in the US. There's a new system out right now that allows you to simply say I'm eating a small meal, a medium meal or a large meal,

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and then it can and then it can figure out that dosing from there and make up for some error in between. And to me that sounds like an incredible weight lifted. We also see a lot of work needing to be done with exercise. And so how do you teach an algorithm how to adjust to me sitting in my office chair during the day to now having a day where I'm going out for a run or I'm going skiing or I'm doing or I'm gardening, You know, all these things that can throw our blood sugars off. And how do we have these systems catch up on that really quick, much more quickly and effectively and take away some of the work that we have to do? So that's

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that. I'm excited to see how that comes.

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I think really what we're going to start to see though is integration with our smart devices. So if you think about if you wear a smartwatch, it can read your heart rate. OK Can that somehow link in and give some information to my insulin pump system? I've seen some things on even it being able to tell you're leaving your home and smart homes and how can we work those things together? 1 researcher in Europe somewhere was doing something where they were trying to figure out how to tell when people are eating or drinking based on their hand movements and can that be synched in to an algorithm. So it's it's incredible

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and I think with artificial intelligence we're going to see some really cool things but it will be slow because they have to make sure that these things are indeed robust, safe and and what are the possibilities of error. So we weren't going to see it immediately tomorrow, but I think we're going to see some pretty exciting things in the future. I I can't wait to be wowed. I love it. And maybe someone can work on making a faster, fast acting insulin.

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Absolutely. We'll hope for that. Alright, so one last question, It's a bit of a personal question. Just any final words of wisdom in terms of, you know, how to make the best use of of the technology?

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Yeah, you know what I think my biggest advice would be, you know, take a deep breath, like I said earlier, give something new a try. If you're hesitant to use technology or you had a past bad experience with technology, I've heard that a lot. You know, I tried one of the old CGM systems that my clinic put on me back, you know, 15 years ago and it was a horrible experience. Well, let's just open our eyes a bit to our technology has vastly improved and you know give it a try but don't expect overnight results.

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Some people do incredibly well as soon as they put technology on and it's boom, it's life changing right away. And for some people it can take, you know, those first few weeks can be a really big learning curve. I often say, you know it's like having a new baby that first month is tough, then you have three months and then you have six months and it's an ongoing learning experience until it really kind of becomes a part of you and and you know it shouldn't be too much work. What we think the biggest change we see now in new technology versus old technology is that now it should be lifting some of the burden. So by putting on tech,

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I should be able to take a deep breath and and have my system help me no matter what that technology is. And if you're feeling like you need to put more work into it and it's more work, that is a red flag and it's time to go and talk to your healthcare team and say, OK, what? What's going on here and how do we make this work better? Or do I need a different system? But it should be able to lift some of the burden for sure.

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Great. Alright, well we've come to the end of our time. Thank you everyone for taking time out of your busy schedule to join us today. Taking time for ourselves and our personal care is never easy, but it's so important and the benefits are always worth it. If you haven't had a chance to fill in the evaluation yet, please consider doing so now. It does help us learn and prepare for our next sessions to meet your needs better. The link is posted in the chat, so please have a look for it there. With that, a very big thank you

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to Alana, our guest expert. Today I am very intrigued and while I always learn during these open hours, I feel like today was a major milestone for me and I hope all of you took something from today as well. Without the generosity of your time, these open hours would not be possible. And thank you to all of you for joining us today. Open Hours runs the last week of every other month with a different topic and guest expert, so be sure to follow us on social or visit the website regularly for updates. To learn more

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can stay up to date on Diabetes Canada work and resources. You can visit ourwebsite@diabetes.ca or check our social media channels. We're on Facebook, Twitter, Instagram and LinkedIn. You can also call our info team at 1800 Banting BANTING or e-mail info@diabetes.ca with questions. Please join us again in October for our next diabetes open hours. The theme will be how to deal with a new diagnosis. Please stay tuned to our social channels and our Diabetes Canada Open Hours website page for news about the date, time

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and guest for our next conversation. And with that, thank you so much again and we'll see you next time.

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Cayla Runka: Hello, and welcome to diabetes. Open hours, your live Q. A. Opportunity with experts in diabetes, management, and care. My name is Kayla Ranka, and I'll be your moderator, for today.

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Cayla Runka: I would like to start by acknowledging that I'm calling in from Toronto, and that I'm located on the traditional indigenous territory of the Wendy, put in the Shawnee, Anishnabe, and the Mississauga of the Credit.

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Cayla Runka: and that Toronto is now home to many diverse first nations, Inuit and Metis people

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Cayla Runka: as a health focused organization diabetes. Canada recognizes that there is systemic racism within and throughout our institutions, and that we have the responsibility and the power to create culturally safe and appropriate environments of care.

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Cayla Runka: Today's topic is exercise for every body and yes, everybody enjoys and is capable of movement in a way that feels good to you. And while we have experts on the call today, the session is in no way meant to replace a regular visit with, or the information you obtain from your own medical health professional.

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Cayla Runka: Today we are very lucky to have Dr. Jane Yardley and Phd. Candidate, Jordan Reese, with us to answer your questions on diabetes and moving your body, including how often what types and unique considerations for people living with diabetes.

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Cayla Runka: Dr. Yardley is an associate professor of Physical Education at the University of Alberta's Augustana Faculty in Cameras, Alberta, and a member of the Alberta Diabetes Institute. She is co-author of the 2,016 American Diabetes Association, consensus statement on Exercise and Physical activity and diabetes.

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Cayla Runka: and a recipient of the heart and stroke foundation of Canada's Alberta. New Investigator. Award.

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Cayla Runka: Jane's earlier work focused on blood glucose responses to resistance, exercise, and the impact of exercise in the fasted state, and her more recent work focuses on gender related differences in exercise behaviors and blood glucose responses in people with type. One diabetes.

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Cayla Runka: Miss Reese is a Phd. Candidate in the faculty of Kinesiology, sport and recreation at the University of Alberta. Her research focuses on physical activity and nutritional interventions for adults living with type, 2 diabetes.

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Cayla Runka: Jordan is also a certified exercise physiologist through the Canadian Society for Exercise Physiology, and has 3 years of experience working as an exercise specialist in primary care

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Cayla Runka: before we get started. A few housekeeping things, please note this session will be recorded, and may be included as part of our public facing channels, including our website and Youtube channel. Please know that we will take all measures to protect your privacy and will not be sharing any names or record of the chat

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Cayla Runka: we ask that any comments or reactions you share be affirming and positive, and that you use this time and this feature as an opportunity to further your learning, engagement, and curiosity, and support the same in a respectful way for others. We also encourage you to discuss your learnings with your regular health care provider, prior to making any changes to your current routine.

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Cayla Runka: And with that are you ready to get started, Jane and Jordan?

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Jordan Rees: Yes.

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Cayla Runka: great. So perhaps, while we wait for the first questions to come in, maybe we can chat about some of the basics.

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Cayla Runka: so can we start by just briefly discussing the benefits of moving your body regularly for everyone, really not just for people living with diabetes.

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Dr. Jane Yardley, PhD: Jordan, did you want to take this one, or do you want me to get things started?

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Jordan Rees: You can get things started, go for it.

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Dr. Jane Yardley, PhD: Well, the way I would describe this to students in my undergraduate classes is that basically moving the body benefits every single Oregon system and part of the body. It's good for your muscles. It's good for your heart. It's even good for your digestion, your nervous system, your immune system.

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Dr. Jane Yardley, PhD: it pretty much. Every part of your body is gonna benefit from moving more. simply because that's what we're designed to do. We're not actually designed to sit for long periods of time. And so the more often we move the body, and often the more vigorously we move it.

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Dr. Jane Yardley, PhD: the bigger the benefits to almost every system in the body, and that includes things like metabolism as well. which is why it's very important in the context of of diabetes for blood glucose management.

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Dr. Jane Yardley, PhD: Jordan, is there anything you want to add to that?

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Jordan Rees: Yeah, I'll just highlight, maybe. if we go from like a sedentary behavior to even just small increases in physical activity. We can get many of those benefits from the 10 min at a time of moving our body. It doesn't always have to be a significant amount of activity. We can start small and still see how many of those benefits

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Cayla Runka: that's great. Actually, that leads perfectly into the next question. And you know, the concept of exercise you're working out really brings a lot of moans and grows from people. We all have busy lives. we have multiple priorities that we're pulled into on a regular basis. So it sometimes feels like fitting in exercise is a chore. So when we talk about regular physical activity, what exactly does that mean? And is there variance like you just mentioned Jordan, for a smaller

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Cayla Runka: frequent movements versus just the standard recommendations that come out of you know. Health. Canada.

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Jordan Rees: Yeah, that's a a great question.

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Jordan Rees: I think, maybe just to start, we can differentiate between what physical activity is versus what exercise is, because we often use those terms kind of interchangeably.

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Jordan Rees: So when we're thinking about physical activity. It's any movement that we're kind of doing throughout our day that increases our energy expenditure. So we're contracting our skeletal muscle. we're moving our body. we're increasing our energy expenditure above being a sedentary

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Jordan Rees: versus exercise where that's more of a planned activity. There's a little bit more structure to it. Perhaps we're engaging in it with kind of a goal in mind. We want to improve our health, our fitness.

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Jordan Rees: So those are kind of the 2 different areas that we think of, although there is some overlap between those

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Jordan Rees: but in terms of increasing our overall physical activity throughout the day. I know time is a huge barrier for many people, and when we think about like our 24 h clock.

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Jordan Rees: 8 h is kind of sleep. Maybe we're working for 8 h, and then we have family care chores that 24 h gets eaten up quite quickly.

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Jordan Rees: So if you can think about ways to fit activity into those things that we're already doing throughout the day. Like transportation is one way we can kind of increase our activity.

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Jordan Rees: I'm thinking about small mini movement breaks during our work day can be really small things, strategies that you kind of incorporate into the things that you're already doing.

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Jordan Rees: Jane, did you want to add anything to that.

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Dr. Jane Yardley, PhD: Yeah, there were a few questions about this during the pandemic, of course, because a lot of us were working from home which decreased. Naturally, physical activity levels because

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Dr. Jane Yardley, PhD: we weren't even walking to our car or from our car to our office. and so there were a lot of little things that could be done throughout the day, just to make sure that you are standing up and moving which can now be incorporated into an office space as well. keeping water on your desk is a good idea. But If you want to be be sure that you're gonna get up more often. keeping it in the smaller glass ensures that, you know you have to get up and fill it

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Dr. Jane Yardley, PhD: more often, and of course, the more of those you drink, the more often you have to get up and use the washroom in in that regard. If you're in a building with more than one washroom. You can walk to the farthest one, just to get in a few extra steps a bit more movement. While you're up and out of your desk already. Same thing with that with foods. Make sure you you're not leaving those at your desk, because then there's absolutely no reason for you to move when you're hungry.

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Dr. Jane Yardley, PhD: So if you are at home, make sure those foods stay in the kitchen which forces you to get up and move when you actually want to eat, or again, in an office environment. If there is a kitchenette or a fridge, or anything like that, leave your food away from your desk, so it forces you to get up and move

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Dr. Jane Yardley, PhD: And then, you know, a lot of people drop their kids off at school when it's only a few blocks away. It's a definitely a good idea for everyone to to walk those couple of blocks if it's possible. I know schedules are sometimes tight, and weather is sometimes not very friendly.

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Dr. Jane Yardley, PhD: but that is another idea that can automatically get a little bit of physical activity into the day.

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Cayla Runka: Oh, my gosh! I just want to ask you for more tips. Now I think all of those are very applicable for me. I have a massive jug of water sitting on my desk, and if I had a smaller cup I would be up a lot more often than I am right now. that's great. Thank you for that.

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Cayla Runka: When we think about the recommendations for physical activity again, we'll get into diabetes specific, but for the general population. It is still 5 times a week, 30 min a day for the, you know. Cardiovascular workout. Can you talk a bit about that as well as the different types of exercise. We're to be getting on a regular basis.

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Jordan Rees: Sure, I can go first, and then Jane can maybe add, if that works

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Jordan Rees: so we can break exercise down into those different types. Maybe the most common one that we'll think of, or first thing that comes to mind

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Jordan Rees: is aerobic exercise.

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Jordan Rees: So that would be things like going for a brisk walk, maybe cycling, swimming where we're doing kind of a repetitive movement for a period of time of about 10 min or more. So we're moving our body continuously. We're working our cardiovascular system. That would be what we call aerobic exercise.

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Jordan Rees: there's also something called resistance, exercise, or strength training, where we're looking at kind of lifting weights or moving our body against a resistance, helping to increase our muscle, strength and endurance, and these are both very important types of exercise. And it's recommended that we do both, if possible.

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Jordan Rees: And then there's also anaerobic or interval exercise. So it's similar to aerobic exercise, but at a higher intensity. So we're working harder for a shorter period of time.

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Jordan Rees: So those are kind of the 3 different types.

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Jordan Rees: perhaps add on to that. Does she have something to add?

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Dr. Jane Yardley, PhD: I just get to expand a little on some things. the higher intensities. we've actually got a lot of data showing right now that there are huge benefits. You get a much bigger B for your buck doing a shorter, more intense, or interval type workout where you go of intense for a short period of time, and then recover for another couple of minutes and then go back and do that again. so it's a very effective way to improve fitness

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Dr. Jane Yardley, PhD: and metabolism. and that goes for you know, people without diabetes and people with diabetes.

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Dr. Jane Yardley, PhD: personally, I'm a big fan of what we call resistance exercise, which can come in the form of weightlifting resistance. Bands, body weight exercises anything where the muscles are working against some form of resistance. And I'm honestly a true believer that everyone.

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Dr. Jane Yardley, PhD: male, female, all ages. Diabetes, no diabetes should be doing some resistance exercise throughout life. because it is the best way to keep your joints strong to keep a good range of motion which usually translates into better functional mobility as we get older. And what that means is when you're getting into that, you know. 6, seventh, eighth, ninth decade of life

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Dr. Jane Yardley, PhD: you're able to get out of a chair. You're able to put things on a high shelf. You're able to get up and downstairs. Get out of bed. Use the bath without assistance. And those are all really important things to be able to do, and we know that they're all much easier throughout life if we take the time to do strength exercises on a regular basis from an early age.

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Cayla Runka: All right. Thank you. So. Dr. Yardley, you mentioned people with diabetes, and so is one of these types of activities more beneficial for people with diabetes than the others, and if so, does it vary based on whether you have type one or type, 2 diabetes.

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Dr. Jane Yardley, PhD: any type of movement is beneficial. I think that's one thing we have to say right off the bat. you're you're better to move than to not move. And each type of activity that we've mentioned aerobic resistance, high intensity, interval. Each of them has their own set of benefits, and the one thing that I always bring up is that enjoyment is key.

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Dr. Jane Yardley, PhD: because if you hate that type of activity you are never going to do it, or if you do it, you will do it rarely and be grudgingly. And it's it's just not going to help quite as much. There won't be at the level of enthusiasm that you need And so what I tend to say is that any exercise is good. Exercise and good exercise is the exercise that you enjoy, and you are more likely to do

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Dr. Jane Yardley, PhD: in terms of benefits. It really just depends what type of benefit you're looking for. If you're trying to prevent cardiovascular disease, then it's very important to do exercises that will improve your cardiovascular fitness, so your heart and your blood vessels respond really well to aerobic exercise, high intensity, interval, exercise, but also resistance, exercise.

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Dr. Jane Yardley, PhD: and in terms of functional mobility. As I just said, that high intensity and resistance exercise is a really good idea in terms of blood glucose management. I'll let Jordan. Talk about type 2 diabetes. in type, one diabetes we don't really have a lot of evidence that any type of activity is going to be better for lowering hemoglobin a one C. We know there's a high risk of hypoglycemia with type, one diabetes which is a major barrier to activity, and that aerobic exercise is actually what converse the highest risk

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Dr. Jane Yardley, PhD: of hypoglycemia so we see less of a risk of that big drop in blood glucose with the high intensity, interval, exercise, and the resistance exercise. So if it's blood glucose and avoiding hypoglycemia that you're most concerned about. the more intense th those exercises are usually the less likely you are to have those lows during an activity.

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Jordan.

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Jordan Rees: Yeah, I'll just add on to that in terms of type, 2 diabetes. So there's quite a bit of evidence to support both aerobic and resistance exercise for improving blood sugars and adults with type 2 diabetes. perhaps there's more research looking at aerobic exercise in lowering our A one C or blood sugar

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Jordan Rees: and they recommend accumulating about a hundred 50 min per week to see meaningful reductions in our A one C or blood sugar.

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Jordan Rees: And we can see those reductions even similar to some types of diabetes. Medication, so it can be quite significant if we're engaging in that regular aerobic exercise, and we're consistent with that.

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Jordan Rees: And then we know that if we add on resistance exercise to that. There's additive effects to that.

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Jordan Rees: So we'll see greater reductions in our A one C, and then, along with all the other benefits that we can get with that resistance in terms of building more muscle improving our strength and endurance as well.

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Jordan Rees: So there's quite strong evidence for blood sugar management with aerobic and resistance exercise.

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Cayla Runka: We will definitely talk more about blood, sugar, management and exercise. We do have a couple of questions. in the chat that I do want to get to. So the first one is what are the risks of inactivity? Specifically for people living with diabetes? and perhaps you've kind of touched on it. But maybe you could add a little bit more to that question.

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Jordan Rees: Certainly I can start off. So yeah, there's more and more research, looking at sedentary behaviors, and we now actually have for our Canadian population

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Jordan Rees: 24 h movement guidelines. So previously, we're more focused on kind of exercise alone. Now we're thinking about our movement kind of throughout the day. How much time are we spending and sedentary behavior? And what are the risks of that. So there's evidence to show that

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Jordan Rees: more time in that sedentary behavior where we're maybe sitting watching TV or sitting in our car or sitting scrolling on our phone. Those types of activities increases the risk of things like high blood pressure.

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Jordan Rees: obesity or insulin resistance. It has an impact on our mood as well, so it can impact many different aspects of our health.

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Jordan Rees: And there's more of an emphasis on breaking up that sedentary time. every 20 to 30 min. Just a small get up, go to the washroom, come back to your desk

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Jordan Rees: just to kind of get our body moving and break it out of that sedentary behavior. I think kind of the average adult in Canada spends at least 10 h

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Jordan Rees: in that sedentary behavior, and the recommendations are to try and keep it below 8. So thinking about, how can we create more movement within our day?

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Dr. Jane Yardley, PhD: And I guess the one thing I can add to that specifically in the context of type. One diabetes is that we have. We have population level studies that show that those who are more active actually live quite a bit longer and have fewer complications, or if they develop complications, that they progress more slowly.

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Dr. Jane Yardley, PhD: so people who are in active are more likely to die prematurely to have problems with heart, with a cardiovascular disease. and and also to experience more diabetes, related complications and to have those complications develop more quickly.

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Cayla Runka: Okay, maybe I'll start with you, Dr. Yardley, then, because the next question is for those people that are currently physically in active and living with diabetes. Are there recommendations on where to begin and how to kind of

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Cayla Runka: get started and then stay motivated. And again, I would just like to add that this session is in no way meant to replace the conversation you need to have with your regular medical providers. So we will definitely answer that question, but definitely have a touch point with your care provider on that as well.

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Dr. Jane Yardley, PhD: Well. This, this comes into the realm of of exercise, psychology and physical activity. Psychology. so I'm I'm not going to pretend to be an expert in this. But What we always say is, you know, think about what do what you enjoyed as a kid, kids are naturally fairly active.

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Dr. Jane Yardley, PhD: and if you think back to to what you did as a kid, whether it was, you know, riding a bike, or swimming, or playing soccer with your friends out on the street? If there were activities that you once enjoyed, there's a good chance that you're going to enjoy those again. remember that you're not gonna be able to jump into them quite the way that kids can, because they're also just more able to adapt and and usually a little bit fitter because of their higher activity levels.

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Dr. Jane Yardley, PhD: so you know, number one, start slowly.

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Dr. Jane Yardley, PhD: be forgiving to yourself. if you can afford it. I sincerely recommend employing a personal trainer, you know we will hire experts for almost every aspect of our life and our health. We'll go to dieticians. We'll we'll go to ophthalmologists, pediatrists. Think of a personal trainer as being a health expert along the same lines, somebody who can give you some tips, some tricks, some programs, some help to get started, some

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guidance to do so in a slowly and and progressive way where you won't get injured, and you'll be able to keep enjoying those activities for the rest of your life.

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Dr. Jane Yardley, PhD: Jordan, do you have anything you want to add to that.

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Jordan Rees: Yeah, I think. we all know that physical activity has benefits, and I'm sure a lot of us have tried to engage in activity in the past, and maybe we did it for a week or so, and then we fell off the wagon there.

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Jordan Rees: So thinking about, perhaps, what has stopped you in the past? What were some of the barriers that you came across? Was it time? Was it too expensive? There's lots of reasons why we won't engage in physical activity.

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Jordan Rees: So thinking about some of your personal barriers and how you're gonna kind of problem solve around those ahead of time it could be perhaps setting up your runners and your clothing the night before. Have them ready to go by your bag to take to work.

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Jordan Rees: and then you're gonna go for a lunch time walk, for example. So you're setting yourself up for success in little ways. I think that can be really helpful in getting started and starting to build that confidence as you're newly engaging in an activity

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Cayla Runka: I love that I think confidence is a big thing, too, especially if you're just starting out on on a physical activity program. And I also would love to say that my massage therapist, who's obviously on her feet all day long. So she doesn't want to go for a walk or run, or a bike when she's standing, but she starts her day by dancing to one or 2 of her favorite songs, and she ends her day that way as well. And I love that idea so

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Cayla Runka: happy to pass that on for anyone listening right now. Excuse me so specifically, let's talk about people living with diabetes and let's start with those I I use the phrase, type one but Let's just talk about people who are taking insulin because there is both type one and type 2 that use insulin to help maintain the blood sugar. So are there special considerations for people who are taking insulin.

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Cayla Runka: that need to be considered when they are exercising or or starting a program

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Dr. Jane Yardley, PhD: definitely insulin is the main reason why blood glucose levels will drop really quickly. Once exercise starts And so it really helps to plan in advance when you know you're going to be doing activities and that can even include things like gardening or walking to the grocery store. You have to remember that these are still physical activity, and they're still causing muscle contraction. So for anyone who's using insulin injections it's recommended

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Dr. Jane Yardley, PhD: that the the dose be decreased prior to exercise. If it's a long acting insulin that, you're using only long acting insulin. there are recommendations of about a 10%25 decrease either the night before or the morning of the day that you're planning on being active.

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Dr. Jane Yardley, PhD: if you're using fast acting insulin at meals. You can decrease that fast acting insulin they say up to 50 or 80 depending on how close your meal is to the activity that you're going to be doing, really try to avoid doing activities when your insulin is going to be peaking and we know that for most of the faster acting formulations. Now, that's somewhere around 30 to 50 min, 30 to 60 min. after injection.

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Dr. Jane Yardley, PhD: for insulin pumps. The recommendation is usually to decrease the infusion rate. and that can be 50 to 80. I've even seen some recommendations as high as 100, depending on the activity and the timing of that activity. and we want to be doing that about 90 min to 2 h ahead of exercise.

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Dr. Jane Yardley, PhD: If it's impossible to decrease insulin in advance. And that happens for some people. Because you just, you know, all of a sudden it's like, Oh, hey, I've got time. I'm gonna go do something active now, and if that's the case, making sure to have some fast carbohydrates around and accessible in case those blood glucose levels drop pretty low.

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using continuous glucose. Monitors, we know, is a very successful tool. to help at least know where blood glucose levels are, and be vigilant of them dropping so that we can preempt the the low glucose

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Dr. Jane Yardley, PhD: and my personal favorites one that's been coming out a bit more in the research lately is actually fasted exercise for people who are using insulin injections or insulin infusions. there tends to be a lot less insulin in circulation if exercise is performed first thing in the morning before breakfast, so no snacks, no boluses

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Dr. Jane Yardley, PhD: get out of bed and get going and in addition to the lower insulin, there are other hormones, things like growth, hormone and cortisol, that are a little higher in the morning which will tend to promote fat as a fuel source rather than glucose. and that means that glucose levels will actually tend to stay pretty stable or even increase a little bit for most people if they're doing that exercise before their breakfast, but again, always be vigilant keep an eye on what's going on, and if you have that continuous glucose monitor, keep it nearby.

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Cayla Runka: Okay, great. So assuming that you know, people that are taking insulin,

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Cayla Runka: keep something close by, have something available, because lows tend to be the

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Cayla Runka: biggest risk I'm assuming for people on insulin

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Dr. Jane Yardley, PhD: biggest risk and also biggest barrier to being physically active fear of hypoglycemia is consistently listed as the number one reason why people with what type one diabetes, for sure. But I I would think that that also extends to individuals with type 2 diabetes who are using insulin.

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Cayla Runka: And then Jordan. let's talk about people who are not on insulin anymore. And Maybe some of oral medications are just managing with diet lifestyle and you speak about, you know the same thing. some of the risks, if there are any and maybe even some of the barriers, because I'm assuming you know, moving when you live in a larger body can also be a bit of a complication for some people in terms of their motivation to get out and be active as well.

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Jordan Rees: Yeah, certainly. So with type 2 diabetes or people who are just taking oral medication or managing with just diet and exercise alone. The risk of hypolycemia is quite low.

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Jordan Rees: but there still is that fear some people here the risk of hypolycen and diabetes. We're coming from that type. One diabetes community, I think a lot of people with type 2 have that fear of becoming hypoglycemic?

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Jordan Rees: so maybe clarifying that the risk is quite low, and individuals taking oral glucose medication

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Jordan Rees: and also

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Jordan Rees: like, it's a disease of hyperglycemia or high blood glucose. And when we're engaging in regular activity, it helps to lower that. But the risk for hypoglycemia is low. So that's kind of just some education around that, I think, is helpful for people with diabetes

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Jordan Rees: in terms of the timing of exercise.

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Jordan Rees: depends what your. I guess goals are so typically with type 2 diabetes. After someone has a meal we'll see a post prandal increase or a a spike in blood glucose after they have a meal.

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Jordan Rees: and that could be a very effective time to exercise for this population to help kind of balance out that spike. To reduce those hyperglycemic peaks throughout the day.

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Jordan Rees: So there is this idea of exercise snacking in type 2 diabetes, or maybe we can't fit in like a 60 min walk, but if you can fit in 10 to 20 min after each meal, that could help to kind of reduce those spikes and glucose that we see throughout the day.

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Jordan Rees: That could be one kind of strategy to break it up into smaller chunks.

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Jordan Rees: the idea of fasted exercise in type 2 diabetes is maybe less studied. but perhaps there could be some benefits over the long term if we're regularly engaging in fasted exercise

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Jordan Rees: when we think about diabetes like how it develops. typically, we have excess storage of fats in our organs and our muscle, and when we engage in regular fasted exercise. Perhaps we might see the fuel source coming from those stores in our organs. So that could be one message as well, but less research in that area

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Jordan Rees: in terms of exercising in a larger body.

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Jordan Rees: It's finding movement that feels good for your body. So there's research on aquatic exercise in terms of reducing joint pain and feeling like it's easier to move in the water. there's less risk of kind of rubbing of the skin, which can be quite painful as well.

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Jordan Rees: So finding activities that feel good for you. And water could be one kind of option, for sure.

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Cayla Runka: Right? I'm assuming that would apply to as we age as well when our joints and and body parts are starting to get a little bit more less fluid and more painful.

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Jordan Rees: Certainly. Yeah, with the osteoarthritis, especially in the lower limbs, aquatic exercise can be very beneficial.

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Cayla Runka: Okay, great. We have another question in the chat about specifically longer periods of exercise. So if you're doing multi hour exercise or training for an event, any suggestions for drinks, or products that would contain electrolytes and glucose for people living with diabetes.

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Cayla Runka: I know it's not probably a topic area that you tend to cover. But I thought, I guess, because it's there.

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Dr. Jane Yardley, PhD: so what I'm speaking from now is mostly personal experience, and not actually from from the research perspective. I mean, what we do know from the research perspective is that if you want something that's going to be absorbed quickly and appear in the bloodstream fairly quickly, that a lot of these commercial products are designed to be used by different transporters in the gut, more than one type of transporter in the gut.

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Dr. Jane Yardley, PhD: And so some of these commercial products are extremely effective for maintaining energy throughout longer amounts of exercise

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Dr. Jane Yardley, PhD: when we say longer amounts of exercise normally for anything up to 90 min. You don't really need a lot in terms of supplementation 90 min. Whether you have diabetes or not is usually the the point at which you start needing to to to take in a little bit of carbohydrate and potentially electrolyte depending on the temperature. Electrolytes aren't always necessary unless, again, you're not talking about really long amounts of time

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Dr. Jane Yardley, PhD: at at relatively warm temperatures. and you know, in in terms of the amount of carbohydrate intake. there is a guideline of one gram per kilogram of body mass per hour. But at the same time there are studies showing that once you get sort of beyond 60 grams per hour that you start to see a lot of upset stomach and problems digesting.

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Dr. Jane Yardley, PhD: and especially that gets worse as the intensity of the exercise gets worse. so a lot of this is gonna depend on how long, what type of activity it's easier to eat while on a bike than while running. For example, just because of the bouncing that happens in the gut and and how much performance you know. you're expecting to get out of your body. But in terms of commercial products.

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Dr. Jane Yardley, PhD: there are so many out there, and the tip is usually try lots of different things in training and don't do anything new on race day. So if you know which event you're going to participate in check to see what's going to be available at the aid stations on the course, and see if that's something that your body agrees with. If your body agrees with it, then continue to train with it if it doesn't find something else. But make sure that you are carrying your own supplies on race day.

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Dr. Jane Yardley, PhD: so I can't really give specific product information. because that's really not my area, but that those are sort of some general guidelines for distance. Yeah, and great great advice. on the that note, though. How big of a role does hydration play in exercise and people living with diabetes?

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Dr. Jane Yardley, PhD: I'm gonna just hazard a guess here that it's probably more important for your people with type, one diabetes, then type 2, simply because there's a higher risk of hyperglycemia so high glucose during competition just because of adrenaline. So if you're still talking sort of racing and training at higher intensities, there is. There's a tendency for sugars to kind of creep up over the course of of events.

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And the the longer that that sugar stay high, the more likely that you will be dehydrated because your body tries to flush it out in your urine

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Dr. Jane Yardley, PhD: and so especially on on warm days, because we also know. And I'm again mostly speaking from the perspective of type one diabetes here. we know that there are some minor impairments, and being able to cool the body for people with type, one diabetes. And so it's really important to maintain hydration during those events. Little trick from somebody who's done a lot of distance stuff. when you go through those aid stations, grab 2 cups of water.

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one for you, one over your head that helps you cool things down a little bit as you keep on going.

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Dr. Jane Yardley, PhD: I'm sure Jordan has some stuff to add to that.

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Jordan Rees: Yeah, I'll just add a similar for type, 2 diabetes. There's a reduced capacity to dissipate heat. So it is really important. If you're going out for a walk, and it's 30 degrees to ensure you're well hydrated for that.

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Jordan Rees: and as well. If you're engaging in activity, and you're starting that activity with high blood sugars to say you test your blood sugars, and there are around 16 recommended to say, very well hydrated during your exercise session. so it does apply to both type one and type 2.

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Cayla Runka: Okay. Great. we have one more question. So if anyone else listing has further questions, please feel free to put them in the chat, so we can answer a few more of those, but I will ask this sort of one last one and that is for people that

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Cayla Runka: have been regular regularly exercising. is it worthwhile to change up your activities? with respect to whether it's, you know, diabetes, management, or otherwise? doing the same things over and over again, does it kind of reduce the benefits that you see from the activity that you're doing?

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Jordan Rees: I can start.

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Jordan Rees: So I I think we can look at this question in a few different ways. One of them is, are you bored with your activity?

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Jordan Rees: You're bored with your activity. You're not enjoying it anymore, you're less likely to do that activity. So keeping things kind of fresh and trying new things can be a helpful way to stay active over the long term

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Jordan Rees: in terms of health benefits. If we're regularly engaging in that, in an activity, we'll get those health benefits our body will adapt, and that activity will become easier over time. So, for example, if we're lifting weights, for we start to get stronger, that weight becomes easier. We do need to think about increasing the intensity of that

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Jordan Rees: But if we're thinking about

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Jordan Rees: health benefits, you can kind of engage, I think, in the same activity, and get those health benefits. Perhaps we're not going to see an increase in performance over time. If we're not kind of challenging our body and progressively overloading it and increasing kind of the intensity or volume of the activity, but overall for health benefits. If we're just regularly engaging in activity, we'll get those. But maybe Jane wants to add something to that as well.

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Dr. Jane Yardley, PhD: I think I would echo a lot of the same thing that you know, if you're loving it, and you want to keep doing it. Keep doing it. in terms of improving fitness. We normally need to see some changes in the program from time to time to stimulate new adaptations. But at the same time, if you're looking at this in the context of managing, say insulin

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Dr. Jane Yardley, PhD: different activities are going to need different insulin adjustments, and so changing that routine can sometimes lead to frustration, because it will also change the way that the glucose responds both during and after the activity. so you kind of have to weigh up, you know, as Jordan said, if you're getting bored with your activities, then

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Dr. Jane Yardley, PhD: yes, a change is a great idea. and if you want to to stretch yourself to push yourself you know, maybe you want to do a 5 K. Race that you've never done before. for that you will have to have some progression and even some periodization. Those are 2 words that a trainer would introduce which essentially means building on cycles of training, so that you get the right amount of recovery and the right amount of stress on the box

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Dr. Jane Yardley, PhD: to get better. but you know, if if you do a half hour, walk every day, and you want to keep doing that half hour, walk every day, that half hour, walk every day, is going to help you stay healthy and mobile for sure.

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Cayla Runka: Great! And I know Jane, you mentioned this earlier about checking your blood sugars before you exercise for people that maybe are not your, you know, going to the gym or exercise class kind of people, but more having a walk, or or a bike, or something, through their neighborhood. Is it recommended to test your blood sugar beforehand, or does it depend on your blood, sugar, and sort of what your normal pattern is?

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Dr. Jane Yardley, PhD: it's always a good idea to know where you are at in terms of blood sugar levels. If you're about to go out and be active. you know, if you know when you're going to be active, you. You want to aim to be somewhere in the 8 to 10 minimal per liter range for any type of a aerobic activity, whether that's a walk or a jog. it. We have a lot of study showing that if you start a lot higher it just means you're going to drop faster. but it's always recommended to know where you're at before you go out. And it's even a really good idea to know what direction you.

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Dr. Jane Yardley, PhD: Your blood glucose levels are moving in. So if you're not wearing a continuous glucose monitor, and you're using synthetic insulin, for example, because those are the the things that are going to be the biggest risks.

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Dr. Jane Yardley, PhD: it's a good idea to check, you know, maybe 2 or 3 times over the hour before going out to do your activity, because then you'll know whether or not your glucose is generally going up or generally going down, because there's a difference between being at, say, 7.5, and generally going up when you're about to go for a half hour, 40 min walk

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Dr. Jane Yardley, PhD: than being at 7.5, and generally going down. The latter one might mean that you end up finishing that walk early. if you didn't bring any snacks with you. so yeah, generally a good idea to to be vigilant.

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Cayla Runka: Anything to add there, Jordan, or

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Jordan Rees: I don't have too much to add. There, I would say, with type 2 diabetes. we're not thinking about checking our blood sugars as regularly. It's obviously dependent on the individual and what their doctor recommends. Perhaps they're newly diagnosed. That might be a time where you're checking blood sugars more regularly around exercise. But typically we're not as concerned about those lows.

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Cayla Runka: Me. so just before I ask one last question to our experts. we've popped a brief evaluation into the chat. If you would kindly take a minute to provide us some feedback, so we can continue to learn and grow and better meet your needs.

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Cayla Runka: also, if you have ideas on other topics, you'd like to hear more on feel free to pop that in the chat as well. So my last question is really generic, and I will. I'll start with you, Jordan. Anything we haven't covered, or any parting words of wisdom, or maybe even further tips on getting started on. increased movement of our bodies. for those living with type 2,

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Jordan Rees: let's say my biggest message is to find activities that you like doing, because exercise and physical activity can be such a

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Jordan Rees: an additive part to your life, and it can bring you a lot of benefits in terms of mental health, can make you feel happier, give you more confidence, more self esteem. So really seeking out those activities that you enjoy doing

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Jordan Rees: and perhaps making it a social thing. If you're struggling, doing it on your own, it could be something that you could

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Jordan Rees: rather than going to a movie with a friend, you could go and do something active with a friend. So finding those things that you'd like to do.

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Cayla Runka: That's great. Thank you. And Dr. Yardley

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Dr. Jane Yardley, PhD: as soon as you asked that question I was gonna say that the last half of what Jordan said. There, you know. Fine! Find what you enjoy doing. Which was what you said first. but find people you enjoy doing them with.

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Dr. Jane Yardley, PhD: I'm I used to be very good at going out and doing stuff by myself when I was in my twenties. The older I get the less motivated I am. and the more I feel. Okay, I need to meet somebody to do this activity. so I have my regular running buddy and and my regular cycling buddies. And if if if you're not 100%25 confident in what you're doing, having a group to do it with means. You can learn from the rest of

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of the group.

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Dr. Jane Yardley, PhD: and for people with type one diabetes again, because this is the area that I work with the most. There are actually groups of very active people with type, one diabetes who love to share They love to. you know, help. People grow and learn

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Dr. Jane Yardley, PhD: how to be more active, how to manage, insulin what to expect with different types of activities. so finding groups like that that can help support you both in terms of your movement and in terms of your diabetes. Management? I think, can be very important for keeping lifelong activity.

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Cayla Runka: That's great. Thank you both so much. So. we've come to the end of our time. thank you. Everyone for taking time out of your busy schedule to join us today. sometimes it's hard to take time for ourselves and our personal care. but it's so important. And honestly, I think the benefits are always worth the time, put in.

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Cayla Runka: if you haven't filled in the evaluation, please consider doing so now. The link can be found in the chat, and a very big thank you to our guest experts today. I know, I learned a lot, and I'm sure all of you did as well. Without the generosity of your time our open hours would not be possible. So thank you both.

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Cayla Runka: and thank you everyone for joining us. Open hours runs the last week of every other month with the different topic, and guest experts, so be sure to follow us on social or visit the website regularly for updates

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Cayla Runka: to learn more and stay up to date on diabetes, Canada's work and resources. You can visit our website at diabetes Ca, or check out our social media channels. We are on Facebook, Twitter, Instagram, and Linkedin. You can also call our info team at 1 800 banding. That's B, a, N, T. I, ng, or email at info@diabetes.ca with questions.

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Cayla Runka: So join us again in August for our next diabetes. Open hours the theme will be making technology work for you.

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Cayla Runka: Please stay tuned for our social channels and our website, for news about the date time and guest expert for our next conversation, and for those of you who are looking for a more concrete goal to get moving. Consider joining diabetes, Canada's lace up to end diabetes. Challenge. you can find the website through diabetes. Ca, and join the movement to end diabetes and spend your September with people across Canada who are challenging themselves and their teams to lease up to end diabetes.

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Cayla Runka: And with that I thank you again, and we'll see you next time.

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Cayla Runka: I'm assuming that

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zoom.webinars@diabetes.ca: nice job guys. Yeah, we had a we had a just a a comment there at the end. Just thanks so much. All great session

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Cayla Runka: so very informative, so wonderful. Thank you, Jane and Jordan, that was great. thanks so much for inviting me. We covered enough information for everybody. This is intended to be broad and not sort of a deep dive, so Hopefully, everybody had a good response. So we'll see.

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Dr. Jane Yardley, PhD: I guess. One thing I I should I usually mention is that like, I'm happy to have people email me if they have more specific questions. So if that does come up. If you get people that are writing and saying, Oh, I have these other questions. Feel free to send them my way. I don't mind, you know doing some one on ones, because some people do have very specific questions.

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Cayla Runka: Thank you for that. I can't imagine how many emails you must get on a day. We will try and not have a million of them for you. But that's wonderful. Thank you for that.

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Cayla Runka: All right, thanks, Olivia.

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Cayla Runka: Everybody has a great rest of their day. Alright, thanks, guys! Bye.

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[Music] welcome everyone my name is Anne besner

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I work with the people affected by diabetes knowledge and connection team at diabetes Canada and I will be your

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moderator for today's webinar I'd like to begin by acknowledging that I'm joining today's event from Ottawa

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which is the traditional unseated territory of the Algonquin anishinaabeg people

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as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout

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our institutions and that we have the responsibility and power to create culturally safe and

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appropriate environments of care from wherever you are tuning in I invite

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you to take a moment to reflect on the land on which we live recognize the harms and mistakes of the

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past and consider how we can all contribute in a meaningful way to reconciliation and collaboration

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we are here to kick off a new live webinar series at diabetes Canada called diabetes open hours thank you so much

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for being part of this event diabetes open hours is all about you the

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person who is affected by diabetes if you have been diagnosed or are caring for someone with diabetes you're not

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alone millions of Canadians are living this reality but diabetes is complex and different

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people experience it differently whether diabetes is new to you or you've been living with it for a long time

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you've inevitably got questions questions about risk factors complications management options

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questions like why me diabetes open hours is a live virtual

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agenda free hour that allows participants to interact with a feature guest in a community of individuals with

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lived and professional diabetes experience this is your time to ask Customs tell

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your story and share with others in a safe non-judgmental space diabetes open hours will take place

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toward the end of the month every second month each one will have a different guest that will be welcoming and a different

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broad theme diabetes open hours is being recorded and will be archived on the diabetes

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Canada website as well as on our YouTube channel for on-demand viewing

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today's theme is nutrition and we are so pleased to have with us Jenna Walsh registered dietitian and certified

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diabetes educator Jenna Walsh completed her degree in human nutrition at the University of

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Guelph followed by a dietetic internship through the Ottawa Hospital she has been working as a clinical

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dietitian in Renfrew County since 2010 dividing her time between long-term care

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inpatient and outpatient support Private Practice as well as Community nutrition

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which includes developing and coordinating an initiative called kids in the kitchen and more recently a

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virtual Eating Disorders Support Program she added certified diabetes educator to

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her resume in 2017 and continues to support those living with diabetes in

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her community by normalizing food and movement as part of their diabetes management

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she loves spending time outdoors with her spouse and three daughters and in the kitchen whipping up new recipes

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welcome Jenna thank you so much for being here thank you so much Anne I'm very much

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looking forward to chatting with everyone today so thank you okay here's how things are going to go

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over the next hour participants who are joining us for today's event can use the chat feature

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to submit their diabetes related questions to Jenna we know that nutrition is a really interesting

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subject it's a huge topic and one that can be a source of confusion for many because it's very Dynamic and evolving

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sometimes it's hard to separate nutrition fact from fiction and challenging to identify reliable sources

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of info about nutrition but not to worry Jenna is here to help us Wade through it all

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as a certified diabetes educator she has a wealth of knowledge when it comes to All Things diabetes and as a registered

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dietitian of course her area specialty is nutrition so we're in really good hands today with Jenna

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using that chart feature please starting now and throughout the next hour type in your diabetes nutrition questions for

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Jenna so you can simply click on the chat icon that's near the bottom of your screen to open the chat

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you can post your question by typing it into the text box with the recipient being everyone and that way everybody

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will be able to see your question we also encourage people to share their diabetes stories in the chat

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we welcome supportive positive comments and emojis from the audience so feel free to be actively part of the

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conversation through the chat as a moderator I'll relay the questions comments and stories to the group and

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we'll do our best to get through as many as we can in the time that we have together a few quick ground rules regarding the

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chat we just ask that any comments or reactions that you share be affirming

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and positive and that you use this time and the chat feature as an opportunity to further

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your learning engagement and curiosity and support the same for others

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following this webinar we'll be sending out an evaluation to hear what you thought about open hours and how we can

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better tailor it to suit your needs so with all of that Jenna are you ready

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to begin good to go great let's get started

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so while we are waiting for some questions to come in maybe we can just start by sort of setting the stage

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Jenna can you talk to us really briefly about what the connection is between nutrition and diabetes and what rules

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does healthy eating play in diabetes management um so I think I would start I mean I I

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think I'm a little bit biased in terms of the the role I I feel that nutrition

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plays um at the same time I really try to approach diabetes management with with

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patients and clients as part of management um we all come from very different uh

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socioeconomic backgrounds we all grew up with a different relationship with food some of our parents may have loved being

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in the kitchen they may have included Us in the kitchen other people may have grown up not having a clue how to cook

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we all have different food budgets um cultural preferences and so

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nutrition is a very um individualized part of management

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I think it needs to be and it should be but it can absolutely make a drastic

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role and in impact on our diabetes management so even into the guidelines we see at least a one to two percent A1C

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reduction potential with with nutrition I would say absolutely I've seen much higher than that with patients depending

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where A1C is starting and what level of change they end up making so nutrition is a pretty big one

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absolutely yeah that's very true Jenna

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um now we have people joining us who are impacted by diabetes in lots of different ways

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um may have nearly been diagnosed or have been living with diabetes for quite some time

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um maybe we can just kind of go back to basics um and this is useful for for anybody

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um who's living with diabetes can you take a second to just talk to us a little bit about carbohydrates so

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um what are carbohydrates and uh what impact do they have generally on blood

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sugar yeah absolutely and and I'm glad you bring that up because more often than not when I'm speaking to people I'd say

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at least half will pause me and say you know what which foods are carbohydrates um so there's a few different categories

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that we start to talk about when we talk about carbohydrates but essentially it's think of them as a like a chain I like

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people to think of food kind of like Lego blocks that make sense for people and then once we eat carbohydrates they

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essentially are broken down to simple sugars in our in our body so even if something is sugar-free they can still

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have carbohydrates meaning they will still impact your blood sugar once we ingest them so the big one that most

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people know about are starch-based foods so any grain based um think your wheat your oats your

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barley um all of those grains are carbohydrates

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and any of the foods that they end up making we also then have our starchy veggies that's where potatoes fall into

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as well and then our fruit they all naturally that's where we get their delicious sweetness from is from sugars

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right it's natural and dairy as well so oftentimes people forget that Dairy

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especially milk has lactose and lactose is simply a sugar or a carbohydrate so I

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like people to think not so much as like does it have sugar but thinking in terms of carbohydrates and that makes label

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reading a lot easier as well now with respect to diabetes though in blood sugar management just because

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carbohydrates affect our blood sugar it doesn't mean we can't eat them

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the most important piece I ask people to pay attention to is how much can each

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person's own body handle or tolerate at a meal or an eating period and blood

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sugar stay within target range so that's again where our nutrition becomes very individualized because a

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what carbohydrates do you like eating right which one still give you enjoyment

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with your meals and allow you to continue to eat that way how much of it do you need to feel satisfied from that

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meal and then on top of that you know does it keep your blood sugars within a within a safe range

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that's really helpful Jenna just a reminder to everybody that if you have questions please go to that chat feature

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and put them right in we're happy to answer any questions you have related to diabetes nutrition

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if you're more comfortable coming off mute you can certainly pose your question as well out loud

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um I see here from a comment in the chat that Kathy is having a bit of difficulty understanding with with an echo so we'll

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work on that Kathy apologies for that um but you can come off mute anybody if

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you'd like to ask a question or feel free to put that in the chat and while we're waiting for some more of those questions to come in Jenna

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um wondering if you could talk a little bit more about um some some different foods and their effects on blood sugar so what about

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vegetables you mentioned that potatoes are a starchy vegetable but what about other veggies what what impact do those

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have on um blood sugar yeah um so we we try to divide Foods up into

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sort of those starchy and then non-starchy right so non-starchy typically being

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um things like your dark leafy greens things like zucchini and cucumbers and celery whereas some other ones where

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that might have more sugar in them may have a bigger impact unless people are on multiple daily

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injections of insulin I try not to get them too focused on the exact number of carbohydrates in

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Foods versus focusing on eating more vegetables in general checking blood

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sugars two hours after and just seeing how that meal has affected them because the one really neat thing that

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some Studies have shown us is within each person right so the individual

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person not larger populations we will see repetitive similar responses to food

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so one person might say their blood sugars go through the roof after having you know some bran flakes and a banana

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and it might be you know whatever maybe they've had 45 grams worth of carbohydrates at that meal the person

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next to them might not it might be pretty modest we can expect for that person where that blood sugar has spiked

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with that specific food we can expect that to repeat so it's it's simple

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enough simple it's still a lot of tedious work and learning but we can start to learn our own patterns and

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which foods our body does well with versus what foods our body struggles a little bit more with and so absolutely

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some of those squashes the sweet potatoes potatoes the ones that really when we think about it have a little bit

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more of that sweeter taste tend to have more complex carbohydrates and and some sugars in them and they may

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they may affect your blood sugars more there's a more complex part to that in terms of what we know to be the glycemic

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index in terms of how much a particular food will spike a blood sugar so that part's important as well

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all really important points and and we can see some questions now coming in through the chat which is terrific keep

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those coming everybody um so Kathy asked a really excellent question here

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um thanks Kathy how do carbs impact type 1 diabetes versus type 2 diabetes versus

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pre-diabetes so maybe you can kind of unpack that a little bit for us great question

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um so I want you to think about type 1 diabetes uh so let's back up a little bit with diabetes when we eat those

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carbohydrates our body breaks them down into those very simple carbohydrates and then asks

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the pancreas for insulin so the pancreas is that organ that we have and in those

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beta cells that we have in the pancreas it secretes insulin insulin is just a hormone its job is to hook onto that

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Sugar bring it to our muscle and brain cells and convince them to open up and

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let that sugar in now sometimes with diabetes the insulin comes takes it cells don't

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open up that's foreign resistance with other people we may it may be more

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genetic in terms of type 1 diabetes sometimes it's a viral infection or something that damages those beta cells

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and they no longer are making insulin people with type 1 diabetes are not

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making any insulin okay so we pay a little bit more attention to you know specifically how

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many grams of carbohydrates we're getting in a meal because we have to then give ourselves the exact amount of

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insulin to keep blood sugars in range with type 2 diabetes we have a little

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bit more flexibility sometimes because we still have some insulin being made so the body is still taking care of some of

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that naturally right so we we have a little bit of wiggle room to say it also depends too if we're on any

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other medications so with type 2 diabetes we would also potentially be on some oral medications or pills that

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address different parts of blood sugar management so they may work at the cell level to reduce that insulin resistance

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we talked about convince those cells to open up and let the sugar in some medications work at the liver so while

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we're not eating the liver also slowly release the sugar back into our bloodstream so that the levels are

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consistent some medications work at the kidneys so the kidneys also filter out sugar

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um and and also keeps them in our blood so some medications try to convince the kidneys to pee more sugar out so those

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carbohydrates are important in all three stages so pre-diabetes type 2 and type 1

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were a little bit more specific with the amounts

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uh with type 1 because we're giving insulin for every gram of carbohydrate

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essentially type 2 if we're on insulin so sometimes we're still in insulin we are again

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being a little bit more specific we're paying attention to you know if I have 45 grams of carbohydrates how much extra

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insulin do I need right so we're still paying attention we may not be as specific with those

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starchy versus non-starchy veggies because you start to learn yourself how your body does

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with pre-diabetes think of pre-diabetes kind of as that yellow warning flag that

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things are starting to go awry we need to be more specific and more pay a

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little bit more attention to how our body's doing with meals now guidelines still don't really

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suggest that we have to be testing our blood sugars in the pre-diabetes stage I am a very vocal advocate for testing our

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blood sugars at this stage because of what we just talked about you can eat

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your normal meals and check your blood sugars two hours after to see how your body is coping with what you're eating

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um and I find even with people if we can get a you know continuous or floss glucose monitor on in the pre-diabetes

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stage for that two weeks we see such better outcomes because they

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can make small tweaks without being overly restrictive and they can maintain those changes for

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a long time and so little things Kathy like for

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example I often hear people when they're diagnosed with pre-diabetes being terrified if things even like carrots

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where as I would rather you eat carrots because they're nutritious and they're so valuable with lots of nutrition and

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let's just check and see how your body does and what are you eating with the carrots in terms of protein and other

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nutrients to see how that impacts it I hope that answered your question

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that's a really good point Jenna um certainly when we're eating we're not just consuming carbohydrates right so

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what else would make up our plate in terms of foods or nutrients and what

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kind of an impact would those things have on blood sugar and then how can we kind of incorporate

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all things to eat in a in a really well balanced way would you say

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yeah um I mean ideally we I try to focus um more on a plate method right where

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we're really trying to get Back to Basics around eating enough food first I

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I really don't find that anyone does well when we try to impose restriction and taking things away as opposed to

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First focusing on you know are you eating enough vegetables at every meal because they're high in fiber and

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they're typically low on carbohydrates are you eating enough protein a to maintain muscle mass

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um fantastic in terms of Just Energy and also satiety keeping us full longer and

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then those carbohydrates which also give us all the you know vitamins and minerals and fiber having all of those

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together again if I go back to that Lego analogy for people it's like having a really intricate Lego block that your

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body has to work really hard to pull all of those pieces apart it takes longer for the body to access those

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carbohydrates and so we don't see this massive Spike of blood sugars but you know hopefully more Rolling Hills

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and so for a lot of patients where we start is okay what are you currently doing when are you eating what are you

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eating how much are you eating and is there room to add so far you know typically having say you

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know toast and jam and a coffee for breakfast great but we're just having carbohydrates and

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carbohydrates can we add some veggies can we add some protein it might be adding some peanut butter and um sliced tomatoes on the side or

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something right a veggie omelet and one piece of toast try a whole bunch of different varieties a to see how their

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individual body tolerates I think that's really helpful

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um we've got another question coming in here from Jennifer uh Jennifer works at diabetes Canada and has lived with type

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1 diabetes for a long time and also happens to be a dietitian so I'm very knowledgeable when it comes to food and

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nutrition but she says in spite of all of this eating out for her can be an ongoing challenge so what's your advice on

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eating out for people who are living with diabetes um perhaps for for people with type 1 but also for people with type 2.

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um and how how would you go about sort of estimating um carb amounts of things like sauces

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which which may be a little bit trickier to figure out um and then working to kind of maintain

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those blood sugar targets yeah absolutely and I mean um eating out in in general is can be a

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challenge um for anyone living with diabetes in terms of knowing how much and also how it then

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impacts their blood sugars right so uh especially for type 1 whether they're MDI or whether they're pumping there's a

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few things I'm a big fan of first of all is be part of a group so any sort of

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diabetes online support groups Facebook has a ton of them but there's more outside of Facebook I really truly find

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that people living the experience have more inside scoop and knowledge of the

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best places to eat where they're serving consistent amounts right so most of the

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food chains that that we frequent have their nutrition information available

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but the sauces and all the little pieces really come down to are they following the amounts that that standard recipe

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suggests that they're putting on when it comes to sauces right versus are they just doing a big old squirt

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um easy enough we can ask for those things on the side that's always the safest

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it's sometimes annoying for sure but safest in terms of if we're if we're dosing specific amounts or bolusing

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the second piece too is what you may do especially if you're eating out often is

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you may have some of your own staple foods for a meal and just be getting a portion that's takeout so I've had some

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patients have success with that especially if they're on the road a lot say you're a busy um you know parent with sports and

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you're on the road a lot or um with work if you're traveling with work having some of those Staples where

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you're boosting fiber you're boosting protein um that can be easy as well to know the

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specific amounts that you're getting or vice versa you're bringing your carbohydrate amounts and what you're

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ordering might be like you know a salad with chicken to get extra

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it's a super question from Jennifer thanks so much and just as a reminder to everybody keep

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those questions coming recall that open hours is all about you so ask anything that's on your mind about diabetes and

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nutrition feel free to use the chat feature or you can come off mute and ask your question in person

22:42

uh Jenna we've heard a lot about low carb diets so maybe we could talk a

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little bit about about that um what is your perspective on low carb

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diets um are they a fud are they helpful for people with diabetes

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um give us the lowdown yes so this is still a really big topic

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and still a very controversial one and controversial even I find in in terms of my own head

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um because it's only effective if it's effective

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and realistic for the patient long term and so when we look at eating patterns

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for people whether it's ketogenic meaning less than five percent of the diet is carbohydrates versus low carb

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which is typically under 20 percent of total calories coming from carbohydrates

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um it's effective we can eat well nutritionally balanced if it fits their

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budget they enjoy the foods they're eating they're eating enough nutrition and they're still managing their

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diabetes Well right so we can still be eating that 20 percent have very low carb very low carb

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and a higher carb meal without any medications and blood sugar still you know increase after that one meal so

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there's still some education there's still some learning there's still self-monitoring of blood glucose even in

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those contexts um is it necessary I would say no

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we can still manage our diabetes very well with a you know standard Mediterranean style of eating or a more

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flexible carbohydrates which I find for most people again I

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work a lot with eating disorders so I'm very sensitive to restriction and what

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long-term impacts that can have um if we can make sure that carbohydrates don't feel like a bad food

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for patients I'm all for that so yes it can be

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effective for patients if they're interested in addressing or trying a lower

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carbohydrate diet I definitely suggest that they chat with an RD or with someone who has experience just to make

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sure they're getting enough food they're never feeling restricted and they're still managing well

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in your experience what are some of the risks of somebody following a low carbohydrate diet particularly if if

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somebody maybe isn't um doing it alongside a registered dietitian or or hasn't

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um consulted with a healthcare provider about that so if someone's living with diabetes are are their risks

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yeah um absolutely um I think I think the biggest thing

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that we really want to look at right is um the reason that they're choosing

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right so it might naturally already be the way that they prefer to eat one of

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the key things that we really want to look at is you know what medications are they on some of them are not safe to

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continue taking and so we really want to look at you know where is insulin at and the sglt2s some of the sulfonurias

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certain medications we really should look at stopping so that's one thing

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that we definitely want to start with if there's any history of Eating Disorders or disordered eating

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that big red flag for me and it's something I I really dig deeply in with with people

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um risk factors too is really a cost right if they have a fairly low uh budget for

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food High veggies and high protein is really expensive

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so my my concern is actually more in terms of how are they managing to eat

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enough nutrition following a low carb diet uh that's a

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that's a big one that I think is overlooked way too often um I mean outside of that those are the

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biggest factors so the medications you know the disordered eating and then is it reasonable for that for that

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patient it's helpful to think about the benefits and the risks and making decisions about

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eating patterns um so and speaking of eating patterns you mentioned the Mediterranean diet

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so just wondering if you can describe what that eating pattern is like for people who aren't familiar with the

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Mediterranean diet yeah so I think it's great to think of it more as a as a lifestyle that's

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really the way that we know there's more benefit we're we're focusing on lots of plant Foods

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um lots of plant-based fats and proteins nuts and seeds you know olive oils avocados

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um less red meat so it's not gone but it's definitely less frequent like a few

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times a month as opposed to a few times a week more fatty fish like trout and and tuna sardines

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Etc um the lifestyle Factor too comes in in terms of focusing on taking time to eat

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right we're not scarfing food down in five minutes and going on a better day is making time to

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cook trying to cook more meals at home trying to sit socially together to eat

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we actually see much better outcomes and much more satisfaction from food when

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we're able to do that digestively too we tend to actually have better Digestive Health when we actually

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sit you know kind of that 30 45 minutes that we would all ideally have for three meals a day

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is important as well so it's not so much a diet in today's sense of the word but a way of eating

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now you mentioned with the Mediterranean way of eating that that it heavily features vegetables

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um I think uh one thing that a lot of people are wondering about uh when they're diagnosed with diabetes or

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they've been living with it for a while is is there any benefit to adopting a vegetarian diet so cutting out animal

28:45

products all together and and you know whether it's a vegetarian diet or a vegan diet or any sort of variation can

28:52

you talk to us a little bit about that is it necessary to be vegetarian when you have diabetes

28:57

yeah so definitely not necessary um the interesting thing with the evidence that we have with uh vegetarian

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Lifestyles is that we also see a fairly significant reduction in heart disease for those who do follow more of a

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plant-based diet so less elevated cholesterol less elevated blood pressure

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which we know risk factors for both right when we have diabetes and heart disease is is high so we see

29:22

improvements there um we also because I I got a lot of questions when people are asking to eat

29:28

more plant-based and we're encouraging them to eat more pulses which is you know they're high fiber

29:35

um beans and legumes and higher in carbohydrates and there's that moment of

29:40

confusion of what I thought I had to watch my carbohydrates we don't see as much of an impact with a

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lot of those pulses when they're Incorporated with other plant proteins as well in high fiber grains because

29:52

there is more protein in fiber so we see some benefits there as well

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from a higher intake of fiber when we're following more plant-based proteins

30:02

because things like um you know almonds and walnuts and black beans and lentils they do they

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have protein but they also have a ton of fiber that helps to reduce cholesterol and

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also Keeps Us full longer and is lower on that glycemic index we talked about

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so we definitely see good at in outcomes sorry with respect to diabetes

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I would argue it's potentially cheaper meat is still through the roof right now since covid so budget wise we can really

30:33

stretch that dollar with more plant-based I find for people it's more of a lifestyle switch we're very much

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still a meat potatoes veggie way of eating and so it can be more of a switch that way

30:45

I find that's helpful for people to pick say one meal a day to start in terms of

30:52

trying to transition to more plant proteins so they may have a salad or a soup and

30:57

instead of putting meat on it putting again even canned black beans or canned lentils in that pot of soup or you know

31:04

a quarter of a cup even to start on their salad or if they're having a wrap you know mashing some chickpeas and and

31:11

using that as the protein instead of leftover chicken or ham or something along those lines necessary no but

31:18

there's definitely benefits that's great I was actually going to ask you if you could provide some

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suggestions for how people can incorporate more plant-based proteins in their diet so

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um good to get those ideas for people who maybe are not accustomed to eating a lot of plant-based proteins but want to

31:35

want to start um so we're about halfway through open hours now everybody the time is just

31:42

flying by thanks again so much for joining us uh we're here with Jenna Walsh registered dietitian and certified

31:48

diabetes educator she's here to answer all of your nutrition related questions so use that chat feature to ask anything

31:56

about diabetes and nutrition you can certainly also share your story about how you're affected by diabetes talk a

32:03

little bit about how diabetes is impacting your life um and and we'll just keep going

32:09

um Jenna you were talking before a little bit about um

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different types of carbohydrates and wondered if you could just provide a little information about simple versus

32:22

complex carbs so people may have heard those terms before and there may be a little bit of confusion about what those

32:27

are so tell us about simple and complex cards

32:33

yeah so think of your simple carbohydrates basically as your sugars

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there are one unit doesn't take your body much ever to break down it's going to be things like

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your honey your maple syrup um you know juice really is is

32:49

everything's been broken down and removed as well they're they're very easy for the body to use right away now

32:56

most people when I say that say okay so they're about they're not bad but if we're having them

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we want to have them with again going back to that protein and the fiber to help again reduce that Spike where

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they're beneficial is when people are having a low so when blood sugars fall under that

33:14

four or three point eight we actually want to be reaching for those simple sugars

33:19

tablespoon of honey you know a half a cup of juice a half a cup of regular pop because that's what's actually going to

33:26

take little time for your body to bring those sugars back up to a safe level now on the flip side of that your complex

33:32

carbohydrates I want you to think of a whole bunch of sugars tied together like a chain

33:39

um they're complex they've got some hydrogen and oxygen as well and you know potentially different fiber molecules

33:45

some protein all of those good things again that really complex Lego block right

33:51

takes more effort for the body to break it down uh and to absorb it into the

33:56

bloodstream so from a meal in day to day into we want

34:02

to focus on more complex carbohydrate and yeah try to build most of our meals around

34:09

those on the flip side of that if we're having a low these are not the ones we want to

34:14

grab we don't want um you know a half a cup of lentils with whatever mixed in

34:20

veggies mixed in it's going to take too long for the body to bring those sugars up so complex exactly as they sound they're

34:27

complicated for the body to break down simple super easy very quick for the blood sugar to spike

34:36

okay that makes sense um now related to that concept and also something you mentioned before I'm just

34:43

wondering if you can expand a little bit on this whole concept of carb Counting what is it

34:49

who needs to do it how do you do it why is it important yeah

34:55

I um with type 2 diabetes I I avoid getting too in depth with carb counting

35:03

because I try not to have food become numbers for people with insulin use we do get into carb

35:11

counting not necessarily right away we start with kind of that plate method again but we're very much looking at a food

35:18

label or measuring food we have different lists for foods that let us know how many grams of carbohydrate per

35:26

weight of food so then we would be essentially weighing that food using that calculation to

35:32

figure out in what we're about to eat how many grams of carbohydrates

35:38

that with insulin we figure out a ratio of how many units of insulin we need at

35:44

a meal per grams of carbohydrate so that's pretty complex and detailed

35:51

for for today there may be some people out there any of our type ones especially or any of our type twos on

35:57

MDI who maybe have already you know been dabbling in that or experts in it that

36:03

is the simplest way to look at it if we are for example looking at a food product

36:09

and it says you know there's 48 grams of carbohydrates we also use an exchange

36:15

system to simplify that where roughly 15 grams of carbohydrate would be one

36:21

carbohydrate so for example we have some great resources that sort of already list the

36:27

carbohydrates in foods and what portion would equal one and the simplest way is

36:33

typically one piece of bread one cup of milk and one medium sized fruit are all roughly equal to 15 grams or one serving

36:41

so there's a difference depending where a patient is at with their their diabetes or what type and what

36:48

medications or insulins they're using that determines whether we get into that in depth

36:54

discussion around carbohydrates because it it even goes beyond that rate it also depends on the amount of fiber subtract

37:00

fiber from the total carbohydrate um the complexity of that meal again we

37:05

talked about you know how much protein is in there and fat so

37:12

but you can see why nutrition is such an interesting topic to people because it's it's complex and

37:20

um one question kind of leads into the next um so so happy to have you here to help

37:26

us um figure this all out um let's talk about carbs a little longer

37:33

and then maybe we'll shift away and again just encouraging people to bring up anything that they're wondering about

37:38

related to diabetes nutrition in the chat or you can come off mute to ask your question to Jenna

37:44

we welcome story sharing as well and reactions in the in the chat feature

37:51

um you mentioned uh recently um in one of your responses the glycemic

37:57

index um so walk us through that for people who don't know what the glycemic index

38:03

is tell us about how you use it and kind of what it's all

38:09

about yeah so um the easiest way to do it is there's

38:15

been different studies and evaluations on different foods on how quickly they

38:20

raise our blood sugar so from there then um

38:26

Foods were categorized using basically a light system so like green yellow red

38:32

into being low glycemic index meaning they had minimal impact or less impact

38:37

things like you know really um higher fiber higher protein really is

38:43

the easiest way to simplify it greens and cereals versus as they get more into

38:49

the red they're typically more refined with less protein and fiber right so

38:54

like really dense 12 grain bread being low versus like a low fiber low protein

39:02

white bread now since then though I mean if you look in

39:07

the bread aisle right there's 200 varieties of bread we also now have white bread that has added fiber and

39:12

protein and so it's different so we can't just simplify it that way um but we use it as a really good

39:17

starting point in education piece for patients um I don't know if I can share my screen

39:22

in but I did have it open in case anybody asked me amazing thank you you shared it perfect

39:29

I I figured that would come up it comes up a lot so it is one of those things I always say to people you know what use

39:35

it as a guide as a starting point and then little things right like I I brought up before

39:40

in terms of bananas for some people because that's a big one but even something like barley is low on

39:46

the glycemic index for some people they might have barley and it might still impact their blood

39:52

sugars fairly significantly we can also take a high glycemic index food

40:00

like instant white rice and add protein

40:06

canned tuna chicken lentils and veggies Frozen fresh canned

40:13

whatever you know fits your budget or makes you happy and make that high glycemic index

40:19

food a low glycemic index meal so again I never like people to feel stuck

40:27

with Foods or deterred based on their budget or their ability to cook certain foods we

40:34

can still eat really well on any of those budgets and also with any of the foods that we're used to

40:39

eating so again use it as a guide but keep in mind when we talk glycemic index and blood sugar spiking

40:47

we still have that ability to to reduce the glycemic load of a meal by adding protein and fiber and fat

40:56

I see a question in the chat here from Maria thanks Maria um so Maria is wondering about

41:01

incorporating glycemic variability into patient education and Maria's wondering

41:07

how you personally use this concept in your practice it's a it's a super

41:13

question Maria thank you yeah absolutely and um I think for some people so I think what

41:20

you're meaning is you know some people will stay fairly low carbohydrate and then you know occasionally have higher

41:26

carbohydrate meals um and or choosing right from some of those lower glycemic index foods and and

41:32

higher and trying to pair them and so both are always fine

41:38

right like having variety and variability in Foods is normal it's

41:43

natural that's an intuitive way of eating for a lot of people the most

41:48

important piece I always say or encourage people is just check your blood sugars

41:54

right so if most of the time you're eating fairly low glycemic index or low carbohydrate or whatever and blood

42:01

sugars are typically within Target and you do have something that's higher glycemic index or you do go out for

42:07

higher carbohydrate meal or you have one at home it's fine just check and see where your blood

42:13

sugars are at later because if we stay suddenly out of nowhere have um you know a lasagna or a spaghetti or

42:19

pizza and that's all we eat we have some room that even if blood sugars are high later again we can reduce that glycemic

42:26

load by adding some veggies with the next time around having more protein

42:31

right so maybe having less pasta have more sauce have a salad on the side so you can always have that variability

42:38

and that variety we always encourage that I'm hoping most people who are doing education are encouraging that as

42:45

well because it's not realistic for us to assume living with diabetes these are

42:50

the only Foods we're allowed to eat for the rest of our our time here we need to have variety

42:58

yeah that's that's a really terrific question from Maria um and just want to direct everybody's

43:04

attention to the chat where I put in the link to diabetes Canada's resource about the glycemic index food guide so

43:11

you can access that it's a PDF on the diabetes Canada website

43:17

um so wondering a little bit about sweeteners Jenna if you can talk to us a

43:22

bit about sugars and sweeteners so artificial sweeteners and then sort of natural sources of sugar

43:29

um and and starting with the whole idea of like are all sugar is created equal so brown sugar white sugar honey

43:37

molasses maple syrup are those all the same or are some better than others hmm

43:46

yeah it's such a big topic um sugar is sugar so when we're talking in a diabetes World

43:53

um all of the the sugars right whether it's agave syrup which again is like

43:58

this trendy sugar um lactose honey glucose all of it maple

44:05

syrup molasses it's all gonna give us you know those four grams of carbohydrates

44:11

um so in a diabetes world they're all the same some people will argue you know natural maple syrup has more

44:17

micronutrients the amount of sugar that we would have to eat to get any valuable

44:23

nutrition from them blood sugars would be through the roof so it's not a source of micronutrients

44:29

when we when we look at it and so the biggest thing is always if you're having sugar

44:35

or maple syrup or honey eat the one that you enjoy that's the most important piece when we

44:41

start to get into sweeteners right so everyone also has their own personal belief in view on sweeteners

44:48

that they're either okay or they're not good for us

44:54

from an Evidence point of view which is where we practice from is we look at you know what is the the

45:01

safety level that's been tested it doesn't necessarily mean Beyond there it's not safe it means that's the level

45:07

at which they've tested and there's been no adverse effects right so with each

45:13

sweetener that's out there um so there's sugar alcohols for example sugar alcohols are also naturally found

45:21

in in foods right so like sorbitol Mannitol all of these are are natural

45:27

sugars and same with Xylitol in Foods um there's no issue with them they they

45:34

don't boost our blood sugar like regular sugar does

45:39

the difference being with sugar alcohols is if you're having too much typically Beyond 10 grams a day you might have

45:45

digestive side effects because they pull fluid into the gut okay so any of those ones typically that end in ol

45:51

are those sugar alcohols outside of that there's there's a bunch

45:57

of of sugar-free substitutes available out there the one I typically like to

46:02

highlight to people where they potentially could be eating beyond that suggested safe limit is the cyclamate

46:09

which is like the sugar twin or the Sweet and Low the ADI which is that acceptable daily amount is really around

46:17

um just under that 600 milligrams and one of those pockets would be close to 270 milligrams so for people if they're

46:23

constantly eating Sweet and Low um that's the only one that you know to kind of just be cautious with outside of

46:30

that things like sucralose which is you know your Splenda again great you'd have to eat a lot of Splenda I think it's

46:37

close to two cups in a day to even come close to that um ADI uh Stevia again same thing you

46:45

can buy the actual Stevia plants and plant them if you really like it um

46:50

the levels are there it would take a lot for people to get close to that ADI and

46:55

again that tested level doesn't necessarily mean there's adverse effects Beyond it

47:01

um it's just more that that's the level they've been tested at again the bigger thing to look at that I

47:08

say to people you know if they're baking and all of a sudden they're feeling like okay well I'm gonna have to buy a Splenda or Stevia and start baking if

47:15

you're making cookies that have oats and flour and spending more money to add Stevia or

47:22

splenda that you don't like there's still carbohydrates in those cookies from the flower and the oats so

47:29

removing the sugar doesn't remove the carbohydrates it absolutely can decrease it but there's a balance between

47:36

the satisfaction from food and how much you need to be satisfied and enjoy versus

47:42

um just feeling restricted by a lot of Foods right so that's a balance if

47:50

you're having coffee and you're just as happy with stevia or splenda or whatever in your coffee amazing that makes a big

47:55

difference because some people will end up with a tablespoon or more um but in terms of baking and cooking again just be mindful in terms of

48:02

there's still going to be carbohydrates likely in a lot of those Foods

48:07

there's also a great resource and sorry and I can remove some of that as well yes I just popped into the chat a link

48:14

to the diabetes Canada resource on sugars and sweeteners again it's a PDF that people can access that has good

48:21

general information about sugars that affect blood glucose and

48:26

um sugars and sweeteners that don't so much so that's there for people to take a look at

48:32

um so we've got about 10 minutes left in our time here

48:38

um I can't believe how quickly this hour is going now is your chance everybody to put those questions into the chat come

48:44

off mute if you'd like to share your story or to talk to us a little bit about how diabetes impacts your life and

48:51

what you're wondering about nutrition uh maybe we can shift away a little bit

48:56

from um carbs and talk a bit about some other

49:01

things that we find in our food so alcohol and caffeine so what is the deal

49:07

with these for somebody living with diabetes do they have to avoid them are there special things that they should

49:12

know about intake of alcohol and caffeine what what do you tell people

49:18

yeah so um caffeine in general right so caffeine is

49:23

is going to constrict blood vessels and just the way that it affects the body is going to increase blood sugars and so we

49:30

know that even if it's black uh it doesn't mean don't drink it again biggest thing of awareness right if you get up in the morning and you have a

49:36

coffee and test your blood sugars two hours after and you know it's eight or ten or whatever and you haven't eaten

49:41

anything it's just be mindful that it's probably the coffee which is okay if you're you know hitting

49:48

Tim's for a triple triple there's a lot of added sugar in your coffee so I find it's not so much just

49:53

the caffeine sometimes it's what we're adding to it to be mindful that it can be impacting your blood sugar

50:00

um with alcohol the same is true in a few ways it's a bit more complex

50:05

right so alcohol in itself if we're just having liquor with no added carbohydrates is

50:12

going to divert the liver from releasing sugar while it breaks down the alcohol so we sometimes actually see blood

50:18

sugars dip a little bit now it gets a bit more complicated depending how much we have and also what

50:24

medications we're on because if we're on medications that can cause our blood sugars to go low

50:30

we run the risk of going low right I also find that if people are

50:35

having things like beer or alcohol as well like any of the coolers that do

50:41

have carbohydrates or even wine we get kind of just more erratic blood

50:46

sugars where you might see a dip but then you might see them Spike one way or the other because it also then depends

50:52

on how we're eating and behaving while we're having those drinks so

50:58

typically I mean people with pre-diabetes and type 2 if they're not on insulin it's not as much of a concern

51:05

from a safety perspective the other thing that alcohol does is it increases our triglycerides or it can which is a

51:13

blood fat which again it's just more that we kind of see that increased double risk of heart disease with diabetes

51:20

um there were just recently updated guidelines around the alcohol suggested

51:25

alcohol limits they're quite strict I don't know if people have already seen them and sort of what their thoughts on

51:31

on them are but it's really suggesting less than two drinks a week um and that's more from a heart health

51:38

perspective chronic disease perspective and and also cancer so

51:44

um you don't have to cut it out again it comes back to management right I mean if you're going to have a few

51:49

glasses of wine help them enjoy them but check your blood sugars that's all

51:55

yeah I think those those alcohol guidelines that you were talking about Jenna that were recently released are from the um Canadian Center on substance

52:03

use and addiction so people can check those out online

52:08

um and and you know good to consider the impact of both alcohol and caffeine on

52:14

blood sugars um so that people with diabetes are really aware when they're consuming

52:19

different things what effect it might have no speaking of beverages

52:25

um we know we hear from a lot of places a lot of sources that water is really important for our health

52:32

um but some people just are not crazy about water it can be maybe boring or

52:37

Bland so even though we know we should probably drink a fair bit of water in the day

52:43

um maybe we're less inclined so so what tips or tricks do you have for people to increase their intake of water

52:51

yeah uh first starting point I always suggest is whatever else you're having

52:57

at ice cubes it's an easy starting point tons and tons of ice every time you're having something else add ice

53:04

um outside of that is there's a little bit of mind over matter

53:09

too sometimes right like sometimes I find it's habit if we're always grabbing for something sweet it's because we've also trained our brain that this is what

53:16

I enjoy water tastes gross I hear sometimes because we're actually expecting the sweetness there's there's

53:23

some gradual transition that we see when people actually just actually start increasing their water so we we can

53:29

actually just start there versus also adding frozen fruit you can buy Frozen sliced

53:36

lemons and limes which are Super convenient to add into even a full jug of water and leave it in the fridge some

53:41

people really just like cold water so actually getting a really nice decanter or something that fits in your fridge

53:48

um to leave it in there so it's nice and cold the other thing that I ask is depending on your water

53:55

um you might not like the taste of it so some water is really high in iron or or

54:01

other minerals it might be worth investing in like a Culligan system right just even the ones where you can

54:07

get the filled up jugs so those are options you can also get now like the

54:12

carbonated um like the PC waters for the bubblies they're sugar-free they're really just

54:19

flavored carbonated waters um those are nice sometimes they're also a really nice alternative if you're

54:25

looking for that drink in the afternoon or in the evening there's something that's just a little bit different right

54:32

um yeah I'm a big fan of adding the frozen fruit sometimes even veggies like adding

54:37

mint and cucumber is lovely um and you can sometimes even just save

54:42

the tips of your cucumber and throw them in as in a tupperware or baggie in the freezer

54:48

and then throw them in your jug of water so that's super easy to do as well

54:55

outside of that I sometimes too if people are drinking coffee all day is even just start with before you fill up

55:01

another cup fill your mug with water and just down it

55:07

an easy way to start yeah that's a really good tips

55:12

um just on a couple minutes left here and welcoming any last questions comments stories anything in the chat or

55:20

you can come off mute to share um Jenna

55:26

um you've talked a couple times about cost and we we know right now that we're dealing with Rising food costs

55:32

um and that healthy eating can be quite expensive and sometimes people feel like

55:39

prohibitively so so what are what are some tips that you have

55:46

um really I mean for anybody but but specifically for people who are living with diabetes about

55:51

um eating well on a budget yeah um first thing and I think most people

55:56

who are on a budget know this is don't buy into the name brand um the No Name you know the the store

56:04

brand are typically as new nutritious for a fraction of the cost I'm a huge

56:11

fan of frozen veggies and fruit they're as nutritious you know they're picked up

56:17

Prime flash frozen for the most part and they last longer they're not going to spoil on us and now the lovely thing is

56:23

you know you can buy frozen spinach and frozen kale and Frozen edamame beans and you know pretty much every veggie Frozen

56:31

butternut squash all of those things that give you a ton of variety they give

56:37

you a lot of options for your meals and they're they're less expensive

56:42

I definitely don't recommend you know buying things out of season like strawberries and berries this time of

56:48

year are astronomical um there is some value sometimes also in

56:54

the points programs so different grocery stores like independent for example will do the PC

57:01

points you can surprisingly actually build up quite a bit of money to then get free groceries right so

57:09

people if you think of kind of some of those like coupon clipping behaviors if

57:14

you're mindful of what foods points are available for and you're

57:19

buying more of those things in bulk those weeks especially if they're frozen or canned items you can build up a lot

57:25

of return income for that outside of that canned and bagged beans so again

57:31

going back to the vegetarian it's like a dollar 25 to buy a bag of dried beans

57:37

um there's tons of YouTube videos on how to cook them what to add them to you can add them to anything

57:42

they're fantastic for protein and fiber balanced nutritionally right when we

57:49

really get down to it in terms of those two nutrients alone and so then adding even just

57:55

um whether it's rice or whether it's some frozen veggies and you have a nutritionally balanced meal for really

58:00

under a dollar fifty or two bucks compared to if we're trying to buy fresh veggies and meat and whatever else so it

58:07

makes a big difference that's a great practical note to leave things on

58:14

um Jenna I just want to thank you so much for being with us today on Diabetes open hours it was a pleasure and I

58:20

learned a lot from you I I hope that our our viewers did as well

58:25

um and and just as a final message to everybody we want to thank you the participants for joining us today and for being part of this very first

58:32

diabetes open hours um there will be an evaluation coming to you so please let us know what you

58:38

thought about this format and uh we are looking for ways to um to really tailor

58:43

this to suit you the the participants so please share your feedback with us to learn more and to stay up to date on

58:50

Diabetes Canada work and resources you can also visit our website diabetes.ca or check out our social

58:56

media channels we're on Facebook Twitter Instagram LinkedIn you can also call our

59:01

information team at 1 800 Banting so b-a-n-t-i-n-g or email us at info

59:08

diabetes.ca with Customs join us in April for our next diabetes open hours

59:13

and please stay tuned to our social channels and to the diabetes Canada webinar page if you Google diabetes

59:19

Canada upcoming webinars you'll find that page and there will be information there posted shortly about our next open

59:25

hours what the date will be and the topic as well as the registration information we hope you found this

59:31

webinar helpful for you and we look forward to hearing your feedback and to seeing you back again soon thanks so much

59:38

foreign [Music]

English (auto-generated)

01:04:38:05 - 01:05:04:16
Cayla Runka
Hello and welcome, everyone. My name is Cayla Runka and I work at Diabetes Canada on the Knowledge and Connections team and I'll be your moderator for today. I would like to start by acknowledging that I'm calling in today from Toronto and that I'm located on the traditional Indigenous territory of the Wendat, Haudenosaunee and Anishnabeg and the Mississaugas at the credit and that Toronto is now home to many diverse first nations, Inuit and native people.

01:05:05:18 - 01:05:34:06
Cayla Runka
As a health focused organization, Diabetes Canada recognizes that there is systemic racism within and throughout our institutions and that we have the responsibility and the power to create culturally safe and appropriate environments of care. We are here today as part of our new initiative, Open Hours. Diabetes Open Hours is our live call in show, especially for you to ask any and all questions regarding you or a loved one's lived experience with diabetes.

01:05:35:06 - 01:05:55:08
Cayla Runka
The program runs the last week and every other month with a different topic and guest expert, so be sure to follow us on social or visit the website regularly for updates. And while we do have a medical expert on the call with us today, this session is in no way meant to replace a regular visit with or the information you obtain from your own medical health professional.

01:05:56:12 - 01:06:21:02
Cayla Runka
So today's theme is Know your numbers and the ABCs. And we're very lucky to have Dr. Harpreet Bajaj here today to answer your questions on blood sugars, ups and downs, hemoglobin A1C blood pressure and cholesterol, otherwise known as your ABC. Dr. Bajaj is an endocrinologist and the medical director of Endocrine and Metabolic Research at LMC Health Care Centricity Research.

01:06:21:18 - 01:06:50:22
Cayla Runka
He is a research associate at Mount Sinai Hospital, Toronto, and an adjunct lecturer at McMaster University. He is the principal investigator of the Canadian Diabetes Prevention Program, a nationwide collaborative effort between LMC, Diabetes Canada and the Public Health Agency of Canada. And Dr. Bajaj currently serves Diabetes Canada as the chair of the Clinical Practice Guidelines Steering Committee. Before we get started, just a few housekeeping things.

01:06:50:23 - 01:07:20:18
Cayla Runka
Please note this session will be recorded and may be included as part of our public facing channels, including our website and YouTube channel. Please know that we will take all measures to protect your privacy and will not be sharing any names or record of the chat or Q&A features. We ask that any comments or reactions you share be affirming and positive and that you use this time and this feature as an opportunity to further your learning, engagement and curiosity and support the same in a respectful way for others.

01:07:21:16 - 01:07:44:16
Cayla Runka
On the Zoom taskbar below, you will notice two buttons the chat and the Q&A buttons. Simply click the icon and type your question or comment into the space provided since guests will be muted, the chat button is an opportunity to communicate with each other and share your thoughts and personal anecdotes and stories. The chat is visible to others on this call, but again, there will be no use of the chat on the video recording of this session.

01:07:45:11 - 01:08:06:03
Cayla Runka
Now the other button I mentioned is for the Q&A. This will allow you to post your questions throughout the session confidentially directly to our guest expert. If you would like your question to remain anonymous. Also, if you choose to unmute at any time to ask a question, that's fine. But please know your voice may appear in the recording of the video but your name and account image will not.

01:08:07:04 - 01:08:16:09
Cayla Runka
Lastly, the closed captioned feature has been activated for this session, so please feel free to use this feature if it will be helpful to you. And with that, are you ready, Dr. Bajaj?

01:08:16:17 - 01:08:20:00
Dr. Harpreet Bajaj
I am, Cayla, and thanks for that introduction. Yes, Let's go.

01:08:20:06 - 01:08:47:06
Cayla Runka
All right, great. So maybe while we're waiting for the first questions to come in, we can chat about some of the basics. So I have only experienced living with diabetes through my relationship with my mum. But I do know there are concerns with highs and lows and maintaining a steady blood sugar level. So maybe we could start by just generally speaking, about blood sugar, its role in the body and what happens for people with diabetes when they're trying to control those levels.

01:08:47:24 - 01:09:30:17
Dr. Harpreet Bajaj
Sure, yeah. Let's start with the basics. Absolutely. And at various points, I’ll try to, you know, give an analogy to how we drive a car, because many people, many among us drive a car. Right. So so I'll I'll just try to give analogies to that as we speak during this conversation if that's okay. So what does glucose do or what are the normal levels normal as And when we consider and consider glucose not to be a medical problem, let's discuss that first.

01:09:31:12 - 01:10:06:15
Dr. Harpreet Bajaj
So glucose in the body is useful to give us energy and there are various body organs that use glucose. We can also use other sources of fuel other than glucose as well to maintain that energy and body function. So other sources of fuel may be fat, maybe what we call ketone bodies. There may be some other fuel sources that are very useful as well in other other organs of the body.

01:10:07:12 - 01:10:37:03
Dr. Harpreet Bajaj
Now there is one organ in the body, which is the brain that only can use glucose as the only fuel. So our brain is totally and completely dependent on glucose to use and as as a fuel to maintain its function. The other organs like heart and liver and kidneys can use other alternative fuel as well other than glucose, but not the brain is how it is.

01:10:37:15 - 01:11:06:01
Dr. Harpreet Bajaj
And so for that reason, because it's so essential for brain function, for that reason, our body has many different hormone systems to try and maintain the glucose in a good range, not in a low range, not in a very high range in a normal circumstance. So one of the main hormones in our body that controls this sugar in the normal range is insulin hormone.

01:11:06:11 - 01:11:30:07
Dr. Harpreet Bajaj
So insulin is is a hormone that is released into sugars are going up. Or if we eat when those sugars are supposed to be going up, the insulin is released from the pancreas to try and bring it down into the normal range and the opposing hormone to insulin. So a hormone that that does opposite the work of insulin to try and maintain that balance is glucagon.

01:11:30:10 - 01:11:55:06
Dr. Harpreet Bajaj
Glucagon is also made in the pancreas. And it it's kind of, you know, if the sugar is going too low, then the glucagon starts going up so that the sugars are maintaining the normal level. Again, there are other hormone systems as well in the body that maintain the sugars, but it's mostly the insulin and glucagon that counterbalance to try and control the sugars within that range.

01:11:55:22 - 01:12:26:05
Dr. Harpreet Bajaj
So then what is the normal level of glucose in people where we think there there is not a medical problem. Usually the range is between 4 to 6 in the morning time and the fasting time that we think that the sugars are in the normal range and after meals we expect a little spike. But that spike up to about eight millimoles per liter is okay in a normal person.

01:12:26:11 - 01:12:58:09
Dr. Harpreet Bajaj
That's what we think is a normal range for glucose levels, if you will. The analogy to the car, you know, if we are driving on a highway and I'm not recommending that we drive too fast or something, of course. Right. But let's think about driving on a highway that has 100 kilometers per hour speed limit. And so typically you would not get a ticket at least, right, if you're driving at 110 or 90 or, you know, somewhere around that range.

01:12:58:09 - 01:13:22:00
Dr. Harpreet Bajaj
Right. So so that's the analogy to the car driving on a highway is, you know, we try to maintain that that driving speed around the road. It doesn't have to be exactly the 100 and may vary in between this range, let's say 90 to 110, 115 so that we are within that safe zone, if we will and we will not get the ticket.

01:13:22:04 - 01:13:43:09
Dr. Harpreet Bajaj
How do we do that? By pressing the accelerator or the or the brake. Right. So those are the ways we we control that. So that's the analogy to insulin and glucose as well. Right? So those are the two hormones that kind of maintain the glucose in that normal range. Such as Well. So I hope that answers your first question.

01:13:43:16 - 01:14:00:22
Cayla Runka
Yes, for sure. And then I guess one of the questions that came up was what kind of things acts our blood sugar? So if we're looking at maintaining that sort of steady state, where do we need to pay particular attention?

01:14:01:24 - 01:14:46:20
Dr. Harpreet Bajaj
Yeah, so and that's a great question. So and even in people without diabetes, but also especially in people who live with diabetes as well, there are many different things that can affect the sugar. Of course, we know eating does and we mentioned that it can spike up to it, even even in people without diabetes as well. But there are other circumstances other than eating, for example, exercise, any kind of exercise, even even a moderate to a mild exercise level as well can, you know, help bring down high sugars to a normal range.

01:14:47:16 - 01:15:18:23
Dr. Harpreet Bajaj
Other factors, bodily stress, not sleeping enough or getting not not getting enough sleep can affect blood sugars and and adversely so it can raise the sugar as well also just the day and just the time of the day as well. Because as we are waking up, many of our hormones like the adrenaline hormone, cortisol hormone, are trying to ramp up in the morning to try and get us awake and give us the energy boost.

01:15:19:07 - 01:15:46:24
Dr. Harpreet Bajaj
And that itself in the morning can raise the sugar a little bit or more and different people as well. So it can vary from person to person. Then illness can also affect the sugar. So illness as in having a fever, having some infection can increase the sugars. Then there are some medications that can also elevate the sugars.

01:15:47:10 - 01:16:22:00
Dr. Harpreet Bajaj
And those medications could be steroid, for example, steroid medications that are sometimes prescribed for asthma or other conditions, autoimmune conditions as well, or some other medications that can sometimes increase the sugars as well. So those are, in a nutshell, some of the conditions that can increase the sugars normal. And in a person who does not have diabetes, there's still the insulin and glucagon will try to maintain the sugars within the normal range.

01:16:22:19 - 01:16:47:06
Dr. Harpreet Bajaj
But in people with diabetes, of course, these all of these factors, whether it's steroids, whether it's, you know, certain kinds of foods or exercise or lack of exercise can play a major role as well with the sugar control as well. Now, I said that, you know, 4 to 6 is the normal sugar for a person without diabetes, for people living with diabetes.

01:16:47:14 - 01:17:16:00
Dr. Harpreet Bajaj
The target range is up to seven for fasting. And then the target range for after meal is up to ten, 2 hours after a meal as well. So 2 hours after a meal, we want the spike to stay in the single digits, not in double digits. So kind of like, again, going back to the car analogy, okay, maybe up to 120 kilometers per hour.

01:17:16:10 - 01:17:32:10
Dr. Harpreet Bajaj
Most people would not get a ticket, right, well maybe some cop will still give you a ticket. But up to 120, probably you will not get a ticket as well. So don't quote me on that. Okay. You get into trouble. So that's that's the car analogy to that.

01:17:33:10 - 01:18:01:11
Cayla Runka
Great. And you've mentioned it a couple of times that blood sugar varies throughout the day. So the next question is, you know, when do you realize something might need to be addressed? How how long can your blood sugar be high before you need to start worrying about maybe making some changes with medication or other parts of those things you've mentioned that impact blood sugar?

01:18:02:17 - 01:18:31:14
Dr. Harpreet Bajaj
Yeah. So in people with diabetes is I guess what we are talking about, about this question. And so in people with diabetes, you know, once in a while if the sugars go up because we had a treat, you know, we indulge a little bit, that's not when we need to start adjusting the medication. Of course, everybody's, you know, allowed to have their birthday cake or whatever other treat that you like.

01:18:32:16 - 01:19:06:08
Dr. Harpreet Bajaj
And, you know, the at least the suggestion or request is that we maintain we try to we can try to maintain portions, smaller portions of those treats and maybe even some people can try to compensate for having that treat by by reducing other carbs within that meal, if you will. So having less of, let's say, bread or rice or potatoes selected so that it compensates for that piece of cake that you had as well.

01:19:07:06 - 01:19:29:03
Dr. Harpreet Bajaj
So then if it's just one off, we don't need to start increasing or changing medications. However, if it's a consistent daily pattern or most days of the week, then we need to start looking at, hey, after dinner is when when the sugar starts spiking more than ten on most days of the week. Maybe we need to address that.

01:19:29:14 - 01:19:59:02
Dr. Harpreet Bajaj
The other lab parameter that helps us and all of this is called the hemoglobin, the A1 C or the A1 C test, as we call it. It's a blood test. So it's not something that we test at home. And this A1C number kind of in a, you know, easy way it, you know, to understand it, it's basically an average of three months of last three months, of sugars before that test was done.

01:19:59:14 - 01:20:17:15
Dr. Harpreet Bajaj
So if I get a blood test today and I can do it any time of the day, doesn't matter if I do it morning or afternoon or night, it kind of averages out what my sugars have been for the last three months. So what was my sugar in February, March and now in April is what it will tell me.

01:20:17:24 - 01:21:02:19
Dr. Harpreet Bajaj
And all of the sugars, not just the morning or evening sugars, but all of the sugars over the last three months. How they've been now the normal range for this A1 C test is less than 6%25. So that's for people without diabetes. We say normal is less than six. If the A1C is between 6 to 6.4, we the Diabetes Canada guidelines say it's it's termed as pre-diabetes so it's a precursor to diabetes condition that people as pre-diabetes which means that there is a high risk that the sugars can worsen into the type two diabetes or range from that.

01:21:03:02 - 01:21:30:01
Dr. Harpreet Bajaj
And then anything more than 6.4. So if we go to 6.5 or above is considered type two diabetes. So the target, as I said, for, you know, after if you're doing the finger prick or other means of, of testing your glucose at home, we said after meal it should be less than ten fasting, it should be less than seven for people with diabetes or A1C

01:21:30:01 - 01:21:45:04
Dr. Harpreet Bajaj
test the target. So that's the first of the ABCs Cayla as well. The A of the ABCs is A1 C and the target for most people is less than seven on that ABCs.

01:21:45:24 - 01:21:59:24
Cayla Runka
Okay. And then while we're on that A of the ABCs, how frequently should you be getting your A1C tested and does that vary based on whether you have type one or type two diabetes?

01:22:00:23 - 01:22:29:01
Dr. Harpreet Bajaj
Yeah, that's a great question. I mean, it is it needs to be individualized. And, you know, you have to look at various factors when you determine how frequently you get it. So maximum so every three months is what we what the Diabetes Canada guidelines would say maximum every three months or maximum four times a year is when we should get it.

01:22:29:12 - 01:23:10:08
Dr. Harpreet Bajaj
So everyone sees an average of three months. And so if you get it every three months, that that makes sense as well. But for some people, some people who might have might not need to have it every three months. You don't need to necessarily go to a lab every three months. Right. If you have if somebody and if an individual has diabetes, that is very well control on A1C and they're doing their their testing at home and it is variable control and they are on, let's say, one or two blood pressure medications that they've been stable on for many, many months as well.

01:23:10:08 - 01:23:34:11
Dr. Harpreet Bajaj
So nothing new is changing. No new medication was added or deleted as well. Then, you know, you can do it every six months as well. So it can vary a little. But how frequently we should have this blood test, but in most people every three months. But it can, you know, be the last to up to six months.

01:23:34:24 - 01:23:42:13
Dr. Harpreet Bajaj
If we think somebody is somebody has diabetes that is within the target range that they want it to be.

01:23:42:23 - 01:24:09:16
Cayla Runka
Okay. So, yes, very individual. Best to work with your personal health care provider on that front. Just before we move to another participant question, we haven't talked about the blood or low blood sugar yet, so maybe we could just spend a minute on, you know, what does that look like and what some of those values are and what people can look out for when they are experiencing a low blood sugar.

01:24:10:15 - 01:24:31:17
Dr. Harpreet Bajaj
Yeah. So it's very important to understand this. So you asked about, you know, Cayla, you asked about the high sugars and when we should address that. I said if it's consistently high is when we address that. But for low blood sugar, even one low blood sugar can be can be challenging and can be burdensome. It can it can lead to symptoms.

01:24:31:17 - 01:24:56:15
Dr. Harpreet Bajaj
So it's low sugars. And, you know, on the other hand, if you think about high sugars, many people would not have any symptoms. Even some people, if they've had high sugars up to 15 or even 20, sometimes some of, you know, individuals may not have any symptoms from high sugars. On the other hand, low sugars can cause a lot of symptoms.

01:24:56:15 - 01:25:26:22
Dr. Harpreet Bajaj
So what are the symptoms? The first stage of symptoms is basically warning signs of low sugars. These warning signs, signs could be trembling or shivering. So they could be a heartbeat going very fast. So what we call it called palpitations of the heart rate. So a racing of the heartbeat, they can be sweating. They can be just a sense of disorientation or hunger as well.

01:25:27:04 - 01:25:58:13
Dr. Harpreet Bajaj
So those are some of the warning signs of low sugar. The second stage, if it goes very low, typically typically around two or less than two, is when people can have other major problems with low sugar as well as their can, possibly with low sugars. People can have problems with coma, they can have seizures, they can have heart arrhythmias as well.

01:25:59:11 - 01:26:30:04
Dr. Harpreet Bajaj
So there can be major problems from low sugars if they go very low. So so it's very important to to understand the low sugars. Now, however, it's scary, right? Having low sugars sounds very scary with all of what I've just said. Fortunately, we know that which medications in diabetes can have the possibility of causing low sugars.

01:26:30:04 - 01:26:58:08
Dr. Harpreet Bajaj
Right. So so it's not all of the medications that people might be taking for diabetes that can cause low sugars. So some of the medications that can cause low sugars are, of course, one is insulin. So if somebody is taking insulin to manage their diabetes, you know, it's absolutely necessary to have a good understanding around low sugars and how to deal with them and how to treat the low sugars as well.

01:26:59:20 - 01:27:29:13
Dr. Harpreet Bajaj
And then the other medication, the other class of medications that can have the potential for low sugars is called a sulfonylurea class. So these medications, like gliclazide or glyburide or glimepiride are available in Canada. And these medications can also cause low sugars. These medications are used in type two diabetes. Insulin can be used in type one, diabetes can also be used in type two diabetes.

01:27:29:13 - 01:27:38:14
Dr. Harpreet Bajaj
Of course, insulin. But so those are the medications, insulin or sulfonylureas that can cause low sugars or hypoglycemia.

01:27:38:23 - 01:27:46:24
Cayla Runka
Okay. So both people living with type one and those with type two on medications are at risk for low blood sugar.

01:27:48:02 - 01:28:23:03
Dr. Harpreet Bajaj
Yeah. So both people with type one. Absolutely, because they are typically on insulin, which is the hormone that that is deficient in people living with type one diabetes. And so that is a risk factor for people with type two diabetes. It's the people who are using either insulin or any of these sulfonylurea medications. But these days we are seeing less and less use of the sulfonylurea medications and other medications outside of sulfonylurea or insulin do not cause hypoglycemia.

01:28:23:11 - 01:28:34:03
Dr. Harpreet Bajaj
And so people living with type two diabetes, if they're using other medications, they don’t they don't they have a very negligible or zero risk of of causing hypoglycemia.

01:28:34:06 - 01:28:50:02
Cayla Runka
Okay, good to know. We have a participant question wondering if you can explain what time in range is and if this is a new sort of measure and its importance.

01:28:51:01 - 01:29:16:19
Dr. Harpreet Bajaj
Yeah, so, so time in range. Maybe I’ll go back to my analogy on the on the car driving in this so you know that 90 to 110 kind of range right. So is where we want to keep driving at for safety Of course. And so time and range is kind of that safety zone, if you will, for managing blood glucose levels.

01:29:17:13 - 01:29:46:11
Dr. Harpreet Bajaj
So what is that? What is the target for that? So there's an international consensus on CGM. So continuous glucose monitoring, continuous glucose monitoring is not the typical finger prick, but these are sensors that can be put on either the arm or the abdomen or other places in the body that continuously monitor glucoses for 24 hours and not just a static number.

01:29:46:11 - 01:30:22:03
Dr. Harpreet Bajaj
When you check your sugars with a finger prick. But these are sensors that stay on the body just like a tuning. They're small, quite small, and they go on as a patch and these can monitor the glucose levels, you know, for 24 hours, for seven days or two weeks, depending on the on the device that you're using. So on these continuous glucose monitoring devices, you can get a time and range percentage as to how much the person living with diabetes or otherwise has their glucose is within the certain range.

01:30:22:15 - 01:30:56:17
Dr. Harpreet Bajaj
So this international consensus recommendation is suggest using the 4 to 10 millimoles per liter range. So anything less than four is considered below the range. Anything above ten is considered above the range. So anything between between the four and ten number is then is then the time in range if you will. That's, that's the Green Zone. Right. So that's where, that's where ideally the people's level should be now.

01:30:56:17 - 01:31:34:06
Dr. Harpreet Bajaj
And people, especially people who may be using insulin to manage their diabetes, we know that glucoses do fluctuate. And so the consensus, this international consensus recommends that 70%25 of the time in range be maintained is what the recommendation is. So 70%25 of the time between 4 to 10 is what the guideline states and then less than 4%25 below the range and then less than 25, 26%25 above the range of ten is what the guideline suggests.

01:31:34:15 - 01:31:52:00
Dr. Harpreet Bajaj
So that's a green zone time in range. The target for that, especially in people with diabetes who are who are, you know, injecting insulin for to manage their diabetes. The recommended goal or target is 70%25 in that range.

01:31:52:13 - 01:32:29:03
Cayla Runka
Okay. And I'm assuming the importance of that is again, to maintain that sort of stable blood sugar level to prevent some of the side effects. And that and there's actually another participant question similar to that. So they're wondering if they're above normal number on a day to day basis, whether it's fasting or post meals. If if they're above that range one day does damage to the body and organs per se happen sort of that day, or is it only when it's elevated over a longer period of time?

01:32:29:19 - 01:33:16:16
Dr. Harpreet Bajaj
Yeah, that's a very good question. And, you know, that answer, the response to that. It is it is over a long period of time. So so higher glucose levels over time, over many years is when the damage starts showing up, typically about 10 to 15 years from the diagnosis of diabetes. If a person living with with diabetes, if their glucose levels have been above that range or that target that we discussed, then the complications of diabetes potentially can happen at that time.

01:33:16:24 - 01:33:29:18
Dr. Harpreet Bajaj
So it's not just one of higher sugar that causes bodily harm at that point, but it's typically over many months and years if the glucoses are high.

01:33:31:04 - 01:33:46:10
Cayla Runka
And just a follow up question on the time in range, someone is wondering whether someone who is using a glucometer and doesn't have access to a CGM device and also assess time in range with the glucometer.

01:33:47:06 - 01:34:16:06
Dr. Harpreet Bajaj
Yeah. So before the CGM devices became available, we had this, you know, people were doing many different things. They would you know, one of the methods was to check glucose levels 7 times in one day. We don't typically ask, but that's a very onerous, very you know, it's it's very time consuming and also a lot of finger pricks for that.

01:34:16:15 - 01:34:44:19
Dr. Harpreet Bajaj
But that's one other way of checking on what the time in range is. So seven times would include, you know, before and after a meal three times a day as well as at middle of the night. So midnight kind of a blood glucose test. So so that can be another way to find out what your what somebodys glucose fluctuations are.

01:34:45:01 - 01:35:39:04
Dr. Harpreet Bajaj
And if the glucose fluctuations are within that green zone that we discussed or not, typically we don't do that. And you know, typically maybe we'll ask to alternate glucose testing if if somebody does not have access to CGM. Unfortunately, access is a limitation. Access and costs are big limitations. And the CGM use, then, you know, depending on on what medications are being used, their healthcare provider may and discuss whether alternate testing alternate as in you know, test glucose fasting one day, another day after breakfast, another day after lunch, you know, to get kind of a sense of where the glucoses lie.

01:35:39:04 - 01:35:49:09
Dr. Harpreet Bajaj
May be a less onerous and less expensive as well as less painful way of glucose testing as well.

01:35:49:17 - 01:36:16:12
Cayla Runka
Right? I can imagine. Yes. There's a couple more questions and then maybe we'll move on to the B part of ABC. And since we haven't discussed that, that was components yet. So one question is around type two specifically and whether there's a natural progression once you're diagnosed as you age in, even if it's managed well, is there always sort of that progression of the disease as you get older?

01:36:17:17 - 01:37:10:18
Dr. Harpreet Bajaj
Yeah, So that's a good question. So, you know, in our medical school or or other graduate school, that's typically that the definition that we've learned for for type two diabetes, that type two diabetes is a chronic condition, chronic means permanent condition and a progressive condition progressive as it worsens over time. And some studies like landmark study from UK called the UK PVS, suggest that the pancreas, which makes insulin the ability of the pancreas to make insulin after a diagnosis of type two diabetes reduces over time by about 6%25 per year.

01:37:11:09 - 01:37:38:16
Dr. Harpreet Bajaj
So about 6%25 or less ability of the pancreas over over a year, year by year. Then you can imagine, you know, if 6%25 times whatever, it can lead to 50%25 and 60%25 decline over 10 to 15 years. Right. So so that's kind of been there. And that's that's that's how most of us learned about type two diabetes.

01:37:39:05 - 01:38:16:12
Dr. Harpreet Bajaj
Now, more recently, there has been some suggestions, some studies suggesting that it's not all a downhill slope, if you will. There is a possibility that that some of this and this downhill progression can be reduced, at least. So that slope of reduction, slope of worsening of about pancreas to ability to make insulin can be reduced. One way that has been suggested is weight loss.

01:38:16:22 - 01:38:52:02
Dr. Harpreet Bajaj
So weight loss with either it is with various dietary modifications or exercise or with bariatric surgery. There is a lot of literature from the bariatric surgery, which is a surgical operation. It's also called the gastric bypass surgery, bariatric surgery. So with this, there have been some studies suggesting that the pancreas ability to to make insulin does not deteriorate as much over time as well.

01:38:52:24 - 01:39:09:09
Cayla Runka
Okay. Speaking of dietary, one of the questions is can diabetes be controlled by diet exclusively? So I'm assuming that answer may differ between type one and type two.

01:39:10:18 - 01:39:40:21
Dr. Harpreet Bajaj
Yeah, thanks for pointing that out. Of course. So type one diabetes, where the pancreas has a minimum or zero production of insulin, of course, insulin is the treatment that that individual will need and it should not be withheld and it should be started as soon as possible and maintained throughout life. It's life sustaining for people with type one diabetes, and that's very important to understand the difference between type one and type two.

01:39:42:06 - 01:40:20:13
Dr. Harpreet Bajaj
For people with type two diabetes, initially, early on, within the first few years of type two diabetes and later on, well, you know, diet plays a big role. Dietary interventions play a big role in terms of maintaining glucose within those targets that we discussed. Of course, individual situations and social situations, individual barriers, challenges play a role. And all of all of what is possible for an individual.

01:40:20:13 - 01:41:02:05
Dr. Harpreet Bajaj
But, you know, in Diabetes Canada guidelines, we do suggest, you know, right from diagnosis of type two diabetes, a comprehensive management. So medications plus minus or I should say a diet plus lifestyle or health behavior modifications plus or minus medications is what is recommended as a comprehensive management of glucose control if and then monitoring after that. So monitoring for the glucose checks at home as well as that A1 c test that we that we discussed as well.

01:41:02:22 - 01:41:35:00
Dr. Harpreet Bajaj
So that can guide whether an individual their glucoses can be maintained within that target that we that we discussed as well with solely with diet or do medications need to be added or increased over time as well. So for some individuals, yes, and especially initially, diet can be very, very helpful and not necessarily need a medication, at least in the in the initial few years of diagnosis of type two diabetes.

01:41:35:22 - 01:41:58:10
Cayla Runka
All right. We have one more question on the As and then we're going to move on to B the question is, if your hemoglobin A1C is under control and is staying quite level and within those range numbers that were provided, is it recommended to get a continuous glucose monitor or are you able to just continue on the way that you've been doing things

01:41:59:07 - 01:42:31:24
Dr. Harpreet Bajaj
Yeah. So it's more of a cost and access question and it'll have to depend on that. There is these, these monitors unfortunately are quite expensive. Also, if you look at that data, how much difference does it make, you know, in terms of whether we are talking about difference, You know, if somebody is using these continuous meters versus what we typically do with a finger prick, does it make a difference on A1C?

01:42:31:24 - 01:43:10:10
Dr. Harpreet Bajaj
There are various studies that have been done on these comparisons. They suggest that for some people it may make a difference on the A1C. So for people who use who use insulin to control their type two diabetes or type one diabetes, these continuous meters may be a useful tool for some individuals with type two diabetes who are on at least two or three oral drugs that are that they're using for their diet type of diabetes.

01:43:11:05 - 01:43:46:04
Dr. Harpreet Bajaj
It may also be useful to control to help everyone see get better. At least one one or two studies that have been done suggest that. But it's not just the A1C control. It's also about reducing the risk of low sugars or hypoglycemia as well. So I think the question that you asked is about if somebody is A1C’s already within the target, let's say less than seven, let's say their glucose, the A1C is 6.8, then what's the role of of these continuous glucose monitors?

01:43:46:22 - 01:44:17:13
Dr. Harpreet Bajaj
So in people with type one diabetes or people with type two who may be using insulin, there may still be a role to monitor as well as alarm about low blood sugar, low blood sugars as well, because many of these sensors have built in alarms around because of less than 3.9 or so. And so that can be very useful so as to prevent catastrophic low blood sugar as well.

01:44:18:06 - 01:44:38:12
Dr. Harpreet Bajaj
So it depends on and on the individual situation. But in some cases, especially in type one, to reduce the risk of hypoglycemia and to monitor and manage hypoglycemia risk, continuous glucose monitors may be useful and even if the A1C less than seven.

01:44:39:10 - 01:44:54:15
Cayla Runka
Right. Okay. So the B part of ABC blood pressure, I'm going to kick it off with just the question around. Do people living with diabetes have a higher risk of experiencing issues with their blood pressure?

01:44:55:15 - 01:45:31:24
Dr. Harpreet Bajaj
Yeah. So people with type two diabetes, there is a definite kind of association with higher sugars and higher blood pressure. So blood pressure also varies from individual to individual. There are many different individual things that change blood pressure. Of course, age is one of them. As we grow older, our blood pressures do rise. Of course, salt plays some role in blood pressure also in a person without having a high blood pressure problem or in people with high blood pressure problems as well.

01:45:32:07 - 01:45:44:21
Dr. Harpreet Bajaj
All can play a role. So in terms of blood pressure, you know, individual variations are there, but in people with type two diabetes, there is a higher chance of having a problem with high blood pressure.

01:45:46:02 - 01:46:12:10
Cayla Runka
Okay. Then sort of the two part question from one of the participants. So if you are at risk for higher blood pressure because of living with diabetes, but you also have a hereditary genetic component in your family of high blood pressure, can lifestyle interventions be effective? And then if so, I guess what might some of those things be?

01:46:12:10 - 01:46:15:24
Cayla Runka
Or will you inevitably probably require medication?

01:46:17:07 - 01:46:57:07
Dr. Harpreet Bajaj
Yeah, so much like glucose, blood pressure as well. The first line of therapy for high blood pressure in many individuals, unless the blood pressure is is very high above the targets, then initially health behavior changes. So whether it is dietary control or weight reduction or salt reduction or I should mention alcohol reduction as well. So those can be helpful in terms of reducing the blood pressure.

01:46:57:15 - 01:47:31:19
Dr. Harpreet Bajaj
However, if the blood pressure is more than 20 millimeter mercury more than the target, and most people, we think that these these health behavior modifications may not be enough by themselves. And so blood pressure medication would be recommended right from the word go. And those individuals as as such. So in most people, if blood pressure is about ten millimeter mercury, more than the target range, initially health behavior changes can be can be suggested.

01:47:31:19 - 01:47:43:16
Dr. Harpreet Bajaj
And then monitoring is what we need to do, monitoring at home as well as maybe at your health care provider visits as well to see if that's making a change or not and when medications may be necessary.

01:47:44:14 - 01:47:50:17
Cayla Runka
Okay. And then just so we're clear that the normal range for blood pressure would be quite.

01:47:51:04 - 01:48:17:00
Dr. Harpreet Bajaj
Low in people with diabetes. Let's talk about the ABCs of diabetes, Cayla and people with diabetes. The target range, which is recommended is 1 to 3 for the higher number, the systolic blood pressure and then 80 for the lower number or the diastolic blood pressure. So that's a target that is recommended for people living with type one or type two diabetes.

01:48:17:14 - 01:48:32:11
Cayla Runka
Okay. And so you had said that ten, ten, millimoles above that would be oftentimes lifestyle interventions. But 20 or more is when potentially medications would come into play initially.

01:48:32:11 - 01:48:40:19
Dr. Harpreet Bajaj
And if lifestyle modifications or health behavior changes are not working, then we stopped medications, even for ten above the target. Ten. Okay.

01:48:41:20 - 01:49:08:08
Cayla Runka
So let's move on to C the ABCs part is cholesterol. And, you know, I know even with my sort of health care background, when I get my blood work done, I find it very confusing. The breakdown of the blood lipid levels that I see on my paperwork. So maybe we could start with just a general idea of what those values are and their importance, and then we can get to some of the targets with respect to diabetes.

01:49:08:18 - 01:49:36:08
Dr. Harpreet Bajaj
Sure. Yeah. And Cayla we should mention that these blood pressure and cholesterol targets are important to reduce the risk of heart problems. So heart attacks or strokes or what we call peripheral artery disease, which is basically less circulation or problem with circulation in the feet, the blood circulation in the feet as well. And so that's where the blood pressure and cholesterol targets play a major role.

01:49:36:13 - 01:49:59:05
Dr. Harpreet Bajaj
So that's why it's like ABC. It's not just it's not just glucose control in people with diabetes, but a multi-pronged strategy to control all these three levels such so the different cholesterols that we see on a lab report, the most important one, and probably the only one that we should look at because we don't necessarily change those.

01:49:59:10 - 01:50:27:01
Dr. Harpreet Bajaj
And research shows that looking at other levels is is confusing and it doesn't change anything anyway. So the one cholesterol, the one cholesterol that we should be looking at is the LDL cholesterol or what is called the lousy cholesterol. Right. So, L for lousy, Right. So that's a good way to remember which cholesterol we’re talking about. So LDL is the is the bad cholesterol, as it's called.

01:50:27:03 - 01:50:53:01
Dr. Harpreet Bajaj
Bad as in that's what causes the blockages to happen in the heart arteries or in the in the arteries that supply blood to our brain or to the feet and circulation as well. Right. So so that LDL cholesterol, the target for people with with diabetes is less than 2 millimoles per liter as the target for most people.

01:50:53:21 - 01:51:31:21
Dr. Harpreet Bajaj
And you know that that's recommended to be maintained to reduce the risk of of having heart attacks, strokes or having circulation problems in the feet. Now, I should mention that beyond just looking at a target LDL in the guidelines, you know, in the guidelines for Diabetes Canada, as well as the guidelines that come from our our sister organization, the Canadian Cardiovascular Society, which makes lipid guidelines or cholesterol guidelines as well.

01:51:31:22 - 01:52:20:23
Dr. Harpreet Bajaj
Right. The recommendation, even if some people may have their LDL cholesterol within that less than 2 millimoles per liter, they're still recommended a medication, most commonly a statin type medication, to reduce their risk of having or reduced the, you know, a for prevention of a heart attack or stroke. And the reason for that is, you know, some big studies have been done that even if there really is less than two, for example, in people with type two diabetes, there was a big study, even if the cholesterol were less than to giving or starting a medication like a statin, would actually reduce their risk of having a heart attack by about 50%25.

01:52:21:10 - 01:52:54:19
Dr. Harpreet Bajaj
And so for that heart protection is when statin recommendation is there. It's kind of like going back to my analogy on cars, right? It's kind of like no matter what speed you're driving and if you're driving low or high or whatever, you should always wear a seatbelt. So that seatbelt is your statin, if you will. So people with diabetes, no matter where the glucose is, no matter what their blood pressure LDL is, if you're above 40 years of age as one of the recommendation.

01:52:54:19 - 01:53:04:12
Dr. Harpreet Bajaj
Right. So if you're about 54 years of age and and if the individual is living with diabetes, then a statin medication is recommended regardless.

01:53:06:12 - 01:53:31:18
Cayla Runka
Great. And we're coming to the end of our time. I just want to let everyone online know that I've put a little summary all about the ABCDE and S's of diabetes care into the chat. And before we wrap it up, I just want to know, Dr. Bajaj, do you have any sort of parting words for people in terms of these tests and targets that we've been talking about?

01:53:32:20 - 01:53:59:13
Dr. Harpreet Bajaj
And let's we know we've talked a lot about, you know, medical terminology and maybe even, I hope, help to understand some of these terminologies and why they matter and what the targets are. You know, in a nutshell, on a big picture level, I think, you know, the the bottom line is that we know a lot more about living with type two or Type one diabetes.

01:54:00:05 - 01:54:26:16
Dr. Harpreet Bajaj
So living with diabetes, we know a lot more from research as well as experiences than we did ever before. And so, you know, maybe 20, 30 years ago, people would think of have having a diagnosis of diabetes and then be concerned whether their lifespan is going to be affected, whether they're going to get complications, what what, what their future is going to hold.

01:54:27:02 - 01:55:03:08
Dr. Harpreet Bajaj
But now, over the last 23 or 20, 30 years, with innovation in technology, with more research, having been done, we can be actually quite confident that people with diabetes, whether type one or type two, we have the right tools and strategies to to help to try and have similar quality of life with minimizing complications of of diabetes as well as, you know, solve that lifespan issues.

01:55:03:16 - 01:55:26:22
Dr. Harpreet Bajaj
So whether people with diabetes have a smaller lifespan is also been clarified in many of the research studies which suggest that people with diabetes can live as long as people living people without diabetes as well. So so with these tools that technology and innovation in medicine, I think that is that is the case. So I want to end on that positive note.

01:55:26:23 - 01:55:52:12
Cayla Runka
Yes, thank you. What a wonderful way to end. And I know I learnt a lot, so I hope the participants did as well. And everyone, thank you for taking the time out of your busy schedule to join us. It's not easy. We're busier than ever, but the benefits are always worth it. After the session, I'll follow up with an email, with an evaluation and some additional resources on the topics that we covered today.

01:55:53:00 - 01:56:12:12
Cayla Runka
And with that, a very, very big thank you to our guest expert today, Dr. Bajaj. I sure hope our participants enjoyed it as much as I did, and the generosity of your time and expertise, our Open Hours would not be possible. So very much appreciate the time and effort you spent with us today.

01:56:13:03 - 01:56:17:10
Dr. Harpreet Bajaj
So pleasure Cayla and stay healthy and stay safe.

01:56:17:24 - 01:56:53:11
Cayla Runka
Great. Thank you. To learn more and stay up to date on Diabetes Canada's work and resources, you can visit our website at diabetes.ca or check out our social media channels. We're on Facebook, Twitter, Instagram and LinkedIn. You can also feel free to call our info team at 1-800-BANTING. That's B-A-N-T-I-N-G or email info@diabetes.ca with any questions. Be sure you stay close for our next episode, which will be in June and feature another guest expert speaking on fitness for everybody.

01:56:54:07 - 01:57:11:16
Cayla Runka
So stay tuned for that and we hope the webinar was good for you and look forward to hearing some feedback from you in the next little while. So thank you again Dr. Bajaj.