Diabetes Canada is delighted to invite you to a special webinar presentation for individuals living with type 1 diabetes and their caregivers. We will be hosting a dynamic conversation on virtual care for type 1 diabetes during and after the COVID-19 pandemic, offering diverse perspectives from distinguished presenters. In addition to learning more about options for virtual care, this webinar will provide an opportunity to ask the experts about your concerns, understand the importance of the latest technologies, and access key resources. #LetsEndDiabetes
Featured Speakers:
Dr. Ilana Halperin, endocrinologist, assistant professor at Sunnybrook Health Sciences Centre and the University of Toronto Department of Medicine’s Division of Endocrinology & Metabolism
Karen Cox, nurse practitioner who lives with T1D
Mark Buckle, patient advocate
so
00:03
welcome everyone uh my name is brooks
00:05
roach i'm a diabetes education
00:07
specialist with diabetes canada
00:09
my pronouns are he and him and i would
00:11
like to begin by acknowledging that i'm
00:13
joining this webinar
00:14
from the traditional and unseated
00:15
territory of the mikmaha people
00:17
so wherever you are joining are watching
00:19
from i'd like to invite you to
00:21
express gratitude for the land on which
00:22
we live and acknowledge all the past
00:25
inhabitants of the indigenous lands we
00:27
now call canada
00:29
i am super excited to be here today to
00:31
talk with a few experts about the
00:32
connections between type 1 diabetes
00:35
virtual care and the cova 19 pandemic
00:38
we are going to discuss among other
00:40
things how those of us with type 1
00:42
diabetes
00:43
have been impacted and the challenges
00:45
and opportunities posed by virtual care
00:47
both now and in the future we have the
00:51
great pleasure being joined today by
00:53
three guests first dr elena halperin who
00:56
is an endocrinologist
00:57
an assistant professor at sunnybrook
00:59
health sciences center
01:00
and the university of toronto department
01:02
of medicine's division of endocrinology
01:04
and metabolism
01:06
karen cox who is a nurse practitioner
01:08
who lives with type 1 diabetes
01:11
and we have mark buckle who is a
01:13
passionate advocate for access to type 1
01:15
technologies
01:16
and who also lives with the disease so a
01:19
sincere welcome and thank you to you all
01:21
for being here uh our experts will be
01:27
answering some key questions
01:29
that diabetes canada has been hearing
01:30
from our community and that our experts
01:32
have been hearing and experiencing from
01:34
their patients
01:34
and from life with type 1 diabetes over
01:36
the past year and a half
01:37
roughly we'll also be taking questions
01:40
from our viewers
01:41
so some questions have already been
01:43
submitted and you can ask yours
01:45
by replying in the comments below
01:48
i'd like to get started by passing a
01:50
question to dr halperin so
01:53
i'm wondering if you can walk us through
01:55
the impact that the covet 19 pandemic
01:57
has had on people with type 1 diabetes
02:00
for sure so i think i would start by
02:03
talking about the impact that cope 19
02:05
has had on everyone
02:06
and i often talk about how living life
02:09
with type 1 diabetes and anything else
02:11
you're trying to do
02:12
whether it's go to school be pregnant
02:16
have a full-time job is just that much
02:18
harder because living with diabetes is a
02:19
full-time job
02:20
and of course the stress and the
02:22
isolation that everyone has experienced
02:24
over the last
02:25
16 17 months is going to be that much
02:27
more magnified
02:28
especially for people who might be
02:30
struggling with access to medications
02:32
and access to face-to-face care for
02:34
acute complications of diabetes
02:36
and i know we'll speak about that a
02:37
little bit more later on but i think
02:40
certainly this has been a challenging
02:42
time for people living with diabetes
02:44
due to concerns about getting sicker
02:46
from covid and just
02:48
in general being isolated from their
02:50
support people
02:51
friends and family etc i have noticed
02:53
that some of my patients however
02:55
have done well in the pandemic because
02:57
working from home and having a little
02:58
bit more control over their routine has
03:00
actually made
03:01
their diabetes management a little bit
03:03
more predictable
03:05
for some less physical activity has been
03:07
frustrating but others have found like
03:09
different and sort of
03:10
unique ways of incorporating predictable
03:13
exercise into their work from home
03:14
routine
03:15
and certainly i've had patients tell me
03:17
that being able to control their diet
03:20
has been much more helpful than what
03:22
they were necessarily eating when they
03:24
were not working from home so certainly
03:25
that has been the case for everyone but
03:26
some people have actually done better in
03:28
the pandemic
03:30
and one thing we've definitely learned
03:31
that we'll speak to more throughout the
03:33
the next hour is how well diabetes is
03:36
suited to virtual care
03:38
and i believe that in the future i will
03:40
be continuing a sort of a hybrid model
03:42
with my patients living with diabetes
03:43
where i would definitely like to see
03:44
them in the office at least
03:46
once a year for a physical examination a
03:48
foot check blood pressure a weight check
03:49
etc
03:50
um but especially with well-connected
03:52
digital platforms uh we can stay
03:55
connected and offer good quality care
03:57
even when we're not face to face
04:03
it's really helpful um helena i want to
04:06
thank you for that and i want to kind of
04:07
connect a few dots on this next question
04:10
which is directed to karen and mark
04:12
and we've heard now the the sort of
04:15
clinical
04:16
approach to what's happened and i'm
04:18
wondering if you two can share
04:19
a bit of both so what's it been like at
04:21
the individual level
04:23
to both live with type 1 diabetes and to
04:26
treat it so in karen case you're doing a
04:28
bit of both and and mark as someone
04:30
that's
04:30
that's living with uh with type one and
04:32
trying to navigate all the other
04:34
challenges that life has brought forward
04:36
uh what's that been like over the course
04:38
of this pandemic
04:42
yeah karen if you want to start um
04:46
there yeah um so i would say that it's
04:49
been it's
04:49
been challenging but i feel like over
04:52
the last year i have
04:53
um kind of learned how in a lot of ways
04:56
to manage this chronic condition
04:59
better in a sense um so like atlanta was
05:02
saying
05:03
like definitely physical activity has
05:05
become really
05:07
like a key aspect of my day-to-day life
05:09
and diabetes management
05:11
i have three young children and there is
05:14
not a lot to do with them when there is
05:15
nothing open and we have no family to be
05:17
with
05:18
and so getting outdoors and being
05:20
physically active with them has had a
05:22
huge positive impact on my diabetes
05:24
because i'm finding that i've learned so
05:26
much with the technology available
05:28
and just about insulin sensitivity and
05:30
the benefits of
05:31
cardiovascular exercise on on my health
05:35
and my
05:35
overall well-being and it helps me to i
05:38
think be a better
05:39
diabetic and i think it helps me to be a
05:40
better mother when i'm exercising and
05:43
just feeling mentally and physically fit
05:46
um but i would say that the pandemic has
05:48
had its challenges too i miss
05:50
in-person care um as a patient
05:53
i miss being seen by my endocrinologist
05:56
um i like i like that that human
05:59
interaction and i like being seen in
06:01
person and even though
06:03
you know diabetes is 24 7 chronic
06:05
disease and
06:07
even though it's on us to to manage this
06:09
condition
06:10
every day for the rest of our lives um
06:13
there's something nice about having
06:15
that relationship and rapport with an
06:16
endocrinologist who can like help you
06:18
navigate
06:19
those like treacherous waters when
06:20
you're needing help adjusting a basal
06:22
insulin or adjusting your boluses or
06:24
whatever else and having somebody
06:25
look objectively at that and to see you
06:27
in person and to check your blood
06:29
pressure and to look at your feet
06:30
and to check your weight and just to
06:32
check in and see like how are you doing
06:34
like
06:35
you know it's hard having diabetes like
06:37
just to have that like one-on-one
06:39
person discussion so for those reasons
06:42
during the pandemic i have
06:43
i've struggled a little bit because i i
06:45
like having in-person care
06:48
um yeah
06:52
yeah thanks karen i i can definitely
06:54
relate to a lot of the points you made
06:56
there
06:56
um just like lifestyle in general got a
06:59
lot easier
07:00
more predictable kind of as a lana
07:02
mentioned as well
07:04
and i guess on the other side of it
07:06
there was a a bit of an unexpected thing
07:08
that the pandemic brought for me so
07:11
um prepanemic i was using a continuous
07:14
glucose monitor
07:15
primarily on and off but mostly on for
07:18
the last five years
07:20
i was also looping for about two years
07:22
of it and i was fortunate to do all that
07:25
because
07:25
i had a job that provided really good
07:28
benefits and full coverage for
07:30
advanced glucose monitors so fgms and
07:33
cgms
07:34
but then the pandemic happened and i was
07:37
laid off
07:38
like a lot of people were and so
07:41
it was a good amount of time without
07:43
work and i kind of got to a point where
07:46
i had to
07:47
cut back some of my diabetes budget um
07:50
it was kind of the first time i ever
07:51
kind of faced this
07:52
in my over 24 years of living with it
07:55
so i went back to the basics i
07:59
went to finger pricking and mdi again
08:02
and i know a lot of people still treat
08:05
like that
08:06
and they use that as their their go-to
08:07
management source but
08:09
kind of after being on a pump for about
08:11
17 years and again
08:13
uh cgm for five and uh hybrid close week
08:16
for two
08:17
um as i mentioned to atlanta and brook
08:19
slackley last week it was kind of like
08:21
going back to the land before time
08:22
diabetes edition um so uh yeah it was uh
08:26
it was a little tough to get used to
08:28
that after kind of having this really
08:29
good source of management
08:31
um but it really opened my eyes um that
08:34
you know how just beneficial living with
08:37
these technologies can be
08:39
and how getting in a crunch where you
08:42
don't have access to it
08:43
is uh is does take a toll you know it's
08:45
a i rely on if i said it wasn't a little
08:48
bit of a struggle
08:49
on the mental health side of things
08:50
because you know going from a cgm with
08:53
288 readings a day
08:55
back to you know on average 10 readings
08:57
a day with finger pricks
08:59
um it's a bit frustrating when you have
09:01
those days where
09:02
um you know your blood sugars are high
09:04
and you just didn't expect it you didn't
09:06
see it going there
09:07
uh so that that side of the the pandemic
09:10
was
09:10
was a bit tough um but it was also very
09:12
eye-opening um wasn't all bad
09:15
uh but it uh it definitely you know
09:17
opened my eyes to the importance and
09:19
just how
09:20
uh well i had it with with all the
09:22
technologies
09:23
um luckily yeah i got a job again and
09:26
all that's
09:27
that's good but uh yeah it was it was
09:29
definitely a bit of a struggle there for
09:31
a bit um
09:32
because of uh good old covid
09:36
thanks thanks for sharing that uh karen
09:38
and and mark i mean
09:39
i really appreciate the this notion of
09:42
i believe it was the the great
09:43
philosopher john mayer who said just you
09:45
know you don't know what you got till
09:46
it's gone
09:47
it's sort of the case of that it's some
09:49
of the incredible benefits that come
09:50
from using this technology
09:52
get so integrated into daily life that's
09:54
what they're they're for and when
09:57
you know i personally haven't had to
09:58
make one of those uh removals
10:00
of a certain treatment whether it's the
10:02
pump or cgm but
10:04
i can imagine that's such a difficult
10:05
transition almost a feels like a step
10:08
backward
10:09
um so it's a really thanks for sharing
10:11
and i'm sure there's a lot of folks out
10:12
there that can
10:13
relate to that challenge on the note of
10:16
these these sort of
10:18
changes and and changes potentially for
10:20
the for the worse or the challenges that
10:22
have been posed by the pandemic i'm
10:23
wondering
10:24
uh elena and karen if you can comment on
10:27
what changes or whether you've noticed
10:29
changes in the prevalence or severity
10:32
of type one and new diagnoses during the
10:35
pandemic
10:37
i'll let alana take this one just
10:39
because i don't typically see
10:41
new type ones in my practice so
10:45
yeah so i think um like anecdotally
10:48
i early on i saw quite quite
10:51
it seemed like i was seeing more new
10:53
patients but
10:54
in the literature what it seems like for
10:57
sure
10:58
is that we're seeing people presenting
10:59
later so whether there's
11:01
truly an increase in autoimmune disease
11:04
in the context of the pandemic is
11:06
remains to be seen but certainly people
11:09
have been afraid to seek
11:10
medical care for what they would
11:12
consider to be mild symptoms
11:14
and so there's definitely been some
11:15
literature especially in the pediatric
11:16
space about more children presenting
11:18
with dka
11:20
so the milder symptoms of presentation
11:22
like
11:23
feeling thirsty peeing a lot losing some
11:25
weight might
11:26
be sort of brushed aside because nobody
11:29
wants to seek acute medical care they're
11:31
afraid to get coveted in an emergency
11:33
department
11:34
and so when people do present with a new
11:36
diagnosis of type 1 they seem to be
11:38
sicker
11:39
and i think that's just an important
11:41
message to leave people with i mean i
11:42
really hope forest is behind us
11:44
now with the pandemic and with very high
11:47
rates of vaccination but
11:48
we can we we have seen that the excess
11:52
mortality in the last year has not just
11:54
been related to people dying from covid
11:56
it's been related to people dying from
11:57
cardiac disease
11:59
presenting with cancers that are more
12:01
advanced
12:02
and this is a real a real fallout of the
12:04
pandemic for fear of seeking medical
12:06
care face to face
12:08
but it's been an important message i
12:09
think for physicians across the country
12:11
to let people know that
12:12
doctors offices are open we do want to
12:15
hear from you and then if we need to see
12:17
you in person we will
12:18
you know the fear of not having enough
12:20
ppe that was like a
12:21
that was a phase one or whatever wave
12:23
one problem
12:25
um but empty emergency departments don't
12:27
usually bode well for long-term
12:29
health and so um i think that's
12:31
something to to keep in mind for even
12:33
people living with diabetes not to
12:34
dismiss symptoms that you might be
12:36
having whether it's some chest pain
12:37
shortness
12:38
of breath something funny growing on the
12:40
bottom of your foot
12:41
these are things that should not be
12:42
ignored just because of the pandemic
12:53
karen i wonder if you could share some
12:55
of your uh
12:56
experience from the past past year on
12:59
severity and sort of the way that you've
13:00
engaged with with type ones uh
13:03
throughout the
13:05
karen one system i think you you
13:06
mentioned when we were on another talk
13:08
that i think would be helpful for you to
13:09
talk about is your experience with
13:11
people's mental health struggles in the
13:12
pandemic
13:13
yeah for sure i mean i think everybody
13:16
is
13:16
um everyone's struggling and and it has
13:19
been
13:20
like in such a such a hard year
13:23
but for people with a chronic illness
13:25
and for for those with diabetes it's
13:27
been even harder
13:28
it's hard to manage a chronic illness
13:29
without a pandemic so when you have that
13:31
on top of everything else it's a strain
13:33
on your mental health so
13:34
i would say that um in my practice i do
13:38
typically see patients who
13:39
um i don't typically i wouldn't
13:42
typically see like a new diabetic but i
13:43
might see somebody with an
13:45
established diagnosis of diabetes um
13:48
long-standing diabetes who's coming in
13:50
complaining of something like fatigue
13:52
or a low mood or you know kind of
13:55
feeling hopeless
13:56
hopeless or worthless and those kind of
13:58
things are definitely
14:00
more pronounced the last year with the
14:02
pandemic
14:03
um because people are struggling it's
14:06
during the pandemic
14:07
it's been hard to manage just um without
14:10
a chronic illness so when you add having
14:11
to manage something 24 hours a day
14:13
it's just an added complexity and it's
14:16
draining people's
14:17
um mental health that's the bottom line
14:23
yeah absolutely and thanks for for
14:25
sharing that karen it's
14:27
a bit of an aside but you know there's
14:29
so much
14:30
difficulty and there's so much even
14:32
diagnosable distress in the form of
14:34
diabetes distress it is a it is a mental
14:37
health
14:37
condition and it's uh its prevalence is
14:40
around 53
14:42
according to dr michael vallis out of
14:44
dalhousie and halifax
14:46
uh in the type 1 population so this is a
14:49
predisposition to
14:50
depression to anxiety and as you
14:52
mentioned those feelings of hopelessness
14:53
or worthlessness
14:55
they they crop up quite naturally in
14:57
this constant management of
14:59
the disease like type one that's so
15:01
built on
15:02
self management so built on constant
15:04
decision making
15:05
um and it can be very easy to tie our
15:08
worth to
15:09
a number in the form of a1c or in the
15:11
form of uh
15:12
you know how are we quantifying how well
15:14
we're doing uh it can feel very
15:16
exhausting for people
15:18
for sure and i would say to like i i say
15:20
to my husband like i've got to get a run
15:22
in like i stay
15:23
sane because i get a run run-in i have
15:25
to go for a run
15:27
so like that is my that is my refuge
15:29
that is my that is how i maintain
15:31
a level of sanity go for a wreck
15:38
i'm i'm thinking about you know some of
15:41
the so many changes have occurred over
15:43
the past year and
15:44
um elena i'm thinking about the
15:47
significant change that many of our
15:48
viewers have likely experienced
15:49
firsthand
15:50
and been interested in and it is this
15:53
transition
15:53
into virtual care as a really
15:55
predominant way of
15:57
of caring for type 1 diabetes so um can
16:00
you explore kind of what this
16:01
means and the different ways that we can
16:03
provide or receive care virtually
16:06
yeah for sure i think um you know
16:10
sometimes pandemics come in weird
16:12
they're silver linings i guess is what i
16:14
was going to say and so even before the
16:15
pandemic i was already sort of
16:18
maybe an early adopter in in the use of
16:21
virtual care
16:22
but at least here in ontario and of
16:23
course across we know this is the
16:25
national webinar and so this is going to
16:26
be very different
16:27
in different jurisdictions but um um
16:31
i was using ontario telemedicine to
16:33
provide some
16:34
some clinical care initially is really
16:36
for people who live far away but
16:38
increasingly um the province was
16:40
recognizing that there are some
16:42
some conditions that lend themselves
16:44
well to what i would call
16:45
high frequency low touch care so
16:48
multiple frequent checkpoints but not
16:49
necessarily needing a you know
16:51
like a full 30 45 minute type of
16:55
assessment with a large physical exam
16:57
component and i think that even before
16:59
the pandemic diabetes was
17:00
was something that was right for that
17:02
especially when you couple it with
17:04
diabetes technology
17:06
so for people who are lucky enough to
17:07
have access to technology like
17:09
continuous glucose monitors and the
17:11
sharing platforms that come along with
17:12
those continuous glucose monitors
17:14
you can have really positive
17:15
interactions with your health care team
17:17
without actually having to
17:19
even do an email but perhaps for some
17:22
people you're not comfortable with your
17:23
data on the cloud or the pump doesn't
17:25
download to the cloud system properly
17:27
but the cgm does
17:28
and even with a quick download at home
17:30
and then an email with your pump
17:31
printouts
17:32
um you can really have useful
17:34
interactions with your healthcare team
17:35
without necessarily meeting in person
17:38
and so i like to kind of distinguish
17:39
between virtual care and digital health
17:42
a little bit
17:43
when i've been given the opportunity to
17:44
speak about this i do because i think
17:46
virtual care is just care provided
17:49
virtually and ideally it's with a health
17:51
care provider that you already have a
17:52
nice established relationship with
17:55
um and um you know maybe that
17:57
relationship is something that you know
17:58
some of the care is provided in person
18:00
and some of the care is provided
18:01
virtually and
18:02
after the pandemic and the need for
18:03
physical distancing is no longer the
18:05
reason to provide care virtually
18:07
it should be sort of it as much as
18:10
possible a choice for the patient
18:12
as a patient like karen said would
18:13
prefer to come in person then she can
18:15
come in person
18:16
but maybe one time it just doesn't make
18:18
sense for her to come in person because
18:19
of all of her competing demands with her
18:20
young children and her work schedule and
18:22
then it can be done virtually
18:24
obviously if there's a clinical concern
18:26
that comes up that needs physical
18:27
assessment then that can be
18:28
you know converted into a physical
18:30
in-person appointment but i hope the
18:32
future is sort of a blended hybrid model
18:34
that sort of has this digital health
18:36
ecosystem around
18:37
care and so that includes the ability to
18:40
do secure messaging or email
18:42
with your healthcare providers as well
18:44
as sharing data through the platforms
18:46
that we've spoken about
18:47
and um and then you know having the
18:50
right care at the right time for the
18:52
right person
18:52
um and obviously that is gonna depend a
18:54
lot on how the provincial governments
18:56
decide to continue funding physician
18:58
care after the pandemic
19:00
um every every province is put in some
19:02
form of temporary funding to support
19:04
virtual care in the context of physical
19:06
distancing
19:07
we don't know what that's going to look
19:08
like and then of course i recognize
19:12
that i'm very lucky because i happen to
19:14
have a population of patients living
19:16
with diabetes who are pretty
19:17
technologically plugged in
19:19
both maybe because my province gives
19:21
good access but in fact we are one of
19:23
the laggards when it comes to covering
19:24
cgm and there's been some great
19:26
announcements for some other
19:27
provinces in the last couple weeks when
19:29
it comes to covering dexcom
19:31
but probably where i work in the city i
19:32
have patients who have good insurance
19:34
and can afford
19:35
to be on these advanced technologies and
19:37
so there's certainly other
19:39
other people living with diabetes and
19:40
other diabetes care providers who are
19:43
in awe at the fact that when i have a
19:45
busy clinic i think i mentioned this to
19:46
mark and brooks
19:47
and karen before i have right now dexcom
19:50
dyasen
19:51
libreview carelink uh tidepool
19:55
all of those windows open on one desktop
19:57
on one
19:58
computer screen and then i've got my
19:59
zoom screen and my electronic medical
20:01
record open and that's how i conduct my
20:03
busy day
20:03
because i'm using all those different
20:05
sharing platforms to provide care to my
20:07
patients whereas lots of people are
20:08
still having their patients read out
20:10
their blood sugars one blood sugar at a
20:12
time which is
20:12
incredibly painful for everyone involved
20:14
and doesn't really allow you to focus on
20:16
what matters most to the patient
20:18
so it's just a few of my thoughts about
20:20
what connected care can look like in the
20:22
future for
20:23
for um when it comes to diabetes
20:28
thanks elena and i i really like the the
20:30
distinction you've
20:31
you've made between virtual care as a
20:34
tool or a
20:35
channel and digital health as a sort of
20:38
ecosystem it's almost like the
20:40
metaphor that pops into my head is uh
20:42
it's virtual care
20:43
is a set of it's the trees the digital
20:46
health is the whole forest and
20:47
everything it lives in and how it
20:48
interacts with one another
20:50
um i'm curious i have a quick follow-up
20:53
question i was thinking
20:55
karen to your point i was interested
20:57
where you said you actually prefer
20:58
these in-person visits and i'm sure
21:01
there are folks like that i'm wondering
21:03
um maybe elena and karen if you're if
21:05
you'd like to talk a little bit about
21:07
what's called white coat syndrome and
21:09
what uh digital health means
21:11
for folks that might be hesitant to to
21:13
go in person it might
21:16
you know prefer this this digital
21:17
approach or the opposite
21:19
uh or someone a bit more in karen's case
21:21
that might really thrive on
21:23
on engaging face-to-face with a care
21:24
provider
21:28
i think that um i think that like
21:30
atlanta said offering a hybrid model
21:32
could be really really good because with
21:33
white coat syndrome we know that
21:35
patients are going to come into the
21:36
office and have their blood pressure
21:37
checked and it's going to be
21:38
160 on 110 and from a diabetes
21:41
cardiovascular risk
21:43
standpoint that is not ideal blood
21:45
pressure
21:46
but we know at home the same patient's
21:47
going to have a beautiful blood pressure
21:49
of 120 on 80 and
21:50
we we love that blood pressure so i
21:52
think that there's a good con
21:54
there's a good like opportunity for a
21:56
hybrid model
21:57
where maybe you have patients who are
21:59
hypothetically checking their blood
22:00
pressure at home
22:00
making sure that their blood pressure is
22:02
under control
22:04
and reducing those like long-term
22:07
diabetic complications
22:08
but then being seen so that they can
22:10
have their objective foot assess
22:11
making sure that if they do have
22:13
neuropathy somebody's assessing them to
22:16
make sure that they're
22:16
not at risk for diabetic foot ulcer and
22:19
eventually potentially a foot amputation
22:21
like i think that there's a potential
22:24
role for
22:24
hybrid like atlanta was saying
22:32
i would just i i completely agree i mean
22:35
i think we just need to
22:36
put the patient at the center of these
22:37
conversations a lot more
22:40
and i think prior to the pandemic
22:44
there was a desire both from policy
22:47
makers
22:47
and canadians to see
22:51
more virtual care but what the pandemic
22:53
forced us to do is see how well it could
22:55
be done
22:56
overnight um and it would have taken
22:59
years and years of like political
23:01
conversations um and we would have made
23:04
a very small dent in it
23:05
one thing i'll also bring up i think
23:07
this is likely the case across
23:08
all jurisdictions but of course i'm most
23:10
familiar with ontario
23:12
is that virtual care can be provided on
23:15
the phone
23:16
so a lot of people think about virtual
23:18
care as being like what we're doing
23:19
right now
23:19
using you know video conferencing
23:22
platforms
23:23
but there's big equity issues when it
23:24
comes to virtual care and
23:27
we want to make sure that people can
23:29
access care safely
23:30
and effectively from a place that makes
23:33
sense for them
23:35
and that's probably something that the
23:37
pandemic really did show us
23:38
is that both for patients and providers
23:41
i would say probably 80 plus percent of
23:43
the virtual care has been provided
23:44
across canada
23:45
has been my phone not by video um and so
23:48
again that'll be something that we'll
23:49
have to consider
23:50
personally especially when i'm meeting a
23:52
new patient i think video goes a long
23:55
way
23:55
um to be able to sort of get those those
23:58
non-verbal cues and
24:00
sort of you know have a face behind a
24:02
voice
24:03
um but for well-established visits
24:05
patients that i already know well
24:07
it's so much easier and more convenient
24:09
to just you know have a quick catch up
24:11
on the phone while we're both looking at
24:12
the clarity
24:13
um website and we don't necessarily need
24:16
that additional video piece
24:21
i think that there's a really important
24:23
notion
24:24
in what's just been said and that's this
24:26
concept of equity
24:28
and equitable access to these
24:30
technologies to these forms of care and
24:32
i'd like to pass a bit of a impromptu
24:35
question
24:35
over to mark because mark i know you've
24:37
been involved in a lot of
24:40
uh advocacy efforts in both in in your
24:42
home province in newfoundland labrador
24:43
but across the country and
24:45
i think this this notion of equitable
24:47
access when we talk about whether it's
24:48
insulin pumps whether it's
24:50
advanced glucose monitors that really
24:52
shows up jurisdiction through
24:54
jurisdiction you know
24:55
you and i are uh mark you and i are
24:57
calling in from atlanta canada which has
24:59
no coverage for let's say cgm and
25:01
limited coverage for pumps meanwhile
25:03
there are
25:04
other jurisdictions that are uh
25:06
essentially offering full coverage for
25:07
both
25:08
so what's your take it's a bit of a
25:11
loaded question
25:12
what's your take on this this split that
25:14
that's happening between jurisdictions
25:16
and
25:17
what's the i guess opportunity and
25:19
challenge recognizing
25:20
uh this dissonance between provinces and
25:23
territories right now
25:26
thanks brooks yeah i mean you know i
25:28
could go on
25:29
uh on this question for for days so i'll
25:32
try and keep it short but
25:34
um i think when it comes to the uh so
25:36
the advanced glucose monitor
25:38
portion of the digital health component
25:41
they go
25:42
very much hand in hand as we've kind of
25:44
touched on previously
25:46
in order to get the most out of a
25:48
virtual appointment
25:50
having data and all your information and
25:52
your blood sugars logged and just being
25:54
able to pull that in a really nice
25:56
report um you don't get that same level
25:59
of numbers through uh you know
26:01
fingerpricks through the
26:02
the traditional methods of glucose
26:05
monitoring
26:06
and um so what we find is is um
26:09
you know that that life gets easier when
26:12
you have these
26:13
these advanced technologies and um
26:16
not only does it get easier but we've
26:18
noticed that it's really much
26:19
the the literature supports this um you
26:22
know the anecdotal
26:23
experiences of people living with it
26:25
supports it
26:26
that um that these technologies are just
26:29
kind of worth their weight in gold you
26:30
know as
26:31
the saying goes an ounce of prevention
26:33
is worth a pound of a cure
26:34
and we very much see this with with
26:36
again continuous glucose
26:38
monitors specifically and flash glucose
26:40
monitors as well
26:42
but the the coverage isn't isn't equal
26:44
as you'd mentioned so
26:46
um you know there's a couple provinces
26:49
actually several provinces now who've
26:50
got on board to fully support
26:52
um fully provide cgms um in terms of
26:55
coverage
26:56
and partial coverage and then in the
26:58
atlantic provinces um
27:00
well not just the atlantic province but
27:01
in newfoundland where i'm living there
27:03
there is no coverage
27:04
and there's there's a lot more provinces
27:06
like that as well
27:07
and we know that um those who get to
27:10
access it
27:11
and you know like myself at that point
27:14
in time when i didn't have that access
27:15
it was kind of
27:16
linked to me having a job and when i
27:18
didn't have a job i couldn't access it
27:20
and
27:21
i you know had a privilege of of going
27:24
um coming from a family that could put
27:26
me through a good school and that's why
27:28
i was able to get that job but there's
27:30
so many people out there that don't have
27:31
that same opportunity so i was so
27:33
fortunate that i was able to have that
27:35
advanced care for years and years while
27:38
others
27:38
others don't but a big part of what
27:41
we're trying to do with this advocacy
27:43
initiative is just to raise awareness
27:44
that not only
27:45
is it just hugely helping people's
27:48
quality of life
27:49
reducing the mental toll the diabetes
27:51
distress as we previously talked about
27:53
but we're seeing that it's a win-win
27:55
from a feasibility perspective on the
27:57
health care system as well
27:59
so brooks actually did up a fantastic
28:02
presentation that did a cost budget
28:04
analysis on um continuous glucose
28:07
monitors and
28:08
and it doesn't take much to crunch the
28:10
numbers to see that they're worth it
28:12
considering that if you go to hospital a
28:14
single stay in
28:16
hospital overnight is on average about
28:18
six thousand to sixty two hundred
28:19
dollars
28:20
and the price of a cgm for a full year
28:23
is
28:23
about thirty six hundred if you're
28:26
looking at the dexcom g6
28:28
and a little higher and lower depending
28:30
on the systems that you're using um but
28:31
long story short
28:33
is there's many people who can access
28:35
this because of
28:37
varying factors and it's it's not only
28:39
not that it's not fair
28:41
um but it's more so that that it just
28:44
doesn't make sense from
28:46
you know an entire uh economy and in the
28:49
feasibility aspect
28:50
um there would be a lot more money saved
28:52
if everybody had this and just
28:54
you know overall uh well-being of our
28:57
residents
28:58
and would be much better so um yeah
29:01
that's
29:01
that's kind of the what we're advocating
29:04
for
29:04
is is for full coverage nationwide um
29:08
brooks you're heavily involved in the
29:09
diabetes 360 strategy which touches into
29:12
this as well
29:13
and there's a lot of a lot of great work
29:15
going on i highly recommend anybody who
29:17
wants to get involved in advocacy to go
29:18
check
29:19
out type one together the facebook page
29:22
um
29:22
that's where the true advocates are not
29:25
myself but
29:26
uh you know uh john whitehead jen
29:28
alexander et cetera they're they're
29:29
doing really good work on the advocacy
29:31
perspective
29:32
um but in terms of virtual care to stay
29:35
stay on track here
29:36
um yeah again the uh virtual care very
29:40
much favors those with access to the
29:41
technology
29:43
and while it seems exciting and easy um
29:46
you know to talk about virtual care
29:48
it's just important to remember that
29:49
it's much easier for those who have
29:50
access to the technology
29:53
and barriers still exist right so again
29:56
to touch on
29:57
affordability of the devices whether
29:59
it's insulin pumps
30:00
cgm's coverage isn't the same across
30:03
each province
30:05
varies from province to province some
30:06
are doing much better than others
30:08
um so we know there's still a big
30:11
opportunity to improve all that
30:13
um things like even like wi-fi and
30:15
computer access is
30:16
is problems for some individuals in the
30:18
community and
30:19
i'll come to an end here on this little
30:21
rant but um it's important to just
30:23
ensure
30:23
that we have readily accessible
30:25
technologies um
30:27
in order to successfully navigate a
30:29
virtual appointment
30:30
so i completely agree with everything
30:34
i completely agree with everything mark
30:36
said um i mean i could not have said it
30:38
better myself time we just add insulin
30:40
is still not readily um accessible
30:42
to everyone and you know i mean i've
30:45
cgms have taught me more than ever
30:46
before
30:47
um about the importance of sort of
30:49
second generation basal insulins and the
30:52
like and we
30:52
we don't we don't those are not
30:54
universally available on formulary and
30:56
depending where you live in canada some
30:57
people are still using
30:59
quite antiquated insulins a lot of
31:01
people think about it as being an
31:02
american issue because
31:04
the cost of insulin is so much higher in
31:05
the us and canada but there's still
31:07
major
31:08
major barriers for access to good
31:10
insulins
31:11
for many canadians so another area for
31:14
us to include in our advocacy efforts
31:16
when we think about equity and diabetes
31:17
care
31:20
yeah that's a great point i forgot about
31:22
that sorry to cut you off brooks but
31:24
um we're seeing that as well a lot in
31:26
the community here is
31:28
because the provincial plans cover
31:31
certain insulin and not others people
31:33
don't get to use the insulins that work
31:35
best for them so trusiva is an example
31:37
of long-acting insulin that tends to
31:38
work well with
31:40
a lot of people not not everybody but
31:42
certain and ones and
31:44
some some people can't access that and
31:46
therefore they're they're suffering the
31:48
consequences of you know struggling with
31:50
their sugars a little bit more so
31:51
thanks for bringing that up
31:55
i'd like to quickly echo you know mark
31:57
calling out the uh
31:58
not calling out that's negative
31:59
connotations celebrating the the
32:01
wonderful advocacy work that's being
32:02
done
32:03
all across the country and i think this
32:05
this call as well as an example of that
32:06
there's there's a piece that's
32:08
involved in policy change but also
32:10
having these conversations that raise
32:11
awareness
32:12
is super important so yeah shout out to
32:14
everyone that is involved in advocacy
32:16
and for those that want to get involved
32:17
further
32:18
as mark mentioned type one together is a
32:20
great resource as well as diabetes
32:21
canada has
32:22
uh regional and provincial pages that
32:25
encourage discussion and
32:26
share resources as well you can check
32:29
out our website diabetes.ca or send an
32:31
email to advocacy
32:33
diabetes.ta and uh you know that's part
32:36
of my team and we'd be happy to set you
32:38
up with some opportunities to
32:40
make your voice heard and help make a
32:41
difference um
32:43
there's a lot of wonderful work going on
32:44
that's worth celebrating so thanks mark
32:47
um and shout out to you as well of
32:48
course uh doing doing wonderful things
32:50
in newfoundland
32:52
and labrador um thanks
32:56
you know i'd like to before we open up
32:58
for a question and answer
33:00
period i'd like to just sort of open up
33:02
the floor to the three of you to share
33:04
what your overall experience has been
33:06
with with virtual care for type 1
33:08
diabetes
33:08
and what opportunities and challenges
33:10
you see in the near or longer term
33:12
future
33:20
so for myself my virtual care
33:24
for me kind of came to the forefront
33:25
even before the pandemic when i was
33:27
pregnant with um
33:28
my twin boys two years ago and
33:31
um at the time my wonderful amazing
33:34
endocrinologist dr halperin
33:36
was always available over um email to
33:39
kind of check it i would just say to her
33:41
you know my sugars are up again
33:43
the last 24 hours can you pop onto
33:44
clarity and look and critique
33:46
and let me know and within an hour or
33:48
two i'd usually hear back from her with
33:50
a little bit of feedback and some
33:51
suggestions
33:52
for how to manage my sugars a little bit
33:54
better so
33:55
i think that um there's a huge role for
33:58
um virtual care and i think that it
34:01
certainly has its place
34:02
in in helping us manage our chronic
34:05
disease
34:06
um and i think even just as a patient
34:08
with you know
34:09
diabetes you have to you have to manage
34:11
it on your own it's it's a
34:13
diabetes self-management is the hallmark
34:15
of
34:17
you know good long-term care um and i
34:20
think that
34:21
the technology is out there and access
34:24
you know if people can access it
34:26
um and they want to talk about that
34:28
technology and they have access to it
34:29
and they want to learn more about it and
34:30
want to talk to
34:31
somebody with diabetes about it i'd be
34:33
happy to chat but the technology is out
34:35
there
34:36
and um allows like you're you're kind of
34:39
on high alert all the time with the
34:40
technology that's out there because you
34:42
you get
34:42
push notifications about your blood
34:44
sugars all the time and you don't
34:45
necessarily
34:46
love that because diabetes is 24 7. but
34:49
um it's great technology and um
34:53
and it really is a game changer for
34:54
managing diabetes so if you can access
34:56
it and you're not sure about
34:58
you know it it's it's a foreign idea and
35:01
you're not
35:01
sure it's something that you want to
35:02
embrace you want somebody to
35:04
chat about with it i'd be happy to talk
35:06
because it's great um
35:08
but from a virtual care standpoint i
35:09
think it's here to say and i think that
35:11
we just need to
35:12
kind of find ways being focused on the
35:14
patient that works for
35:16
the patient but and the provider um in
35:18
order to just like in
35:19
overall enhance um type 1 diabetic
35:21
outcomes because
35:23
diabetes is tough and um
35:26
yeah that's what i'll say
35:30
so i don't want everyone to think that
35:31
their endo is no good because they don't
35:33
respond to emails in two hours
35:35
karen is a special patient she cared as
35:38
one of my very very first patients
35:40
uh and she actually followed me from
35:42
where i was doing my training
35:44
downtown toronto up to sunnybrook and
35:47
then
35:47
tried to separate from me when she moved
35:49
out to guelph and then came back to me
35:51
when she
35:51
opened again and then with virtual care
35:54
it's easy to keep in touch so
35:55
i i think that um one other thing i
35:58
would mention
35:58
is a follow-up to what karen said was
36:00
that i recently had to put a standing
36:02
uh um response on my emails because
36:06
i just get too many and it can be hard
36:08
to keep track
36:09
um and so if i could do it all over
36:12
again
36:13
i wish that i had created a secure
36:15
platform as opposed to email
36:17
i really like that i'm accessible to my
36:19
patients all the time but when i respond
36:21
in real time it doesn't always make its
36:23
way to the chart
36:24
and i don't always have all of the
36:26
information that i should have when i
36:27
respond
36:28
um so i i don't um you know i do talk
36:32
about that a lot as being part of that
36:33
digital
36:34
ecosystem is a lot of physicians are now
36:36
working with electronic medical records
36:38
and there's a lot of different ways to
36:39
do
36:40
secure messaging um which can still even
36:43
go to the physician's
36:44
personal devices if the physician
36:46
chooses to do that
36:47
but i do think that you know part of of
36:50
good
36:50
good diabetes care it can be
36:52
asynchronous as
36:53
karen spoke to it can be a lot easier
36:55
for her to say
36:56
i've noticed this trend with my blood my
36:58
glucose after dinner for the last week
37:01
can you pop on to clarity here are my
37:02
updated pump settings
37:04
and a patient who makes it easy for the
37:06
provider does that here are my pump
37:08
settings
37:08
i'm noticing this trend what do you
37:10
think um
37:12
as opposed to just sort of saying
37:13
everything's high and i don't know what
37:15
to do and then i need to ask for
37:16
so many different things and you know i
37:18
think it's like we're a partnership and
37:20
i've used the term a lot to say i see
37:22
myself more and more and virtual care
37:23
has brought this out for me
37:25
as sort of a coach or a cheerleader for
37:26
the person living with diabetes
37:28
i have developed a certain amount of
37:29
expertise when it comes to looking at
37:31
people's
37:33
cgm reports whether they're flash or
37:35
glucose monitoring to me
37:37
interpolate interpreting the ambulatory
37:39
glucose profile as an art that i now
37:40
teach a lot of other people just like we
37:42
interpret an electrocardiogram
37:44
there's an art to interpreting an
37:45
ambulatory glucose profile that involves
37:47
engaging with the patient
37:49
so as opposed to an electrocardiogram
37:50
where you may not have to ask the
37:51
patient
37:52
what happened when that happened you
37:54
need to have those conversations with
37:55
patients but sometimes it can be done
37:57
asynchronously which is more efficient
37:59
for everybody
38:00
and so i do think that that's another
38:02
area from a policy perspective that
38:03
requires attention
38:05
because those are not actually paid
38:06
interactions almost anywhere in canada
38:09
so that's just something we do because
38:10
we care about our patients doing well
38:12
but not every end is going to do that
38:14
and i don't want everyone to walk away
38:15
and expect that
38:16
um but i do love my job and i love being
38:19
able to help people like here and
38:20
deliver beautiful babies into the world
38:22
despite you know the challenges of
38:24
living with diabetes and so that's why i
38:25
do it
38:33
that's really i really appreciate that
38:35
note of like again it's
38:37
coming back to values of what does the
38:40
patient what can you allow a patient to
38:42
do um
38:44
is a really really wonderful lens to
38:46
take on providing care
38:47
so kudos to you for that elena um
38:51
so folks we're going to now open the
38:53
floor to questions
38:54
um so i see one question that's been
38:56
submitted through our facebook chat and
38:58
i'll
38:59
i'll start with this and i think this is
39:01
a fairly broad question that
39:03
also touches on policy change and
39:06
it's i'll open this up to the three of
39:08
you uh if you have an opinion or a
39:10
thought please feel free to share
39:11
the question is how can we educate
39:14
schools better
39:15
for children with type 1 diabetes
39:21
i'm just going to take it i guess i'll
39:24
try so
39:25
as an endocrinology trainee we were um
39:27
have to do an advocacy
39:29
project to learn about what it is to be
39:31
an advocate and and work in advocacy as
39:33
one of the roles of physicians
39:35
um and certainly advocacy has been a
39:36
huge thing for physicians during the
39:38
pandemic but even before that so we try
39:40
to work with actually with diabetes
39:42
canada around preparing some
39:44
some educational information for schools
39:47
but
39:47
it is really hard because as i'm sure
39:50
many of you who are joining in know
39:52
that although this group who's right now
39:54
together with us on facebook
39:56
live we were joking before that on this
39:58
panel i'm the only one who's not living
40:00
with type one
40:01
and so i was the odd one out but the
40:03
reality is most kids go to school and
40:05
they may be the only kid with diabetes
40:07
and it almost reminds me of a place
40:09
where i'm much more comfortable than
40:10
schools to be honest
40:12
um is the hospital so the bulk of
40:14
patients living with diabetes who make
40:16
their way into the general medicine
40:17
awards in the hospital have type two
40:19
and type one is a different disease and
40:21
sometimes they wish it was named
40:22
differently
40:23
because the the the two can be conflated
40:26
and then healthcare professionals who
40:27
are not experts in type one and i'm sure
40:29
many of you living with type 1 can
40:30
appreciate times where you've interacted
40:32
with healthcare professionals
40:33
who are not experts in type 1 and you
40:35
felt scared that your diabetes was being
40:37
mismanaged while you were in hospital
40:38
and felt like you could manage it better
40:40
than the nurse or the doctor looking
40:42
after you and that is real because you
40:43
can
40:44
because they're not trained to
40:45
understand type 1 diabetes and so the
40:47
same is true for schools and so
40:49
i think it's not easy to say that you
40:51
know it needs to be part of education
40:53
because
40:54
they could learn it just like all of the
40:56
doctors and nurses learned it during
40:57
their training but then they don't see
40:58
it so they don't
40:59
use it but i think there are diabetes
41:02
canada has worked hard to provide and
41:04
create tools and brooks can probably
41:06
speak to this
41:07
that can be used so that if you're a
41:08
parent in a community where you have
41:10
a child at school and the school isn't
41:13
comfortable or familiar with
41:14
caring for a kid at school with diabetes
41:16
that you can use those toolkits to work
41:18
with your school your
41:20
teacher your principal because it's not
41:22
easy to say that they should learn about
41:23
diabetes
41:24
during their training because they may
41:25
but then if they don't get exposed to it
41:27
on a regular basis they're not going to
41:28
be able to put that into action
41:30
for sure again cgm and and the following
41:33
uh capabilities that glucose monitors
41:35
provide is hugely beneficial but takes
41:38
us back to that equity issue
41:39
i've certainly heard stories about times
41:42
where you know
41:42
the parent is calling the school because
41:44
they can see that in half an hour their
41:46
kid is going to be low before the kid or
41:47
the teacher know that they're going to
41:48
be low and then they're saying bring my
41:50
kids some juice
41:51
um and you know that's hard it's hard
41:53
work for parents full-time job because
41:54
you probably also have a full-time job
41:56
but
41:56
i think in some ways the cgm's have
41:58
definitely helped
42:00
but obviously we still have a long way
42:01
to go in that space i'm not sure if
42:02
anyone else wants to add to that
42:04
response
42:08
yeah just to to piggyback on that i
42:10
completely agree with what you were
42:11
saying there atlanta
42:12
and you know coming back to the um the
42:15
kind of the
42:16
the win-win component of cgm's in
42:18
general and the same thing goes with
42:20
with children i think back when i was
42:22
five diagnosed with type one and running
42:25
around and you know
42:26
a couple checks throughout the day which
42:28
i wasn't paying any attention to kind of
42:30
thing but
42:31
um i was having a lot of lows those days
42:33
we'll leave it there
42:34
and you know if you have that kind of
42:37
support system
42:38
um whether it's integrated into a school
42:42
you're really yeah it might be looked at
42:44
as an extra expense to some of our
42:46
policy makers
42:47
um but the mishaps that you can avoid by
42:50
having that support system
42:51
um again worth its weight in gold and uh
42:54
and it really just
42:55
you know provides parents and and
42:57
children with that extra level of
42:59
comfort and all around is uh
43:00
really a win-win for for the system in
43:02
general so just wanted to touch on that
43:08
and i think if we just go back to basics
43:11
in terms of school-aged children
43:13
and managing type 1 diabetes at school
43:17
i also was a child when i was diagnosed
43:19
i was 10
43:20
and i think a big thing this is not
43:23
necessarily speaking to policy changes
43:26
but i think as a parent or as a as a
43:28
child
43:29
um just having a safety plan in place
43:32
and having teachers and support staff at
43:35
the school familiar with signs of
43:36
hypoglycemia and what to do
43:38
and having safety kits wherever those
43:40
kids are um
43:42
glucago gone on hand fixed sugars when i
43:44
was 10 i carried skittles everywhere
43:46
because my pediatric endocrinologist
43:48
told me that those are the fastest
43:49
acting sugar
43:50
i was happy to carry those around that
43:52
was pretty cool so
43:54
having safety just having a bit of a
43:56
safety net for kids in school
43:58
um and having teachers and support staff
44:00
recognize signs of hypoglycemia is
44:02
important
44:04
i would actually just follow up on that
44:06
with one other thought which is another
44:07
thing that i think has made
44:09
why type one is so close to my heart is
44:11
i've had the privilege of working at
44:12
camp hironda for the last
44:14
i guess well now or the second summer of
44:15
camp yoronda which is a diabetes canada
44:17
funded camp here in ontario
44:19
that we're not running but i worked
44:20
there since i was an endocrine trainee
44:22
so at least eight years
44:24
and um sometimes the parents would say
44:26
to me
44:27
i hate what happens to my kids sugars at
44:29
camp i do such a better job controlling
44:31
the sugars at camp
44:32
at home than you guys do at camp but
44:34
then i remind them that the key to camp
44:36
was safety
44:37
and for kids to have fun and so
44:39
sometimes you know glucose control can't
44:41
be perfect in a classroom setting either
44:42
but to karen's point you know safety
44:44
comes first
44:45
and um and that's certainly the the
44:48
tactic that we take at camp is
44:50
a lot for again the opposite of what
44:51
these kids have experienced being the
44:53
only kid in their whole school with
44:54
diabetes and suddenly they get to go to
44:55
a camp where um
44:57
you know my kids are the odd ones out
44:58
because they're one of some of the only
45:00
campers at the camp who don't have
45:01
diabetes
45:02
uh and it's a it's a it's important to
45:04
put safety first and let kids be kids
45:06
sometimes
45:11
yeah i think that's really really great
45:12
point and it's it's not that it's about
45:14
creating a perfect
45:15
pristine polished environment it's about
45:18
harm reduction so removing the chance
45:20
of really negative outcomes and that's a
45:23
you know it's always a great starting
45:24
point in developing
45:25
these safety systems
45:29
so i'm not seeing any other questions
45:31
coming in so i'm gonna
45:32
i'll comment then when you talk about
45:33
harm reduction i'll bring up one other
45:35
thought one other point which is there's
45:36
another time in
45:37
in patients lives that i think is really
45:39
important to talk about harm reduction
45:41
and that's actually the transition from
45:42
pediatric to adult care
45:44
which is a real a real um passion of
45:46
mine and
45:47
i i've now had the very wonderful
45:50
experience of having
45:51
three or four i think i might be up to
45:53
five sort of huronda campers graduated
45:56
to my care so they were in pediatric
45:57
programs and i was their camp doc and
45:59
now i'm just their doc
46:02
and um one of the things i always start
46:04
off with and i say to the parents of the
46:05
first visit is
46:06
emerging adulthood and emerging is just
46:09
really hard
46:10
you know think about emerging adulthood
46:11
in the context of the pandemic
46:13
even more magnified in terms of all of
46:15
the pressures associated with the social
46:17
isolation
46:18
maybe moving away from home for the
46:20
first time and then you layer on
46:22
like kind of becoming an independent
46:24
person living with diabetes
46:26
and it's that much more challenging and
46:28
so i am not too concerned about a1cs in
46:30
those years that to me it's about
46:32
establishing a rapport and making
46:33
patients know that this is my office
46:35
is a safe and non-judgmental place and
46:38
the key is to safety keep you out of
46:39
hospital i don't want severe
46:40
hypoglycemia i don't want dka
46:43
and we talk really about all of the
46:45
things that happen in young adulthood in
46:46
terms of drinking and drugs and all that
46:48
stuff
46:49
and it's important to be able to have
46:50
those conversations with with your
46:52
diabetes team
46:53
and so for if there's parents listening
46:55
today or young adults listening today i
46:56
think that that's just an important
46:58
message as well
46:59
is that the diabetes isn't going away
47:01
and of course
47:02
you know a1c as a as a long-term
47:06
preventive measure is important um but
47:09
you know it's about
47:10
both the acute and long-term
47:11
complications and that um
47:13
you know if patients feel like they're
47:14
coming to the principal's office to be
47:16
judged
47:17
on what their a1c is then their parents
47:19
stop telling them they have to go they
47:20
may just stop showing up and then those
47:22
are the people who really end up
47:23
becoming
47:24
a burden on our health care system 15
47:25
years later to mark's point
47:27
when they start to experience all those
47:29
diabetes complications and now that i've
47:31
been at this job i've actually been able
47:32
to see many patients under my care
47:34
mature from
47:35
sort of not really caring about their
47:37
diabetes to really caring about their
47:38
diabetes
47:39
and getting through that challenging
47:41
time of young adulthood emerging into
47:43
adulthood
47:47
fantastic thank you elena for sharing
47:49
that um
47:51
we're coming to the end of our time
47:53
together which this has been a fantastic
47:55
conversation and before we close off
47:56
does anyone else
47:58
um have any final remarks that you'd
48:00
like to share with our viewers or
48:01
something you wish you
48:03
uh a piece of information you wish you
48:04
could share
48:12
i just wanted to note on earlier too i
48:14
did mention the advocacy side of things
48:16
but i did miss
48:17
a lot of work as as you kind of
48:19
piggyback down there
48:21
there's so much wonderful advocacy work
48:23
going on right now i know quebec just
48:25
had a really good announcement in terms
48:26
of the advocacy funding as well
48:28
and uh diet kids had a big portion in
48:31
that so
48:32
lots of gratitude to go around with with
48:33
the wonderful advocacy work going on
48:35
across the country and i
48:36
apologize if i left anybody out
48:45
karen any final remarks i'd also like to
48:46
give a shout out to this is probably the
48:48
best webinar that's ever
48:49
uh been provided to from inside a
48:53
minivan
48:53
uh i don't don't know if it's happened
48:55
elsewhere karen's power is out so she's
48:58
gone mobile yeah
49:01
guys the minivan my husband calls this
49:04
our
49:04
um lamborghini so that's what i'm
49:08
driving today
49:10
um but final thoughts um i think virtual
49:13
care is here to stay
49:14
i think that's okay but i don't think we
49:16
all have i think we have to be kind of
49:18
comfortable with uncomfortable uh
49:21
scenarios here we might not be
49:22
necessarily comfortable with providing
49:24
and receiving virtual care
49:26
um but i think it's going to be here to
49:29
stay and that's not a bad thing
49:31
i think we just have to kind of all
49:32
figure out together with
49:34
us diabetics being the center of it all
49:36
what's best for us
49:40
yeah and just on that i i really hope it
49:43
is here to stay
49:44
um you know i think you know to your
49:46
point earlier karen
49:47
i really do enjoy the face-to-face
49:49
interactions with the
49:50
the diabetes teams um but then i have
49:53
those bad days where
49:54
i just don't want to go into the clinic
49:57
and i'd rather you know do it from home
49:58
so really
50:00
touching on atlanta's idea of the hybrid
50:02
model um
50:03
you know giving the the patient-centered
50:06
voice
50:06
as well as the provider is is super
50:09
important so
50:10
um yeah i think overall moving forward i
50:13
i really hope that it continues down
50:14
this path
50:15
so
50:18
yeah in in summary i think it's here to
50:21
stay and we can all play a part in
50:23
making sure that happens
50:25
um i'd like to thank you so much
50:28
our three guests mark karen elena uh
50:31
i really appreciate this conversation
50:33
and i hope that our viewers did as well
50:35
and for those that view this in the
50:36
future i'm sure they'll they'll glean
50:38
something from it too
50:39
so to our viewers please never hesitate
50:41
to reach out to us
50:43
you can reach diabetes canada via email
50:45
at info
50:46
diabetes.ca on the phone at 1-800
50:48
banting
50:49
or you can find an answer hopefully to
50:52
your question at diabetes.ca
50:54
uh we hope this webinar has been really
50:56
helpful for you i know
50:57
i learned from this and and i'm leaving
51:00
feeling a lot better and
51:01
more knowledgeable about this topic and
51:03
uh i think hopeful and
51:04
and grateful for the the key feelings
51:06
which is uh
51:08
really important to celebrate those
51:09
moments living with type 1 when we can
51:12
find a bit of hope for what's coming
51:13
next so i'm excited about this
51:15
this topic thank you all and uh take
51:18
care of yourselves be well
51:20
thanks so much
Category Tags: Children & Adults, General Tips, Just the Basics, Management, Research;