Sex, Drugs & Diabetes

0:01 okay welcome everyone and thank you for being here my name is brooks roach i am manager of patient knowledge and 0:06 connection with diabetes canada and i'd like to begin by acknowledging that i am joining this webinar from the 0:12 traditional and unseated territory of migma people and wherever you're joining or watching from today i invite you to 0:18 just take a moment to express some gratitude and recognition for the indigenous lands that we now 0:23 call canada we are here today to talk about a pair of topics that often do not receive 0:30 enough attention in the diabetes community or certainly traditionally haven't so 0:35 lo and behold people living with diabetes do have sex and do use drugs and we wanted to come together to share 0:42 some knowledge and tools to keep in mind when navigating these pieces of our personal lives 0:48 so i'm very very pleased to welcome our two guests today dr alice chang who is an endocrinologist at trillium health 0:55 partners and unity health toronto and an associate professor at the university of toronto welcome dr chang thank you 1:01 thanks for having me it's a great topic it is yeah and uh happy to have a couple experts and our other expert is dr 1:08 celine huo who is a full clinical professor pediatric endocrinologist and head of the endocrinology division at 1:15 chu saint justin in montreal as well as president-elect of the canadian society 1:20 of endocrinology and metabolism full bio and welcome celine happy to have you hello everyone for the purpose 1:27 of our talk i won't be talking about children but adolescents and adults 1:32 okay excellent so again thank you both for being here and i personally as someone who lives 1:37 with type one i'm just really interested to hear about this some of these topics that have been taboo and to dive right 1:43 in so the format today is that our two experts will be answering some key questions that they've heard from 1:50 patients and seen in their work and research i'd also like to take a moment to remind 1:55 viewers that while this session is relevant to people of almost any age the recommendations you'll hear are intended 2:01 for an adult audience so as celine mentioned adolescents or their caregivers are strongly encouraged to 2:06 ask further questions specifically to their diabetes care team we will be taking questions from viewers 2:12 so you can ask your questions by replying in the comments below and if you would prefer to keep your questions anonymous recognizing this may be a 2:19 sensitive topic or one you would rather keep private you can send a direct message to diabetes canada on facebook 2:26 so with that we will dive right into the discussion and i would like to pass it 2:32 to dr chang and ask let's start at the beginning so if someone with living with 2:37 diabetes was considering starting to have sex either for the first time or with a new partner what are some of the 2:43 key considerations they should keep in mind so i i think a very important message to 2:49 take away from today is to remind everyone that someone living with diabetes can absolutely have a 2:55 satisfying and enjoyable sex life just like anyone else who may not live with 3:00 diabetes so i think that's a very important starting point to come from and just like everyone else in order to 3:07 try to achieve that satisfying and enjoyable sex life it is very much about communication it's about strong direct 3:14 communication with your potential partner so that everybody is on the same 3:20 page and specific to diabetes there are some practical considerations that one needs 3:27 to discuss with their potential partner so let's start off with uh how can sex 3:32 impact one's blood sugars or vice versa so remember uh sexual activity is is 3:38 exercise uh so it it is considered physical activity it is considered exercise and therefore the potential for 3:47 a low blood sugar is certainly there uh depending on on how vigorous the sex may be or the 3:54 duration etc but all of that does in fact uh is exercise and therefore could make 4:00 the blood sugars lower so ensure that your partner is aware of that possibility ensure that you have 4:06 candies or dex tabs or juice or somewhere within arm's reach then that of course is important to consider 4:15 the other thing that one needs to think about is uh potential wearable technology that you may be using 4:22 so for some of you who are listening you may be wearing a sensor you may be wearing an insulin pump there may be a 4:29 tubed pump a tubeless pump so there are certain technologies that you may wear may be wearing on your body 4:35 and i think it's important to have a conversation with your partner about that piece 4:40 and this is always one of the fun debates that one could have at a session is are you a pump on or pump off kind of 4:46 person some people choose to leave their pump on when engaging in sexual activity and some people choose to take their 4:52 pump off and i think that's very much a personal decision and it may change from session 4:58 to session but it is important that again you've thought about it and that you've discussed it with your partner 5:04 because it's just sort of you know what happens if my leg gets tangled in the tubing and you know those kind of things 5:10 do need to be uh discussed ahead of time and and sort of go with the flow and so everybody's 5:16 not um anxious or surprised or or unsure about what to do in those situations so 5:22 i think those are kind of important conversations to uh to have uh with a potential partner and those 5:27 are some of the ones that are sort of specific to diabetes and one other thing that i will mention about blood sugar as 5:32 i said how sexual activity can impact the blood sugars but the blood sugars can impact sexual activity 5:39 so if someone is in fact experiencing hypoglycemia um during sex then that is going to 5:46 impact uh performance so i think that is also relevant to be aware of is how 5:52 blood sugars can also impact sexual activity 5:57 thank you dr chang all very useful things to think about and it's the the debate of pump on pump off does 6:03 rage on um wondering if you could speak a little bit about sexual function and diabetes 6:10 sure excellent excellent question so those living with diabetes particularly 6:16 of longer duration may in fact experience sexual dysfunction or abnormal function from a sexual 6:22 perspective now let's start with in men so in men i think we've all seen the commercials 6:28 it's no longer a taboo topic which is great men may experience erectile dysfunction 6:34 now as we know from the tv commercials etc it's not just men living with diabetes who can experience erectile 6:39 dysfunction but in fact any man can experience erectile dysfunction 6:44 and particularly those with diabetes though they may have some more risk factors for it 6:50 such as some circulation issues or neuropathy nerve related issues from 6:56 long-standing diabetes that may impact erectile function so i i think the key there is again to 7:03 communicate but to communicate with your health care team because if you are experiencing any 7:09 erectile dysfunction uh please mention it and what your team will do is uh perhaps 7:15 do some blood work to check for things like low testosterone which again any man may experience but those living with 7:20 diabetes may experience it a little more often and then that can be treated and as well of course we've got excellent 7:26 medications to address the erectile dysfunction which can be very effective 7:32 but if it's not discussed then of course your healthcare team is not able to help 7:37 you now it is our role to ask the question but sometimes the question does not come 7:42 up in which case we would very much hope that our patients would be able to share the information 7:48 with us and then being able to maintain glucose levels close to target is ultimately going to 7:55 help with that situation and sometimes can be an additional motivating factor for people uh to work on their on their 8:02 blood sugars so that's on the the male side of things now let's talk about female 8:07 now female sexual dysfunction is definitely not discussed publicly you don't see tv ads about it it's not 8:14 discussed uh in movies and and tv shows etc and it's also not something that we're very good about asking 8:22 however we we should be and we do realize that female sexual dysfunction is 8:27 common in general uh but also in those living with diabetes and it may come in 8:32 the form of impacting either desire or impacting arousal or impacting orgasm 8:38 which are sort of phases of the sexual response and depending on where the issue is there may be different treatments that 8:45 could be offered so again number one is to mention it is to mention it is to discuss it with your 8:51 health care team and then based on what the situation is there may be blood tests that need to be 8:57 done to rule out other contributing causes there may be simple therapies like vaginal creams that could deal with 9:04 vaginal dryness or it may involve a referral to a sex therapist who could help with some of 9:09 the sexual desire pieces but it it can happen and it's not something to sort of just brush 9:16 under the rug it is something to discuss with your team because there may very well be things that could be done to to 9:22 help you yeah thank you thank you also i think 9:27 that point of communication is really resounding like across all of what you shared and i'm wondering 9:34 just thinking about if someone as you say you know it's it's great if they do get this targeted question from a healthcare provider you 9:40 know specifically asking about this and i was just thinking i wonder if you have any advice from folks who may not have 9:45 that question coming in from a healthcare provider how could they feel comfortable about 9:51 reaching this topic well one thing that i think all of us do uh even if we forget to ask the pointed 9:57 question all of us will do it towards the end of the visit would say do you have any other questions right i would hope that all of us tend to end our 10:02 appointments with that and then that is a great opportunity to actually say 10:08 uh this is what i have experienced over the last you know whatever period of time 10:14 one thing i would say is that all of us as healthcare providers want to know if you're having an issue 10:22 we may forget to ask but we appreciate when you share that 10:27 information is everyone going to know how to help you maybe not but is everyone going to want to know and then 10:33 direct you to someone who may be able to help you the answer is yes so 10:39 people are going to be open to it people are going to appreciate the fact that you've shared it 10:44 however um we sometimes forget to ask and and that is very much our issue i think in men we tend to remember but i 10:51 got to say when i went through medical school and residency asking women about sexual function just was not 10:56 we weren't taught to do it so therefore we don't ask um but but please bring it up because we we want to help and like i 11:03 said even if the person you're mentioning it to doesn't know what to do they can send you to someone who 11:08 who uh who can help i think that's really helpful keeping in mind that it's not a deliberate um 11:16 blocking out of the the topic it's just people are busy people are healthcare providers may just have a lot on their 11:21 plate and not explicitly ask but that they want to help is a really important lens to keep in mind um 11:29 okay we're going to press pause on topic one uh of sex and move on to drugs so 11:36 with that uh abrupt shift i'm gonna ask you dr huo 11:42 if i am an individual who lives with diabetes and uses drugs which is many of us 11:47 whether that's alcohol cannabis or illicit substances what do i need to know 11:54 that's a great question as well um if we uh take the different substances 12:02 differently alcohol and cannabis are now legal in canada cannabis has been now 12:08 legalized in canada since uh 2018 so people are 12:15 more willing to give information legally and report their use of cannabis so what 12:22 we've known since it's been legalized it's um that for instance if in most of the 12:28 provinces reported use is between 15 to 25 12:34 according to the different provinces uh people living with diabetes will report officially less use and what's uh 12:42 commonly reported for other people not living with diabetes and the people 12:48 living with type 1 diabetes report it more often of course the type of use the type of 12:55 product the mode of administration differs so that's not necessarily asked 13:01 once people contribute the information what has stemmed out uh our potential 13:08 risks though so the risks that people should be aware of 13:14 and then again we don't know what the chicken and the egg is is it just an association is it really related to 13:21 diabetes is it related to other factors we have to keep that in mind but for type 1 diabetes the use of cannabis has 13:29 been related to a slight deterioration in uh the uh glucose control 13:37 namely the hba1c uh the famous blood test that everybody gets once they see their physician and 13:45 but that again when you analyze more according to a level of education 13:51 socioeconomic level this may not be as much of an impact and a risk what has been mostly 13:59 reported in people living with type 1 diabetes is an increased risk 14:04 let's say two to three times of having diabetic ketoacidosis and that's a 14:09 severe complication of type 1 diabetes so what is 14:15 more um more so what's also reported is the fact that if you have a tendency to have a 14:23 diabetic ketoacidosis which will bring you to the hospital you have more of a 14:28 risk of being readmitted within the next year if you have um use 14:34 of cannabis and more so if you use cannabis and other substances so these 14:40 are risks that people living with type 1 should be aware of as for type 2 the use is less reported 14:49 but numbers seem to indicate that there is an increased risk of having vascular 14:55 problems of having cardiovascular problems as well and um these things have to be taken 15:03 into account there are also um there's also information coming in that 15:08 maybe the function of the kidneys may be compromised at some point 15:14 so these are potential risks um then again there's 15:20 up till now we don't know is it a matter of long-term use is it a matter of 15:26 amounts that are being used is it a a matter of the mode of administration of the cannabis is it the type of cannabis 15:33 we don't know so this at least for cannabis is known and the use of cannabis not only may 15:41 impact on glycemic control and also on potential complications of diabetes but 15:48 it's also uh being written also that it may impact on the way we self-care for 15:55 our diabetes so for instance um the way we eat can be perturbed uh while using 16:03 cannabis the way we check our blood glucose and the level of vigilance may 16:09 be um perturbed as well so for those reasons there may be 16:14 risks associated with the glycemic control and also are the way we 16:20 self-care for ourselves if we live with diabetes so that's for cannabis 16:27 um i will go along what what dr chang has said 16:34 before if you don't engage in the discussion with your patients i deal with adolescents as well and young 16:40 adults as nora roberts the famous novelist said 16:46 if you don't ask a question the answer will always be no so ask the question 16:51 engage in it if you don't feel comfortable well at least you'll know the information and as dr chang said 16:57 please bring it to the people who would at least give some advice but officially the recommendations 17:05 overall from physicians would be to uh try to minimally uh use cannabis 17:12 recreationally i'm not talking here about medicinal use of cannabis this is a different topic completely 17:20 but if it is going um to be a part of 17:25 your i would say extracurricular activities uh then the best thing to uh do is to 17:33 make sure that somebody will help you to ensure that at least your self-care is 17:39 not perturbed because of your recreational use of cannabis these are 17:44 the main lines um for other substances there isn't much 17:51 uh published both for type 1 and type 2 diabetes more so in canada because it's illegal so if you report it 17:58 you're not supposed to use it so we doubt very much that the numbers are 18:03 reliable there as for alcohol alcohol 18:08 for anybody should be a topic of discussion in any 18:15 follow-up in healthcare situation that's for sure and alcohol more so when its 18:22 use is not considered moderate can have impact on health there are additional 18:29 risks for people living with diabetes and 18:34 then again it's hard to generalize the information because yes there's the type 18:40 of diabetes that can influence your reaction to the alcohol intake more so if it's more 18:47 than moderate or just socially once in a while but there's individual predispositions 18:53 as to how you metabolize the alcohol and whatever so the recommendations are 18:59 general there are for safety but it's it's a matter of controlling the risks 19:06 risks and can also with the use of alcohol include um worsening of other health 19:14 problems uh more so if you have them to start with so for instance high blood pressure 19:20 very common people living with type 2 diabetes an increase in some of the fats in the 19:27 blood which are called triglycerides so more so if you have them those people who already have inflammation to their 19:35 pancreas can have uh serious bouts of inflammation which are very painful and 19:41 can lead to very serious medical um imbalances as well um and also it's it's 19:48 it's known that alcohol use can impact on the function of the liver and as we 19:54 know the liver is very important not only in releasing the sugar we need in 19:59 between meals and when we sleep but it's also very important to metabolize or to help the way some of 20:07 our medications work when we treat diabetes so for those 20:13 reasons there are moderate 20:19 i would say uh risks in the in the moderate long term but in the short term 20:26 the use of uh using alcohol i would say within um 20:31 [Music] more than uh less than less than minimal amounts uh can impact in some 20:38 individuals um in the short term and uh there are potential two risks if 20:44 your blood sugar is already very very high more so if you have type 2 diabetes and 20:50 you take certain medications your blood sugar is very high and you take alcohol this can lead to dehydration alcohol 20:57 makes you go pee and then again your blood sugar may spike right up and you 21:03 may feel very dehydrated and end up very very sick 21:08 while most people will agree that many types of 21:14 drinks include carbohydrates uh sugars 21:20 the initial thought would be oh yeah the alcohol would lead to an increase in 21:25 blood sugar not necessarily wrong but don't forget not all alcohol types uh include a lot 21:32 of carbohydrates sugars but uh what actually happens is once 21:38 your body starts getting rid of the alcohol then it's so busy that 21:43 the liver can't provide sufficient sugar uh in between meals or more so if 21:50 you've drunk um alcohol without having uh a meal or food 21:57 in the meantime so the risk of having uh 22:02 alcohol of taking alcohol is actually to having a low blood sugar 22:08 low blood sugar can also more so in time people with type 1 diabetes but in type 2 diabetes if you 22:15 take even something with a lot of sugar in the drink your pancreas is still secreting insulin 22:22 it can go really high up in terms of secreting insulin and then you will end up having hypoglycemia anyway 22:29 so let's not forget there is sugar in alcohol but the immediate 22:36 danger is more the low blood sugars and this can be a problem until you wake 22:44 up the next morning whether you have a headache for having drunk too much or not but you can also have a very severe 22:51 headache if you're in a hypoglycemia or have treated hypoglycemia during the the night 22:57 so there are some measures that we recommend we discuss this uh openly with 23:03 all our patients pretending that people will never drink alcohol for many will prove to be difficult and so there are 23:12 many ways in which you can prevent for sure there's the types of alcohol 23:18 i.e concentration here what is included in terms of sugars 23:24 in the alcohol that you drink monitoring 23:29 checking for your blood sugar having a partner somebody who helps you uh to actually make sure that 23:37 the blood sugar is still normal and these are additional 23:43 uh this is an additional help that you may need simply because alcohol may perturb your cell your sense of 23:50 feeling well or unwell and let's not forget also that alcohol may lead to symptoms which may be 23:58 difficult to distinguish from hypoglycemia or oh i'm just i'm 24:05 just having a little bit of a headache because i've done too much there 24:11 so overall these are the messages for substance and alcohol use 24:17 uh yes engage with patients but i would say also 24:22 um let's discuss it openly prevention here is much better than having to deal i 24:29 speak for myself speaking um uh dealing with adolescents uh you have this 17 year old in the 24:36 emergency who doesn't feel well and then they have to explain to their parents 24:41 what actually happened whereas you know if they just they they discuss it before beforehand this would never have shown 24:48 up on the radar okay thanks very much that's a very 24:55 in-depth rundown like i feel like that's a great uh sort of starting kit if someone's 25:00 looking into whether it's beginning to use alcohol or cannabis or looking to 25:06 revisit the way that they engage with those substances that's really helpful 25:11 lay of the land so thank you um on the note of opening that dialogue and 25:16 similar kind of point around the importance of just communication and you know you can you know i love that that 25:21 quote about the only way to get a definite no is not to ask so just go first um 25:28 on the note of an open dialogue i would now like to open the floor questions so we have a couple that have already come 25:35 in and i would just encourage folks to engage you know as mentioned in the 25:40 comments section or via direct message and you know potentially treat this as a 25:45 chance to test out the way that you might ask about your own health situation um because we want this to be 25:51 you know this is a very uh open and understanding setting so i want to welcome any type of question so a couple 25:58 that have come in already which i'll share with you folks and the first is probably the most direct uh and easy to 26:03 answer is um franklin asks is there a link to studies on cannabis and diabetes so what 26:10 i'll say is certainly and i can connect with you dr huo and we can share those 26:15 uh in the comments section on this video after the fact um so just stay tuned and we'll follow up but great question and 26:22 happy to help you explore a bit further the next question is regarding um the 26:29 use of cbd to help sleep issues so wondering perhaps um celine if you could touch on 26:36 the distinction between perhaps thc and cbd if relevant and then as you 26:41 mentioned these sort of medicinal uses if it's been prescribed 26:46 um the literature 26:52 on thc which is known to have effects on quotes unquote's well-being 27:00 either stimulating or relaxing properties are i would say 27:08 more preponderant in the literature the information is more preponderant than it is for a cbd 27:14 the quality of the literature for cbd because it has various uses 27:20 is is is is more difficult to um to get 27:27 thc doesn't act on the body on the same 27:34 receptors as cbd thc acts throughout the body and there 27:41 are um this is why we can explain this is how we explain actually why it has some 27:48 central nervous system positive and sometimes not so positive effects 27:54 whereas cbd acts elsewhere in the body and it acts on 28:01 let's translate it this way pain receptors so um 28:08 those pain receptors have not been as well characterized as the receptors for 28:14 thc so the effect of cbd on sleep 28:21 more so in people with diabetes where whether it would have a positive impact 28:28 i'm not in a position to tell you how necessarily it would 28:33 work whether it would enhance or improve the situation 28:41 don't take from this message that i don't believe in the medicinal 28:47 use of cbd all i'm saying is that we don't know as much yet 28:53 and we can't focus and target those specific people who could potentially benefit from it as 29:02 of today okay very helpful thank you 29:09 the next comment we've received is in and around menopause so i'll field this one to alice and it's 29:16 this individual has lived with type 1 diabetes for 46 years and is having trouble with blood glucose 29:23 levels since starting menopause they say they've gone to the gym and sugar is going up and since menopause 29:30 it's quote unquote never normal so menopause is a 29:36 pain in the butt for everyone when diabetes or not because it is a change in your 29:44 hormonal profile and and what's happening is that your ovaries have 29:49 packed up they're quit the eggs are done and you no longer get the cycling of uh 29:55 of hormones which in some ways is good but then you're now missing estrogen 30:00 which can then wreak havoc on things like sleep mood energy levels for some people 30:06 memory and and then when you're not sleeping that then worsens the memory and it can also wreak havoc on um blood 30:14 sugars but in a different way when you were having your periods it the the havoc that the hormone was causing 30:21 was the fluctuation but if your periods were predictable you could somewhat predict what was going to happen and 30:26 adjust your insulin accordingly with menopause you you lose that um fluctuation which is great but then your 30:34 your body needs to readjust itself and that perimenopausal period is uh very 30:42 difficult because sometimes your hormones go up and then sometimes they go down and then it's 30:47 it's unpredictable so then it makes it very hard to be able to adjust your insulin accordingly 30:54 for some women their insulin requirements go down in menopause but then for others it goes up because there 31:00 may be an associated weight gain that may occur in menopause and then with increased weight in increased 31:06 insulin resistance and then therefore um higher insulin requirements so it's very hard to say 31:12 you know there's a rule of thumb that it's definitely going to go up or definitely going to go down all that i can say is that it is all 31:19 about frequent monitoring and then tweaking of your therapy accordingly 31:25 your body's response to exercise should be no different really in menopause versus not in 31:32 menopause however because your body has changed and likely body weight has changed 31:38 then it is different from before and and the perimenopause like i said is just it's just a big old roller coaster 31:45 so i wish i had a simple answer for you i wish i had a magic bullet for you but it really is about frequent monitoring 31:51 and then frequent adjustments if you're not sleeping if you're having terrible hot flashes then please speak to your 31:58 healthcare team because there are things that can be done to help hot flashes are very difficult because 32:04 they feel like hypoglycemia and sometimes it feels like hyperglycemia and then you don't know what's going on 32:10 so again it's about frequent monitoring so i i wish i had a magic bullet for you 32:16 uh if it is terrible certainly hormone replacement therapy is something that can be offered can be offered safely in 32:22 people living with diabetes as well so if you're miserable please go see your team because there are ways to 32:29 uh to try to lessen the symptoms of perimenopause and and menopause 32:38 thank you and and i hope this is uh helpful to our audience and thank you for for asking and uh hope that that can 32:44 steer you in in the right direction recognizing it sometimes as you say tough to have the magic bullet but sometimes just 32:51 heading you know heading down the right street at least can be a good first step um 32:56 another question and it's it's somewhat related although at a very different uh potentially life stage and it's about 33:03 uh planning for pregnancy so alice i'll feel that back back your way 33:09 so first message just like i had with sex i think the first message is to say that uh women living with diabetes can 33:15 absolutely have a healthy pregnancy healthy successful pregnancy and and that is the expectation in 2022 that 33:23 that would be the case it does require some extra thinking and that extra thinking is planning 33:29 which technically other pregnancies should have as well right so it is just about planning ahead 33:35 and avoiding surprises so specific to diabetes there actually is a checklist that you can find on the 33:41 diabetes canada website which sort of like a preconception checklist so we want to make sure that certain things 33:46 have been achieved prior to conception so these include things like having the the blood sugars at target so an a1c 33:54 less than seven percent preferably even less than 6.5 making sure if they're on any other 33:59 medications that can impact a pregnancy that we stop those things like statins 34:04 ace inhibitors just getting rid of those medications ensuring that you've screened for complications so having had your eyes 34:11 checked within the past year making sure your kidneys have been checked the urine has been checked um 34:17 and then folic acid ensuring you've been taking folic acid at least one milligram per day for a 34:23 good three months prior to conception so that your body's chopped full of folic acid and then that way the um the 34:30 developing embryo will have the nutrients that it in fact requires 34:35 and those would be the components of the of the preconception checklist so blood 34:40 sugars other medications folic acid eyes checked screening for complications 34:46 so always plan your pregnancy obviously with your partner but plan it with your with your doctor and your diabetes team 34:53 and i often joke with my patients that as soon as you discover you're pregnant the first phone call you make should 34:58 probably be to me and then to your partner in that order because it's critical that 35:04 the team be aware and that once you are pregnant that we put you in the right kind of clinics where you're going to 35:10 get um very specialized care and we're going to stay on top of things because in pregnancy 35:16 it's critical to then maintain the glucose control to ensure successful pregnancy and as well maintaining 35:22 vitamins through the first um part of the pregnancy aspirin may be needed in in the 35:28 beginning part as well so there are great things that we can do and it's all about preparation 35:35 planning ahead communication and then once you are pregnant let us know asap and we put you in with the team and the 35:42 expectation is for a successful pregnancy 35:49 thank you and also very uh helpful and prescriptive you know get your tests get your folic acid so and call alice first 35:56 call your your team first um okay um another question and this is in 36:02 recognition um silly and you had mentioned you know that it's it's much easier to 36:08 report on and have a bit more of a direct answer on substances that are legal and 36:13 this person's wondering if you have any specific guidance or you know just how to how to approach something if they 36:20 are interested in trying or have been a user of uh illicit substances 36:27 one very very easy uh way of getting the information is i'll take the example for adolescents i 36:34 don't ask an adolescent do you have you used cannabis 36:40 or pot or whatever their terminology uh in the past year i 36:45 usually ask them how many times have you actually used pot in the last year i usually get frank answers when i ask it 36:53 that way rather than do you use it generally um 36:58 so this is one way um and if somebody even if somebody answers oh 37:05 just once or whatever i'll i'll probably take this opportunity as well when i ask about cannabis to ask about 37:12 alcohol at the same time and other substance use as well during those things and 37:19 i must say that um the ease with which you bring up the the 37:26 question will probably help in the answer so if you don't feel very comfortable with it you may even 37:33 rehearse if you have adolescents at home or with your your partner or even rehearse at home so that at least 37:40 when you ask the question you don't feel it at ease yourself so that's one thing and um usually when 37:48 we address substance use whether it be alcohol cannabis or something else 37:55 i usually try to approach it by substance if it's a real problem in terms of use 38:02 then i would ask the help of my colleagues in adolescent 38:08 medicine because usually there are other issues at stakes than just the diabetes 38:14 then but when i deal with a particular use of a 38:20 substance first goal is to try to cut down if it's at all possible and there 38:25 are many ways and we can also send you the link as to how you can stream screen for that and 38:31 also how you can help people to at least start cutting on the use recreational use or 38:37 non-recreational use or abuse let's call things the way they should be called for some people we would be pleased to 38:44 send you those uh links okay great well um we'll share those as 38:50 well in the comments uh so we'll have a little bundle of resources for viewers after the fact 38:56 um and and thanks for the question because again can be difficult to ask when something is taboo or in this case 39:01 you know even illegal uh it can be hard to to own up to something and try to get help so 39:07 um i i if i may add also one of my personal fears is that somebody will come up with 39:13 a name i don't know and i have no idea what the substance is about well then i just ask okay tell me about it and i'll 39:20 you know i'll read about sometimes it's just a different name for something that already exists or a mixture of things 39:26 that already exist but i'm very humble uh when it comes to that 39:31 i all you know i would say every two weeks i hear a new name i haven't heard and well that's part of education i guess 39:42 we have uh we have a question that's not doesn't cleanly necessarily fit into 39:47 the two categories we've discussed but i think it may be relevant just to ask you folks given your your expertise and it's 39:53 a question can you help me with pain sciatica and arthritis for diabetes as i am taking 39:59 too many meds and nothing is helping do you have any guidance for this person so i i constantly know i'll jump in here 40:06 um pain pain management is is uh difficult obviously as this person who's asking is 40:13 already alluded to and and in in the diabetes space we often think about diabetic neuropathy or nerve damage uh 40:20 that can manifest as painful diabetic neuropathy and in the case of painful diabetic neuropathy we sort of go 40:26 through a cocktail of medications that we may choose to try right so we may choose to 40:31 try things like tricyclic medications we could then try things like uh pregabalin 40:37 we might try things like gabapentin duloxetine uh sort of in that antidepressant group that may help 40:44 um and sometimes things like non-steroidal anti-inflammatories um nsaids can can be helpful and then 40:52 i personally do not tend to prescribe the narcotics or the opioids simply because i don't 40:58 know enough about them nor do i follow people closely enough to be able to 41:03 prescribe that safely but in those individuals where we sort of try those basic things and it's not cutting it 41:09 i always will involve a neurologist because the neurologist can then do the proper test to see is this actually 41:16 painful diabetic neuropathy or is this some other form of neuropathy and then if necessary they will also 41:22 involve the pain clinic so for the person who's asking the question who clearly sounds frustrated which is completely understandable um if 41:30 you're not already engaged with the pain clinic i would ask for that referral to a pain clinic because at the pain clinic 41:37 they see all types of pain not just diabetic neuropathy pain but all types of pain and will have access to 41:42 different modalities and treatments and blocks and things that that certainly your endocrinologist would not have 41:49 access to uh and even most neurologists would not uh or your primary care physician so i i would strongly 41:55 recommend that you visit or ask for a referral to a pain clinic to have assessment there and and 42:02 cannabis may very well be part of the armamentarium for treatment of the pain but not something for you to experiment 42:08 with on your own because it is about the dosing and the type and then the cbd versus the thc and 42:15 and it gets uh fancy but in a good way and not something that you would just 42:20 sort of buy at the store and then try out right so i i would encourage again a referral to a pain clinic uh who often 42:27 will have expertise in in cannabis as well as a potential pain treatment 42:36 thank you and um just to add noting that um been tested to see if it's if it is in 42:42 fact neuropathy it's a disc herniation um so again maybe uh 42:48 an added layer of complexity um we we also have a question and i'll just 42:53 direct this person that sonia is asking a question about the odsp specifically 42:58 if fiasco will be covered in insulin pumps for those who are on odsp um and i would just advise i think we 43:05 have some print resources but i would i would advise reaching out to uh via email info 43:11 dot ca or 1 800 banting as they have all the the most updated resources and can 43:17 dive in a bit more in a bit more depth with your specific situation to help you so i just hear you that way and thanks 43:23 for asking um so i want to 43:28 just say a big thank you to those who who ask questions and and uh you know 43:33 express their curiosity and and thanks for some really thoughtful answers as well to our our panelists 43:39 um and before we wrap up i want to also give another chance for uh for the two of you doctors chang huo to 43:46 to touch on anything else that you might want to share or anything that you feel is important to highlight from this session 43:53 um so celine maybe i'll i'll go first i i think a big theme out of everything that i talked about is uh is 43:59 communication it's uh communicating between you and your potential partner or partners um communicating between you 44:06 and your health care team and talking about 44:11 talking about whatever is bothering you planning ahead and even if we as healthcare providers 44:18 are not asking the right questions and and that will happen and i apologize on behalf of all of my colleagues including 44:24 myself ahead of time because that for sure that will happen we we do want to know 44:29 uh so share it with us and if we don't know how to help you then 44:34 we'll find you somebody who can't or we will try to direct you to the right resources so it is all about 44:39 communication but you absolutely living with diabetes should and can uh have a satisfying enjoyable sex life 44:47 a successful pregnancy uh and navigates through stages like menopause with as 44:53 much difficulty as everyone else so so the the expectation is that you should 44:58 be able to experience all of those phases in the same way as everyone else with just a few extra details that we 45:04 need to think about but that's what the team is there for is to help you with that 45:11 well said now i will quote gandhi now andy said 45:17 if you don't ask you won't know so if you don't ask you won't know it's pretty much the same 45:23 if you don't engage in the conversation with your health care provider then nobody will know about the information 45:30 there's no there's no problem in admitting that there is recreation or even abuse of the 45:37 substances it's it's part of you know health discussions um and um 45:43 okay if the health care professional is not comfortable at least a it will be 45:49 on the map and needs to be discussed further if the person you've just confided in is not the person who 45:56 actually should be taking over this situation hopefully that will guide you to the proper 46:01 person and uh let's not pretend that people don't drink let's not 46:08 pretend that people never use uh recreational cannabis or other 46:14 substances and if we start from there i think it's a very good start 46:20 well said indeed to both of you and i think that theme of communicating openly and 46:26 you know recognizing it it can be really tough to share but it can can also open up a lot of doors to better understand 46:32 yourself and to you know i think alice what you've described is to have it be just as 46:37 difficult as for someone without diabetes is a really really interesting way to think about it because a lot of the time yeah this is 46:44 these are challenging spaces to navigate but um to be able to handle the hurdles of 46:50 diabetes well they can feel the right amount of challenging um 46:56 i want to say thanks again to you both um again to those who have asked comments 47:01 that we weren't necessarily able to resolve or may take a bit more time again feel free to follow along at 47:07 diabetes.ca or at diabetes canada on social media and if you want specific 47:13 information or direction to your situation call 1-800 banting or email info 47:18 diabetes.ca i really hope this webinar has been helpful for anyone who was curious about 47:26 sex drugs and life with diabetes uh our next conversation will be in november uh 47:32 on november 3rd for a conversation about destigmatizing diabetes so it's a very similar notion of what the the power of 47:39 having an open conversation can can do so keep an eye out and tune in if you're interested and you're also encouraged to 47:46 attend our conferences if you want to take our uh take your education a step further so we have no limits with type 1 47:53 diabetes on october 15 and let's end diabetes type 2 diabetes on the 22nd 47:59 both are free events and take place virtually so we would love to see folks there to come learn from 48:06 experts hear from diabetes champions and uh gain steps from their experiences and to connect 48:11 with each other so hope to see you there and hope to uh again hope that this was helpful for you i know it was helpful 48:17 for me and i really appreciate your time to our guests so so thanks again and be well 48:23 thank you thank you brooks great job thank you yes goodbye everyone have a great day English (auto-generated) AllConversationListenableWatched