[Music] 0:12 hi my name is Glenn tibo I'm a dad husband son brother former politician motorcycle Enthusiast 53-year-old 0:20 kickboxer and the current executive director of government Affairs Advocacy and policy here at diabetes Canada I 0:26 also live with type 2 diabetes and that's been a 7-year Journey for me so far and like most of you on this call 0:32 there was some initial learnings that I had to go through when I was first diagnosed I was a little too proud to go 0:38 see the doctor especially as an elected official I always said I was too busy but I knew something was up when I had a 0:44 hard time seeing a clock across the legislature so much so that I was confusing the number 39 and 59 and why 0:51 that's important is during question period the opposition parties have a set number of questions and each question 0:57 can be a minute long and then the government can answer answer that with a one minute answer so you always want to 1:03 fill that time to ensure there's no extra time for extra questions well for the first year I was always bang on 59 1:10 seconds to 1 minute then it started to end I started seeing 37 or 38 and 39 is 1:16 59 consistently and I would always sit down thinking ha nailed it but all my 1:22 colleagues were looking at me like what the heck you left them another 20 seconds do that three times and that's a 1:27 full additional question well and when you're the minister of energy you get way more than three questions per 1:33 question period so it was becoming a bit of an issue two weeks later and after a lot of heckling from my own party I 1:40 finally went to see the doc he called me back the next day very concerned because my sugar was 1:46 27 so with a lot of discussion some new medications and a new found reason to 1:52 change my lifestyle I was able to get my di diabetes under control and where it needed to be and like I said earlier 7 1:59 years years later it's still a battle for me every day my job and responsibilities being a dad of two 2:05 daughters especially one of them just getting through taining years and the other one smack dab in the middle of it 2:10 being 16 still has stress and how I manage that stress is key for me rather 2:16 than sticking to being you know a stress eater I would always hover hover around the pantry I would now I take my dog for 2:24 a walk I go to a kickboxing class or sometimes I go for a nice long relaxing motorcycle ride and that helps me 2:30 refocus on what I need to do to keep me where I need to be so I want to thank 2:36 you for letting me share a small part of my diabetes Journey with you and with 2:42 that it's my pleasure to introduce our keynote speaker cerra Stevens who will be providing information on stress and 2:49 its impact on well-being Sierra is a registered nurse and diabetes a 2:55 certified diabetes educator residing in the beautiful Annapolis Valley of Nova Scotia she has lived with type 1 3:01 diabetes for over 25 years and she's worked with people who live with diabetes in a variety of Health Care 3:06 settings including both critical and primary care and one of Sierra's ultimate career goals is to help 3:13 extinguish the shame stigma and misinformation that often surrounds diabetes both within General society and 3:21 the institution of healthcare itself she is a self-proclaimed Fitness and Wellness nerd and recently completed her 3:27 first Sprint Tri aalon and is a certified yoga instructor Sierra 3:33 recognizes the importance of mental Fitness in both her day-to-day life and regarding her own diabetes self 3:40 management she aims to live life outside of her comfort zone and ultimately hopes to help others living with diabetes do 3:47 the same so this session will also be moderated by Kayla RKA from the 3:52 knowledge and connection team at diabetes Canada so over to you Kayla welcome everyone to the first day 4:00 of diabetes Canada connect I'm Kayla Ranka and it's my pleasure to moderate this session on stress and its impact on 4:07 well-being with that I will turn it over to Siara Stevens our guest speaker today to introduce herself hello everybody um 4:16 as k Sorry Kayla said my name is Sierra Stevens and I'm a registered nurse 4:22 diabetes educator a yoga instructor and a self-proclaimed Fitness and Wellness nerd and I live well with type 1 4:30 diabetes and it's my pleasure to talk to you today about stress great thank you 4:36 um so stress we all experience it um I sometimes very loud in your faith kind 4:41 of stress and other times it kind of sits in the background weedling away at our our General Health and well-being so 4:48 you know maybe we can just start by talking about stress we throw that word around a lot what ises it actually 4:54 mean for sure I hear that word a lot whether it's at work or when I'm talking 5:00 to family and friends and I'll definitely expand on it stress means the 5:05 way our body feels and the way our mind 5:10 feels and reacts in response to a stress sore and in other words stress is what 5:17 you physically feel in your body when you encounter a stress sore or the way 5:22 that um your thoughts start to kind of tumble around responding to a stress and 5:28 how people respond to stressor or how they experience stress is very unique 5:33 just like being a human we're all pretty different right so you Ed the word 5:38 stressor can you maybe give us a few examples of what those might be definitely I thought that I should touch 5:45 base on a stressor in regard to diabetes as well in general and when I think of 5:51 what a stressor is diabetes wise perhaps thinking about a high blood sugar in the 5:57 morning so maybe somebody somebody has like something really special going on that day like their wedding and they 6:03 wake up and they have a high blood sugar to start the day having that high blood sugar in itself can be a stressor or it 6:11 can be something on Diabetes related which could be anything for a job interview for example and uh yeah people 6:19 can be pretty cool as a cucumber for those or we have other people like myself when they're having an interview 6:25 for a job who can feel pretty stressed so the interesting thing is whether it's 6:31 a stressor for a high blood sugar a stressor that is a high blood sugar or a job interview your body sees those 6:38 things in the same way and can start to react to that type of stress in the same 6:44 way back in yeah back in the older like 6:49 years and years and years ago when we used to be hunter gatherers and we had 6:54 to you know flee from attackers or wild animals that stress response really it 7:01 it especially came in handy to help us fight or flee when we encountered something like 7:07 that and now stress is still useful we don't tend to encounter those type of things but our body still responds to 7:13 the same way in the same way so stress can be a 7:19 good thing definitely it definitely can and there's actually a word for good stress and that is use stress and really 7:28 stress can be very motivating especially in short births to help you get something done like preparing for this 7:35 interview today I knew that I needed to put it in my schedule and uh get my my 7:40 thoughts going about it and that type of us stress helped me to get ready and be prepared so I could really give you 7:47 useful information today um a little bit of stress can just really kind of help you be prepared for your day and be able 7:53 to face it head on yeah I know I've heard people say they thrive on stress sometimes I am not one of those people 7:59 but I I guess for some people that's a good thing um I'm assuming though that 8:06 uh when you're exposed to high levels of stress or stress over a long period of time um that it does have some negative 8:13 impacts on the body so can you speak a little bit about what stress does to our bodies definitely so um I think it's 8:21 important to mention that while it can be useful too much of it or repeated exposure to it can be harmful and that 8:28 response a person has to a stress to a stress sore and that stress they have uh 8:34 can be kind of overdone and um kind of happen more quickly that stress feeling 8:41 can happen more fast than it did initially when you're having repeated exposure to the 8:47 stressors considering that stress is a pretty normal part of our our you know being human it's it's really something 8:54 important for us to talk about in some cases though as I mentioned a person may experience that too often and then it 9:01 becomes a normal part of their day I like to think of our brain as something that learns what's normal for us and as 9:08 we are exposed to something um that stressor might beat beat down kind of like certain Pathways in our brain and 9:14 then our brain will start to react in a similar way to a certain memory or a certain stress and then you know you get 9:22 that heart rate response more quickly um type of thing and there's certain 9:28 structures in your brain that recognize stress and set off a series of events and they do this through different 9:34 hormones that our brain releases um one of one example of those hormones is 9:40 cortisol and cortisol helps our body to be prepared to fight Invaders such as a 9:45 virus and it gets our immune system ready to take action and in order to do 9:51 that what our body thinks we need to do is increase our blood pressure increase 9:56 our heart rate and even increase our blood sug sugar to give us more energy to comat combat that stressful 10:03 situation some people notice things like um their stomach being upset when they're stressed some people might you 10:10 know have more active bowels with stress or more constipation it just kind of depends on the person but it's kind of 10:16 all that body's response to hormones um another thing is the chemical Messengers floating around to 10:23 stress can speed up your heart rate like I mentioned and that's that um you know people feel like they have palpitations 10:30 sometimes with stress or that their heart's just going really fast or is 10:35 going really fast the good thing is is we know that there uh are ways to help manage stress to combat these negative 10:42 consequences and I definitely want to make sure we talk more about those today yeah for sure and I'm gonna wing it here 10:49 for a second yeah so I'm assuming that maybe the body responds differently to 10:56 that immediate stress like that kind of butterflies in the stomach instant kind of stress differently than it does to 11:04 this low grade constant stress that maybe some of us might be experiencing 11:09 does it respond differently in that situation they it actually can respond 11:16 it can your body can start to feel like that's your normal way of living with that lowgrade stress and you can 11:24 actually a person cannot really realize that they're starting to live with that normal low grade amount of stress so 11:32 that's where kind of getting really in tune with yourself like we'll chat about it in a bit can be really helpful great 11:38 okay so same kind of negative impacts no matter if it's in your face are kind of hidden wow exactly yes all right so I 11:46 know uh and the viewers know that you live with diabetes um you're also a 11:51 health professional that works with people with diabetes on a daily basis so um I guess in your work as well as your 11:57 personal experience um sort of what have you leared about 12:03 stress I've I've seen that stress is one of the like a piece of the puzzle that 12:09 can often be missed or not talked about perhaps as much as it needs to be and I've kind of thought about how it should 12:17 really be another Vital sign when you go to uh talk to a health care provider um 12:25 because you know I would say that one of the greatest barriers that people have to achieving their diabetes related 12:30 goals is quite simply those things that are taking higher precedence in their life than their diabetes often because 12:37 of stress and people they you know we need to feel safe as a human and we need 12:44 to feel understood and in order to you know be our best self and to feel well our stress levels need to be managed and 12:50 lower um and until a person can really see stress for what it is and have a personalized kind of game plan for 12:57 managing it it can be ult to make strides towards diabetes related goals I used to like on a personal note 13:05 I used to feel like you know that everyone always talks about diabetes and stress but I don't really notice it and 13:11 I wasn't noticing diabetes immediately or I was noticing di diabetes yes I 13:17 wasn't noticing how stress immediately impacted my blood sugars it didn't seem to to me and then as time went on I 13:26 started noticing that maybe how stress influences my diabetes is in a more of a 13:32 subtle and compounding way in that it builds up over time and then it kind of pushes my diabetes to the back of my 13:40 mind and then all of a sudden I'm noticing that for example my time in range is getting lower or my A1C might 13:47 be creeping up a little bit and it's because I'm the type of person who's kind of getting everything done for 13:53 everybody else then maybe I'm taking a little bit of a backseat and then on the other hand I've met people people 13:59 completely different from me who notice the minute that they're stress that their blood sugars are going up and I always I can't really drive it home 14:05 enough that diabetes is so so individualized yeah I can imagine um and 14:11 I mean obviously stressors are a normal part of a human experience um uh you 14:16 know and most people living today also happen to have diabetes on top of just that normal human experience um so since 14:24 we started just now talking about um how stress impacts diabetes management maybe you can continue on with that and um 14:31 point out a little bit more in terms of the impacts on Diabetes from stress absolutely I think the the ultimate goal 14:39 of healthy diabetes management is for a person to live well and that's you know what their picture of living well is and 14:45 their ability to live well live well and long with diabetes and one component of 14:51 this is to aim for you know blood sugars in that safe range and and blood pressure and cholesterol levels kind of 14:57 that those three three things that really help to keep our blood vessels healthy and those healthy blood vessels 15:03 are what to help to prevent or prevent progression of complications which is what you know all 15:10 people living with diabetes are hoping for and working towards uh many people think mostly of blood sugar management 15:17 when they think of diabetes and when they think of diabetes and stress they might think of how their stress 15:24 influences their blood sugar but I think there's actually even more to it than that because um our responses can affect 15:31 our blood sugar our response to stress but it can also perhaps influence our blood pressure as well and maybe even 15:39 our cholesterol in other ways so it's interesting to think it's not really only blood sugar that we're thinking 15:45 about is those other parts of diabetes I I got thinking about those 15:50 other parts because my husband I was asking them you know I'm doing this interview coming up soon and uh you live 15:57 with a person who has diabetes all the time and can you weigh in on how you think stress might influence me or 16:03 other people with diabetes and it wasn't surprising that he was immediately naming things off and he was thinking 16:09 about how um you know living with diabetes can influence your sleep uh and 16:15 how stress can also influence your sleep so and and I think you know him hearing 16:20 my beeps he's thinking about the beeps he might hear at night but so sleep if 16:25 your sleep is decreased that can influence your diabetes IES as well as your stress levels and stress might also 16:31 influence um the way a person the choices a person makes for food whether 16:37 that be certain food choices or the amount like some people when they're stressed they find they eat more whereas 16:43 some people might find that they eat less and those different scenarios can influence diabetes in different 16:50 ways I've also thought about how stress um interplays with the menstrual cycle 16:57 for people who menstruate and different phases of the menstrual cycle uh you 17:02 have more insulin resistance so a lot of people will need uh more insulin during those phases and if you add on top of 17:09 that higher levels of stress that could mean even more insulin resistance so that's another way uh that our body can 17:17 or that our diabetes could be influenced by stress movement of course is a an 17:23 important piece of the puzzle when you live with diabetes every every extra bit of movement can um help to suck up that 17:30 extra glucose from your blood vessels but if you're feeling more stressed getting out the door um for myself can 17:36 be a bit more of a challenge but then once I do it of course I I start to feel I start to feel a bit better or a lot 17:43 better um and I also mentioned before how stress may cause us to prioritize 17:49 things a bit differently um you know when we have to do lists related to work and family and friends it might push 17:56 that diabetes a little further back and the hormones that we released when we're stressed can cause decreased insulin 18:02 sensitivity or that increased insulin resistance making it so that our insulin doesn't work as well as when we're less 18:09 stressed and this can be a challenge even if we become less stressed and our insulin sensitivity returns to normal we 18:16 may need to change insulin doses again if you're on insulin living with diabetes um and if you're not on insulin 18:23 you might notice that your blood sugar start to return to normal so uh there's a lot of things coming into play there's 18:29 lots of factors yeah no for sure and I I'm a registered dietitian by trade and 18:34 and I almost feel like I I speak more to people about stress and sleep impacting 18:42 their nutrition and the choices that they're making as much as I do about the actual food and choices that they're 18:48 making so it sounds like that's pretty consistent um across the board um okay so yeah yeah no I um I I 18:56 feel like we need to talk more about stress I was just yeah I was just thinking that I'd love to see more of it 19:02 um starting earlier in school and maybe there is now I don't have children so I'm not sure what they're talking about 19:07 in school but yeah yeah for sure and I mean you and I are both health professionals I think often um that 19:14 makes us a little better equipped in terms of recognizing stress or stressors and then maybe having some cop coping 19:20 mechanisms to um take care of that but can you share some tips or um you know 19:27 some some management tactics that people might be able to use when you know the stress itself can't go 19:34 away and I guess I'll give an example there so if you have a very stressful job but you need obviously to work and 19:41 and make an income you can't just quit your job to get rid of the stressor so are there ways to cope with things when 19:47 you know that stress is there and it's going to continue to be there yeah I think you touched on something really 19:53 important and that's that not all stressors are going to necessarily go away and they may change change and look 19:58 different over time and the fact that they'll be there makes it really 20:04 important to be able to notice and kind of get familiar with your body and notice when you're feeling that you're 20:10 actually getting stressed so you can uh take action in the healthiest way 20:15 possible and healthy coping mechanisms for stress will look different so you might be somebody who needs to go spend 20:22 time with people if you're stressed or you might be somebody you know who needs to go take more time for your yourself 20:28 and with yourself and uh personally I'm usually like that I need to kind of back off and uh go spend some me time and I 20:36 notice if I'm getting stressed I kind of start to feel more resentment which isn't like me but it's just because I need to go kind of take some Sierra time 20:44 um and I think it's really important that you get honest with yourself about what you really do need when you're stressed and actually how much control 20:50 you have over it and if I had to kind of break down how to uh kind of acknowledge 20:56 and manage stress into a bit of a three part toolkit I'd say the first step is noticing how your body feels and when 21:03 you're stressed the second naming the stressor so you're kind of that way once you've 21:10 named it once you can notice when it pops up in your life and that may sound really simple but that practice can be 21:17 really beneficial and then the third step is to have a plan of what you do 21:22 when you when that stressor comes around and then if that plan doesn't see seem 21:28 like it's working well for you not feeling like a failure but revisiting it and changing it so it might work better 21:34 the next time so I guess if I use myself as an 21:39 example there um when I start to feel stressed like I said I start to notice 21:45 that everything on my plate feels like too much I might I might feel a little bit resentful even when people are 21:52 asking me to do fun things like go out to dinner um so and I also so when I 21:58 feel stressed physically I'll feel kind of like heat coming towards the center of my body like feel it moving inward so 22:04 those are my physical signs of stress and those can be those cues like okay you're starting to feel this way again 22:11 what might make you feel be feeling this way so naming it okay yeah I took on a lot in uh in September maybe maybe next 22:20 time I'll I'll just kind of manage my schedule a little bit differently and then putting that plan into action so 22:27 actually deciding on like okay so what will I do what uh how will I decide to 22:32 manage my schedule differently and this plan of noticing acknowledging that 22:38 you're getting stressed naming the stressor and putting a plan into action if you repeat that enough you start to 22:45 kind of rewire your brain's way of considering scenarios and our brain is 22:50 something it's called neuroplastic and that's a fancy word for that it can change so those um your normal way of 22:57 thinking in your normal way of becoming stressed those Pathways can kind of get changed so you may not feel as stressed 23:05 as early on the next time when you encounter a stressor yeah you um hit the 23:10 nail on the head for me and how I know when that kind of low volume lingering stress has gotten to the point of too 23:17 much for me and that's the feeling that things I normally can handle Small 23:23 Things um start to feel much bigger than they actually are and that's a sure sign for me 23:28 that um I need to do something about it so for sure thank you for that um you mentioned making a plan to manage stress 23:36 so can you maybe give us a few examples of some so proven ways to help reduce 23:41 your stress absolutely and there are there's lots of different ideas and options out 23:48 there but I thought I'd kind of break it down into some little bite-size things that you could take away some tools 23:53 today and I thought I would uh break it down simply into a bit of an acronym sort of abmt so 24:03 a for acknowledge the stress which we talked about a little bit B for breathing M for moving and T for talking 24:11 and we'll talk about each of these so a BMT and the a standing for acknowledging 24:18 the stress and one way that you can do this is of course noticing how you're 24:23 feeling in your body and for some people that's really hard to do like it's like what do you mean like I'm here I'm 24:29 feeling that I'm here in this room but one way that you notice how you're feeling is through mindfulness which is 24:35 a word we hear a a lot um especially as more research is being done and I think 24:40 we'll just it's going to continue to be more and more present until one day it's starting to be prescribed just like 24:45 exercise is being prescribed which would be a great thing um so earlier I talked about how your brain recognizes 24:52 stressors and takes action be like using different parts of your brain to do that 24:58 so if you imagine your brain like a factory there's three key workers in your factory there's more than that but 25:04 when it comes to a stressor so I want to talk a little bit about your hippocampus and your amydala and your prefrontal 25:10 cortex and that sounds really fancy but we're going to make it not sound confusing um so when you encounter a 25:17 stressor such as a high morning blood sugar your brain May quickly remember 25:22 that you've had this experience before and that's your hippocampus I always picture 25:27 hippopotamus but that's your hippocampus taking part remembering like oh yeah I've experienced this stressor before 25:34 and then the hippocampus connects with your amydala which takes note um that you remembered it and that also perhaps 25:41 you felt frustrated and then if those two are working together you quickly go 25:46 from oh yeah this again I feel frustrated I felt frustrated last time or maybe avoidant or maybe angry and um 25:54 every time those two work together the hippo the Hipp campus in the amydala they can make you get to that from you 26:01 know you might have felt fine before you checked your sugar then you saw it was higher they can get you to that frustrated angry stressed environment 26:08 really quickly but luckily we have something in our brain called the prefrontal cortex which is kind of that 26:14 when you can run something through that prefrontal cortex it helps to not make 26:19 you go from zero to 60 as quickly so to speak so it helps our brain slow down 26:25 our reaction to stress and respond to it more productively so even if you do go 26:30 from 0 to 60 then once you do get your prefrontal cortex involved it'll help 26:37 you to uh kind of calm yourself so mindfulness is one of these things that 26:42 gets the prefrontal cortex involved it helps you to process that stress a bit more um manageably and mindfulness what 26:51 is it so John kabit Zin he's kind of the mindfulness Guru um a professor and 26:57 leader in the mindfulness world he describes it as paying attention on purpose to the present moment 27:05 non-judgmentally and it's really just exactly that um just paying attention to 27:11 something but not judging it not judging how you're feeling and uh not really 27:17 thinking about all the other things you have to do but knowing it's normal that you'll do that because you're 27:22 human and there are many ways that a person can incorporate mindfulness so 27:28 how you can start to do that could even be through mindful breathing which is 27:33 just sitting as you are and as you inhale saying inhale as you exhale 27:39 saying exhale to yourself like you can do that in your head and that's taking you out of you know your environment and 27:45 into your body and just kind of focusing on the way that breathing feels another 27:51 way could be going for a walk and just kind of rather than just going through the paces of the walk like you know how 27:56 if you're driving home sometimes times you might all of a sudden you're home you didn't even notice what was there but mindfully walking would be you go 28:03 for your walk and you notice all the colors and you notice all the sounds or say to yourself I think I'm going to try 28:08 to notice everything that's yellow so these things make you more Mindful and 28:13 you process things through your prefrontal cortex more so you kind of get your brain used to being more 28:19 Mindful and slowing down some people do something called the five senses meditation so that's um if they're 28:26 noticing they're getting being stressed they'll notice they'll take a moment look around them what are five things 28:31 that I can see what are four things that I can feel so maybe that's the temperature of the room you know the 28:39 feel of the table beneath them and so on three things that you can hear so maybe 28:44 like I can hear a long mower right now hopefully you can't two things that you can smell and that one thing that you 28:51 can taste and by the time you're at the end of those five things it can kind of help with that anxiety cycle or the 28:57 stress that's building in your body so those are a few ways to uh kind of acknowledge the stress or help you to 29:03 become more Mindful and then for B that was a and b 29:09 stands for breathing so we talked a little bit about mindful breathing and that is one way to come into your 29:14 breathing take your head out of all the to-dos and bring your thoughts back to your body um Andrew huberman he's um he 29:24 has a popular podcast called the huberman lab po podcast and he is a tenured professor at Stanford and a 29:31 neuroscientist and um he has a breathing technique that he talks about called the 29:36 fast lane to calm he didn't come up with it but that's what he calls it um and this technique is called the physiologic 29:43 Sigh so before anybody tries this it's a good idea to know um like if you if you 29:49 have a heart rate that's a lower heart rate or if you have any heart troubles you'd want to talk to your doctor before 29:55 you tried it because it actually is Prov impr it like it slows down your heart and the benefit of slowing down your 30:00 heart rate is when your body notices that your heart rate's slowing down it thinks okay I'm calm I'm safe and it can 30:08 help with that stress feeling so the physiologic Sigh you do it by doing a double inhale and an exhale three times 30:16 one to three times in a row and that that lowers your heart rate so it looks like the second inhale is kind of um an 30:23 awkward feeling but I'll show you what it looks like it's like a 30:31 so a nice long exhale and doing that one to three times can help to tell your 30:36 body you're okay even when you're not feeling okay it's kind of a trick it's like a hack um and it's best used when 30:42 you're starting to feel that stress build the m in the abmt stands for 30:48 movement and of course it's no secret that there's tons of research about moving your body and I just always like 30:54 to say it doesn't have to be anything fancy you know you don't have to be going to a gym or a runner a triathlete 31:00 or any of those things it's dancing with your grandkids or playing outside or gardening any extra movement will help 31:08 to um release some of those feel-good hormones that can help to combat those feelings you have distress with stress 31:14 and any any breaking up of sitting time will be beneficial too so if you're sitting right now and you feel like 31:20 standing feel free and then of course the T in the abmt stands for to and I mean mean 31:28 basically talk social support So talking with someone if you're open to for some 31:33 people that does mean counseling or therapy from you know a social worker or a counselor or a therapist psychologist 31:40 um but social support has been shown to be invaluable um and improve resilience to 31:46 stress and as humans we are wired for social interactions and research has shown that loneliness can be very 31:53 detrimental to our health even heard it kind of compared to smok um and some research even suggests that 32:00 loneliness increases stress so finding ways that you can connect even if it's not with humans if you're not a pupil 32:06 person maybe it's with pets or connecting with nature nature I 32:12 was just going to say I'm G to add an end to your acronym nature for me is a huge driver the fresh air and the beauty 32:20 and everything it just takes you to a place that um you know sitting on your couch probably doesn't do or or you know 32:27 know anything else so get Outdoors um so I know you're a yoga 32:33 teacher and you have an interest in meditation and um meditation and yoga 32:38 have been amazing in my personal life to help me deal with stress over the years 32:43 so um would you be able to lead us through a brief meditation just so people can understand what that 32:50 component of managing stress might look like for sure I'd love to and meditation helps to tap into that mindfulness of 32:56 course um sometimes I find that when people hear meditation are like nope can't do 33:02 it can't slow down my mind and that's I mean that's the whole reason we do it right um I there's a saying and I can't 33:10 remember it exactly on the spot but the the more resistant you are to it to try it you probably need it a bit more right 33:16 and and it's it's okay to feel like you can't calm down your thoughts because that's the whole point that it's to help you um to be able to maybe start to slow 33:24 them down or just have the experience what it feel like to have your thoughts slow um one of the favorite one of my 33:31 favorite meditations that I would teach in classes is one that comes from uh the 33:37 Calo Center or KOLO I might be saying it wrong um in Maine and uh it was created 33:43 by two senior yoga teachers named sand of shear and Grace McLoud and uh it 33:49 helps to move you through your senses a bit like the five senses uh the five uh Technique we were talking about earlier 33:56 and gets you out of your thoughts and into the present moment so you can do it sitting right in your chair as you are 34:02 now and if you want to just um take a moment to close your eyes if you're 34:08 feeling comfortable with that and I'll just talk you through 34:16 this so the first part of this meditation is to notice your breath 34:22 notice your breathing 34:29 and notice where you feel your inhales moving through your 34:40 body as well as your exhales do your inhales reach your 34:48 throat or do they land somewhere mid chest or do your inhales happen to land 34:56 all the way down within your abdomen in your 35:05 belly start to notice the length of your inhales and your 35:15 exhales not judging how anything feels but just noticing how your body feels when you 35:21 focus on your breath and if it's challenging today just know that that can change with 35:34 practice and as you start to bring attention to your breathing you might notice you know that there's a different 35:40 temperature when your air exit your nostrils compared to when your air is coming [Music] 35:46 in you might even be able to start feeling the air as it moves through the sinus cavities in your 35:55 head and you may notice that the inhales start to reach more down into your belly 36:01 whereas you could really only feel them in your throat 36:16 start so just resting your air your your thoughts on your breath the inhales and 36:23 the exhales and when you when you start to notice your mind wandering to walking your dog later or whatever it is don't 36:30 judge that just allow your thoughts to come back to your 36:39 breath the next component is relaxing how much more can you relax 36:46 your body right now notice what your face feels like and 36:54 can you release any p up kind of pressure or tension between your 37:02 eyebrows behind your ears to kind of soften your 37:09 jaw can you relax your neck muscles your 37:15 shoulders your arms and elbows your palms maybe they're baled up maybe you can just let your hands fall 37:24 open maybe you're holding your belly tight just let it relax your lower 37:33 back notice what your hips feel like people often tend to hold a lot of tension 37:40 there your glutes your thighs your lower legs your 37:48 feet and just take note does your body feel differently than it did about you know one minute ago when you brought 37:54 some attention to the tension where you that you might have been 38:06 holding next notice what you feel notice what it feels like to connect with 38:12 either your chair maybe you're sitting on the floor notice the vibrations in the room 38:19 if there are any do you hear any sounds 38:29 perhaps you're starting to get a bit of a cold do you notice any any uh pain or congestion in your 38:40 body and if you feel any of that tension just like we were talking about before 38:45 try to as you inhale send some relaxation to those 38:54 areas and start to notice also so how you feel 38:59 emotionally and know that just like the weather you're a human being and that 39:04 being perfect and feeling perfect every day is probably not a realistic 39:10 expectation but when you do have those great days to Rebel in it and enjoy 39:21 it and next I'd ask you ask you to watch the thoughts that flow through your 39:29 mind non-judgmentally so noticing them maybe not adding a whole lot of extra 39:37 thought to them just being kind to yourself about what's taking up the content of your 39:42 brain but noticing what's taking up that time in your mind and and is it is it worth it for 39:51 you and almost imagine being a witness to your thoughts so kind of like like a silent 40:01 Observer letting your sense of feeling move Beyond you know that physical part 40:06 and just watching watching the thoughts that are floating through notice how the 40:12 rational mind um kind of wants to compare and judge and seek 40:19 understanding um and just kind of say we don't need to do that right now we'll just 40:25 be 40:31 and then allow how much can you allow your experience right now to be exactly what 40:38 it is no less no more and know that it's it's the right 40:43 thing right 40:54 now so together together we'll take some nice easy breaths just inhaling through your 41:01 nose and exhaling through your 41:07 mouth and two more like that a nice long 41:14 inhale and release that breath let your shoulders 41:21 drop and then one more breath [Music] in 41:27 and let that breath go and if your eyes are closed just gently letting them come back to open 41:34 and coming back to the room back to the present moment just notice how your body feels 41:41 and if if you are finding like it feels better that's amazing if it was a bit uncomfortable that's that's pretty 41:47 normal too but like I said research has shown that with time this can be so 41:54 beneficial that was great thank you you and also like I um I feel like to the 42:00 point we were discussing earlier that becoming more aware of your body and the feelings going on in your body help you 42:07 become more aware of the stress that you're experiencing and I feel like meditations like that one where you 42:13 aren't doing affirmations or listening to music or sounds but rather just being 42:18 in your body um really help with that body awareness that can help you 42:24 identify and then EX dress better that's such a good point yeah it's great for 42:30 sure so just before we close this session off um are you able to share any 42:35 books or podcasts or apps I know you've mentioned a few throughout um that people could maybe take away from today 42:42 and um use to help manage their stress at home definitely for sure one that I 42:48 have used myself and that I recommend to people I work with or my friends or 42:53 patients is the free app from anxiety Canada called Mind shift and it's got it 43:01 has a number of useful like applications within it my favorite one is the thought Journal so if you're having these kind 43:07 of repetitive thoughts on repeat um you can go in and write out a thought and then it'll help you change it to be 43:14 maybe a bit more of a rational thought or um just to kind of make you question 43:19 your thinking because everything we think isn't always right so that's a great one uh another thing to do is to 43:26 look into the mental health services that are offered in your Province I know 43:31 I'm in Nova Scotia and uh there are a ton that not necessarily everyone is aware of so uh talking to healthc care 43:39 providers uh we have a number we can call here it's 211 to find and ask questions about that so if there's a 43:45 phone number you can call in your Province to see what resources are available uh that's a great 43:50 idea trying a free trial of any of the meditation apps like Comm or head space 43:57 if you need something or you would like something to listen to while you're trying out meditation or you know free 44:02 free YouTube videos there's a lot of great um YouTube things on YouTube and 44:07 it's about finding someone that you connect with a few books that I've really liked are the stress proof brain 44:14 by Melanie Greenberg uh I've read that recently and it just really broke down stress piece by piece and the best part 44:21 of it was the kind of the tools that are in it and uh are it's like an it's an 44:27 easy read it's not overly medical so I highly recommend that I like Buddha's 44:33 brain by Rick Hansen and Richard mandas and I like that kind of especially because of my yoga background but they 44:39 connect the S like Buddhism and mindfulness and the science like the neuroscience and the Brain science so 44:46 that's a really neat read and then lastly of course uh the Live free with type one diabetes podcast by the 44:52 diabetes psych psychologist mark hyon is a is a something that could be really 44:58 helpful with stress as well so I know that's type one but I think anyone with diabetes can benefit 45:05 from that yes what unites us um that's wonderful I know I have 45:12 taken a lot away from today um and I'm sure that um the people watching this 45:18 will also find it very informative so thank you oh you're you're so welcome and I I hope everyone's enjoyed 45:24 themselves today and uh I hope you'll uh if you have any questions or comments please join us in the diabetes dialogues 45:32 room from 1: to 2:00 p.m. on November 18th great yes yeah s will be there to 45:38 answer all your questions on that day so we'll see you then thank you again you're 45:47 [Music] welcome

0:03 [Music] 0:09 hi there my name is Michael valis I'm a 0:12 health psychologist from delaz 0:14 University in alax and I'd like to make 0:17 this presentation uh to you concerning 0:20 the really important concept of diabetes 0:23 distress some of the burdens associated 0:25 with diabetes and importantly how we can 0:28 move from being over welmed to being 0:31 empowered these are my disclosures the 0:34 interactions that I have with uh 0:36 for-profit uh 0:38 companies and the reference point for my 0:41 presentation is the following 0:44 psychological issues associated with 0:46 diabetes are certainly not experienced 0:49 by 0:50 all very few people experience 0:52 psychological issues with diabetes all 0:54 of the time but many people experience 0:57 occasional Tim limited problems and 1:00 managing diabetes is really around 1:02 overcoming challenges and so in some 1:05 ways we need to accept the condition and 1:08 work with it and this is where the 1:11 distress and the mental health aspects 1:13 of diabetes become so very The Mental Health Continuum 1:16 important and it's critically important 1:18 for us to put the distress associated 1:20 with diabetes into the proper context 1:23 and so I'd like to explain that to you 1:25 by talking about mental health really as 1:26 a Continuum and this is quite an 1:29 important um uh uh perspective really to 1:33 appreciate and let me explain it to you 1:36 because it really just describes life 1:38 and our experience of the events that 1:40 occur in our lives and what I mean by 1:42 that is the perception of threat will 1:46 naturally lead to the feeling of anxiety 1:48 the perception of loss naturally leads 1:50 to the feeling of sadness or depression 1:53 and the perception of intrusion or 1:55 unfairness leads to the perception of 1:58 the experience rather of anger so if 2:00 you're feeling irritable if you're 2:01 feeling resentful if you're feeling sad 2:03 if you're feeling anxious it's sometimes 2:05 useful to think okay what's the threat 2:07 what's the loss what's the point of 2:09 unfairness because this then can give 2:11 you a framework from which to move 2:14 forward and what's important about that 2:17 is because psychologists divide up 2:19 emotional experiences that people have 2:22 into two general categories and as you 2:24 see one category which describes many 2:27 experiences that we have from a mental 2:29 health point of you is what we call 2:31 primary emotions and this is where you 2:33 would expect that the threat would 2:36 create anxiety and a little bit of 2:38 threat should create a little bit of 2:40 anxiety a lot of threat should create a 2:43 lot of anxiety a threat that doesn't go 2:45 away should create anxiety that lasts 2:47 and I'm hoping that you can see how I'm 2:49 normalizing that experience because 2:51 what's really important about this is 2:53 life is ex is filled with stresses and 2:56 strains and those have emotional impact 2:59 and what what's important about there is 3:00 how we cope with those emotions how we 3:02 go to move forward from those emotions 3:04 and it's really by expressing them not 3:06 keeping them bottled up and actually 3:08 seeking support and so that happens 3:10 everywhere so that's really important I 3:12 think in terms of an empowerment point 3:14 of view acting on your distress as 3:16 appropriate but it is important to note 3:18 that sometimes stress gets overwhelming 3:20 we call those secondary emotions and 3:23 that's when you start to see some of the 3:25 emotional difficulties and so don't 3:27 assume if you're struggling that in fact 3:29 there's a significant problem it may be 3:31 that this is something that can be 3:32 managed if it's faced and 3:35 supported um it's important to 3:37 understand The Human Condition and and 3:39 when you think about the fact that you 3:40 know we have our plans we have our our 3:43 organized approach to life and all is 3:45 good but then life is also full of 3:47 stress and what's really important to 3:49 understand is that as stress goes up in 3:51 in a person's life it's really common 3:53 for self-care to go down and so this is 3:56 why it's important for us to identify 3:57 the stress so we can take action on Quality of Life 4:01 it and this is a point that I I think is 4:04 worth thinking about is that currently 4:06 in the in our in our society and 4:09 certainly inside the medical system we 4:11 we really have only one way to talk 4:13 about mental health and we tend to talk 4:14 about it in terms of of the diagnosis of 4:17 mental health disorders so the language 4:19 is often oh you're down well maybe 4:21 you're depressed or maybe you have an 4:22 anxiety disorder you're struggling with 4:24 maybe you have a personality disorder 4:27 and so there's the tendency to use 4:28 language that really finds um 4:31 significant mental health disorders and 4:33 those are based on really what's called 4:35 the diagnostic manual um and and it 4:39 really identifies Psychopathology is the 4:42 term which really means pathology of the 4:46 psyche but maybe the experiences that 4:49 people have are more normal that is 4:52 perhaps they're not abnormal and fall 4:54 outside of what would be anticipated 4:56 just like what I'm describing about 4:58 perception of lost threat 5:00 and so this raises the question as to 5:02 whether the emotions that someone is 5:04 experiencing should be seen as just part 5:06 of life to be managed or something that 5:08 really needs help and if we look at this 5:10 kind of Continuum of distress then at 5:13 some point the distress becomes so high 5:16 that it interferes with functioning and 5:18 this is where the diagnosis comes in but 5:21 there's a lot of Journey before you get 5:23 to that point anxious when threatened 5:26 sad when experience a loss angry when 5:28 experiencing unfairness 5:30 and so this sort of normal understanding 5:32 of emotions leads us to try of 5:35 understand like how do we really 5:38 understand ourselves and so a really 5:40 useful way of thinking about this is 5:43 what we call quality of life and what's 5:45 important about quality of life is that 5:46 it identifies distress as an important 5:49 component but doesn't stop there quality 5:51 of life is a balance between distress 5:54 the things that pull you down but also 5:56 well-being the things that bring you up 5:58 and shifting from overwhelmed to 6:00 empowered sometimes means focusing on 6:02 the well-being Dimension not just the 6:04 distress Dimension what I like about 6:06 this model is it allows us to understand 6:09 okay if you're feeling distressed what's 6:10 driving that distress and that distress 6:13 could be driven by the chronic disease 6:15 by diabetes itself and we know there's a 6:17 lot of aspects of diabetes that do cause 6:19 distress which I'll talk about but it's 6:22 also important to understand that just 6:23 problems of living social what we call 6:25 the Social determinance of health so 6:27 income location 6:30 marginalization uh life event stresses 6:33 that are really just m barriers that 6:36 would get in the way Social Services can 6:38 sometimes be really really useful there 6:40 and also we recognize that there could 6:42 be Psychopathology here so this is a 6:44 model that maybe guide you a little bit 6:46 and in terms of how do you manage the 6:48 distress that you're experiencing but 6:50 equally important with this is this idea 6:52 that we can talk about positivism or 6:55 resilience coping skills building on 6:58 your strengths and so I know this is a 7:00 talk about diabetes to stress but I Positivity 7:02 think it's important for us to 7:03 contextualize this by thinking about 7:05 positivism what can you do to enhance 7:08 the positive experiences in your life 7:10 and this is really what we call a 7:12 strength based approach that promotes 7:15 really resilience that ability to get 7:16 back and there's research in this area 7:19 around happiness that tells us that um 7:22 that happiness isn't really the result 7:24 of huge accomplishments and huge efforts 7:26 but actually small daily habits that 7:29 really determine well-being and habits 7:32 are that are shown to be consistent 7:34 amongst people that are you know 7:35 naturally happy they devote time to 7:37 family and friends they practice 7:39 gratitude and optimism they Savor life 7:41 Pleasures engage in meical activity 7:44 they're able to stay in the moment so 7:46 there does seem to be some strategies 7:47 that we could adopt that might actually 7:49 build on our 7:51 positivism and when we look at um 7:54 noticing the good in life what we see is 7:56 that intentional activity seems to be a 7:59 extremely powerful determinant of how 8:03 you're how optimistic how much of a 8:05 positive attitude that you take genetics 8:08 plays a big role but there's a lot that 8:10 we can do and optimism therefore really 8:12 could be looked at as a habit so as you 8:15 think about managing distress please 8:16 also think about what you could do 8:18 independently to increase the positivism 8:20 in your life and so we sometimes talk 8:22 about these happiness interventions as 8:24 you see here regularly setting aside 8:26 time to recall moments of gratitude 8:29 positive thinking about 8:32 oneself practicing altruism and kindness 8:36 affirming your most important values and 8:39 savoring your positive experiences now 8:42 this is an attitude that one can adopt 8:44 that's been associated with improved 8:46 coping and so I wanted to put distress 8:50 presentation in the context of happiness 8:53 at the same time and so now let's talk Diabetes Distress 8:55 about distress and this I think is 8:58 relevant for most of us us and so if 9:00 you're living with diabetes if you're a 9:01 family member or affected by diabetes 9:04 then it's important to recognize 9:05 potential sources of distress and if we 9:07 ask this question what's distressing 9:09 about diabetes we actually have a lot of 9:11 answers the behavioral demands of 9:13 self-care can be overwhelming there's a 9:15 lot of work to do maintaining glucose 9:18 control is actually 9:20 complex uh diabetes selfcare demands are 9:24 constant there's no real breaks and 9:26 diabetes can be unforgiving and diabetes 9:29 is certainly plagued by 9:32 uncertainty and so what you see there is 9:35 the threat and the loss and the 9:38 unfairness when you think about what 9:40 it's like to navigate the world of 9:42 diabetes and so this really justifies 9:45 kind of the normalization of the concept 9:47 of 9:49 distress and so one of the things that 9:51 we um find helpful when we think about 9:53 the concept of diabetes distress is to 9:58 really understand understand what's 9:59 driving it and in particular we like to 10:03 uh to frame diabetes distress in terms 10:06 of what the source of distress is 10:08 because then you can direct your coping 10:10 resources towards those let me be more 10:13 clear the first aspect of diabetes 10:16 distress that we like to identify is 10:18 what we call the emotional burden the 10:21 sense that you're feeling overwhelmed or 10:22 feeling bad about yourself because of 10:25 your diabetes that emotional weight if 10:27 diabetes was a a weight that you carried 10:29 in a napsack would it be a you know one 10:31 lb loaf of bread would it be a 5 lb B 10:34 bag of potatoes would it be a 50 lb iron 10:37 andil would it be a two-ton truck what's 10:38 the emotional burden second what 10:43 distress is associated with all of the 10:45 self-management tasks what we call 10:47 regimen distress the self- monitoring 10:50 the monitoring activity the 10:52 recordkeeping the medical therapies the 10:55 monitoring your feet and eyes over time 10:58 all of the time masks that could be ever 11:00 present in a person's life can be 11:03 burdensome and then there's the 11:05 relational aspects of diabetes we don't 11:08 experience or live with diabetes in 11:11 isolation and here we talk about 11:13 provider based distress something that 11:15 as a psychologist think is really 11:16 important for individuals living with 11:18 diabetes and Healthcare Providers to 11:21 acknowledge which is sometimes the 11:23 medical system the relationship with the 11:25 provider can be distressing and if 11:27 you've ever felt like uh sometimes going 11:29 to see um a medical provider or ENT 11:31 diabetes you feel like you're being 11:32 called into the principal's office or 11:33 you're feeling guilty that you're not 11:35 doing enough that's the kind of Provider 11:37 distress that we'd like to identify so 11:39 we can help you work through and the 11:41 final aspect of distress is what we call 11:43 social support distress people in your 11:45 life so emotional burden if diabetes 11:48 were a weight on your backpack that you 11:50 carried around how heavy would it be 11:51 important question to reflect on because 11:55 you may use words like you're feeling 11:57 overwhelmed you're feeling burnt out 11:59 you might experience what we call a 12:02 sense of powerlessness that there's 12:03 nothing that you can do because of the 12:05 complexity because of the number of 12:08 different factors that actually impact a 12:10 person's glucose level at any moment in 12:12 time you can feel sometimes like there's 12:14 not a lot that you can do to make a 12:16 difference and by identifying these it' 12:18 be really important for you because 12:20 acknowledging them bringing them into 12:22 the care plan is in most cases the way 12:26 that you manage these burdens regimen 12:29 distress is really around the actual 12:31 management tasks eating related distress 12:35 as you well know diabetes changes your 12:37 relationship with food because of 12:39 glucose in the food that virtually most 12:42 Foods we eat so they do have an impact 12:44 on your glucose levels and therefore 12:46 kind of food almost becomes like a 12:48 medicine in a way and so that is a 12:51 source of distress and certainly 12:53 hypoglycemia distress which I'd like to 12:55 talk about in a little um bit because 12:57 it's also an important important aspect 13:00 and so with regard to the the regimen is 13:02 it just overall tasks or specifically 13:04 related to food or to the potential for 13:06 low glucose levels and if you can 13:09 understand your emotional experience 13:10 that's then the strategy that leads to 13:12 the solutions that can be helpful to you 13:15 provider-based 13:16 distress um you know have you ever felt 13:18 like I can't really tell my diabetes 13:20 doctor what's really on my mind or my 13:22 doctor provides my diabetes doctor 13:25 providers don't really understand what 13:26 it's like to live with diabetes I don't 13:28 really get the help I need from my 13:30 diabetes providers um my diabetes 13:32 providers don't know enough about 13:33 diabetes care and so you can see from 13:36 what I'm presenting here these are 13:37 actually normal these are common 13:40 experiences that people have and so 13:42 we're trying to really you know open up 13:44 the uh opportunity and encourage people 13:46 living with diabetes to express these 13:48 concerns to us so we can then help 13:51 manage those and social support distress 13:54 people might treat you differently if 13:56 they find out you have diabetes you may 13:58 feel that you have to hide your diabetes 13:59 from other people you're concerned that 14:01 diabetes makes you less attractive to 14:03 employers people will think less of you 14:05 and we do see there is a signal for 14:07 diabetes stigma and again if you're 14:10 experiencing this this I think can be 14:12 really beneficial for you to become 14:13 aware of because when we understand the 14:17 sources of our distress so threat loss 14:22 unfairness then that allows us to direct 14:25 our coping resources and when it comes 14:28 to coping 14:29 the best way to think about it is for 14:31 you to identify what's worked for you in 14:34 the past so what are your natural coping 14:38 strategies what are the coping 14:40 strategies of your friends or people 14:42 that you trust or people that you might 14:45 be encounter who also live with diabetes 14:47 who are able to manage the diabetes 14:50 quite well so can we learn from others 14:52 in other words trying to to Really 14:54 encourage us to problem solve and to 14:57 really kind of identify ify the nature 15:00 of the stour the more specific you know 15:01 what the problem is the more you can 15:03 match that to a strategy and Diabetes 15:07 Care is Shifting towards providing you 15:09 with the opportunity not only to problem 15:11 solve around eating behaviors or 15:14 exercise behaviors or self-monitoring of 15:16 your blood glucose but also your 15:18 emotional 15:19 experiences now as we talk about 15:21 diabetes distress there's also important 15:23 to talk about two uh relevant issues for 15:26 diabetes that have sort of also been 15:29 identified through this work that we've 15:30 done in defining diabetes distress as a 15:33 separate category and that is um for Psychological Insulin Resistance 15:37 particularly with type two diabetes 15:39 there's often some concerns that people 15:41 have around um shifting from oral 15:44 medication just taking pills to taking 15:46 insulin and interestingly the term 15:48 that's used is called psychological 15:50 insulin resistance um I'm just showing 15:53 you data from a large survey based study 15:56 16 countries were involved in the Sur 15:58 survey and you can see that a great 16:00 number of people with type 2 diabetes um 16:03 actually you know are concerned about 16:06 starting insulin means that that you 16:08 know you've not really been able to do 16:10 your job really well so so these are 16:12 saying that this is actually a concern 16:13 and and there are certain attitudes that 16:15 people have around whether diabetes um 16:19 takes control away from you when you 16:21 shift to insulin whether that means your 16:23 disease is more serious whether it means 16:25 that it to you you feel that perhaps 16:27 it's a it's a personal failure so again 16:31 understanding these attitudes can be 16:33 really really important because what we 16:35 know is that type two diabetes can 16:37 sometimes progress to the point where 16:39 your pancreas doesn't produce enough 16:40 insulin anymore so insulin resistance 16:43 becomes insulin insufficiency and 16:45 insulin is then required and so asking Attitudes 16:49 yourself a number of questions might be 16:50 really helpful in identifying any 16:53 attitude that you might have that would 16:54 interfere with care and the reason that 16:57 I'm describing this is because there's a 16:59 very recent phenomenon that we've become 17:01 aware of in Diabetes Care called inertia 17:03 and that is when it's appropriate from a 17:05 medical point of view for people's uh 17:08 care to be intensified but there's a 17:10 delay in the intensification and there's 17:13 number of factors that are responsible 17:15 for that delay and one of the important 17:16 factors is your own attitudes and so 17:19 asking yourself and having an 17:20 opportunity to talk about these 17:22 attitudes might speed up the care which 17:24 results in better control for you do you 17:28 feel that insulin will take control or 17:29 Freedom away from you do you think that 17:31 starting insulin means that you failed 17:34 are you nervous about or anxious about 17:37 injecting do you think that starting 17:39 insulin is more work than it's worth 17:41 that you won't get any benefit from it 17:43 do you think that insulin means that 17:45 your disease is more serious and do you 17:47 lack confidence these are relevant 17:50 questions if you could take these issues 17:53 take these questions if you struggle 17:55 with any into your provider then your 17:57 care plan can take these into 17:59 consideration the final thing that I Fear of hypoglycemia 18:01 want to really talk about is is the fear 18:04 of 18:05 hypoglycemia which we know is actually 18:07 really really common especially if 18:10 you've ever had a serious hypoglycemic 18:12 event which is when your blood sugars 18:14 Get Low to the point where you can't 18:15 really treat them yourself and this is 18:18 important because what we we've 18:19 uncovered is that that this type of 18:22 hypoglycemia experience is very 18:24 stressful it's a really powerful stress 18:27 and it's such a stress that people will 18:29 sometimes allow their blood sugars to 18:31 stay high in order to avoid going low um 18:35 showing you additional data about 18:37 concerns about hypoglycemia this is from 18:39 that same study that I'd mentioned U 18:42 before 16 countries just showing how 18:44 common it is for people living with 18:46 diabetes to experience this fear of 18:49 hypoglycemia so there's a strategy that Managing hypoglycemia 18:51 we've encouraged people to do that can 18:52 help them to manage hypoglycemia 18:54 sometimes what will happen is your 18:56 provider will recommend you get your 18:57 sugars under control 18:58 but managing the fear of hypoglycemia is 19:00 a fear problem not a glycemia problem so 19:03 the first thing we do is we determine a 19:05 safe zone so what blood sugar range do 19:07 you feel comfortable with right now if 19:08 you're going to leave the house what are 19:09 you comfortable with and that's the 19:11 starting point that's in a way the 19:12 psychological safe Zone and then we 19:15 don't make recommendations based on 19:17 ideal we don't recommend that you you 19:18 know get your glucose levels let's say 19:20 between seven and nine right away what 19:22 if your safe zone is 12 to 15 what we do 19:24 do is we sort of start with that and 19:26 then we try to lower Gra gradually the 19:28 psychologically safe range till it 19:31 becomes the medically safe range so once 19:34 you've got this on board then there's 19:37 this gradual strategy it's important 19:40 because it's a strategy that really 19:42 engages you so you're in charge it's not 19:45 something that's done to you and then 19:47 you gradually are able to lower that 19:49 psychologically safe range to the 19:51 medically safe range so I hope this has 19:53 been useful to you we've talked about 19:55 diabetes distress we've talked about 19:57 fear of H glycemia we've talked about 19:59 psychological insent resistance and 20:01 importantly we've talked about 20:03 positivism thank 20:10 you

0:03 [Music] 0:13 hello thank you for joining us today my name is Muhammad najib ashra uh najib and I'm pleased to be here today talking 0:20 to you all as someone who has been living with type 1 diabetes for over 33 years and a patient advocate for people 0:26 living with diabetes the topic of mental health is very essential I was unaware of the condition when I 0:32 was first diagnosed as a child it took a toll on me when I could not perform regular activities which I could before 0:39 diagnosis the questions were too many but at that age science was not so Advanced for me to be guided effectively 0:46 or helped in any way except with my family's support I've lived struggles daily since then to reach a stage where 0:52 I can now make a difference in mine as well as others people's life how I stay 0:58 tuned to my mental health while living with diabetes is simply by acknowledging and accepting that there is some 1:03 challenge or obstacle that they need to work on and ignoring is no sign of strength being aware of what your body 1:10 is communicating with you is an essential first step towards tackling this giant of mental health the thing 1:16 that I find most helpful in managing my mental health is selft talk and a cluster of activities I term ambitious 1:24 it stands for accept acknowledge being inquisitive talking or Comm 1:29 communicating optimistic and seeking support when needed thank you for listening to my 1:35 short journey and with that it's my pleasure to introduce our keynote speaker Dr Jessica kishler who will 1:41 speak to us about the emotional side of diabetes including distress burnout and self- advocacy Dr kitler is a clinical 1:49 and health psychologist and associate professor in the department of psychology at the University of Viner 1:55 she specializes in clinical intervention research and psychosocial adjustment M and coping with type 1 diabetes in Youth 2:02 and families she worked as a diabetes psychologist and certified Diabetes Care 2:08 an education specialist at two academic medical centers Children's Hospital of Wisconsin and Cincinnati Children's 2:15 Hospital Medical Center in the United States for almost 15 years before moving to Viner Ontario in 2:22 2020 currently her interest lies in supporting college aged students with type 1 diabetes most effectively 2:29 transitioning into young young adulthood she's also involved in diabetes education practices and appreciates 2:35 working collaboratively in inter disciplinary settings and with that over 2:41 to you Dr gisha hi everyone welcome to the emotional side of diabetes distress 2:46 burnout and self- advocacy my name is Dr Jessica kitler and I am a a clinical and 2:52 health psychologist at the University of Windsor and an associate professor in the department of psychology I'm also a 2:59 certified diabetes IES care and education Specialists um registered in the US and I'm looking forward to um 3:06 presenting a little bit today um about mental health and diabetes and how they 3:12 intersect this is my disclosure slide um so these are the following for-profit 3:18 and non-for-profit organizations that I've had affiliations with over the last two 3:24 years and I want to jump right into the three objectives I'd like to cover today in our time together so the first 3:31 objective is to really understand the diabetes and mental health clinical practice guideline updates from 2018 to 3:41 2023 and then the second is to um learn a little bit more about how the emotional side of your Diabetes Care um 3:49 Can impact um your medical care and your interactions in the healthcare 3:54 system and then number three I want to um spend some time on advocacy and 3:59 learning how to advocate for your own emotional needs within the framework of these new clinical practice 4:06 guidelines so like I mentioned before um our first objective is to understand the updates to the diabetes mental health uh 4:13 clinical practice guidelines um abbreviated cpg so if you hear me say cpg it it refers to clinical practice 4:21 guidelines the last um version was in 2018 and we just published the most 4:27 recent version in 2023 and basically what the clinical practice guidelines um it's put out by diabetes 4:34 Canada and published in the Canadian Journal diabetes and this is a framework of recommendations and best practices 4:42 for the Health Care system in um treating and working with individuals who have all types of diabetes and so 4:50 each of the um clinical practice guidelines has chapters and there's one chapter dedicated to diabetes and mental 4:56 health this last chapter was last updated in 2018 and so being that it's been 5 years 5:03 it was time to do some updates um to those clinical practice guidelines so we 5:09 had a expert working group um that was filled with psychiatrists community 5:14 members endocrinologists psychologists um Family Physicians um and a wide U variety of 5:21 people who have specializations in type 1 type two children adults um and 5:26 bringing all of their expertise at the table to really update uh the guidelines 5:32 from 2018 so this is a brief timeline of when we started to establish ourselves 5:37 in March of 2022 and all of the different steps we went through to have 5:43 um an Evidence review and synthesis team over at McMasters um our writing time we 5:49 presented at diabetes Canada's professional conference last November and then it was published in June 2023 5:57 so given that that was a couple of uh months ago I wanted to spend some time talking to you about um these clinical 6:05 practice guidelines and how they impact you and how you can expect your diabetes um care to change or to be enhanced um 6:14 especially on the emotional or the psychological side of your diabetes so just as a quick big picture 6:22 summary um we reorganized this chapter it was a major overhaul into 14 key 6:27 messages for people with Di I abetes so we're not we don't have time today to go through all 14 of them what I have done 6:35 here is i' I've put in bold um the sections that were new and newly added 6:41 from 2018 to to now so that was stigma associated with diabetes financial 6:46 burden and Co 19 and then I underlined the um the sections that were heavily um 6:52 increased and improved and enhanced and that was diabetes and pregnancy substance use and diabetes and the use 6:58 of psychotropic medications or medications for psychological issues like depression and anxiety and and um 7:05 the intersection between those medications and diabetes management so 7:10 um this clinical practice guidelines is available um on the Canadian Journal of 7:16 diabetes website um it is open source you can go and do a deeper dive into 7:21 this but what we're going to do today is I highlight I'm going to highlight um a little bit on the section on living with 7:28 diabetes and the emotional side of diabetes so we can talk a little bit more about strategies that you can use 7:34 to help um you live your best life with diabetes and then we'll shift over a little bit into stigma associated with 7:42 diabetes and the financial burden of diabetes just to really understand how these two um situations can really 7:49 impact your distress um with diabetes so that's where my focus is going to be but 7:54 please um now that you know the cpg updates are out there please go download them go look at them go read them 8:01 they're long um but there's lots of other information um for you um to know 8:06 and for your Healthcare Providers too so like I said I wanted to start with living with diabetes the emotional 8:13 side of living with diabetes and as I'm as you well know I'm not telling any of 8:19 you anything new um but just to summarize diabetes can be stressful and 8:24 it's associated with challenges and disease acceptance so accepting the fact that you have um diabetes whether it's 8:31 type one type two um gestational all of the above as well as treatment 8:38 acceptance um if you have type two and you're sort of progressing along from oral medications to to insulin um 8:46 accepting that that is the next steps in your in your care and treatment participation your self-management all 8:53 of the daily task that you have to do can be very stressful so we also know 8:58 that diabetes is is associated with increased likelihood of of of mental health disorders so stress is one thing 9:05 but um having a mental health disorder like depression anxiety or uh disordered eating those are the top three um 9:14 clinical disorders that we see at a higher rate within individuals with diabetes so we know that we paying 9:20 attention to your mental health is very important um and uh and we'll talk a 9:26 little bit more about strategies to um enhance this what I'm really going to focus in on today is separate from the 9:35 mental health conditions like depression anxiety or disordered eating is really 9:40 some of the psychological problems that may not have um a clinical diagnosis but 9:45 we know are very significant so the first one being diabetes distress um there's also hesitance to 9:53 initiate insulin like I mentioned before and the fear of hypoglycemia sort of the anxiety or the fears of going low or 9:59 having a low and an uh unfortunate unfortunate space um so but I will talk 10:05 a lot today about um diabetes distress and what you can do to challenge that b 10:11 because we know more than half of the people with diabetes will experience diabetes distress at some point um in 10:18 their lives so I want to highlight that one even though we know that there's way more pieces to the puzzle in terms of 10:25 all of the different emotional pieces to having diabetes so let's jump into how can you improve 10:33 let's let's get some take-home tools of how you can improve your emotional side of your diabet Diabetes Care going 10:40 forward so I'm throwing around a lot of terms and so I want to slow down a little bit and really spend some time 10:47 defining um some words you may have heard or some terms you may have heard and and people use them interchangeably 10:54 and so really picking apart what's the difference so there's diabetes distress and then you'll hear diabetes burnout um 11:02 and so we're going to talk a little bit about what the difference is and and what this chart is over here on the 11:07 right is um a a normal curve and we think if your stress level is very high 11:16 then your performance level or your ability to do your diabetes care and your self-management every day all day 11:23 um it drops obviously when your distress gets really high you can get so distressed that it impacts your 11:30 performance on your diabetes care but we also know too little stress and being 11:36 toback or too um or not worried enough 11:41 not worried enough but not uh concerned enough or taking it seriously enough um we also know that that can decrease your 11:48 performance level because maybe you don't see it as um that important or um 11:53 as as um High Enough of a concern for you so we really do like to have this optimal 12:01 level of your stress so I'm not here to say oh I'm going to take all your stress away I want you to feel completely 12:08 relaxed in at all times there's always going to be a a moderate level of stress 12:13 and that's the the place where we feel like that's the optimal level to have a moderate amount and that's where we have 12:20 the highest performance and you're not so high that you're moving into distress but you're also not so low that you're 12:26 too laidback about all of that need needs to be done so um so that's the 12:31 backdrop a little bit of when we're using the word distress and and what we mean about that stress level being too 12:38 high or too low or just right in the middle so to get into the definitions a 12:44 little bit um of diabetes distress versus diabetes burnout so diabetes 12:49 distress is really the negative emotions I.E the stress that we just talked about on the previous slide that's experienced 12:57 by individuals with with diabetes and they can feel burdened and challenged by their care or they may have ongoing 13:04 worries and um that are associated with diabetes so it's really that emotional side that stressful side and then 13:12 diabetes burnout is where you feel mentally emotionally and physically 13:17 exhausted by the um by diabetes and you then they start to develop some 13:23 difficulties with your Diabetes Care such as avoiding it feels so overwhelming that then you sort of push 13:29 it away a little bit and say oh my gosh it's so overwhelming it's normal human reaction if something is super 13:35 overwhelming if we have um a big report at work or an assignment at school and 13:41 it's just so overwhelming we sort of procrastinate it or put it off or try to avoid it a little bit so that's normal 13:48 human behavior but we know when it comes to diabetes if you start to avoid too 13:53 much or detach from your support systems too much because diabetes is so f 13:58 physically mentally and emotionally overwhelming then you have problems keeping up with your self-management and 14:04 your daily cares and you feel powerless and hopeless about diabetes so some ways 14:10 you avoid or give up on it a little bit so distress has much more of the emotional side but you may or may but 14:17 may or may not still have the ability to keep up with your self-management tasks 14:22 but diabetes burnout is you're so overwhelmed that you start to detach and avoid and procrastinate doing your 14:28 diabetes on uh over time there was a study that was done that was um a 14:34 scoping review um because even individuals in the research world uh 14:40 don't always have these uh terms very well articulated but this was a nice 14:45 article that sort of talked about the difference between distress burnout and depression because they all can overlap 14:52 but also be distinct and so they had just a whole host of different descriptive words over here that that 14:59 really lend lent themselves to distress and then to burn out and this is more of 15:04 the exhaustion the apathy the disengagement uh and then the depression is when it crosses over into Beyond just 15:13 diabetes and you start to become depressed in multiple areas lose interest sleep concentration all of 15:20 those things so um it's just a a good thing to do to think a little bit about distress and then when does it tip into 15:27 to burnout and then when does it tip into depression so when we're thinking about 15:34 um you experiencing distress and and having high levels of distress and you 15:39 sort of say oh I'm kind of over that top of that that hump of that curve or you 15:45 really experience a really um High stressor I want to teach you very 15:50 specific coping strategies because I'm sure a lot of people on this on watching this has seen coping strategies has read 15:58 books about it I've done all these different things and as you know one size does not fit all so I can't sit 16:04 here and say do this coping strategy and this will work for you no matter what 16:09 the stressor is what I want to tell you is we actually have to go back and 16:14 actually think about the characteristics of the stressor because not every 16:20 stressor is the same therefore not every stressor has the same coping response so 16:26 rather than saying oh if I just go for walk that's always going to work or if I just take deep breaths that's always 16:32 going to work it's not always going to work and so I have this um graph here to 16:39 really show almost like a Choose Your Own Adventure if you will um and you want to think a little bit more about 16:46 what is the stressor that I'm experiencing what is it about diabetes right now that is stressing me out is it 16:52 that I'm having technology failures is it that I'm having it lows in the middle of the night is it what is it that is 16:59 causing the stress or am I having fear of lows am I having worries about future 17:05 um complications what what is it that's really making me feel stressed so you have to do a little bit of 17:12 self-reflection and then you have to ask yourself do you feel like you can 17:17 control and I put control in quotes because like really can we ever really control anything but can you control the 17:25 source of that stressor so if the stressor is I work out and I have a low 17:31 every time I'm on the treadmill that might be something that oh I might be able to control that in 17:39 the sense that yes I could use some problem solving skills to do some different diabetes self-management 17:45 skills to cope so before I get on the treadmill I'm going to make sure I have 15 grams of carbs or I'm going to make 17:52 sure I'm running at least at a you know at least at a five or a six or something 17:57 to make sure that I if I go low I have some wiggle room so there are some 18:03 problem solving strategies you can do that you all are masters of of oh let's 18:09 tweak this let's try this let's experiment with this so if it is a stressor but it is something you feel 18:15 like you have a behavioral change that you can do um to cope then yes use your 18:22 problem solving skills but there's sometimes you can you can't really 18:27 manage or control the source of the stressor maybe the stressor is even when 18:34 I run my blood glucose in target range I occasionally have an a low out of the 18:40 blue or I do all these things and and I have this fear of low even though I actually have never had a low driving 18:47 but I have this fear of it well you can't always control that fear because 18:53 you've done all you can problem solving wise to to prevent the low maybe while you're driving but you can con you can 19:00 manage or control the emotion or the thought um in response to that um that 19:07 stressor so you say I've done what I can to um be safe behind the wheel of a car 19:13 I can do U my deep breathing I can regulate my emotions I can tolerate this 19:19 I I know I'm doing the right thing I know I'm safe I know I'm as well as safe as I can be um and I've done the right 19:26 the right thing so you can do what we call cognitive reframing of you know my fear of lows are going to be there but 19:34 i' I've done what I can to to manage that fear um and I can do things to um 19:41 cope with the maybe the heart racing or the fast breath um that is coming 19:47 because of that emotional reaction so um you may not be able to control the and 19:52 say okay I'm never gonna have a fear of a low in the future there's going to be fears of lows at times but you can Ma 19:59 you can manage your reaction to that fear and sometimes diabetes really can 20:06 feel like you can't control either the um the behavior or the thoughts around 20:13 it right so sometimes okay I can take a behavioral approach I can take a thinking and emotional approach and 20:19 sometimes it's just really overwhelming and it might be a a fear of the future 20:25 or a fear of having um to have a more intense Ive uh regimen or something like 20:30 that and so if you feel like I'm stressed and I don't feel like I can control the behaviors or the emotions 20:37 and thoughts then what we want you to do is really engage in what we call mindfulness and that's where for a 20:43 little a short period of time um you get a little distance from diabetes and this 20:49 is where you can go for a walk you can do your mindfulness breathing um there's all kinds of different tools and 20:55 techniques around even just being in the present moment there's a grounding technique where you quickly do five 21:02 things you can see four things you can um touch three things you can hear two 21:07 things you can smell one thing you can taste so you do something that gets your 21:12 body back into the here and now and really grounds you you go out in nature 21:18 and you look at the different colors you do a rainbow walk where you try to look around and find one thing that's red 21:25 green Roy G blue indigo violet um so you do the uh rainbow walk so 21:31 there are all kinds of things where if you can't do the behaviors and you can't get out of your head you do things 21:38 physiologically that get your body and your brain back into the present moment grounding you in a mindfulness activity 21:47 and that gives your brain a chance to reset decrease the amount of stress 21:52 hormones that are being released and help you then go back and focus now you can't stay permanent ently in distance 21:59 and mindfulness because then that crosses over to avoidance but you can go there for a brief period of time just to 22:06 manage um maybe some of the overwhelming thoughts feelings and behaviors that are happening so I wanted to go through the 22:13 slide with a little more depth so that you could really start to think about um where what stressor deserves what type 22:20 of a response um so that you can really design it and individualize it for 22:26 yourself so now want to switch over to stigma associated with diabetes um like 22:32 I said before this was a new section added to the cpg guidelines for 22:37 2023 and as uh many of you have probably already heard but I will Define it for us here stigma is the experience of or 22:46 or perceived experience of so it can actually be an experience where you have it or you're perceiving that it happened 22:55 it it doesn't have to actually have happened you can just perceive it or could be indirect or direct but 23:01 basically it's um experiencing that judgment or the shame um that can come 23:07 along with having um diabetes and so it could be discrimination it could be 23:13 shame it could be judgment but for for some way shape or form others are 23:18 judging or discriminating or making decisions and assumptions about you um 23:24 based on some characteristic and here we're talking about stigma associated with diabetes so you could have social 23:30 stigma where others um May judge on the fact that you have diabetes they may 23:35 judge that you quote unquote caused it um or they may may think of myths about 23:42 it so that's social St stigma um there's also structural stigma which comes from 23:48 um systems like the Health Care System might have stigma um against 23:54 individuals um with diabetes again they make make assumptions about um your 23:59 physical activity level or they may make assumptions about how well or not well 24:04 you're managing your diabetes um so there can be some structural uh stigma 24:10 that that happens and especially relevant here is all the diabetes related so they may make 24:15 judgments about um you because of your diabetes status and a lot of this can 24:21 happen um around weight and weight based stigma that's where a lot of the structural um stigma happens too and and 24:28 Healthcare Providers are are not above um perpetuating negative stereotypes about 24:36 weight and what uh personality characteristics are associated with weight which then can IM negatively 24:43 impact the um patient provider um interactions and Communications and then 24:49 individuals can start to internalize or have that self stigma around their weight and shape and and their body 24:56 composition and so so there's been some research out there that shows that not only does this just feel uncomfortable 25:03 or that this is emotionally um damaging and hard but it also really impacts 25:10 Health outcomes so um there's been some research that shows that individuals who 25:16 perceive or Andor experience weight-based stigma um in the healthcare 25:22 setting um they have higher levels of um elevated cortisol levels and cortisol 25:27 levels are is the stress hormone that gets released and when the cortisol levels are released we know that insulin 25:34 um isn't absorbed as well and so there's more insulin resistance so the insulin isn't working as well higher blood 25:41 pressure and decreased glycemic stability so your blood glucose levels go up and down more um because of these 25:49 or related to I shouldn't say because of but related to these patient provider interactions so when people are 25:56 perceiving um this stigma it really does have a health impact as well as a a 26:01 mental health impact so it's very important that when you notice social 26:07 stigma whether this is with um people in your immediate vicinity at your home in 26:14 your at your work at your school in your neighborhood or the more structural in your health care System Network um we 26:21 know that diabetes stigma um leads to all of these Health outcomes 26:28 but it also leads to decreased self-management so if you feel that social stigma of someone's going to 26:34 judge you um at work you may be a little bit less likely to pull out um your CGM 26:40 on your phone and and and scan your CGM or do something like that so um you want to be very aware of how diabetes stigma 26:49 is being internalized by you um in making sure that you don't let it negatively impact uh your 26:56 self-management um or your other health uh conditions and one of the ways that you can do this 27:03 is really by identifying your support team and really thinking about who is in 27:09 your network who do you surround yourself with because the research really shows that if you have a strong 27:15 social support network it really does buffer social stigma now I wish I could 27:21 wave my magic wand and make some waiter at um a restaurant not discriminate 27:28 against you or or demonstrate social social stigma towards you I can't we 27:33 can't control Society but what you can control is who's in your immediate 27:38 vicinity who's going to help you buffer that help you improve your outlook and your perspective increase your 27:44 self-management skills and promote these Health out these positive Health outcomes and that really can help offset 27:51 this so some of the places that I want you to right now while you're watching this video is to think about is to um 27:59 think about your your social support resources is it all you want it to be are there people that you need to add to 28:06 it you could have people in the Inner Circle um parents siblings friends romantic relationships Partners you 28:14 could have Outer Circle relationships Healthcare team members who are supportive and and not engaging in in 28:20 stigma stigmatizing you extended family community religious groups diabetes 28:25 organizations such as diabetes Canada blogs all of social media that are 28:30 positive and so typically we think of our social support as coming from our Inner Circle but it doesn't always have 28:38 to be we don't have to do this I want you to really be thoughtful about who 28:43 you get to place in your social support network we don't have to have the people 28:49 that are in the Inner Circle if we feel like they're not actually that helpful 28:55 of support so you get to decide which relationships are in your um support 29:01 network and which are in the outer and oftentimes it's based on who you trust to support you in an effective way so 29:08 really spend some time thinking about who do you want to move in who do you want to move out who's maybe in a little 29:15 bit who's in all the way and think of it as something that can move and change over time and that you don't just have 29:22 to accept the people who are in your immediate vicinity if you don't feel like they are supporting you very 29:29 effectively so I want you to um do a little tree ring exercise I'm just going 29:35 to talk you through it so you can either just keep listening to the video or you can pause the video for a few minutes 29:41 and do this tree ring exercise and then come back um but what the tree ring exercise is I keep talking about these 29:47 inner circles and these outer circles I want you on a piece of paper to draw um 29:53 a number of circles so with you in the middle and then an Outer Circle Circle and then maybe another Outer Circle and 29:59 you can go as far out as you want I usually suggest that people do two or three rings and I want you to physically 30:05 write down who is in your inner circle of support that you trust that you find 30:12 effective that would help buffer some of this stigma and I want you to think about maybe some people are in that very 30:19 tight Inner Circle maybe some are out a little bit maybe it's co-workers people at work but maybe your inner circle or 30:25 people that you see um at home or in your neighborhood and then work is a 30:30 little bit outside and then maybe outside of that is your health care you can do it any old way you want but just 30:37 spend a moment to actually in a concrete way think about your support network 30:42 think about where there might be holes think about wow I actually have a lot 30:47 think about where you might want some more holes think about um ways that you can reach out um doing activities like 30:55 this with diabetes Canada and and joining and and um interacting and 31:00 watching uh workshops and and connecting to other people with diabetes um you 31:05 could build that up so take a few minutes and do a treeing exercise for 31:10 yourself to really reflect back where your social support network really 31:22 stands okay and for those of you who paused your video um to do the tree ring 31:28 exercise welcome back for those of you who are continuing to watch and we'll do it later that's fine as well I do want 31:34 to shift gears into another source of distress since we're really focusing in on Diabetes distress is the financial 31:40 distress of diabetes and so we know diabetes is a chronic condition associated with significant health care 31:46 costs there's both the direct cost things like the cost of medications your supplies um if technolog is covered by 31:54 your insurance if it's not covered by um your insurance Insurance healthcare provider appointments food plans all of 32:00 the things um those are direct but there's also indirect Co costs um if you have decreased um productivity during 32:07 work during a day because you're managing a severe low um managing the complications where you might have to 32:13 have extra doctor's appointments and and Miss more work or have hospitalizations related to diabetes so we know there's 32:20 both direct and indirect costs and so again I'm not telling you anything you don't already know but the um clinical 32:27 practice guidelines really talk about um and highlight for the healthc care providers to really put at the Forefront 32:34 how much people with living with people living with diabetes are affected by these costs and how these might impact 32:41 Optimum levels of self-management so if someone's um not able to afford all of 32:47 the insulin that they need in a month or if they're not able to afford all of the strips or they run out and they aren't 32:54 able to get more or whatever that is is that these really do impact um one's 32:59 ability even with the best of intentions to to take care of diabetes and and do all the self-management tasks sometimes 33:07 access to resources and financial um burdens really um negatively impact 33:13 one's ability to to take care of diabetes so your Diabetes Care team should should be regularly inquiring 33:20 about financial burdens um for you they should be um offering some other 33:26 programs government Community programs um that they have worked out to help 33:31 offset some of these costs because we know that that distress um if you don't 33:37 feel financially stable with your diabetes how do you have um the bandwidth and the and the mental 33:43 capacity to manage all of the other pieces of it in terms of feeling overwhelmed with the day-to-day 33:49 management so to summarize um how can the cpg guidelines impact your care um 33:57 with the awareness and impact of diabetes emotional functioning relationships healthc care providers should regularly ask you about your um 34:05 emotional functioning and your coping and your adjustment they should be using 34:11 screening questionnaires so the cpg guidelines really um recommended that um 34:17 they cons that healthc care providers um should consider it they don't require it 34:23 but a healthc care provider should be really asking Andor using screeners and those are 34:29 little questionnaires that have been validated that ask about your emotional U functioning with diabetes um and we 34:36 have specific ones around diabetes distress and depression and anxiety and so there's all kinds of different 34:41 screeners out there so the diabetes team can also help you manage this distress 34:47 use them as a resource they have lots and lots of um strategies and coping and 34:53 and tools that they can help you with or they can refer ref you to a mental health 34:58 services um healthc care providers um are advised and and the cpg guidelines 35:04 are very clear about having them start to manage and pay attention to their own 35:11 weight-based biases and their own internalization of of weight based stigma to minimize how much that is then 35:18 translated to you as as their patients um in these in communication and how 35:25 much um their sort of aware of perpetuating stigma and so Healthcare 35:31 Providers are um also encouraged to inquire and and really keep up todate on 35:36 various um supports for the financial um burdens um and really help reduce the 35:41 direct and indirect cost of Diabetes by um assessing counseling and providing 35:47 resources for you so um in our last little bit I want 35:52 to um end on objective three of of talking about self- advocacy see um so 35:58 we talked a lot about different emotional um aspects to diabetes what you can do as an individual to cope but 36:05 how do we also look at self- advocacy and what can you um sort of expect and 36:10 do within these new um cpg Health Care guidelines for mental health and 36:16 diabetes so um you know we don't spend enough time I think talking about how 36:23 diabetes also has a silver lining it also has a lot of opportunity for for individuals 36:29 to build resilience to have an opportunity to build empathy for others 36:35 with chronic conditions compassion you're building your problem solving skills you're becoming adap adaptable 36:40 and flexible you're creative in how you um problem solve you have responsibility for your health you learn about yourself 36:47 you understand how your body is working and and and what different foods do and exercise you understand your own 36:53 strengths your own limitations and um tolerance for distress or being uncomfortable so these are all ways that 37:01 you're building your resilience and there's also an opportunity for advocacy 37:06 and being part of something that's bigger than just yourself so I want to spend a little bit of time on um the 37:12 advocacy part of of bouncing back and and building your resilience so um I 37:19 always like to define the terms when I mean resilience this is the process of 37:24 adapting well in the face of adversity trauma or other stressors so this is 37:30 something where you bounce back it's not a personality trait I know a lot of times we'll say oh this that's a 37:35 resilient they're a resilient person it really is a learned behavior and it's through your thoughts your behaviors and 37:41 your actions and these are all different ways that you can enhance you how you 37:47 have positive values and positive interactions with the world developing other talents and interests outside of 37:52 diabetes building your friendships and your support Networks um education even 37:58 if it's not formal education how are you learning about diabetes how are you coming to conferences like this how are 38:03 you um uh enhancing your knowledge creating that secure base of who is your 38:09 support network who are your your people in your place that really make you feel 38:15 safe and and that you're not going to be judged and then social competencies around dealing with those social stigmas 38:21 and and coping with um things that might happen out there um with related to diabetes stigma so how you might self- 38:29 advocate for yourself is we know that mood and anxiety symptoms are common in people with diabetes and can lead to 38:36 more formal mental health diagnosis such as um disorder to eating sleeping diabetes distress problems are also 38:43 common and so make sure that if your healthc care provider is not asking you 38:49 about them or is not giving you the screeners that you are raising these in your um diabetes clinic visits and that 38:57 when you are being screened or when a provider does ask you or does give you a formal screener for things like diabetes 39:03 distress fear of hypoglycemia depression that you fill out these questionnaires and you fill them out honestly and that 39:10 you um don't hold back or feel like you have to look like you have it all together really show what's happening so 39:18 that um the healthc care team um knows what's going on and can help you um and 39:24 then the last piece um we want you to do is or there's a couple last pieces is if 39:29 you feel like you are really getting a lot of social stigma diabetes stigma or you feel like you're getting weight 39:35 based stigma either in the Health Care system or um in society or from others 39:41 really talk to your Diabetes Care team about your social stigma concerns and 39:47 how you might want to build up your social support network and speak up if you're really experiencing it in the 39:54 Health Care System um directly from the the healthcare team because this is a a time and a place for all of them to be 40:00 um learning and growing um as a society um and as a Health Care system and then 40:07 um we know that caring for diabetes effectively is expensive so let your health care team know if you're having 40:14 Financial burdens if you're rationing insulin if you're not um doing diabetes 40:19 cares as much as you want to because of the financial burden um because it's 40:24 really important for individuals and your Healthcare team to know that that's the source of the issue and so they can 40:31 help you but also recognize that um you are wanting to do it but you're having 40:37 limits to your access so we've developed a self- advocacy checklist um we have a 40:43 PDF um form of this as well that you'll be able to download and so as you're going through the checklist I'm um 40:49 getting ready for your next Clinic visit um or as just periodically checking in with yourself really be aware of how you 40:57 are emotionally reacting to your diabetes we talked about the first three which is why I bolded them the diabetes 41:03 distress and burnout diabetes distress related to stigma and diabetes distress about the financial burden of diabetes I 41:10 didn't talk about all the other host of things but those are still on there check in about your fear of hypoglycemia 41:17 check in on um whether you're having some hesitancy or reluctance to take 41:22 more insulin or to initiate insulin if you've been on oral medicine and you're looking to start insulin really looking 41:29 at reframing that thought of I need my a 41:34 medical regimen to match what I physically need and not seeing it as a 41:39 failure or some sort of way that you know you're not doing diabetes Well if you have to take more insulin over time 41:47 or you have to move from oral to um insulin that really thinking of this is 41:52 what my body needs and this is what I need to match and I'm actually making my body healthier to take the right 41:58 medicine for what my bi my diabetes needs so really just using some of those 42:04 um thinking and and thought strategies around reframing that um there's issues 42:09 with how how well are you accepting it how much are you engaging in some of that avoidance and not participating 42:16 because it feels overwhelming are you crossed over into feeling um feelings of depression and anxiety that are about 42:23 diabetes but then are also about life in general um and and making sure you're doing a 42:28 check-in on that looking at your eating behaviors um looking at um when are they 42:34 crossing over into maybe being disordered eating or out of control eating or not enough eating so really 42:40 taking stock and inventory and talking to your Healthcare team about that and then filling out any self-report 42:46 screeners um open and honestly and if you aren't giving them ask start asking 42:52 for them um providers have access to them many of them are free um and and you can go on or you can go 42:59 online and there are some that you have access to that you can fill out and bring in or you can ask your team to do 43:05 it um and then the last thing is if your you and your team def decide that a a mental health referral is needed um to 43:12 go um beyond what the Diabetes Care team can do to support your diabetes distress and other things really follow up and 43:20 and find a way to get that extra support so that you are um taking care of both 43:25 the phys physical and the mental health side of your diabetes so um I want to end a little 43:32 bit here on just speaking up about diabetes stigma um there's an additional diabetes Canada webinar on confronting 43:40 diabetes stigma so click over here watch it um if you are someone who really 43:46 wants to get more involved in standing up against stigma because there's no such thing as health without mental 43:53 health so whether it's stigma about the fact that that you're having emotional uh reactions to diabetes or stigma 44:00 around weight or stigma around um feeling shamed and blam because of um 44:06 difficulties with managing your diabetes um this uh diabetes Canada webinar has a 44:11 great series on um learning how to stand up and and do more things to stop stigma 44:18 within our community um and also to stop stigma within our community um and I'll 44:23 I'll just end a little bit here with making sure that we're not um pitting type one against type two we all have 44:29 different types of diabetes and we don't uh we want to make sure that we are not 44:34 accidentally stigmatizing type one versus type two as well so um I'll put that in there to that little plug in 44:40 there too because this webinar talks about that as well all right so um in 44:46 terms of questions and discussion I hope you all enjoyed um watching this video 44:51 and I look forward to um seeing as many of you as I can to my live diabetes 44:57 dialogue session which will be Saturday November 18th from 2:15 to 3:15 I'll be 45:03 there live to answer questions and have discussion um about this topic and I 45:08 really appreciate um all of your attention today and I look forward to seeing you on Saturday thank 45:19 [Music] you

0:03 [Music] 0:19 good morning welcome and uh I'm so 0:22 excited to be at this conference and to 0:25 have this video opportunity to uh talk 0:28 to everyone about ICB internet cognitive 0:31 behavioral therapy and um diabetes and 0:35 I'd like to say hello to everyone my 0:38 name is Felicia I am the account 0:39 executive at mind Beacon and Kush why 0:42 don't you introduce yourself yeah I'm 0:44 Kush Maria I'm a clinical and health 0:46 psychologist and one of the senior 0:48 clinical directors here at mind 0:51 vacan excellent uh Kush do you want to 0:54 start off a little bit about why we're 0:56 both here today sure absolutely and I 0:59 know you've got some question questions 1:00 for me all lined up as well too but you 1:02 know we're going to talk about how you 1:04 can take care of your health um with 1:06 using CBT um you all know a little bit 1:09 about um probably mental health and the 1:11 impact of mental health on um taking 1:13 care of ourselves and so that's that's 1:15 what we're here about today excellent so What is CBT 1:19 let's start talking about what exactly 1:21 do you mean when you hear when we talk 1:24 about CBT CBT of course so CBT or 1:28 cognitive behavioral therapy 1:30 um is a type of therapy used to help 1:32 people manage their mental health and it 1:34 includes um common mental health 1:36 illnesses such as depression or anxiety 1:39 as well as how to cope with everyday 1:40 stressors that are part of life for most 1:42 people now therapy can come in all 1:44 shapes and sizes and usually we think of 1:46 therapy as involving face-to-face 1:48 conversations with a professional in an 1:50 office for once a week um but CBT isn't 1:53 just talk therapy it's made up of 1:55 readings and education activities 1:58 strategies and homework actually so we 2:00 we sort of think of it as a program 2:02 where one would learn skills and and 2:04 practice skills um to face stressors and 2:06 manage symptoms that come with everyday 2:08 life challenges uh the the premise of 2:11 CBT is based on this idea that our 2:13 thoughts feelings and behaviors are all 2:15 connected and specifically that our 2:17 thoughts are what lead to our feelings 2:19 and behaviors um so in CBT people learn 2:21 to understand what types of thoughts 2:23 lead to negative emotions or those 2:25 unhealthful behaviors that we have in 2:26 our lives so that you can eventually 2:28 learn to challenge the thoughts to be 2:30 more balanced more helpful realistic um 2:34 in terms of the types of thoughts that 2:35 we would have um now of course this is 2:38 actually quite important because we 2:39 can't often change the situations we are 2:42 in or the hand that we've been dealt um 2:44 these are not things we usually have 2:46 control over however we do have control 2:49 over what we think which which means we 2:51 have more control over what we feel and 2:53 what we do Why use CBT 2:55 also really interesting so can you let 2:59 us know why use CBT to manage mental 3:02 health when dealing with a chronic 3:03 illness and maybe specifically talk a 3:06 little bit about um how it is with 3:08 dealing type one or type two diabetes 3:12 for sure and so um let's just take a 3:14 step back for a moment there's no doubt 3:15 that coping with any type of chronic 3:17 illness takes a toll on our mental 3:19 health um the day-to-day care needs for 3:21 any person with a chronic illness can 3:23 often feel people um lead people to feel 3:26 overwhelmed angry anxious scared 3:29 depressed um and of course we all know 3:32 that our mental health and our physical 3:33 health are just tightly connected so 3:35 working on our mental health can impact 3:36 our physical and vice versa so I know 3:39 I'm obviously biased as a psychologist 3:41 but we do have evidence that taking care 3:43 of your mental health is an important 3:45 part of taking care of your diabetes and 3:47 also helps with preventing some of those 3:48 long-term complications we're all 3:50 concerned about um there are a lot of 3:52 other reasons that someone might want to 3:54 learn to have tools to kind of manage 3:56 those psychological symptoms of living 3:57 with type 1 or type 2 diabetes 4:00 um and I just really want to encourage 4:01 people to think of CBT as one of those 4:03 options right they it goes along of 4:06 course with all the other practical tips 4:08 I think most people are probably already 4:09 doing such as reaching out for social 4:11 support or talking to others about their 4:13 diabetes worries or literally showing up 4:16 today to this 4:17 event excellent so can you give some Tools and Strategies 4:21 examples of tools or strategies a person 4:24 could learn when they're doing um CBT to 4:27 help maybe specifically with their 4:28 diabetes management 4:30 yeah and so I'm really glad you asked 4:31 this because as I mentioned CBT is a 4:33 type of therapy where one would learn 4:35 sort of various skills to to kind of 4:37 deal with the challenges in their life 4:39 right um and so conclude any or even all 4:41 of the following I'm going to share a 4:43 few in just a moment but you know one of 4:45 them is problem solving strategies you 4:47 know this can be really useful let's say 4:49 you're having trouble figuring out how 4:50 to manage the logistics of living with 4:52 type one or type two diabetes this could 4:54 be things such as attending a doctor's 4:56 visit managing medications healthy meal 4:58 preparation and planning if you can 5:01 understand the barriers and solutions to 5:03 overcome these barriers that can really 5:05 make the difference for example between 5:07 knowing you need to speak up more of the 5:09 doctor's office to share your concerns 5:11 versus actually making that happen so 5:12 problem solving strategies are a big 5:14 part of 5:15 CBT another one are relaxation 5:17 strategies relaxation strategies are 5:20 vital to managing stress when you feel 5:23 calmer it just makes it easier to manage 5:25 the demands that diabetes brings into 5:27 your life so you know in CBT might learn 5:30 various ways to bring daily experiences 5:32 of relaxation um whether it's deep 5:34 breathing or meditation into your 5:36 day-to-day living um now we all know 5:39 learning to relax isn't going to make a 5:40 problem go away but it will make it a 5:43 whole lot easier to deal with the 5:44 problem if your stress levels aren't 5:46 over the 5:47 top um behavioral activation is another 5:50 one it's an important strategy that we 5:52 use in CBT to help people manage low 5:54 moods or depression um it involves 5:57 setting weekly activity goals goals um 6:00 and working towards meeting them when we 6:02 do behavioral activation we see lifts in 6:04 people's moods increases our energy it 6:07 really Fosters the sense of empowerment 6:09 which can of course make it easier to 6:11 manage your diabetes care and generally 6:13 just feel more control in your life um 6:16 but it's often easier said than done so 6:18 in CBT you learn ways to make this 6:20 actually happen in a very systematic and 6:22 a measurable Way by taking small steps 6:25 and and looking at rewards along the way 6:27 as 6:28 well um almost every part of a CBT 6:31 program for chronic illness is going to 6:33 include strategies to manage worry um 6:36 you know we need to have strategies to 6:38 be able to cope with feelings of anxiety 6:40 uncertainty even things such as diabetes 6:42 dist stress or fear of hypoglycemia um 6:45 you know we're often told to just stop 6:47 worrying um and that often backfires 6:50 rather we need to learn um what to do if 6:52 we're caught in the cycle of repetitive 6:54 worry and that's a really important part 6:56 of the CBT program too um the focus of 7:00 much of CBT as I mentioned includes 7:02 recognizing and challenging unhelpful 7:04 thinking so how you think about your 7:06 diabetes is going to have an important 7:08 influence on how you feel and how you 7:10 cope so unhelpful thinking patterns um 7:13 obviously play a role in diabetes to 7:15 stress they play a role in the fear of 7:17 hypoglycemia and psychological barriers 7:19 to insulin so in our CBT program one 7:22 would learn how to recognize and 7:24 challenge thinking patterns that may 7:26 keep you feeling stuck or just really 7:28 get in the way of diabetes 7:30 management um another one is mindfulness 7:33 um so mindfulness we hear this a lot it 7:35 really is the skill of being in the 7:37 present moment rather than always being 7:40 worrying about the future or kind of 7:42 stuck ruminating or thinking over and 7:43 over again about the past so mindfulness 7:46 can be practiced and developed through 7:48 both informal and formal 7:51 exercises um you know directing your 7:53 attention to the present often can also 7:56 help reduce stress reduce negative 7:58 emotions and just again make it easier 8:00 to cope with your Diabetes Care um then 8:04 finally I'll mention acceptance so 8:06 acceptance is an important part of 8:07 managing diabetes um often struggling to 8:10 accept these kind of unwanted or painful 8:13 experiences end up usually causing us 8:14 more pain in the long run um so 8:17 acceptance is about letting go of that 8:19 struggle now recognizing that diabetes 8:21 is a chronic condition that you have to 8:22 live with and manages not the same as 8:24 defeat or helplessness or 8:27 resignation but being in a place of 8:28 except c means that you can make more 8:30 active choices that are going to lead 8:32 you towards a more valued and more 8:34 meaningful life even in the face of 8:36 diabetes so it's not about giving up in 8:37 that 8:39 way really really interesting thanks so How long does it take 8:42 much Kush and how about people may be at 8:45 wondering how long does it take to build 8:48 these skills or see results from this 8:51 type of therapy yeah and you because 8:53 it's skill-based it really depends on 8:55 the client um your therapist is really 8:57 there to guide you through the learning 8:59 help you when you feel stuck provide 9:02 encouragement and personalization of 9:04 whatever you're learning for all the 9:05 steps along the way um in the therapist 9:08 guided icbt program we offer at mind 9:10 Beacon um we provide what we call 12 9:13 active weeks of therapy so meaning in 9:15 those 12 weeks you have the chance to 9:17 communicate with your therapist it's all 9:19 asynchronous so through messaging you 9:21 can send a message any time you want um 9:24 so you get 12 weeks of that and after 9:25 that though you can keep working on your 9:27 own to practice and get better your 9:29 strategies and that could be you know 9:31 building a good relaxation practice or 9:33 challenging new unhelpful thoughts that 9:35 are going to inevitably show up um now 9:38 not everyone is going to need to learn 9:39 or use every strategy that I described 9:41 you really get to focus on what you need 9:44 for symptoms your experiencing so 9:46 someone might see some really immediate 9:48 results such as relief from their 9:49 anxiety and worries or improvements in 9:51 their mood but others might take some 9:53 more time for it to become part of your 9:54 everyday life but the key here is that 9:57 CBT is a short form type of therapy you 10:00 don't need months and years of treatment 10:02 to see 10:04 results amazing and um so how do you How do you know its working 10:09 know if CBT is working for 10:11 you that's a really good um uh like a 10:15 very important question actually to 10:16 answer because it's very in line with 10:18 the CBT approach to therapy which does 10:21 involve measurement of change over time 10:24 you know this the simplest answer is 10:26 you'll know CBT is working for you the 10:28 symptoms that were in interfering in 10:29 your life start to reduce this might be 10:32 feeling less anxiety maybe spending less 10:34 time worrying to being more focused in 10:37 the present having more positive moods 10:39 facing your fears more so really it's 10:42 changes in the emotions and behaviors 10:44 and of course the thinking that matters 10:46 to you um as well I would really hope 10:49 that people would see an impact on their 10:51 management of their diabetes needs um 10:54 you know CBT for coping for coping with 10:56 a chronic illness isn't about 10:58 controlling the illness per se but the 11:01 psychological impacts of having to cope 11:03 with that condition so when CBT is 11:06 working you'd also expect to see better 11:09 coping and adaption to whatever is in 11:11 front of you when it comes to managing 11:13 type 1 or type two diabetes um a more 11:16 traditional CBT for a mental illness 11:18 such as depression and anxiety um 11:21 success would be defined by having less 11:23 of those symptoms as well as less 11:26 interference of those symptoms on your 11:28 life so that really applies in this case 11:30 too you already have plenty to manage 11:31 when it comes to taking care of type one 11:33 or type two diabetes and a good CBT 11:35 program is going to help you focus on 11:37 that versus the mental health side 11:39 effects interesting really interesting What about if you arent sure 11:42 thanks so much and what about if you 11:46 aren't sure maybe that your 11:48 psychological syst symptoms are actually 11:51 related to diabetes ah well CBT isn't 11:54 just for chronic illness management it's 11:56 been around for years um and it's been 11:59 shown to work for many different mental 12:01 health conditions you know maybe you're 12:04 having symptoms of insomnia or you have 12:06 a lot of work stress we have some really 12:07 great CBT programs at mind be and that 12:09 would focus on learning strategies to 12:11 manage those types of problems too um 12:14 one of the great things about CDT is 12:15 that even if you learn skills for a very 12:18 specific concern or specific time in 12:20 your life those skills don't go away and 12:22 they're transferable to other areas of 12:24 your life as different challenges emerge 12:26 and unfortunately we know life is full 12:28 of challenges 12:29 um so for example if you're learning to 12:31 manage worries it doesn't really matter 12:33 if you're repetitively worrying about 12:34 medications and side effects or you're 12:36 worrying about your job changing the 12:38 skills to cope with the worry is the 12:40 same interesting I like your point about How to manage worry 12:43 worry and I was wondering if you can 12:45 talk a little bit more about how to 12:47 control if people are in a constant 12:50 state of worry yeah it's gonna it's 12:52 gonna sound really simple when I share 12:54 but of course none of this is a quick 12:56 fix but it's all doable and people of 12:58 all ages all backgrounds can really 13:00 learn CBT based skills to manage worry 13:03 again regardless of what the worries are 13:04 about the first thing we actually get 13:06 people to do is do some tracking of 13:08 their worries kind of like a worry diary 13:10 the when the what the where and this 13:12 happens to identify themes and patterns 13:14 and ones worry thoughts we then teach 13:17 people to challenge their beliefs about 13:19 worry people often believe that worry is 13:21 a very positive trait or that it's 13:23 helpful but if you think about it 13:25 worrying about the problem is not the 13:28 same as problem solving so sometimes 13:30 people are scared to worry less they're 13:32 scared to give up a worry thinking it's 13:33 going to lead to problems or it's going 13:35 to lead to this like inability to cope 13:37 with the what if um at CBT we also get 13:41 people to learn how to identify the 13:43 difference between a what we call like a 13:44 type one and a type two worry so type 13:47 one worries are productive they're 13:49 useful they're adaptive this can be the 13:51 first step toward active problem solving 13:53 so a type one worries about something 13:55 that's quite specific something that's 13:57 in the here and now a problem that's 13:59 potentially solvable so when you have 14:01 that worry thought in your mind it's 14:02 usually a cue that you got to focus a 14:04 little bit about how to get through this 14:06 problem find out what your strategies 14:07 are Etc type two worries though are very 14:10 unproductive they're useless they're 14:12 problematic they don't lead to problem 14:13 solving but rather they lead to these 14:15 cycles of repetitive rumination extended 14:18 periods of worrying so type two worries 14:20 I usually say it's like about a problem 14:23 that hasn't happened yet it's like a or 14:25 a vague problem maybe in the future or a 14:27 bunch of problems kind of mixed together 14:28 you can't solve that um so knowing the 14:31 difference allows you to problem solve 14:33 around the type one and learn to 14:34 challenge the type two so to learn to 14:36 challenge the type two worries we 14:38 introduce people to thought records and 14:40 thought challenges um and there's a 14:42 whole bunch of things that go with that 14:44 but it's really learning for evidence 14:45 for and evidence against and coming up 14:47 with more balanced thoughts we also 14:49 teach people to use worry time it's like 14:51 a really it's kind of a little bit of a 14:52 trick we plan ourselves but you know if 14:54 you have a worry time a specific time in 14:55 your day that's focused on worrying you 14:57 teach yourself to save your worries for 15:00 that time versus reacting to every 15:02 single worry that pops in your head and 15:04 kind of chasing that thought we know how 15:05 disruptive that can be um we also 15:08 learned that through that ex people 15:10 often learn that if they postpone their 15:11 worry they don't need the they don't 15:13 feel the need to react to every what if 15:15 that comes into their mind and that just 15:17 you know makes us always feel so much Final comments 15:21 better what you've talked about today 15:23 has been so so interesting and even 15:25 though I've been in the industry for 15:27 quite a while every time I talk to you k 15:29 you I learned something new and exciting 15:31 and I just want to thank you so do you 15:34 think that maybe you could provide any 15:35 final comments for the listeners um to 15:38 or take home messages so that they 15:40 really do understand you know what 15:42 cognitive behavioral therapy is and how 15:44 it can help individuals with diabetes 15:47 thanks yeah absolutely absolutely and a 15:49 few things you you come to mind so thank 15:50 you for that but um the first thing I 15:53 want to share with people is you don't 15:55 need to be really unwell to start 15:57 therapy 15:59 you know actually I would prefer that 16:01 people start therapy before things get 16:02 really tough um you know maybe you have 16:05 some daily anxieties that are hard to 16:07 shake maybe you find yourself feeling 16:09 more defeated some days um by having to 16:12 care and manage type one or type two 16:14 diabetes you know a CBT program for 16:17 chronic illness management might just be 16:19 the push you need to help preventing to 16:22 help prevent really a worsening of those 16:24 symptoms um you know I always say also 16:27 the risk of participating in CBT program 16:29 is pretty low the common barriers we 16:31 hear from people are usually about 16:32 finding the time you know and the cost 16:35 for a CBT program but at my beacon you 16:37 know we've worked really hard on making 16:39 a program that is flexible um so you can 16:41 really do it at any time in your day 16:43 that makes sense it's not about making 16:44 appointments and coming out of you know 16:46 your home every now and then um a 16:49 program that's customized to your needs 16:51 that's Guided by a professional um it 16:54 does not as I said have those 16:55 traditional model of weekly visits to a 16:57 therapists that of course can be be 16:58 quite costly um so I encourage people to 17:01 think about you know if they're feeling 17:02 ready to reach out for some help um 17:05 don't hesitate don't wait um and I also 17:09 encourage you to join Dr leor Newman 17:12 she's going to be on this Saturday for 17:14 the diabetes dialogue set to at 2:15 17:17 she's going to give you some additional 17:18 details about our therapist assisted 17:20 internet delivered CBT program mind 17:22 Beacon but if you can't wait for that 17:24 I'd encourage you to check out um ww. 17:26 mind beacon.com just to learn 17:29 more excellent it's always great to talk 17:32 to you K and I hope everybody has 17:34 learned um a lot about cognitive 17:36 behavioral therapy and we look forward 17:37 to um talking to the listeners um on 17:41 Saturday thank you thank you so much and 17:43 best of luck to all of 17:49 [Music] 17:51 you

0:00 [Music] hello and welcome to diabetes open hours 0:05 your live Q&A opportunity with experts in diabetes management and care my name 0:10 is Kayla Ranka and I'll be your moderator for today I would like to start by acknowledging that I'm calling 0:16 in from Toronto and that I'm located on the traditional indigenous territory of the wendat honi anishnabe and the Miss 0:23 sagas of the credit and that Toronto is now home to many diverse First Nations Inuit and matey peoples 0:30 as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout 0:37 our institutions and that we have the responsibility and power to create culturally safe and appropriate 0:44 environments of care our topic today is dealing with a diabetes diagnosis and is supported with 0:51 an unrestricted educational grant from copi and while we have an expert on the 0:56 call today this webinar is for educational purposes only the content discussed in this webinar is 1:02 not intended to be medical advice and to the extent that medical advice is required you should consult with a 1:08 qualified medical professional the information discussed in this webinar cannot replace consultations with a 1:14 qualified Healthcare professional to meet your individual medical needs and lastly the views and opinions expressed 1:21 in this webinar are those of the speaker and do not necessarily reflect the views or positions of diabetes 1:28 Canada having said that today we are very lucky to have Dr Dana Lee Bagley 1:33 with us Dr Dana is a registered clinical psychologist in British Columbia Alberta 1:39 Ontario and Nova Scotia her registrations include Clinical Psychology Health psychology and 1:46 organizational psychology she is the co-founder and chief scientific officer 1:51 of the impact me app she has worked for almost 15 years in multidisciplinary 1:57 teams on medical Surgical and C Cancer Care Hospital units and conducts research as an assistant professor in 2:04 the department of family medicine with a cross appointment in the department of Psychology and Neuroscience at Dal 2:10 Housey University and she's an Adjunct professor in the department of psychology at St Mary's University and 2:17 if that wasn't enough she is also the author of the book healthy habits suck how to get off the couch and live a 2:23 healthy life even if you don't want to and I certainly feel like that's a book we could all definitely use in our lives 2:31 before we get started just a few housekeeping things please note this event is being recorded and will be 2:37 shared on our website and YouTube channel for on demand viewing any questions or comments that you submit 2:43 via the chat function will be visible to other participants during the event but we will not share any names or record of 2:49 the chat in the recording we ask that any comments or reactions you share be affirming and positive and we encourage 2:56 you to discuss your learnings with your regular healthcare provider prior to making any changes to your 3:01 current routine and with that are you ready to get started Dr Dana yes great thank you 3:09 for joining us today and for all of you participants feel free to start putting uh your questions into the chat and Time of Diagnosis 3:16 while we're waiting um why don't we start with the actual time of diagnosis 3:21 so what might some of the emotions that individuals uh may feel when they hear the word diabetes from their healthcare 3:27 provider um I'm sure sh probably is one of the top ones on that list yeah we know that people are going 3:34 to feel you know a variety of um emotions when they first get diagnosed so that includes things like um shock it 3:43 includes things like grief um confusion I think it's helpful for people to know 3:48 that there are like grief is a really normal part of getting a diagnosis and 3:54 it's grief over a lot of different things right grief is just a reaction to loss and that loss sometimes in includes 4:00 your um ideas about the future that might be different now it includes uh potentially a loss of your identity uh 4:07 loss of certain roles um that there are changes that will happen kind of throughout your life potentially uh 4:13 because of that diagnosis and so that's very common for people to go through some people have heard of like the five 4:19 stages of grief I think it's um important to know that there aren't actually five stages of grief and so uh 4:27 what's helpful about that model is to recognize there's lots of different um emotions that show up in response to 4:33 grief all of those emotions are normal and natural uh but you don't have to go through a set order of stages of grief 4:42 to be um coping well with a loss um and and believing that you have to go 4:48 through a certain stage you know model actually can lead to complicated grief so just about recognizing there's lots 4:54 of different emotions that show up uh we talk about the three ends so notice it 4:59 name it and normalize it right so recognizing you're feeling different things um you know naming it it could be 5:06 sadness it could be anger it could be numbness it could be um you know a variety of different emotions and that 5:12 those are all normal responses to a big change in your life like 5:18 this okay great um yeah so so this grieving period we often do hear about Grief Management 5:23 it and like you mentioned whether it's um due to you know things changing rapidly or potentially even worry about 5:30 their family and now their family history has changed with the diagnosis of a a chronic medical condition as well 5:36 um so do you are there specific tactics that people can use maybe to get through 5:44 that time of grief and move on to you know the management stage of of a new 5:49 diagnosis yeah so one of the main things we do work on with people um with a chronic disease which you know starts a 5:57 diagnosis um is a term we call psychological flexibility and that's like your ability to have like a large 6:03 behavioral repertoire meaning you could do lots of different things and it's really important for people experiencing 6:08 a chronic disease to figure out how to be value driven instead of goal driven so our culture talks a lot about being 6:14 goal driven and you know those are achievements you want to do they're outcomes that you want to have happened 6:20 but we don't always control those right they're often controlled by lots of different things not just our own 6:26 efforts being value driven is about how you want to show up as a human so it's not about what you want to get from the 6:32 world it's about what you want to contribute to the world so whether you want to contribute creativity or kindness or compassion it's about how 6:38 you want to show up and if we can um move to being value driven it gives us a 6:45 much larger opportunity to do things that matter to us it's quite likely that there are things that will have to 6:51 change in your life about um what you can do and but that doesn't mean you 6:56 can't have a meaningful life you can for sure have a mean meaningful life it's just going to look different and frankly 7:02 that's true for all humans as we grow up right it very rarely looks the way we thought it was going to look and so that 7:07 psychological flexibility about being able and willing to um express your values in a different way so for example 7:16 you know um perhaps uh it was a part of your role was to like make meals for 7:21 everybody right and now some of the meals that you make are things that you're not supposed to eat because of your diagnosis right so we're trying to 7:28 find you another way to care about your loved ones that might involve different meals or different activities but it's 7:34 still an expression of your care and affection for them and so that's something that we are trying to work on 7:40 with people is to be have more options for how to express your values we can always find them and the key is uh your 7:47 willingness to have it look different and feel different than how you thought it was going to look or 7:52 feel wow I I love that that actually spoke to me um incredibly as you know a Selfblame 7:57 mom and and someone who car cares for my family via food and I can imagine that um that's a big change for people 8:04 especially with a diabetes diagnosis um you know learning you have a chronic medical condition um can be 8:11 hard to accept um and uh depending on how you move through that stage 8:17 sometimes people move into a period of self-blame so um why did this happen to 8:23 me how could I have prevented it um can you speak to that feeling a little bit and and you know some tactics maybe to 8:30 help people again deal with that concept of of self-blame Y so you know we all 8:36 want to recognize that we live in an environment in like you know North America that absolutely does not is not 8:43 conducive to health it's not conducive to health behaviors it encourages unhealthy behaviors it's actually 8:49 incredibly difficult to to do like to maintain healthy behaviors in our culture our environment just does not 8:55 support that and it it's not a neutral environment it actually supports um unhealthy habits right so what we talk 9:02 about this as like a compassionate reality check which is like certainly there are things that that you've done 9:09 and that you could continue to do that will impact your um condition and you want to be aware of those and you want 9:14 to work on those as much as possible because they you know are under your control but there's a whole bunch of 9:19 other factors that lead to these diagnoses that are absolutely out of our control right there are um different 9:25 rates of diabetes depending on um different like economic classes right there's differences in terms of um 9:32 different um ethnicities there's differences in terms of like where you live for example uh whether rates are 9:39 higher in you know one country versus another country none of those are things that we chose right we don't choose 9:45 where we're born we don't choose what era we're born in we don't choose whether we're male or female and all of 9:50 those things also impact our health so it's kind of a terrible thing that our culture has done to act like if you just 9:57 believe in your dreams anything is possible because it sort of conveys that you have some unlimited control over 10:03 your body and if you had just tried harder you could have stopped this from happening right but most of us are 10:09 facing an uphill battle when it comes to health and there are all a whole bunch of factors that influence that but we 10:14 actually have no control over and so we're balancing the two things which is uh there's a whole bunch of this that 10:21 isn't your fault and it's your responsibility right so there's a bunch of things that you can do to help your 10:27 condition and even when you're doing everything right your condition can still be Progressive it can still go up 10:33 and down it doesn't mean what you're doing doesn't count doesn't matter it just means that there are some parts of 10:39 our bodies we don't have control over and we live in an environment that does not help us make good choices so I once 10:46 uh you know once worked with this woman who was um diagnosed with breast cancer in her 40s so I know it's a different 10:51 diagnosis but kind of relates to the same idea which um you know and she just run a marathon or something like that so 10:57 she was like super healthy and she was so angry right that she'd gotten this um diagnosis when she um was so healthy and 11:04 she was like all my healthy habits were for nothing but we don't know that maybe she was destined to get um breast cancer 11:11 in her 20s and all of her healthy habits delayed the progression until her 40s 11:17 right she was definitely going to go through chemo a lot better because she was healthier the rest of her body was healthier and so there's some parts of 11:23 our bodies we don't have control over we can't directly you know um change them 11:28 and so you want to control the things you do have control which is your behaviors and there are lots of behaviors that will make your condition 11:35 better or worse and at the same time there are parts that even when you're doing everything right you won't have 11:40 control over it so getting into that shame cycle typically isn't good for people it usually like goes down a a 11:47 path that actually doesn't help you make good choices it doesn't help you live a meaningful life and so we just want to 11:53 recognize that again you can use our three ends of notice it name it normalize it of course it's normal to 11:59 feel that way is it really going to help me if I let this be in charge of my day right and chances are it's not and so 12:06 then go do something that's value driven go do something that matters to you go take care of yourself in some way and 12:12 some you know easy kind of thing that you can do to remind yourself that it's an and not a but right that you can do 12:19 things that influence your condition and you should and you can be doing everything right and your condition can 12:25 still progress that's a great um thought and also a fantastic segue into the next Organizing 12:32 question so you know espe specifically with a diabetes diagnosis there's a lot 12:38 of things that end up needing to change um changes to the diet changes to your 12:43 physical activity um treatment plans medication schedules blood sugar checks 12:49 and uh all of those details take up a number of sort of points throughout a 12:55 day and um for some that additional routine might be a little overwhelming 13:00 so are there ways to organize or even um wrap one's mind around fitting in all 13:07 these points of a treatment plan throughout the day knowing that again to your point of um value based and and 13:13 moving forward through doing something positive for yourself um is now critical to one's life and well-being yeah so we 13:21 try to get people to attach a value driven reason for change for making 13:26 those changes a lot of people will try to make those changes um based on kind 13:31 of a fear model right I don't want to have the bad outcomes that people have told me will happen with diabetes I 13:38 don't want to go blind I don't want to you know um have problems with my feet and so it becomes driven by distress and 13:45 that can get you going at the start but it will never keep you going because people humans don't like being in 13:51 distress so if you've attached all of those healthy behaviors to distress or 13:56 something bad happening to you that's what become linked in your mind right it's not a positive thing it's this 14:02 dangerous thing that you're trying to prevent and so values are always about moving towards something that matters not about getting away from something 14:08 bad and so um Health we actually describe as not a value it's a means to 14:13 an end what will the health allow you to do so if uh being healthy gives you more energy you know if taking care of your 14:20 diabetes makes you more stable or reliable if it helps you uh you know do your job better right those are the 14:27 things we're looking for not even just like well I could live longer okay well if you live longer what 14:33 are you going to use those extra years for why does it matter to be here on the planet and managing diabetes in 14:39 particular there are things that will impact your well-being on a daily basis right so managing your blood sugars um 14:45 will help you think more clearly it'll help you be more productive it'll help you be more reliable and so what matters 14:52 to you and who who and what are the things that are important to you that you want to be more reliable for that you want to have a more clear head Ed 14:59 you know ability to think and to be productive right whether that's your family your relationships your work it's 15:04 going to help you on a day-to-day basis show up as the person you want to be and so connect it to those things that are 15:10 meaningful important to you not a distress model of change the second part is you know if we think about that we 15:17 have sort of a certain capacity like a battery right and that battery will get um drained and there's things that like 15:24 use up that battery if you suddenly need to add in a whole bunch of health behavior 15:29 it's going to use some of that battery and time in your day and so we have to actually start thinking about what am I 15:35 going to give up what am I going to give to somebody else what am I not going to do to make space for these Health 15:41 behaviors because they take both time and energy right um they again will help 15:47 you do the things that matter think about the things that anyone could do versus the things that only you can do 15:52 if anyone could do them could someone else do them for you then do they really require you to do can you save your 15:58 battery for the things that are most important to you right and managing your uh diabetes will always help you show up 16:05 as the person you want to be not in the future but today right now right to the people and the things that matter to you 16:11 but you need to find that time by giving up other things in your life so that you have time because it actually takes you 16:17 know time and energy to properly manage diabetes and so if the whole plan is I'm 16:23 just going to add it on to what I currently do it's not a good strategy because most of us don't have extra hours in the day so you have to figure 16:30 out what you're going to give up what you're going to delegate what you're going to not do in order to have time to 16:35 manage diabetes sound advice for everyone really um quite frankly um but Depression 16:42 especially for those with the additional um uh stress of sort of a chronic 16:49 medical condition so we talked a bit about you know the normal feelings anger uh shock numbness kind of um things that 16:57 you would naturally feel following a diagnosis but we also know that depression um is about twice as common 17:03 in people with diabetes so um maybe you could share some um things to look out 17:10 for um in particular with depression and what might indicate the need to get a 17:16 little extra help yeah so we know that um some of these um you know mental 17:21 health conditions are higher in people with chronic disease and that's in part because it's stressful to live with a 17:27 chronic condition um another part that um we want people to recognize also is 17:33 um diabetes distress and diabetes distress is symptoms of depression symptoms of anxiety symptoms of 17:40 irritability but that are about the illness right so they're about the emotional burden of the illness the 17:45 regimen stress um how it impacts your interpersonal relationships and that's 17:50 almost like 50% of people with diabetes will experience those kinds of diabetes distress and so it's actually very 17:57 normative and so the people who are more likely to experience depression have had a history of depression prior to 18:04 diabetes um and then their risk increases when you have a chronic condition almost everybody can 18:10 experience diabetes distress because it's actually a normal response to this new stressor in your life and so um I 18:18 generally say that when you feel stuck that's a good time to get help like when you feel stuck in depression when you 18:23 feel stuck in anxiety uh when it's taking over your life when it's making the decisions about what to do instead 18:30 of you then that's a good time to get help uh it's important for people both 18:35 to get help about depression but also about diabetes distress because standard treatments for depression will not take 18:42 into account the fact that you have this chronic condition that is generating a huge amount of stress in your life that 18:47 you can't make go away right it's not a you know in classic therapy they look 18:52 for like a distortion and you know overestimation of risk or you know perceptions of feeling hopeless about 18:58 the future but some of that actually is uh entirely normative when you're facing 19:04 a chronic condition that will you know potentially impair the rest of your life or at least have an impact on your life 19:10 and so we want people to recognize that treating diabetes to stress requires 19:16 recognition of this stressor in your life right um that it's using up some battery and it's important to think 19:22 about and you know has a variable Progressive course sometimes for people and uh and that's typically a different 19:29 intervention than what people get when they get um treatment for major depressive disorder for example or an 19:34 anxiety disorder and so um you know both can be helpful if you have both but also 19:41 you know we should probably have more services for diabetes distress embedded within Diabetes Care not something 19:47 separate that you go to mental health clinic to go get that treated it should be integrated into Diabetes 19:55 Care yes I agree and and um the concept of self- advocacy is also an important Stress and Distress 20:01 one I'm just going to pause for a second and encourage any participants to post questions in the chat and our digital 20:08 man manager will get those over to us um but back on to the topic of stress and 20:14 distress um do you have any tips for recharging or letting go of that stress when you're dealing with um a diabetes 20:21 diagnosis so we talk about that there's like three main forms of coping so one form of coping is problem Focus scoping 20:28 and this is very effective when you can get rid of the stressor right so um so 20:34 for example lots of us go through our work life using problem Focus coping there's an email you have to send 20:39 there's a paper you have to write those are technically like solvable stressors if you work harder at it you can you 20:45 know um get rid of that stressor of course in Modern Life something's always there to take its place right but in 20:51 theory they're solvable stressors um that strategy often is helpful when you 20:57 think about health behaviors about trying harder about health behaviors but it doesn't by definition your diabetes 21:04 can't be fixed or made to go away right and so we actually need a different type of coping called emotion Focus coping 21:11 and emotion Focus coping is helpful um when the stressor can't be eliminated and it's about dealing with the emotions 21:18 that show up as a result of a stressor that can't be removed and so um that's 21:24 an important skill to develop when you have a chronic condition because by defition it's not going away it's 21:29 something we have to continuously manage and um lots of people don't have 21:34 that skill set because it's not one we really teach well in our culture we focus so much on problem Focus coping 21:40 and trying to apply problem Focus coping to your chronic disease will actually in some cases make you feel worse because 21:46 you're trying so hard and it's still not doing what you want it to do it doesn't mean that your um efforts don't matter 21:52 or don't count but it's just that there's some aspects of our bodies we don't have direct control over and so uh 21:58 we need to help people learn those emotion focused coping skills the third form of coping is relationship focused 22:03 coping that's about managing and maintaining relationships during times of stress and so we're often trying to 22:10 help people expand their coping toolbox with emotion focused coping and 22:15 relationship focused coping uh because those are necessary to deal with a chronic 22:24 disease I forgot I was on mute you think I've learned by now um okay so Burnout 22:32 burnout um definitely you know stress distress um the treatment plans for 22:38 managing diabetes can be very real for both people living with diabetes as well 22:43 as their care providers um in terms of just getting to that point where it's 22:49 too much so um how can individuals deal with this burnout related to chronic 22:55 disease management um and optimally obviously in a in a positive way yeah so 23:01 I mean we actually know that in general everyone's really burnt out like any statistic that you look at um basically 23:09 uh looks sees that the rates of uh burnout are increasing basically for everybody right this is um a bigger 23:17 concern when you have a chronic disease because there's an extra Demand on your battery right the chronic disease is 23:22 using up some of your battery and so you have less battery to play with and so this is one of like the main things we 23:28 work on with people across the Spectrum um is managing burnout one of the things we want to 23:34 think about is that that battery um you know that that energy is a fixed amount and it's it's like a battery so we will 23:40 use it up so you want to think about recharging activities right a recharging activity is something that makes you 23:46 feel more energetic at the end than when you started so it's not necessarily the same thing as a healthy habit right if 23:52 going for a walk makes you feel angry and irritated then it's not a recharging activity even if it's a healthy habit it 23:58 so some of the ones I've heard people share are things like drumming gardening cuddling with a pet right and they're 24:05 really we're looking for opportunities for Joy opportunities for things that make you smile and so we want to think 24:10 about recharging that battery and again on a daily basis like think of how often you charge your cell phone if you have a 24:16 chronic disease it means that that part of that battery is being used for your chronic disease and so you have less 24:22 battery to play with and again in our culture we kind of act like if you just try harder you can do more but it's a 24:28 fixed amount and so if it's a fixed amount you want to think about if I'm spending it on this then you know means 24:34 you can't spend it on that right we can't just plan to have more and more energy and so thinking about where are 24:40 you spending your battery is that how you want to spend your battery what things are draining your battery what 24:45 things are charging your battery everyone has things in their lives that are just drains sometimes people but 24:51 sometimes activities right that are just drains on your battery and we just need to take that into account but we want to 24:56 make time for the charges we want to make time for opportunities you know for Joy for opportunities to smile um and to 25:03 really think about that battery management um it becomes a big deal in chronic disease when we talk about 25:09 pacing so pacing is about recognizing uh how much energy you have 25:14 and matching your activities to that and so what often people will kind of do is wake up and decide like how am I feeling 25:21 today and that sort of decides what they can get done or not get done but when you do it that way you're at the mercy 25:26 of your illness right it's the illness deciding what you get to do that day pacing is about deciding how much 25:32 activity you can do even on a bad day and keeping the activity level constant even if your condition is going up and 25:39 down um and so it actually makes us feel more empowered because it doesn't matter how we feel today we can do this amount 25:46 of activity and so it makes us more reliable more dependable you don't have to cancel things as often but you're 25:52 often having to um you know it it's less than what you would like it to be right right and so again deciding what you 25:59 want to spend your battery on that's most valuable and often the hardest part of pacing is actually holding back on a 26:05 good day right so people you know have a good day and they're like oh who knows when I'm going to have another good day I better do everything but then they 26:11 overdo it uh and then they kind of pay for it for a few days right and so holding back on a good day when you feel 26:18 good saving the battery for tomorrow is actually a key skill in pacing and so um 26:24 we also talk about adding extra batteries to the system right when you have a chronic disease a really important skill is learning to 26:31 ask for and accept help um and because you have less battery because of your chronic disease so we often need to add 26:37 more batteries meaning we need friends and family your your health care providers can be part of you know that 26:44 Village of support it could be Community groups it could be your church it could be work friends but you're going to need 26:51 some extra batteries and so you know our culture again kind of our dominant Western culture kind of says that um 26:57 it's bad to depend on other people but actually that's the highest like functioning human is someone who is 27:03 connected to a village who is part of you know feels connected to Safe trusting other people and so the 27:10 opposite of Independence isn't dependence it's connection right and so 27:15 it's and we often you know feel lonely the loneliness epidemic right um and 27:21 that's partly because we've overemphasized Independence and we're sacrificing connection as a result and 27:27 so figuring out how to ask for and accept help means how do you add extra batteries to the system and sometimes 27:33 people are glad to help you right sometimes it's actually way more difficult to watch someone you care 27:38 about not accept help right and watch them struggle when they're refusing your help it's not a zero sum game sometimes 27:45 both people feel better when you accept help from somebody else yes yeah that Circle of support is 27:51 so important in so many ways um including uh when you have diabetes um 27:57 if someone is finding things overwhelming um are there places where 28:03 they can go for further help or to find support yes so you know we know that um 28:09 basically there's not enough mental health providers for the need right now right um whether we're talking about um 28:17 mental health support for people with chronic disease or for other you know just living in our crazy world we live 28:23 in now right um so there's not enough um resources for that and so we often are 28:28 you know um looking to how we can create scalable options to help people access 28:34 you know more care and so those are some of the things that we work on um in our company is how can we offer better 28:40 access to um science-based information right more scalable um that's like high 28:46 quality information that people that can help people and so there are some of 28:51 those options now emerging sort of like online tools as well as you know um 28:57 mobile app tools uh we have one that's working on burnout but we will eventually be adding courses on chronic 29:04 disease as well as special you know add-on modules for diabetes and heart 29:09 disease and other um chronic conditions um and we try to embed the science of behavior change into those um apps so 29:17 that it's actually helping you on a daily basis support the difficult you know um behaviors of being healthy uh 29:24 there are you know online resources through government of Canada sometimes your provincial government you know 29:30 again has um opted into uh you know mobile or Technology Solutions for uh 29:37 mental health and so looking into those as options for extra help if you are working you might have an employee 29:44 assistance program that you could access um so like wellness together is a government based one that um people can 29:51 access for mental health support and then Community groups uh patient advocacy groups like diabetes Canada 29:58 those kinds of groups as well because it really helps to have connection with other people who get it right who know 30:04 what you're going through um that really can help us cope as well no that's great and um Dr Dana Feedback 30:11 provided some links to a few um uh 30:16 organizations and the impact me app that um our digital manager will pop into the 30:21 chat for you so I don't see any more questions coming in um so maybe will we 30:27 will wrap this up but before I ask you one last question um we're going to pop 30:34 a brief evaluation into the chat if you could kindly take a minute to provide us with some feedback so we can continue to 30:40 learn grow and better meet your needs that would be great um also if you have 30:46 any ideas on future topics feel free to pop those in the chat as well we're always open to uh ideas on how to meet 30:53 the needs of our uh group of um people living with diabetes so the last 30:59 question is really generic and just wondering if we haven't covered something in particular or if you have 31:04 any parting words of wisdoms regarding a new diagnosis um so in the chat we also I Elevator Pitch 31:12 think provided information about a research study that we're doing that lots of people might be eligible for and so it's about Wellness um for uh people 31:19 living with chronic disease and so you can actually access a program for free for the 12we program that includes 31:26 psychology support or as well as other supports um if you are you know interested in participating in the 31:32 research so that's also available the last part I'll just talk about is um having an elevator pitch about your 31:38 illness um or your condition so an elevator pitch is you know if you only had the length of an elevator ride to 31:44 give somebody information that's kind of what an elevator pitch is about and so it's helpful you know when you have a 31:49 new diagnosis or you go into a new environment to have an elevator pitch about your condition you don't actually 31:55 have to give the diagnosis right uh sometimes what's more meaningful is to give the symptoms that might impact that 32:02 environment so for example in your workplace you don't necessarily have to say I have diabetes but you could say I 32:08 have a health condition that sometimes means I need to take more breaks or I need to manage my diet differently right 32:15 um because those are the things that might impact your workday for example right um and then you can always you 32:21 know end the conversation meaning that people might ask you more questions and you can simply say um you know that's 32:27 all I'd like to share for now but thanks so much for your concern right it's a lovely way to end it thanks so much for 32:32 your concern right uh people often will give you all kinds of tips and suggestions you should do this you should do that and often you know 32:39 they're not appropriate for you or they're not the nuanced things that individuals need and again you just 32:44 thank them for their concern and go about your day we don't have to get into arguments with them about you know 32:50 whether that's an appropriate like course of action or not um but it's helpful if you have a chronic condition 32:56 to let people know because it will probably impact you it might impact your relationships it might impact how you 33:02 show up and you want people to attribute your behavior to your health condition and not that you don't care about things 33:08 or it's not important in lots of workplaces there are accommodations if people need to provide if you have a 33:14 health condition uh which can help you manage your um illness better um often 33:20 you know planning for more breaks planning for time off can be helpful um 33:26 rather than kind of waiting for it to be a crisis and then having to go off and so those are things that you can have 33:31 conversations with your workplace uh to talk about those things um and uh and 33:37 again and then having an elevator pitch with everybody else that you talk to so again you don't you don't have to give 33:42 them all the details you don't even have to give them the diagnosis but just to let them know that you have a health condition that like impacts you or 33:49 impacts you know um your daily behaviors or things like that so that they understand that there's a reason for 33:54 your behavior and sometimes you have to remind people that even your loved ones right they'll forget about you know the 34:01 condition and not because they don't care about you right just sometimes you need to remind them and then sometimes 34:06 we need to give permission to people to not talk about it right it's okay to not talk about it sometimes they always want 34:11 to talk about it sometimes they'll forget to talk about it and so we just have to communicate more um and and 34:17 describe what's happening and be okay with that because um they're not things that we kind of um are good at at 34:25 managing and so we we need some extra help with that sometimes yeah that's that's great advice and also I think too Outro 34:32 the the more we talk about it and the more it is open and out there the less stigmas associated with it as well which 34:39 I know um is a whole other topic for another day um okay well no more questions 34:46 coming in so I guess we've come to the end of our time um thank you for taking 34:51 time out of your busy schedules to join us today um taking time for ourselves and our personal care care is never easy 34:58 but so important and um definitely worth it uh in the long run if you haven't 35:04 filled in the evaluation please consider doing so now the link can be found in the chat and with that a a big thank you 35:12 uh to Dr Dana Our Guest expert today I know I learned a lot and I'm sure you did as well um there was a lot of great 35:20 advice in there for um just healthy living in general um without the 35:26 generosity of your time Dr Dana our open hours would not be possible so thank you again and thanks everyone for joining us 35:33 today on Facebook live open hours runs the last week of every other month with a different topic and guest expert so be 35:40 sure to follow us on social or visit the website regularly for updates to learn more and stay up toate on Diabetes 35:47 Canada's work and resources you can visit our website at 35:55 dibs.com ledin and the platform formally known as Twitter you can also call our 36:02 info team at 1 1800 Banting that's 1 1800b n TI n or email info@ 36:19 diabetes.com and guest for our next conversation and with that thank you 36:25 have a great day and we'll see you 36:32 again

0:00 [Music] 0:03 hello and welcome to diabetes deep Dives 0:06 my name is Candace and I am from 0:07 diabetes Canada if you are new to our 0:10 video series thank you for joining us if 0:12 you have been enjoying the series 0:13 welcome back our diabetes deep Dives 0:17 video series is designed to go beyond 0:18 the surface of General diabetes 0:20 information we hope to spark continued 0:22 interest and learning and leave you with 0:24 practical tips and tools that you can 0:26 easily use we drop a new video every 0:29 month so subscribe subcribe to our 0:30 YouTube channel and click on the 0:31 notification Bell to be notified about 0:33 new content you can also check us out on 0:36 social media to find out when the next 0:38 one will be posted on our YouTube 0:39 channel thanks to those who have 0:41 subscribed and supported our video 0:44 series in this episode we will hear from 0:46 Pina Barbieri a mother of a young adult 0:49 who lives with type 1 diabetes she's 0:51 also a social worker an educator and 0:54 diabetes Canada was very fortunate to 0:56 have her as a volunteer for our decamps 0:58 program not only not only will Pina 1:00 share with us her experiences raising 1:02 her daughter but she'll also unpack what 1:04 it means to be a caregiver and reframe 1:06 the concept of caregiver burnout she 1:09 will also provide tips and strategies to 1:11 thrive in the face of supporting loved 1:13 ones with diabetes using both her 1:15 personal and professional perspectives 1:18 this video is supported by an 1:19 unrestricted educational grant from copi 1:23 we hope after watching this video that 1:24 you will gain a greater understanding of 1:26 how families are impacted by a diabetes 1:29 diagnosis 1:30 and a deeper appreciation of what 1:32 contributes to caregivers experiencing 1:34 stress and burnout as well as strategies 1:36 for dealing with all that being a 1:38 diabetes caregiver entails we also want 1:41 to let you know that some of the content 1:43 in this video may be difficult to hear 1:46 and may trigger some intense emotions we 1:48 encourage you to seek support and or 1:50 stop the video If you find yourself 1:52 reacting to the content in a distressing 1:54 way we recognize that the content in 1:57 this video may not be relevant for 1:58 everyone and will depend on what your 2:00 experience with diabetes is and what 2:02 devices are available to you where you 2:04 live if you have specific questions 2:06 about diabetes management please reach 2:08 out to your Healthcare team these videos 2:11 are for educational purposes only the 2:14 content discussed in this video is not 2:16 intended to be medical advice and to the 2:18 extent that medical advice is required 2:20 you should consult with a qualified 2:22 medical professional the information 2:24 discussed in this video cannot replace 2:26 consultations with qualified Healthcare 2:28 professionals to meet your individual 2:30 medical needs the views and opinions 2:33 expressed in this video are those of the 2:34 speakers and do not necessarily reflect 2:36 the views or positions of diabetes 2:39 Canada as always we hope that this video 2:41 Sparks your interest in learning more 2:43 about diabetes management and now over 2:45 to our guest speaker Pina welcome to 2:49 unpacking caregiving um this is a 2:52 recording for caregivers of children 2:54 living with type 1 diabetes I think you 2:56 can see beside me a list of words 3:00 and wow those are a lot of words these 3:03 are words that describe a journey that 3:05 some of us are on as caregivers to our 3:07 children or siblings or grandchildren or 3:09 whichever way you come by providing care 3:11 for someone who lives with type 1 3:13 diabetes some of the words are actually 3:15 opposites like balancing and juggling 3:19 being proactive but also reactive 3:21 grieving but also holding hope being sad 3:25 and proud smiling and crying keeping 3:29 things stable 3:30 while everything around you is changing 3:33 do any of these words resonate with 3:35 you now I'd like you to imagine a world 3:38 where your role as a caregiver suddenly 3:41 changed almost overnight to include all 3:44 these new job descriptions added to your 3:46 already full plate new roles like 3:48 mathematician working out those isfs do 3:51 I increase insulin sensitivity do I 3:53 decrease it to make it stronger I still 3:56 have to take a minute and walk myself 3:57 through that one new roles like a 4:00 pharmacist learning about new 4:01 medications a doctor making dosing 4:03 decisions a nurse administering insulin 4:06 injection a therapist helping curb 4:09 anxieties and supporting your kids 4:10 through some really really sad times an 4:14 IT expert building your own webites and 4:16 apps a data manager combing over 4:18 thousands of blood sugars looking for 4:20 patterns an EMT running to crisis calls 4:24 I'm not sure I'd sign up for this job it 4:26 actually sounds pretty 4:28 hard 4:30 my child's name is Laura and she's been 4:32 living with type 1 diabetes for the past 4:34 10 years Her diagnosis was lifechanging 4:37 for her and real changing for me my 4:40 name's Pina and I'm the caregiver of a 4:42 child living with type one I'd like to 4:45 spend some time with you today unpacking 4:47 the caregiver experience as it relates 4:50 to type 1 diabetes in my spare time I'm 4:53 also a social worker so I'd like to 4:54 share some strategies and tips that can 4:56 help us navigate the everchanging 4:58 landscape of of caring for someone that 5:01 we love who lives with type 5:04 one if you're the caregiver of a child a 5:07 young adult or even an adult living with 5:09 type one you may have experienced a 5:10 variety of what I like to call ages and 5:12 stages of the diabetes Journey that 5:15 first year that was a tough one I'm sure 5:18 a lot of us remember diagnosis some of 5:21 us may have that day emblazoned in our 5:22 memory others may remember it in bits 5:25 and pieces and others may even struggle 5:27 to bring some of those difficult 5:28 memories to the surface 5:31 Switching gears from that freedom that 5:32 came with the working pancreas to being 5:34 aware of every single carbohydrate that 5:37 your child put in their mouth and all 5:40 those carbohydrates those countless carb 5:42 counts changed how we viewed food and 5:45 meals those first few days then months 5:48 and maybe even years for some of us the 5:50 day-to-day stress that lasted year to 5:52 year packing the diabetes bag making 5:54 sure you have juice or glucagon or 5:56 insulin extra pods extra meters 5:59 navigating healthare systems and 6:00 appointments for some the added stress 6:03 of other autoimmune ill illnesses just 6:05 compounded the caregiver 6:08 role having a child diagnosed at two 6:11 versus a child diagnosed as a teen 6:12 through different spins into how some of 6:14 us had to Pivot with diagnosis and with 6:16 life so many variables and factors 6:19 affected us too many to list 6:22 actually and just like no two person's 6:25 diabetes is the same no two caregivers 6:27 will have the same experience they is no 6:29 way we can cover every single experience 6:32 and emotion in these 20 minutes but what 6:35 I hope to leave you with here is the 6:37 safety to start the discussion of what 6:39 it means to be a t1d caregiver to bring 6:43 awareness and unpack this journey that 6:45 we're on and highlight some strategies 6:47 to help us find balance within our own 6:49 selves but most of all most of all I 6:52 hope you leave here with the reminder to 6:54 be kind to yourself as a caregiver in 6:56 the world of type 6:58 one so remember that word cloud with all 7:01 the added jobs and new expectations that 7:03 came with the type 1 diagnosis well this 7:05 is us in our house 24 hours after our 7:07 daughter's diagnosis where we went from 7:10 a healthy child to a child with a 7:11 lifelong disease we were trying to 7:14 balance all that had changed in our 7:16 daughter's life and all our new roles 7:18 with some normaly so we thought why not 7:20 have a Friday night just dance party on 7:22 day two of 7:25 diabetes putting our child's needs 7:27 before our own needs to grieve that was 7:29 important to us I remember our Clinic 7:32 telling us kid first diabetes second and 7:35 that really resonated with me absolutely 7:38 this made 7:39 sense but at the same time I thought how 7:42 in the world was I going to fit diabetes 7:45 and everything that came with it into a 7:48 childhood and so here begins that 7:50 Journey that we as caregivers feel 7:52 compelled to go on taking on the 7:54 physical mental emotional and social 7:56 impacts of type one on top of everything 7:59 else we 8:01 do a type 1 diagnosis is life-changing 8:04 and it brings with it so many stressors 8:06 and worries the stress and anticipation 8:09 of blood work appointments worries about 8:11 school and educating School staff on 8:13 your child's diabetes working with 8:14 Community organizations to put nursing 8:17 staff in place to help our youngest kids 8:19 stay safe at school or helping our older 8:22 kids navigate this lifechanging event by 8:24 putting IEP accommodations in 8:26 place as life keeps moving and you start 8:29 to figure out what used to be easy like 8:32 birthday parties kids sports family 8:34 vacations and sleepovers and gosh I 8:37 remember heck even just putting your 8:38 child to bed became stressful with 8:40 worries about nighttime blood 8:43 sugars then in her life stages like 8:45 puberty driver's licenses first jobs 8:48 transitioning from pediatric to adult 8:50 diabetes care and moving away to college 8:52 or university life can get very bumpy 8:56 with diabetes and while you're working 8:58 hard to juggle care in for your child 9:00 you often do this at your own expense oh 9:02 and did I mention 9:04 sleep you're doing all of this on less 9:06 sleep than the average person needs 9:08 because diabetes doesn't go away at 9:09 night and lack of sleep correlates with 9:12 decreased focusing decreased 9:15 productivity increased depression 9:17 symptoms increased irritability and 9:19 increased physical health problems not 9:22 what we type 1 caregivers 9:24 need and then just when you think you've 9:26 got the hang of things boom something 9:28 else happens a really bad low blood 9:30 sugar ketones from high blood sugar or 9:33 even just a reminder that sometimes 9:34 diabetes takes precedence over being a 9:36 kid and that sends you back into the 9:39 reality and grief of this disease 9:41 there's actually a term called chronic 9:43 sorrow that's described as an 9:45 intermittent grief reaction that can 9:47 happen with certain triggers even years 9:49 after a type 1D diagnosis for both kids 9:52 and 9:54 caregivers and our kids are heroes 9:57 everyday Heroes absolutely absolutely no 10:00 debate but we caregivers are pretty 10:02 awesome too kind of are every superhero 10:05 we're Batman jumping in action when we 10:07 see that dexc combat signal pop up in 10:09 the middle of the night we're Wonder 10:11 Woman deflecting those low blood sugars 10:13 with juuice boxes in hand and we're the 10:15 Hulk rage bising those stubborn highs 10:18 and we're Superman whose Kryptonite is 10:21 the unpredictability that comes with 10:23 diabetes and renders us feeling 10:25 powerless at times we are Spider-Man 10:28 prepared to scale a building if we have 10:31 to get to our child having a blood sugar 10:32 emergency I know I've driven a little 10:34 too fast trying to get to my daughter at 10:37 school we're Iron Man equipped with 10:39 every Tech Gadget known to man and even 10:41 some DIY and we are even full-time blood 10:45 sugar ninjas only because type 1D mom is 10:49 not an official job 10:52 title yes we're all these superheroes 10:54 but we're also human and frankly being 10:57 even just one superhero can leave us 10:59 feeling 11:01 exhausted actually we're not just 11:03 exhausted caregiving can leave us with a 11:05 lot of other feelings as well a lot of 11:07 us have seen the iceberg analogy in 11:09 relation to anger or even diabetes but 11:12 has anyone ever thought what it would 11:13 look like for us the type 1D caregivers 11:16 I took a shot at creating one since I 11:17 couldn't find one based on my own 11:20 experiences notice what's above the 11:22 surface what everyone sees or what we 11:24 want everyone to see us as calm 11:27 confident coping and control 11:30 and then what's below the surface maybe 11:32 what we don't want anyone to see what we 11:33 try to hide the tough stuff like fear 11:36 and guilt and anger sadness anxiety and 11:40 loss of 11:42 control the reality is that managing 11:45 your child's chronic illness and 11:47 potentially caring for other children 11:48 and managing your own physical and 11:50 mental health managing your family and 11:52 your relationships in your career is a 11:54 recipe for what is often described as 11:56 caregiver burnout burnout is defined in 11:59 the Webster's Dictionary as exhaustion a 12:02 physical or emotional strength or 12:04 motivation usually as a result of 12:06 prolonged stress or 12:09 frustration boy that doesn't sound great 12:11 does it there are so many associations 12:14 with that term burnout for a lot of us I 12:16 know there are for me especially when 12:18 we're talking about caring for our kids 12:20 are we even allowed to feel exhausted or 12:23 does that mean we failed or we're not 12:25 good enough some of us may even end up 12:27 feeling more guilt and May even shame so 12:29 much so that we end up not reaching out 12:31 and asking for 12:32 help I wish we could find another name 12:35 for this burnout term I've thought of 12:36 this long and hard some of these words 12:39 fit 12:40 fatigue uh overload depletion drain 12:44 exhaustion but there really isn't one 12:46 word that captures it adequately 12:48 diabetes is after all a disease and that 12:51 term dis ease literally means the 12:54 absence of ease it's not meant to be 12:57 easy we're going to have ups and downs 12:59 kind of like blood sugar and some days 13:01 boy some days I know I felt like a rock 13:03 star hitting those blood sugar targets 13:05 getting boluses on point and then boom 13:08 diabetes threw one of its everpresent 13:10 curveballs and left me feeling defeated 13:12 deflated and 13:14 incompetent remember that burnout 13:16 definition from earlier the one about 13:17 being exhausted because of prolonged 13:19 stress and frustration well this makes 13:21 sense doesn't it prolonged stress and 13:23 frustration can go hand inand with 13:26 diabetes that's another word we should 13:28 consider prolonged or chronic add that 13:31 to disease and you have chronic lack of 13:34 ease it never 13:37 relents so what can we do how do we 13:39 navigate it and notice I didn't say 13:41 prevent it because burnout is real it's 13:45 normal it's almost expected but most of 13:48 all most of all it's okay so since 13:51 burnout is real and expected how can we 13:55 cope well and here come the strategies 13:58 and tips 13:59 some of us become Advocates and allies 14:01 jumping into those areas where we can 14:03 support our children in the type 1 14:04 community Through walks rides 14:07 fundraisers we try to create meaning and 14:09 become part of the change we want to see 14:12 kind of like what we do with grief work 14:14 after all aren't we all grieving to some 14:16 extent the life we thought we'd have or 14:18 our kids would 14:20 have we also keep doing what we were 14:23 doing routine becomes important 14:25 especially because diabetes took away so 14:28 much so we keep taking our kids to 14:30 hockey or LaCrosse or synchronized 14:32 skating and slowly yes ever so slowly 14:36 diabetes becomes a part of our routine 14:39 is that new normal they talked about 14:40 early on in diagnosis that made no sense 14:42 to you then where I work we often do 14:45 exposure therapy to help us confront 14:47 that which is causing us anxiety it's 14:50 not until we confront our stressors 14:52 through habituation doing something over 14:54 and over again that we can collect 14:56 evidence that disconfirms our initial 14:59 beliefs and fears kind of like what 15:01 happens with diabetes every day is an 15:04 exposure that tells us that we can live 15:07 with diabetes that we can cope with 15:10 diabetes I remember our very first low 15:12 blood sugar our whole house stopped we 15:15 all sat and watched our daughter drink 15:18 her juice waiting for her blood sugar to 15:20 come back up not knowing exactly what 15:22 was going to happen in trying to manage 15:25 those worst case scenario thoughts that 15:27 were swirling in our heads so we waited 15:31 exactly 15 minutes retested and sure 15:34 enough everything turned out okay blood 15:37 sugar was back up then over time you 15:40 have another low and another low and 15:42 another low and it's not long before 15:44 you're taking these lows in stride 15:46 that's habituation doing something over 15:49 and over again and collecting that 15:51 evidence that your worst case scenario 15:53 didn't always have to come true and that 15:55 you could 15:57 cope this helped helps with that anxiety 15:59 and worry that comes with 16:02 diabetes another way to alleviate some 16:04 of the burden and stress caused by 16:06 caregiving in a diabetes world is to 16:08 build connections find your community 16:11 and boy are there ever a bunch of type 16:14 one communities to choose from diabetes 16:17 Facebook groups DIY groups like Loop and 16:20 night Scout organizations like I 16:22 challenge diabetes friends for life 16:24 connected in motion desate decamps and 16:27 even just in formal local Friendly 16:30 coffee clubs where type one caregivers 16:32 meet once a 16:33 month I think the best impact that 16:36 finding your type one Community has is 16:38 that it leaves you knowing that you're 16:39 not alone this goes a long way in 16:42 helping navigate burnout being around 16:44 people who just get it and big bonus 16:47 from your new community is that you can 16:49 make some of the best friends you'll 16:50 ever have in life I know I 16:55 did this next strategy is a tough tough 16:59 one as far as navigating burnout goes 17:02 letting 17:03 go for a disease that came in and 17:05 required us to stick to our kids like 17:07 glue letting go can be really tough for 17:10 some so tough that you may avoid it I 17:13 think what worked best for us was to let 17:15 go a little bit at a time over the 17:18 years one of the ways we can let go a 17:20 little bit at a time is sending our kids 17:23 to diabetes Canada 17:25 decamps it's good for us yes it's okay 17:28 for us caregivers to get a break from 17:30 diabetes I know that thought took me a 17:32 while to get over but it can be super 17:35 fun for our kids to get a break from us 17:37 too teaching our kids how to manage 17:39 their diabetes and sending them to 17:41 places like Camp is a life skill that 17:43 will pay dividends in the long run for 17:45 them and for us too and our kids get to 17:48 make some of their best friends at 17:50 camp and we have fun wow diabetes and 17:53 fun in the same sentence who would have 17:55 thought yes yes we have fun with diabet 17:58 diabetes they say that laughter is the 18:00 best medicine okay well maybe in our 18:02 house insulin is the best medicine but 18:04 laughter is definitely a close second 18:07 see those shoes in the picture they're 18:08 real Jelly Bellies they must have been 18:11 at least a thousand carbs each shoe and 18:14 bonus they gave us easy access to low 18:16 treatments on 18:18 Halloween get creative with this here 18:20 too we started a blood work Buddy system 18:22 at our hospital where we booked blood 18:24 work appointments with other kids living 18:26 with type one who wants to get blood 18:28 work alone it also helped kids who were 18:31 struggling and scared to build their own 18:32 capacity and resilience we even booked 18:35 endoc Clinic appointments together with 18:37 my daughter's diabesity from Camp what 18:39 better way to spend the time waiting for 18:41 your Endo team than catching up with 18:43 your Camp friend and celebrate the 18:45 successes and accomplishments we 18:47 celebrate the Milestones like Diaries 18:50 and pump start days diabetes came into 18:52 our lives and created a lot of losses so 18:55 it's important that you take the moments 18:57 and celebrate the winds and the 18:59 resiliency that you see in your child 19:01 and in yourself too I call this PDG post 19:05 diagnosis growth and it is incredible to 19:08 witness but you have to be open to 19:10 looking for 19:11 it so I'm a realist and I recognize that 19:14 it's not always rainbows and butterflies 19:17 sometimes things go wrong and sometimes 19:19 that can be scary terrifying even 19:23 sickness or pump site failures happen 19:25 low blood sugars happen high blood sugar 19:28 happen remember this is part of the 19:31 disease and it will pass and you will 19:35 cope when you're focused on caregiving 19:38 it might be hard to remember to take 19:39 time for yourself to care for yourself 19:42 self-care can be high level I remember 19:45 after we dropped my daughter off at 19:47 diabetes Camp um my husband and I drove 19:50 straight to the airport for a holiday 19:53 boy was that tough it was really hard to 19:58 trust other people to take care of my 20:00 child with 20:01 diabetes but what better group of 20:04 caregivers can you find for your child 20:07 than a medical team that's on 247 at a 20:10 diabetes 20:13 camp now self-care can also be micr 20:15 level doesn't need to be big doing the 20:18 little things to help offset the burden 20:20 and distress that diabetes can bring 20:21 into your life getting your haircut 20:24 going to dinners going to sporting 20:25 events taking naps spend spending time 20:28 doing something anything other than 20:31 Diabetes Care 20:33 counts now this part is important while 20:35 selfcare absolutely includes taking time 20:38 for things you enjoy and that provide 20:40 restorative rest and relaxation for you 20:43 did you know that self-care is also 20:45 about knowing your own limits setting 20:47 your own boundaries and knowing when you 20:49 need to reach out and ask for help be it 20:52 informal support through family and 20:54 friends or more formalized through 20:56 individual counseling services 20:59 it's okay to speak up and say I'm not 21:01 okay no one to get help for diabetes 21:04 management through your clinics and no 21:06 one to get help for your own mental 21:07 Wellness or your child's breakthrough T1D has 21:11 created a mental health and diabetes 21:13 directory that provides a list of 21:15 trained therapists or clinicians 21:16 specializing in type 1 and diabetes 21:19 distress check them out remember my hope 21:22 for you was to leave here being kind to 21:24 yourself well there's a theory that says 21:26 that we decompensate in our skills when 21:29 we're overworked and 21:30 overwhelmed well doesn't this make sense 21:32 for us as type 1D caregivers we are 21:35 tasked with being our best version of 21:37 ourselves during some of our most 21:39 stressed times let's try not to judge 21:43 ourselves when we're at our most 21:45 stressed practicing self-compassion can 21:48 go a long way in navigating 21:50 burnout next we're going to move to some 21:52 Concepts that may not be easy to wrap 21:54 our heads around but are necessary for 21:56 us to move through the Ang anger 21:58 avoidance and denial that may come with 22:01 diabetes distress and caregiver burnout 22:04 we'll start with 22:05 gratitude this is a big ask but it's oh 22:08 so significant in navigating burnout 22:11 find your gratitude in this journey it 22:14 can be gratitude for new technologies 22:16 that have made diabetes management so 22:18 much easier like my Pebble watch back in 22:20 the day when we couldn't see remote 22:22 blood sugars it can be gratitude for new 22:25 friends made through the diabetes 22:26 communities or or it can simply be 22:29 gratitude for getting through another 22:30 day the trick here is that you have to 22:33 be willing to look for it we can 22:35 sometimes get stuck in everything that 22:37 has changed that's become harder or that 22:39 we've lost take some time reflect on the 22:42 good that you still have another tough 22:44 but necessary process acceptance we 22:48 accept that diabetes is a part of our 22:50 Lives it's a part of our children's 22:52 lives this doesn't mean giving in or 22:54 giving up this means choosing to live 22:56 the best life you can with diabetes you 22:59 can see in the picture we made our 23:01 daughter a birthday cake one year with 23:02 her avatar on it actually we ordered it 23:04 in a wonderful talented Baker made it 23:07 but we made sure to include her insulin 23:09 pump it is after all a part of her and 23:12 we love every bit of 23:14 her P.S I still don't like the word 23:16 acceptance I still secretly cringe when 23:19 I hear it but it is liberating to stop 23:22 fighting it and to lean into it so that 23:25 we can adapt and grow remember that PD 23:29 and most of all we adapt our kids adapt 23:33 and we figure out how to keep going like 23:35 how to test blood sugar while you're 23:36 hula hooping that takes 23:40 skill adapting takes time don't rush it 23:43 don't rush any of the processes go at 23:46 your own pace and take care of yourself 23:48 just like they tell us on airplanes to 23:50 put the oxygen mask on yourself first so 23:52 that you can help others you see none of 23:55 the strategies to navigate burnout Focus 23:57 focus on alleviating the work that comes 24:00 with diabetes that work is real and 24:03 necessary to keep our kids alive rather 24:06 navigating burnout starts with you and 24:08 what you can 24:10 do and then sit back and watch as they 24:15 soar we uh dropped my daughter off at 24:18 University a week after she spent the 24:19 summer up at diabetes 24:24 camp that was a tough 24:26 one and while my role wasn't finished it 24:29 was time to let go and 10 years ago I 24:32 never would have thought I'd be ready 24:34 for this moment but I 24:37 was and if I can give my tenure younger 24:40 self one piece of advice it would be to 24:43 let go of the future worries they tend 24:45 to work themselves 24:46 out today my daughter is living on her 24:49 own in her first year of University 24:50 we've had ups and downs we've had 24:52 bumps but we could not be more prouder 24:55 or more grateful and no it wasn't wasn't 24:57 easy but that was never part of the deal 24:59 with diabetes remember the absence of 25:02 ease now our story is not unique there 25:05 are a lot of families like ours whose 25:07 children have done very well and if 25:09 you're watching this you might be one of 25:10 those families and if you're not that's 25:13 okay too remember those ages and stages 25:15 we talked about I wasn't always in a 25:18 good place with diabetes there were 25:19 highs and there were some really low 25:21 lows and I'm not talking about blood 25:23 sugar but if I can encourage you to hold 25:27 on to hope 25:28 what worked for me was reaching out and 25:30 connecting things will get better but 25:32 you don't have to go this 25:34 alone I just spent part of my summer at 25:37 diabetes camp and I can vouch that there 25:39 are superstars out there kids who grew 25:42 up with diabetes who have and continue 25:44 to overcome so much who are exceptional 25:47 and extraordinary look for the success 25:50 stories they'll take away some of your 25:52 stress and worries and fears and build 25:55 your hope that despite the bumps and all 25:57 of our roads we can navigate and come 26:00 out of some of the darkest tunnels in 26:02 ways we never would have imagined living 26:05 our best lives thank 26:08 you thank you so much for tuning into 26:10 this very enlightening episode of 26:12 diabetes deep Dives and thank you to 26:15 Pina for sharing her story and bringing 26:17 to light the experience of raising a 26:19 child with diabetes again this topic may 26:21 not be relevant to everyone living with 26:23 diabetes but we do hope that you found 26:25 it interesting and learned something new 26:28 please take the opportunity to keep the 26:30 conversation going by posting a comment 26:32 in the comment section on YouTube you 26:34 can provide us feedback about the video 26:36 by clicking on the link to the feedback 26:38 survey in the description box if you 26:40 have ideas for other topics you'd like 26:42 to learn more about you can include that 26:44 in the comments or feedback survey as 26:46 well Pina talked about other 26:48 organizations that support people living 26:50 with type 1 diabetes we've included 26:52 links to those organizations in the 26:54 description box as well as some 26:56 additional diabetes can can resources 26:58 related to caregiving and diabetes for 27:01 more information about diabetes 27:03 management please visit our website at 27:07 diabetes.com 27:10 diabetes.com line at800 Banting that's 1 27:15 18226 27:16 8464 and speak to one of our information 27:19 and support Specialists who can address 27:21 your needs thanks again for joining us 27:23 and see you next 27:26 time 27:27 [Music]