April 29, 2025 • 52 mins
Episode Summary
In the 32nd episode of 'Think Like a Pancreas--The Podcast' host Anna Sabino and her guest, James Vander Mullen delve into the concept of diabetes burnout, particularly as it affects those living with Type 1 Diabetes (T1D).
They offer insights from their personal experiences, emphasizing the critical role of mental health in managing T1D.
The conversation highlights the importance of returning to basics, especially when feeling overwhelmed by modern diabetes management technologies.
They also talk about the parent-child dynamic in diabetes care and offer advice for both parents and individuals on coping with burnout and building resilience.
Key Topics Discussed- Focus on foundational management practices
- Maintain open communication
- Celebrate small victories.
00:13 -- Welcome and Introduction
01:20 -- Meet Anna and James
05:10 -- How do you avoid burnout?
07:03 -- What do you do when you experience burnout?
14:37 -- Does technology add to diabetes burnout?
16:09 -- Burnout presents itself differently for every person.
21:16 -- How to recognize burnout and cope with the experience.
23:04 -- How to help children with diabetes deal with burnout.
27:43 -- What advice would you give parents who deal with burnout?
37:54 -- Tips for dealing with technology in a way that won't lead to mental burnout.
44:06 – Final words
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:13):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Anna (00:36):
Hello everyone.
Welcome to Think Like aPancreas, the podcast.
, my name is Anna Sabino and I amjoined today by James Vander Mullen.
Did I say that right, James?
James (00:49):
Uh, yeah.
Pretty much.
Anna (00:50):
Thanks for, thanks for being here.
James (00:52):
Thanks for having me.
Appreciate it.
Anna (00:54):
Awesome.
Today we're gonna talk aboutdiabetes burnout, but before we get
started, if you're not familiar withIntegrated Diabetes services, make
sure you go ahead and, subscribe toThink like a pancreas, the podcast,
wherever you get your podcasts.
And if you're interested in any ofthe clinical services that we offer,
we're pretty multidisciplinary team.
(01:15):
Go visit us at www.integrateddiabetes.com.
And so I'm gonna introduce myselfbriefly here before we jump into
this sort of always elephant in theroom topic of mental health and T1D.
My name is Anna Sabino.
I'm one of the mental health clinicianson the Integrated Diabetes Services team.
I've lived with type one diabetessince I was six years old, so
(01:37):
well over 30 years at this point.
You can guess my age if you want to, butI wear some technology and really love
working with clients, patients who justfeel, like whether they are stuck or
are in need of support, helping navigatethe sort of emotional rollercoasters
ups and downs of daily life with T1D,whether you call it therapy or not,
(02:01):
I, I am a true believer that everyoneneeds some type of neutral source to
either vent or share or, you know, talkabout questions related to diabetes.
Whether it is like pure on depression,anxiety, or whatnot, or just the day
to day, I love listening to people'sstories and helping them figure
(02:22):
out the best solutions forward.
So enough about me.
James, a little bit about you.
And then I'm just gonna kind oflike piggyback, ask you a bunch of
questions on like, you know, diabetesburnout and like, I think we've all
been there at some point, right?
And, uh, hopefully have our listenersleave with a few maybe tips and
tricks in their back pocket.
James (02:45):
No, thank you for having me.
I appreciate it.
It's, it's cool obviously to meetguys from around the world as well.
You realize it's, uh, I think to start,before I introduce myself, it's uh,
I think it's important for everybodyto realize that type one diabetes is
theoretically and scientifically one ofthe most understood diseases in the world.
And then obviously there is somuch support, so much help, and
(03:07):
there is a lot of work around it.
So I think you can live a verylong and happy life with it.
It's, uh, obviously it's, it's noteasy work, but I think the longer you
deal with it and you come to termswith it, you slowly but surely develop
methods to deal with it in your own way.
I think it's a personal journey.
There's not a one shoe fits all or onesize fits all method, but ultimately, I
(03:32):
think talking about it is a good thing.
Learning from other people, learningways in which people deal with it,
I think it's a very helpful wayto journey through life with it.
But, yeah, so I'm James Van Millerand I live in, uh, in South Africa.
I've had type one diabetes since Iwas four, so I'm 20-- turning 27 now.
(03:52):
So I had it for about 23 oddyears and I started off injecting.
We kind of like, obviouslywhen you first diagnosed you.
Start off with learning how yourbody handles and reacts to insulin.
You learn the differencesbetween short and long term or
short and long acting insulin.
So I think slowly but surely, you kindof work into all the different nuances
of your body, how you react, youractivities that you get up to and how
(04:15):
you handle it, but are now also obviouslyutilize quite a lot of technology.
I'm blessed to be in that positionwhere I can and, obviously I, I enjoy
learning about new things that are.
It's cool to keep abreast of itand it's nice to see that people
are actively taking time to investinto the research and how you can
(04:38):
actually get to a point where.
You live an ordinary life, a normal life,it's just about recognizing the fact
that it's not going away, , unless you'reable to get some type of, uh, transplant.
But I don't think a lot of people optfor that because in the long run you're
having to take, uh, anti-rejection meds.
And I think obviously the side effectfrom that is also very different.
(04:59):
And the last time I looked itwas about 40% acceptance rate
full on otherwise Yeah, you dealwith complications long term.
So I think, yeah.
Anna (05:10):
Thank you so much for, for share, for sharing that, and it sounds
like you've been at this for a while.
And one of the things I wanted to, to jpback in that, that you said pretty early
on in, in your story is that there are,we, we really understand type one diabetes
from the ins and outs like biologically,but mentally is, is really where.
(05:34):
The, the crux of optimal diabetesmanagement and the ability to kind
of live decades with T 1D is notnecessarily as, as understood.
It is a very self-managed,individualized disease, that
there is no one size fits all.
I often say, you know to patientsor to, to clients, you know, you're,
(05:59):
you're doing the job of two organs,your brain and your pancreas, like
this is an impossible mission.
Insulin is one of the only medicationsprescribed in the world, as far as
I know, where there's no dose on it.
Like, you go to a pharmacy andyou pick it up and it's like,
well, here's your vial of insulin.
Good luck.
(06:20):
There's no, you know, take thistwice daily, three different things.
And so my question to you is howdo you, do you not get burnt out?
How does this day after day ofmanaging diabetes, how you know
it is, it is a lot of work.
Even this morning, you know, I just dosedfor something and now my blood sugar is
(06:43):
like, it's 193, which is a little bithigher than I would I would want it to be.
And so you know how day after day it is.
So can be so self-defeating.
How do you prevent.
Yourself from getting to thepoint where you are burnt out?
James (07:00):
Well, it's a simple answer.
You do get burnt out, you can't.
Exactly.
Anna (07:04):
Okay, so, so let's dig into that then.
Let's dig into that then.
How did you know you were experiencingburnout and, and at what point
in your life were you there?
James (07:13):
So for me, obviously when you're younger, your parents
are helping you manage it.
So obviously I was diagnosed andI was very young, and at that
moment I didn't understand it.
So I mean, they told me stories.
They recall me hidingunder the nurse's bed.
I didn't want to be pricked.
I didn't want to be dosed.
This was just after I was diagnosed,
Anna (07:29):
I did the exact same thing in the hospital.
Yeah, I was six years old.
I hid under the crib in hospital.
They tried to find me.
You don't want that.
Nobody wants that attention.
James (07:40):
Yeah.
Yeah.
No, I think, uh, so obviously overtime you monkey see, monkey do, right?
So like for me as a young child, I didn'tnecessarily think of it as anything.
I didn't have a construct in mybrain that, oh, this is lifelong
and this is a day to day.
It doesn't go away.
And if anything, with life stresses,with everything that comes with it, as
(08:00):
you grow up, you have to contribute tosociety, you have to study, you get a job.
You own a business.
You run a business.
And uh, for me, I do.
I have had periods in which I've beenburnt out, but actually been later in.
I think for me, I was in, so justfor context, I'm a lawyer now.
(08:20):
, I did my undergrad at universityand then I did my masters and I felt
the most amount of burnout when Istarted my first year of my masters.
That was in 2021.
And for me, the, the way in which itpresented itself for me personally was
I just didn't take care of the basics.
(08:43):
So basics being.
I'm not sure what insulin or uh, glucosecontrol monitoring you use, but like
for me, just the daily need to, how manycarbs did this meal actually take up?
Like, I need to now put that intomy bolus with it, let it bo and then
let it work out how much insulin isconnected to that and how much to go in.
(09:03):
And I, I just, my burnout presented.
I just stopped doing the basics.
Right.
And they, you can't really putyour finger on it, but because it's
every single day, all the time, it'srelentless and you kind of, it becomes
part and parcel of your journey.
Sometimes when other life stressesare higher or in your brain,
you see them as more important.
That's when it happens.
Anna (09:24):
Yeah.
James (09:24):
It happens because you feel like it's a nuisance.
You feel like it's a constanttapping on the back of your head.
It's in your subconscious.
Quite frankly, you, youfeel it physically too.
I mean, you know, if your bloodsugar's high for me, I can tell
you right now, I feel about seven.
So in South Africa we use adifferent, we use metric systems.
Yeah.
millimols.
So, uh, for me, I know that I'm7.2 now, and if I look, yeah, I am.
(09:50):
Yeah.
I'm, I can literally almost predict.
Yeah.
How I'm feeling because I thinkover time you get so used to
how your body reacts right.
But you to handle it.
It's to recognize the fact that I'mjust not doing the basics right.
And then you have to look atwhy you aren't doing that.
Is there something in particular, Iremember for me in 2021, it was just that.
(10:14):
Also, I was kind of, I was lecturing onthe side while doing my masters as well.
And for me, I just had so many otherthings contributing to my life and
to my stresses, to the, to anxietythat I just stopped doing the basics.
And that's what myburnout kind of felt like.
And I mean, it comes in waves, but forme the best way to deal with it is.
(10:34):
Very important for me personally,is having a good specialist.
Like so for me, Paula Diab, herand I have a great relationship.
I just say, listen, I've just stoppeddoing the basics correctly, and I know,
and you have to, you have to work out away of being honest with yourself because
quite frankly, you know when you are,you know that, okay, I haven't done.
(10:55):
I haven't bolused or I didn'tcarb count correctly today, and
that's probably contributed to whyI'm feeling the way I'm feeling.
Number one, the first step is tryingto find yourself with the phys,
a physician or a specialist thatunderstands you, or that at least you
can be open and honest with and youcan troubleshoot with or find a way
(11:15):
that in your daily routine, how can we.
What small incremental changescan we make that are sustainable
in your day-to-day life?
Because I don't think, I don'tthink it's possible to be on
the money every single day.
It's not possible.
Anna (11:29):
No.
James (11:29):
It's not.
You having had it for over 30 years now.
I've had it for over 23 years now.
It, I know it's not possible.
You'll have beautiful days where youliterally don't, don't go above seven,
and I hover between five and seven forweeks on end sometimes, but then you'll
have two days that completely derail.
Your whole process, andthat's where you lose it.
It's when you get, you almost becometoo comfortable with slacking with.
(11:55):
Mm-hmm.
Not slacking, but yeah, withjust losing touch of what?
Of how you started.
And that's why I think I was lucky.
I think nowadays when peopleare diagnosed, they don't
necessarily prescribe that,no, you must inject insulin.
You must do this, you must do that first.
I was lucky in that I could learnthe basics very early on in my life.
(12:17):
So like I understand what a sandwich wouldcontra would be at if I'm carb counting,
I would be able to tell you on the money.
Right.
But for other people nowadays with thetechnology increases, you are kind of
Anna (12:32):
flying by
James (12:33):
usher into a very Yeah, yeah.
Yeah.
And you kind of, you kind of, you'rerelying on the technology to do the job.
Right.
And that's what it's there for.
And it's great, but I think.
The, the burnout aspect I wouldactually imagine is higher
for people that don't start.
The most rudimentarytreatment of of diabetes.
(12:53):
And quite frankly, I think that'sone of the main reasons why a lot of
athletes prefer that way, because it'sactually, there's less to focus on.
You don't have to worry about, orthe interest or the intricacies,
oh, what's my insulin re, what'smy insulin correction factor?
Should I change it in this time zone?
Should I change it here?
Whereas for them, they know, okay, cool.
(13:14):
Today I'm gonna inject long actinginsulin and I'm gonna eat accordingly.
I've injected 44 units today, andI'm gonna eat to that measure.
I mean, Alexander Zverev, yeah,top 10 in the world, tennis player.
That's why he does it.
And he's spoken about it.
Anna (13:28):
I love, I love everything that you said because I could not agree more,
and maybe because I come from similar toyou where, you know, it's almost like.
Not necessarily ignorance is bliss,and I'm a firm believer that it's
not about, you know, if you feellike you're kind of just burnt out.
I mean, we as humans get burnt out.
(13:50):
You know, as a social worker, as adiabetes educator, as a person, I. I get
burnt out and I know I get burnt out.
Like, and I think my familynow, I have two young kids.
Sometimes I feel like I, I can tell,I look back at my graph, I wear the
the tSlim Tandem X2 system and I'mjust like, Ooh, that time in range,
like wasn't really great today.
(14:11):
What can I do tomorrow?
Do I have more water in the morning?
You know, how can I, how canI shift some of my behaviors
because it is a very isolatingand behaviorally managed illness.
But something that you said really,really struck me that I don't think
a lot of people process is thatit doesn't have to be like all or
(14:32):
nothing when it comes to technology.
And does technology really contribute?
Further into this notion ofdiabetes burnout or are we just
talking about it more often?
Because there's more to talk aboutand there's more platforms and
this, that and the other thing.
I think we've always sort of hadthis notion of this is so hard.
(14:54):
But I work really closely with kids andparents and, and young adults who are
processing the emotions of this diagnosisand grieving and trying to figure out
every ratio, correction factor, allthese things, how do they go to school?
How do we travel, like adaptdiabetes into our like regularly
(15:14):
scheduled programming life?
Mm-hmm.
And.
When I was growing up, and I knowthings are different and I don't wanna
compare, but I didn't think aboutdiabetes like during the school day.
It was like I took a shot, like yousaid, I pricked my finger and then on
the very way, and it was, it's almostlike the technology is good, but like
(15:37):
sometimes I think it's, it comes downto, and it's like, I know this isn't
necessarily super related to burnout, butit kind of is because it's like, if we
don't trust our systems, our technologysystems to do the work that it's
supposed to do, why are we using them?
The role?
If we can understand the role of us andthe role of the technology, we're gonna
(16:01):
have a better relationship with it.
We're gonna be able to understand it,we're gonna be able to make changes.
And I think that's part of the problemis that there's just not enough education
out there and validity for all ofthese fine tuning behaviors that we
have to do as humans that we haven'tadjusted to as like a society where
(16:23):
the expectations are not sort of there.
And so I do think, you know,everyone's, everyone's feeling of
burnout is gonna feel different.
Everyone's version of Okayis gonna be different.
And your version of okay, todaymay be completely different
than tomorrow based on, like yousaid, a thousand other factors.
But.
(16:45):
It is, it is so hard to pinpoint burnoutand you know, I, I, I know that you
have the ability to recognize, oh wow,I am not even able to do the basics.
Were there any other sort of likered flags that you, you know,
(17:06):
I know from a diabetes burnout,mental health perspective, it's
really like not to, you know.
You're not taking your insulin, you'renot doing as well as you have in the past.
And that, that is, I think, a, a cruxto burnout is that everyone's version
of burnout is gonna be different.
Because if you are used to being on youra game and your a game is counting out
(17:28):
every single goldfish you put in yourmouth and now you're sort of slacking,
well, maybe that's burnout to you.
But for someone who maybe has theirtime and range at only 30 or 40%, and
now you're down to like 10%, well.
Your version of burnout is much different.
So I think that's something to keepin mind because I think so much of our
(17:49):
world can be very comparative and like,oh, well I'm not here and you're there
and my A1C is this and yours is that.
And I think it's really importantas we're thinking about burnout,
is that your diabetes burnoutwill vary just like your diabetes.
Just like your diabetes will vary.
We all take different amounts ofinsulin, but sort of circling back,
(18:09):
I know that was sort of a tangent,what else do you feel like you notice?
Kind of creeping in as you, youknow, go over these emotional hps and
rollercoasters, when it comes to burnout?
And can you prevent yourself fromgetting there at all or is it
just like, well, here I am, I'mgonna call my diabetes specialist.
James (18:32):
Yeah, I think, uh, yeah.
So first of all, I agree with thetangents you went on for sure.
I think it's that that is acontributing factor and it, it
will look different for everybody.
I think everybody has to acknowledge that.
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Anna (19:23):
All right, so as we dig into more about burnout, you know, I think something
to think about too is that everyone isgonna be on their own journey all the
time when it comes to type one diabetes.
And I give a lot of talks, and I gaveone last weekend to a group of parents
(19:43):
called Parenting for Independence andone of the slides that I always emphasize
is that, you know, your schedule ofacceptance does not always equal others.
Whether it is you as an individualliving with diabetes and a parent
or a parent and their own parents.
Whenever we have relationships withothers, with other people, our, our
(20:07):
schedule of acceptance as, as it relatesto sort of the grieving process or
just processing what this diagnosismeans can be very, very different.
And therefore, you know, burnoutcan be very, very different.
And everyone may experience burnout atdifferent points of their diagnosis,
(20:27):
whether you're like emotionally burntout, whether you're physically burnt out,
and I think it's so, so important to beable to accept that this burnout is here
and putting this, you know, little labelon it because if you don't, you know,
burnout is sort of the gatekeeper orgateway towards, you know, things like
(20:51):
depression or severe anxiety avoidance ofthings like insulin administration, which
we know is critical for managing diabetes.
And if we don't recognize burnoutas that, that sort of first step
is where it starts to go south andwithout all of that lack of support.
So James, tell me how you feel like asa child, you and as a young adult now
(21:18):
are, are able to kind of, not necessarilycombat burnout, but recognize it and then
use that to cope, if that makes sense.
James (21:30):
Well, I think as a young child, obviously I was diagnosed
fairly young in my life.
I don't recall a period of mylife where I wasn't diabetic.
So yeah, there's notlike, I have a comparison.
So for me, I think in a way that's beenadvantageous throughout my, throughout
my life, dealing with diabetes,dealing with a, a chronic illness, but.
(21:53):
As a young child, you don't, I don't.
I genuinely don't believe you recognizeburnout, and unfortunately it means
that your caregivers, your guardians,your parents, they almost need to look
at you, see if you're understanding thegravity of being a type one diabetic,
needing a specific hormone to get energy.
So there unfortunately, a lot of theburden rests on the relationship between
(22:18):
you and your your family in doing so.
It's also on the adults in the room tokind of impress upon you how important
it is that you need to manage it,and you need to learn to manage it.
And as a child, I think it doesoften start at home and it, it
does often start having a reallygood pediatrician from a young age.
(22:40):
Because if you don't recognize theimportance of growing into your
diabetes, for lack of a betterphrase, you won't recognize it.
And unfortunately, your parents onlyknow how you're feeling if you tell
them and most of the time they won't beable to tell that you're running high
because you haven't been learning toinject yourself or doing it yourself.
(23:03):
So I think at a young age, I thinkburnout and fixing it rests on
that relationship between you andwhoever is helping you grow into it.
But as you get into get older, that'sthen when it becomes that person's
responsibility now, that's now,this is where it's different now.
It's learning to develop arelationship with yourself.
(23:26):
Being able to say, today I feel horriblementally, not physically from being
running high or running low, but I feelhorrible emotionally about having to deal
with the day to day now to deal with that.
I think you have to then look back atwhat you've learned about what happens if
(23:47):
you don't actually take care of yourself.
Now, it's easier said than done,but again, it's about trying to
develop a method of recognizingyou, you can't get away from it.
But there is also, there is slight leeway.
I, I'm, I'm not somebody that believesthat to be a well-functioning human
(24:11):
being, a healthy diabetic thatyou have to be spot on every day.
You have to learn to be, togive yourself a bit of grace.
So if you are having a bad day,you say, okay, what are the basics?
The basics are I need to inject myselfor I need to, I need to do a bolus
wizard on my insulin pp, whateveryou're using to administer insulin.
Anna (24:30):
Mm-hmm.
James (24:30):
And you need to, you need to step back and say, the
basics are, I need insulin.
To break down food for energy.
Now that is the key.
If you look at the basics, I do thinkthat the bigger picture and something
that you're particularly stressedabout, 'cause you know it's probably
not going anywhere, it makes itfar easier to to recenter yourself.
(24:56):
And that might take aday, it might take a week.
But going back to basics, I remembermy specialist, she said to me, in
her mind, the most practical way ofgrowing through your diabetes, living
through your diabetes and actuallythriving with it, is just trying
your very best to do the basics.
And when you look at diabetes froma high level point of view, that
(25:17):
is just administering insulin andrecognizing what you're eating.
It's a invisible enemy.
So it's not like you are gonna be ableto predict your day every day, but what
you can do is you can predict, I know Ineed 44 units of insulin, so I'm using
our metric from here, but I'm I'll, I willneed to administer 44 units, or I'll need
to have a basal rate at minim of 44 units.
(25:40):
Yeah.
To maintain some form ofstability going past that.
I know that.
Okay.
At lunch.
I'll eat a sandwich, I'llhave a coffee probably.
I don't personally put sugar inmy coffee, but I'll put, let's
say I have a teaspoon of sugar.
I'll literally look at it fromthe very, very bare minimum.
I'm not concerned about, I doing anextended bolus on my insulin pump.
(26:02):
I'm not concerned about running high.
I'm concerned about making sure thatwhat I put into my body I'm bolusing for.
That's the bare minim that's required.
Anna (26:12):
I love that.
I love that perspective because Ithink so, so many, so much of the
time, we now have, and it sounds likeyou do too, we now have the ability
to fine tune our management down tolike the 0.005, you know, increments.
Whether it's a basal rate, whetherthey're, whatever the strategy is that
(26:32):
you're using, whether it is the, youknow, DIY looping system or a basal rate
or a temporary basal rate, or automatedinsulin delivery, you wanna change a
target... We have the, we have the optionto manipulate this type of insulin,
but sometimes that can be overwhelming.
I wanna back up for a second because Icompletely agree with you about this sort
(26:56):
of transfer of ownership around burnout.
At what point did you feel like, you sortof, whether it was like this aha moment
or, because this is one of the thingsI'm most passionate about in terms of the
parent child dyad and the relationshipbetween parent child in terms of setting
(27:18):
boundaries and burnout prevention andreally just relationship management.
So when you know you are in your midtwenties, you can look back and have that
foundation built as strong as possible.
As, you know, grow older and we cansay why I am a resilient kid because
of the support I had from my parents.
Two follow up questions to that.
(27:39):
Have your parents ever said to you thatthey were burnt out and what advice would
you give parents today about trying tonot burn out as parents, whether they're
newly diagnosed or, you know, they're10 years in and they're working with a
child who, you know, may not wanna givetheir insulin or is just, doesn't wanna
(28:03):
even admit that they have diabetes,which are too very, you know, common,
you know, behaviors or feelings tohave, which are, you know, very normal.
James (28:12):
Yeah, no.
So I think on the first question,the transfer of ownership for me.
I think it was an innate thing.
Anna (28:20):
Mm-hmm.
James (28:20):
I think I was lucky in that aspect, but it's also my
parents have been together forever.
So for me it's not like I hadto also deal with two separate
parents, two separate households,two separate ways of doing things.
And they did, they did a, a brilliant jobin my mind in establishing how important
it is that you need to learn how toput your insulin, uh, put your port in.
(28:45):
These are things that when you move outof, when you move out of the house, and
I do believe I'm an abi, I'm an ambitiousperson, then that's what I did for me.
I, I knew I'm not gonna be ableto do anything on my own unless
I start doing it on my own.
And I think for me, it probably happenedaround about the age of 10 to 11.
I was, I was, , puttingin my ports myself.
(29:08):
But it, let's say that's not the case.
Let's say the child is just, forwhatever reason, an inverted
commas, a slow launcher.
They, or they, they, theydon't, they don't just fly
Anna (29:21):
love that, love that a slow launcher.
James (29:22):
They're a slow launcher and they slowly, but surely are getting into it.
It's about if let's say the parentis putting in the port and helping
them understand how much insulinthey need to do or how to carb
count or how to learn to carb count.
I do think there, when doing it, youneed to make sure in that moment, so if
(29:45):
you are putting in their insulin port oryou are putting in their GCM or their,
uh, their glucose monitoring port there,you need to basically take their hand,
their physical hand and put it thereand show them, look, it's this easy.
I don't know.
You also use the same pump as me.
We use the Tandem tSlimX2,but this is how you do it.
(30:05):
The best way of learning is by seeingit being done and showing the child
that it's, it's not a taboo thing.
It's not somethingthat's there to hurt you.
It's something that you need.
You need, you need to live withit and you need to learn to do it.
It's physically showing them todo it as if your dad would put you
in a car when you, when you areslightly younger, to learn to drive.
Anna (30:27):
Oh, absolutely.
The modeling, the modeling is key.
And if we don't have modeling.
Then it's, it's very hard to learn.
Yeah.
James (30:39):
And I think, and I think it's sometimes hard love could
work, but again, there, I'mtalking to the relationship again.
You, you know what your childis like and how they take
instruction or how to learn things.
And there you, you haveto have soft skills.
You have to have emotionalintelligence and look at how the
child typically learns things.
And you would probably learn aboutthat from when the child's an infant.
(31:02):
How the child learns how to walkand or first crawl, then walk.
You'll see how they pick up onthings in life and I think it's the
same way as they, as they grow up.
If they aren't somebody that justtakes it by the horns and wants
to do it themself, like for me,I hate having to ask for help.
In the most,
Anna (31:19):
I'm the same way,
James (31:20):
way possible.
So I knew I wanted to learn and I neededto do it, so I just started doing it.
If I had a problem, I would say,listen, mom, what this time it hurt me.
Why do you think?
And she would say, well, I thinkyou probably pressed too hard.
Or, uh, how are you like, I, Ipersonally put it on my buttocks.
So like on my bum cheeks, my, my,
(31:41):
she said, well,whereabouts did you put it?
And like, you just are askedquestions, the kid might not, and
you'll, you'll start to see slowlybut surely how they're learning it.
And then in terms of the secondquestion on potentially parents feeling.
Yeah.
I think you, I believe you saidparents feeling burnt up, burnt
out, or stressed, or quite frankly,it's a, that's a normal feeling.
(32:03):
, I know my mother,
Anna (32:05):
yeah,
James (32:05):
She, she cried.
She cried for days on end and she wasvery concerned about, she couldn't believe
that her son has to deal with this now.
But I do think it, peoplehave to recognize how well.
Managed type one diabetes hasactually become over time and how much
support has developed on it, how muchinformation there is available online.
(32:28):
There, support groups that people need it.
It's about, again, it's avery, it's a very common.
Recommendation to seek help, butI genuinely mean you don't have to
seek help with somebody physically,but you can seek help on your own.
You can genuinely learn and look at howpeople are dealing with it or how parents
are, and quite frankly, all parents willgo through the same mix of emotions.
(32:51):
Yeah, totally.
You'll feel like it's somehow your faultor you'll feel how feel like it's somehow.
God against you, or you'll feel like,you'll just feel me, your kid one, why me
Anna (33:04):
Question everything.
Yeah.
Yeah.
James (33:07):
That is just, and that is a process that people have
to acknowledge that is a thing.
It's, it's like losing aloved one or it's, it's like
losing a significant other.
It's unfortunately,
Anna (33:17):
it's supposed to feel hard.
It's, it's supposed to feel hard.
, yeah, because it's new and every timeour body experiences something new.
We wanna oftentimes just like suppressit and we can't, you know, we,
James (33:32):
I, I would say lean into the feelings.
I would say lean into thefeelings, acknowledge it.
Anna (33:35):
Love that, love that.
James (33:37):
But in doing so, they are also remedies.
I don't, I'm not a huge proponentof wallowing in that feeling.
I am a big proponent of recognizing it.
Yeah.
Recognizing how you typicallydeal with stress, anxiety.
Worries in general and trying to applythose concepts in your own personal life
that you have done as a parent in general,having a child to the current situation.
(34:00):
Absolutely.
Also, and also I do think, I just wannaraise this point, I, I think a lot of
parents, when they first hear that theirchild's being di has been diagnosed
with type one diabetes or is type one,the immediate reaction is a spiral
and you don't feel like you're ready.
And that's fine Nobody's ready.
(34:20):
That's why you have specialists alsowalk you through the process they've
trained their entire lives to do.
So.
You have yourself, Anna, you've,you've somebody that lives with it.
Yeah.
But also walk people through thatprocess and just recognizing that you're
not gonna get it right all the time.
And that's fine because.
It's new for everybodywhen they first get it.
(34:40):
But also recognizing that peoplewith type one diabetes can
live a long and healthy life.
It's just about doing thebasics as much as possible and
as consistently as possible.
And if you can somehow bringsome, a seance of calm,
like for on the, and humor.
Anna (34:57):
And a little bit of humor.
James (34:59):
A bit of humor and like, 'cause personally for me, my parents didn't show
me that they were concerned about it.
I didn't see it firsthand.
So perhaps that could be a good metric.
Maybe try not to freak outin front of your child.
'cause I think that wouldgenerally pass on to them.
But if you can somehow try andworry either with the specialist
(35:19):
separately or in your own time,it's probably best suited.
I don't think.
Freaking out in front of thechild is the best way of doing it.
But it might happen.
But again,
Anna (35:30):
it never, it never is.
Yeah.
I think there are some sort ofteachable moments that can come with
the spontaneity of, you know, emotionsthat come from diabetes, whether it's,
you know, I tears or fears or whatnot.
Uh, but I, I love what yousaid about asking questions.
You know, my mantra is always justlike, ask over, assume, you know?
(35:52):
And I wish more people ask me questionsabout diabetes just in the day-to-day
life as an adult, but I think parentssometimes can just feel so overwhelmed
because they're not yet confident.
The information, and we as asociety now have so much on
demand that we expect the answer.
You know, we ask Alexa, you know,what's the weather gonna be for today?
(36:15):
And she tells us, we wake up inthe morning, everything is on
demand and we wanna solve it.
That is just not how diabetes works.
And I think it takes a lifetime ofresiliency and experience to build up this
ability to not necessarily feel confident.
It's really this ability totrust ourselves that, and create
(36:37):
this ability to not constantlyself-doubt our decision making.
And that takes years as you know,before we sort of like wrap up, I did
wanna talk about, you know, again,this I whole idea of back to basics.
'cause I'm a, I'm a hugeproponent of technology.
It's great, you know,my phone is next to me.
I wear a watch, I havea pump, I've got my CGM.
(36:59):
You do too.
We're wearing the same systems.
It's amazing.
And.
It can also be a challenge for parentsand anyone living with type one to
kind of take it in the other direction,to the point where it is causing
burnout and it is causing issueswith a parent child relationship.
(37:21):
And that can create tension and separationof that reliability in the parent child,
parent child relationship from an earlyage, which you know, now we know some
seven, eight, nine, ten year olds arereceiving phones regardless of diabetes.
But with diabetes, it sort of forcesa jumpstart in technology introduction
(37:42):
that may likely have been, willhave been delayed several years.
So my question here to you is like,what advice do you have for anyone
as it relates to the relationshipwith technology to try to prevent
the mental burnout in the future?
James (38:03):
Yeah, no.
So I think you're totally correct,all of the nuance, , with technology,
you, as much as it might make peopleinitially feel very confident, they're
like, this is amazing because it does,it does change your, your daily routine.
Because if you have been usingrudimentary management, you would
(38:24):
either inject for the full day or youwould inject, inject intermittently
depending on what you're eating bloodglucose monitoring, you have a lot of
information coming through at all times.
Like for example, our blood sugarsread every five minutes and then that
is Bluetooth to your pump and to yourphone at any given moment, and it is
(38:44):
autonomously adjusting your basal rate.
Now again, the concept that we spokeabout earlier in my mind, to manage
your, your, your mental, when you take uptechnology so soon or rapidly because of
type one diabetes, again, apply the sameconcept of going back to basics, to what
(39:09):
is presented to you with the technology.
What I mean by that is just becauseyou have an insulin pump that is a
bit more autonomous to you physicallyinjecting yourself, and that effectively
operates as an external pancreas.
Don't get lulled into justaccepting the, the setup that
you're given with that pump.
(39:30):
Yeah, yeah.
Look at the basics.
You still need to remember that.
To prevent burnout, you have tostill be cognizant of the fact
that I need to be bolusing myself.
And again, I, I believe, to preventburnout with that technology.
Remember that it's stick to basics.
(39:50):
Do your bolus wizard.
Think logically with that, tryand continue carb counting,
like as much as possible.
Try and apply your mind to that, anddon't worry too much about why the basal's
correcting like this, why it's doing that.
Just do the bolusing.
Again, stick to the basicswith the technology.
When you build confidence in doing that,then you can start using all the nuance.
(40:15):
That's perfectly fine, but again, usingall the nuance and being lulled into.
Comfortability is what sometimes willtrigger burnout because you can't
understand or you'll look at other peoplethat are still maintaining a better, uh,
time and range than you, for example.
It's not a substitute for basics, and
Anna (40:33):
I love that it's not a substitute for basics.
Yeah.
It's just, and I see that especiallyis what I see when parents come to me
and they want, they fixate on the why.
Why is it going up?
Why is it going down?
And it's like, woo hoo.
Back up.
This is an autoimmune illness.
It is not our job toalways figure out the why.
(40:55):
We have no idea what ourliver is producing right now.
We have no idea what our smallintestine is doing right now.
Why should we know exactly every singlething that our pancreas is trying to do?
It is an impossible job.
And another point I wanna highlightfor our viewers too, is that.
(41:17):
It's supposed to be impossible,like, and if we, if we view it as a
fight, we're not gonna win if we viewit as a opportunity and an effort.
We're going to pat ourselves on theback more often and I hope that that
type of message and the go back tobasics method, if you are starting to
(41:39):
spiral into this mode of burnout, canreally dial you in because exactly.
Just give the insulin.
Don't worry about the minute carbcounting and measuring every single
goldfish that your child eats.
Give the insulin if that's all youcan do, and we'll figure it out.
I listened to one podcast recently witha parent and an endocrinologist, and the
(42:03):
endocrinologist was just saying, I, Ijust want you to thrive, and right now, if
thriving means not counting carbohydratesand just getting the insulin in the body,
that is more important than any numberpercentage in range or any A1C reduction.
I want you to give the insulin andI want you to think about safety.
(42:24):
Like this is about managingmedication and keeping you safe.
Let's focus on the big picture prioritiesbefore we nail down the advancements.
And so I really truly believe that,and the technology is not for everyone.
We still have the option to useinjections as many people prefer it.
(42:46):
I think when we talk aboutdia--diabetes too, from an identity
perspective, we assume that thistechnology is for everyone and there
is no one size fits all diabetes.
When it comes to connecting theperson, what their personality type
is, are you an, are you a data guy?
(43:06):
Are you a data nerd that likes dataall the time and can manage the input
or are you a mom that is managingfour other kids in the household?
And you need the ease of somethinglike the iLet or the Omnipod that
is just kind of plug and play.
You really have to think about,well, how, how is diabetes going
to be adapted into my alreadyestablished strengths in my home?
(43:29):
And I don't necessarily know if we.
Have those conversations often and enoughearly on in our diabetes management
today to really allow these decisionsto be fluid and prioritized based
on the family unit and the dynamicsand what is going to work with each
(43:52):
individual family, because it reallyis a huge lifestyle change and it can
be an amazing tool, but it can also.
Lead to burnout.
Yeah.
Final words.
James, what, what is your word,
James (44:09):
final words on this, on this topic?
Uh, I mean, obviously I was a, anavid tennis player when I was younger.
I happened to tear my ACL, so I stoppedplaying competitively, all of that.
Anna (44:18):
Bummer.
James (44:20):
Uh.
Like one of my, somebody that I really,really respect heavily is Alexander Zev.
Okay, he also is a, he'sin the top 10 in the world.
He's a type one diabetic.
And when in his younger years he wasusing, again, this is gonna go to a
burnout 'cause he actually touches on itand I'll have to find the interview, but
he touches on how he, when he was younger,because of all the data that he was
(44:44):
getting all the time from the technology,he actually stepped away because
he wanted to take tennis seriously.
But he actually found that trying toanalyze that too much was actually
detracting from him just being anathlete and, and try and living,
and he, he said he started to lookat himself as a type one diabetic.
And that's for me, somethingthat I just don't do either.
(45:05):
Yeah.
I look at myself as James, I lookat myself as a human being, and it's
just something I, it's part of my day.
But he moved back to rudimentarymanagement and he said that for him,
flipped the, uh, flipped the switchin his brain and he looked at laugh
completely differently again, and, yeah.
I really wanna say is type onediabetes is not a life sentence.
(45:27):
It's not something that you haveto actively look at as a negative.
If anything, I think I've developed a lotof life skills, soft skills, hard skills.
I've learned a lot.
And if anything, the doing the buy on yourbloods too is also a great thing to see.
Like I love being able to knowwhat's going on with myself doing
full, uh, some full hormone panelsjust because I want to know.
(45:51):
I would love to know my baselines, butthe long story short, stick to basics.
Don't, don't overanalyze yourself.
Your body is a weird and crazy thing.
It's not something that you'll understanda hundred percent of the time, and it's
something that medical specialists andpsychologists and psychiatrists try their
entire lives to physically understand,and that's a reason why they have a job.
(46:12):
Bodies do crazy things.
This job wouldn't exist if the bodywasn't a insanely complex thing.
You don't have to understand everything.
All you need to understandis that you need insulin to
manage your blood sugar levels.
Yeah.
That is what where you should start.
Always don't try and worry about howwill I manage more time and range.
(46:33):
Do not do that.
Know that all you need to dois bolus for carbohydrates.
That is the basic, and if you cando that as consistently as possible,
you'll lead a much happier life as atype one diabetic when you hit burnout.
Or when you rec or when you learn torecognize that you have management
burnout, for example, which is justnot do, do, uh, bolus incorrectly.
(46:57):
Just not really caring about whenyou change your port, for example.
'cause that can also be a, a factor.
Yeah, a huge factor.
Just go factor.
Just go back to the basics.
If you feel like the technologythat you're using is.
Really starting to stress you out ortake up too much of your time that
you feel like you want it for yourselfpersonally, and you don't want it
to be such a big thing in your life.
(47:18):
Then speak to your specialist and maybe,and they'll probably recommend that
you go back to rudimentary treatment.
Anna (47:24):
Yeah, take a break and
James (47:25):
keep recording.
Anna (47:26):
It's okay.
It's okay to take a break.
James (47:27):
Perfectly fine experience.
I just, I, I'm a big believer.
Not looking at diabetes as a, asa life sentence or as an identity.
And the sooner you do that and youlearn to do that and you talk about
it and you ask questions, the better.
Can't really stress it enough.
(47:48):
It's something that luckily, I thinkinnately, maybe thank God to my parents,
but it's something that I just learnedinnately, almost, or it just came, it
just came to me at a very young age.
But it's not to say that you needto know everything all the time,
and there are people around.
There's Anna Sabino, there's I,
Anna (48:08):
there's a James's, there's IDS, there's a Paula,
James (48:12):
there's people that are diabetic.
It's you.
You can just ask questions andquite frankly, don't try and
compete with everybody else.
It's not that,
Anna (48:20):
well, that was gonna be one, one, you know, as we, as we sort of summarize
like, you know, top three points here.
One, like lean in andreally like try to stop.
The, and accept, okay,it's new, it's hard.
Or maybe this is a new feeling andit might be hard, and that is okay.
(48:43):
Uh, and then two, back to basics.
I, I love, love the back to basics piece.
I've actually considered doing a sortof back to basics or diabetes 1 0 1
for adults with type one, because Ithink as adults and young adults who
are emerging into this adulthood.
My parents were the ones who wereeducated, you know, and likely yours too.
I was six.
(49:04):
You were young also.
I wasn't necessarily educatedon diabetes management.
I had to learn through experience, right?
Be like, oh, what's DKA?
I had to Google that.
My parents, my, probably shouldhave, but didn't sit me down and
be like, this is what DKA is.
They, they're still learning too.
And I think it's so important toknow the basics as you're moving
(49:24):
towards living on your own.
And I think a lot of times that can be abig challenge and just like knowing your
own triggers when it comes to what youfeel like is burnout, whether it's not
bolusing or just letting the pump draindown, or not really wanting to bolus
accurately what your version of burnoutis, might be different than than others.
(49:49):
And that's the last thing isthat really, really focus on you?
It's so, so hard to compare as amom, as a human, as whatever we
are, but you know, your diabetesis yours and only yours, like you
are the only one within your body.
Everyone's gonna take a differentamount of insulin for a slice of pizza
and figure out their own strategy.
(50:09):
This is like the number onetime where it's okay to focus on
you, whatever that looks like.
Peer support, leaning inward.
Leaning into the peoplewho are your strengths?
And I know this is four, but last butnot least, just like celebrate those
little strengths because I think itis so, so easy to flip a switch and
(50:29):
get into that mindset of burnout.
Oh, I should have done this.
Oh, I could have bolused for that.
Oh, maybe I should go for a walk.
What went well today, like evenjust like one meal or one section
of the day was flat overnight.
Pick apart the strengths ofyour day because those will help
(50:51):
jumpstart and fuel your engineto have more moments like that.
Gary Scheiner (50:57):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a Pancreas Podcast is broughtto you by Integrated Diabetes Service.
Where experience meets expertise,passion meets compassion and diabetes
(51:17):
care is personal because we live it too.
Our team of clinicians all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matterwhere you are in the world.
And glucose management, the self-carestrategies, the latest tech.
Sports and exercise.
Weight loss type one.
Pregnancy and emotional wellbeing.
(51:39):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com.
To schedule a consultation on behalfof Think Like a Pancreas, the podcast.
I'm Gary s Shiner, wishing you afantastic week ahead, and don't
(52:03):
forget to think like a pancreas.
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Anna (00:36):
Hello everyone.
Welcome to Think Like aPancreas, the podcast.
, my name is Anna Sabino and I amjoined today by James Vander Mullen.
Did I say that right, James?
James (00:49):
Uh, yeah.
Pretty much.
Anna (00:50):
Thanks for, thanks for being here.
James (00:52):
Thanks for having me.
Appreciate it.
Anna (00:54):
Awesome.
Today we're gonna talk aboutdiabetes burnout, but before we get
started, if you're not familiar withIntegrated Diabetes services, make
sure you go ahead and, subscribe toThink like a pancreas, the podcast,
wherever you get your podcasts.
And if you're interested in any ofthe clinical services that we offer,
we're pretty multidisciplinary team.
(01:15):
Go visit us at www.integrateddiabetes.com.
And so I'm gonna introduce myselfbriefly here before we jump into
this sort of always elephant in theroom topic of mental health and T1D.
My name is Anna Sabino.
I'm one of the mental health clinicianson the Integrated Diabetes Services team.
I've lived with type one diabetessince I was six years old, so
(01:37):
well over 30 years at this point.
You can guess my age if you want to, butI wear some technology and really love
working with clients, patients who justfeel, like whether they are stuck or
are in need of support, helping navigatethe sort of emotional rollercoasters
ups and downs of daily life with T1D,whether you call it therapy or not,
(02:01):
I, I am a true believer that everyoneneeds some type of neutral source to
either vent or share or, you know, talkabout questions related to diabetes.
Whether it is like pure on depression,anxiety, or whatnot, or just the day
to day, I love listening to people'sstories and helping them figure
(02:22):
out the best solutions forward.
So enough about me.
James, a little bit about you.
And then I'm just gonna kind oflike piggyback, ask you a bunch of
questions on like, you know, diabetesburnout and like, I think we've all
been there at some point, right?
And, uh, hopefully have our listenersleave with a few maybe tips and
tricks in their back pocket.
James (02:45):
No, thank you for having me.
I appreciate it.
It's, it's cool obviously to meetguys from around the world as well.
You realize it's, uh, I think to start,before I introduce myself, it's uh,
I think it's important for everybodyto realize that type one diabetes is
theoretically and scientifically one ofthe most understood diseases in the world.
And then obviously there is somuch support, so much help, and
(03:07):
there is a lot of work around it.
So I think you can live a verylong and happy life with it.
It's, uh, obviously it's, it's noteasy work, but I think the longer you
deal with it and you come to termswith it, you slowly but surely develop
methods to deal with it in your own way.
I think it's a personal journey.
There's not a one shoe fits all or onesize fits all method, but ultimately, I
(03:32):
think talking about it is a good thing.
Learning from other people, learningways in which people deal with it,
I think it's a very helpful wayto journey through life with it.
But, yeah, so I'm James Van Millerand I live in, uh, in South Africa.
I've had type one diabetes since Iwas four, so I'm 20-- turning 27 now.
(03:52):
So I had it for about 23 oddyears and I started off injecting.
We kind of like, obviouslywhen you first diagnosed you.
Start off with learning how yourbody handles and reacts to insulin.
You learn the differencesbetween short and long term or
short and long acting insulin.
So I think slowly but surely, you kindof work into all the different nuances
of your body, how you react, youractivities that you get up to and how
(04:15):
you handle it, but are now also obviouslyutilize quite a lot of technology.
I'm blessed to be in that positionwhere I can and, obviously I, I enjoy
learning about new things that are.
It's cool to keep abreast of itand it's nice to see that people
are actively taking time to investinto the research and how you can
(04:38):
actually get to a point where.
You live an ordinary life, a normal life,it's just about recognizing the fact
that it's not going away, , unless you'reable to get some type of, uh, transplant.
But I don't think a lot of people optfor that because in the long run you're
having to take, uh, anti-rejection meds.
And I think obviously the side effectfrom that is also very different.
(04:59):
And the last time I looked itwas about 40% acceptance rate
full on otherwise Yeah, you dealwith complications long term.
So I think, yeah.
Anna (05:10):
Thank you so much for, for share, for sharing that, and it sounds
like you've been at this for a while.
And one of the things I wanted to, to jpback in that, that you said pretty early
on in, in your story is that there are,we, we really understand type one diabetes
from the ins and outs like biologically,but mentally is, is really where.
(05:34):
The, the crux of optimal diabetesmanagement and the ability to kind
of live decades with T 1D is notnecessarily as, as understood.
It is a very self-managed,individualized disease, that
there is no one size fits all.
I often say, you know to patientsor to, to clients, you know, you're,
(05:59):
you're doing the job of two organs,your brain and your pancreas, like
this is an impossible mission.
Insulin is one of the only medicationsprescribed in the world, as far as
I know, where there's no dose on it.
Like, you go to a pharmacy andyou pick it up and it's like,
well, here's your vial of insulin.
Good luck.
(06:20):
There's no, you know, take thistwice daily, three different things.
And so my question to you is howdo you, do you not get burnt out?
How does this day after day ofmanaging diabetes, how you know
it is, it is a lot of work.
Even this morning, you know, I just dosedfor something and now my blood sugar is
(06:43):
like, it's 193, which is a little bithigher than I would I would want it to be.
And so you know how day after day it is.
So can be so self-defeating.
How do you prevent.
Yourself from getting to thepoint where you are burnt out?
James (07:00):
Well, it's a simple answer.
You do get burnt out, you can't.
Exactly.
Anna (07:04):
Okay, so, so let's dig into that then.
Let's dig into that then.
How did you know you were experiencingburnout and, and at what point
in your life were you there?
James (07:13):
So for me, obviously when you're younger, your parents
are helping you manage it.
So obviously I was diagnosed andI was very young, and at that
moment I didn't understand it.
So I mean, they told me stories.
They recall me hidingunder the nurse's bed.
I didn't want to be pricked.
I didn't want to be dosed.
This was just after I was diagnosed,
Anna (07:29):
I did the exact same thing in the hospital.
Yeah, I was six years old.
I hid under the crib in hospital.
They tried to find me.
You don't want that.
Nobody wants that attention.
James (07:40):
Yeah.
Yeah.
No, I think, uh, so obviously overtime you monkey see, monkey do, right?
So like for me as a young child, I didn'tnecessarily think of it as anything.
I didn't have a construct in mybrain that, oh, this is lifelong
and this is a day to day.
It doesn't go away.
And if anything, with life stresses,with everything that comes with it, as
(08:00):
you grow up, you have to contribute tosociety, you have to study, you get a job.
You own a business.
You run a business.
And uh, for me, I do.
I have had periods in which I've beenburnt out, but actually been later in.
I think for me, I was in, so justfor context, I'm a lawyer now.
(08:20):
, I did my undergrad at universityand then I did my masters and I felt
the most amount of burnout when Istarted my first year of my masters.
That was in 2021.
And for me, the, the way in which itpresented itself for me personally was
I just didn't take care of the basics.
(08:43):
So basics being.
I'm not sure what insulin or uh, glucosecontrol monitoring you use, but like
for me, just the daily need to, how manycarbs did this meal actually take up?
Like, I need to now put that intomy bolus with it, let it bo and then
let it work out how much insulin isconnected to that and how much to go in.
(09:03):
And I, I just, my burnout presented.
I just stopped doing the basics.
Right.
And they, you can't really putyour finger on it, but because it's
every single day, all the time, it'srelentless and you kind of, it becomes
part and parcel of your journey.
Sometimes when other life stressesare higher or in your brain,
you see them as more important.
That's when it happens.
Anna (09:24):
Yeah.
James (09:24):
It happens because you feel like it's a nuisance.
You feel like it's a constanttapping on the back of your head.
It's in your subconscious.
Quite frankly, you, youfeel it physically too.
I mean, you know, if your bloodsugar's high for me, I can tell
you right now, I feel about seven.
So in South Africa we use adifferent, we use metric systems.
Yeah.
millimols.
So, uh, for me, I know that I'm7.2 now, and if I look, yeah, I am.
(09:50):
Yeah.
I'm, I can literally almost predict.
Yeah.
How I'm feeling because I thinkover time you get so used to
how your body reacts right.
But you to handle it.
It's to recognize the fact that I'mjust not doing the basics right.
And then you have to look atwhy you aren't doing that.
Is there something in particular, Iremember for me in 2021, it was just that.
(10:14):
Also, I was kind of, I was lecturing onthe side while doing my masters as well.
And for me, I just had so many otherthings contributing to my life and
to my stresses, to the, to anxietythat I just stopped doing the basics.
And that's what myburnout kind of felt like.
And I mean, it comes in waves, but forme the best way to deal with it is.
(10:34):
Very important for me personally,is having a good specialist.
Like so for me, Paula Diab, herand I have a great relationship.
I just say, listen, I've just stoppeddoing the basics correctly, and I know,
and you have to, you have to work out away of being honest with yourself because
quite frankly, you know when you are,you know that, okay, I haven't done.
(10:55):
I haven't bolused or I didn'tcarb count correctly today, and
that's probably contributed to whyI'm feeling the way I'm feeling.
Number one, the first step is tryingto find yourself with the phys,
a physician or a specialist thatunderstands you, or that at least you
can be open and honest with and youcan troubleshoot with or find a way
(11:15):
that in your daily routine, how can we.
What small incremental changescan we make that are sustainable
in your day-to-day life?
Because I don't think, I don'tthink it's possible to be on
the money every single day.
It's not possible.
Anna (11:29):
No.
James (11:29):
It's not.
You having had it for over 30 years now.
I've had it for over 23 years now.
It, I know it's not possible.
You'll have beautiful days where youliterally don't, don't go above seven,
and I hover between five and seven forweeks on end sometimes, but then you'll
have two days that completely derail.
Your whole process, andthat's where you lose it.
It's when you get, you almost becometoo comfortable with slacking with.
(11:55):
Mm-hmm.
Not slacking, but yeah, withjust losing touch of what?
Of how you started.
And that's why I think I was lucky.
I think nowadays when peopleare diagnosed, they don't
necessarily prescribe that,no, you must inject insulin.
You must do this, you must do that first.
I was lucky in that I could learnthe basics very early on in my life.
(12:17):
So like I understand what a sandwich wouldcontra would be at if I'm carb counting,
I would be able to tell you on the money.
Right.
But for other people nowadays with thetechnology increases, you are kind of
Anna (12:32):
flying by
James (12:33):
usher into a very Yeah, yeah.
Yeah.
And you kind of, you kind of, you'rerelying on the technology to do the job.
Right.
And that's what it's there for.
And it's great, but I think.
The, the burnout aspect I wouldactually imagine is higher
for people that don't start.
The most rudimentarytreatment of of diabetes.
(12:53):
And quite frankly, I think that'sone of the main reasons why a lot of
athletes prefer that way, because it'sactually, there's less to focus on.
You don't have to worry about, orthe interest or the intricacies,
oh, what's my insulin re, what'smy insulin correction factor?
Should I change it in this time zone?
Should I change it here?
Whereas for them, they know, okay, cool.
(13:14):
Today I'm gonna inject long actinginsulin and I'm gonna eat accordingly.
I've injected 44 units today, andI'm gonna eat to that measure.
I mean, Alexander Zverev, yeah,top 10 in the world, tennis player.
That's why he does it.
And he's spoken about it.
Anna (13:28):
I love, I love everything that you said because I could not agree more,
and maybe because I come from similar toyou where, you know, it's almost like.
Not necessarily ignorance is bliss,and I'm a firm believer that it's
not about, you know, if you feellike you're kind of just burnt out.
I mean, we as humans get burnt out.
(13:50):
You know, as a social worker, as adiabetes educator, as a person, I. I get
burnt out and I know I get burnt out.
Like, and I think my familynow, I have two young kids.
Sometimes I feel like I, I can tell,I look back at my graph, I wear the
the tSlim Tandem X2 system and I'mjust like, Ooh, that time in range,
like wasn't really great today.
(14:11):
What can I do tomorrow?
Do I have more water in the morning?
You know, how can I, how canI shift some of my behaviors
because it is a very isolatingand behaviorally managed illness.
But something that you said really,really struck me that I don't think
a lot of people process is thatit doesn't have to be like all or
(14:32):
nothing when it comes to technology.
And does technology really contribute?
Further into this notion ofdiabetes burnout or are we just
talking about it more often?
Because there's more to talk aboutand there's more platforms and
this, that and the other thing.
I think we've always sort of hadthis notion of this is so hard.
(14:54):
But I work really closely with kids andparents and, and young adults who are
processing the emotions of this diagnosisand grieving and trying to figure out
every ratio, correction factor, allthese things, how do they go to school?
How do we travel, like adaptdiabetes into our like regularly
(15:14):
scheduled programming life?
Mm-hmm.
And.
When I was growing up, and I knowthings are different and I don't wanna
compare, but I didn't think aboutdiabetes like during the school day.
It was like I took a shot, like yousaid, I pricked my finger and then on
the very way, and it was, it's almostlike the technology is good, but like
(15:37):
sometimes I think it's, it comes downto, and it's like, I know this isn't
necessarily super related to burnout, butit kind of is because it's like, if we
don't trust our systems, our technologysystems to do the work that it's
supposed to do, why are we using them?
The role?
If we can understand the role of us andthe role of the technology, we're gonna
(16:01):
have a better relationship with it.
We're gonna be able to understand it,we're gonna be able to make changes.
And I think that's part of the problemis that there's just not enough education
out there and validity for all ofthese fine tuning behaviors that we
have to do as humans that we haven'tadjusted to as like a society where
(16:23):
the expectations are not sort of there.
And so I do think, you know,everyone's, everyone's feeling of
burnout is gonna feel different.
Everyone's version of Okayis gonna be different.
And your version of okay, todaymay be completely different
than tomorrow based on, like yousaid, a thousand other factors.
But.
(16:45):
It is, it is so hard to pinpoint burnoutand you know, I, I, I know that you
have the ability to recognize, oh wow,I am not even able to do the basics.
Were there any other sort of likered flags that you, you know,
(17:06):
I know from a diabetes burnout,mental health perspective, it's
really like not to, you know.
You're not taking your insulin, you'renot doing as well as you have in the past.
And that, that is, I think, a, a cruxto burnout is that everyone's version
of burnout is gonna be different.
Because if you are used to being on youra game and your a game is counting out
(17:28):
every single goldfish you put in yourmouth and now you're sort of slacking,
well, maybe that's burnout to you.
But for someone who maybe has theirtime and range at only 30 or 40%, and
now you're down to like 10%, well.
Your version of burnout is much different.
So I think that's something to keepin mind because I think so much of our
(17:49):
world can be very comparative and like,oh, well I'm not here and you're there
and my A1C is this and yours is that.
And I think it's really importantas we're thinking about burnout,
is that your diabetes burnoutwill vary just like your diabetes.
Just like your diabetes will vary.
We all take different amounts ofinsulin, but sort of circling back,
(18:09):
I know that was sort of a tangent,what else do you feel like you notice?
Kind of creeping in as you, youknow, go over these emotional hps and
rollercoasters, when it comes to burnout?
And can you prevent yourself fromgetting there at all or is it
just like, well, here I am, I'mgonna call my diabetes specialist.
James (18:32):
Yeah, I think, uh, yeah.
So first of all, I agree with thetangents you went on for sure.
I think it's that that is acontributing factor and it, it
will look different for everybody.
I think everybody has to acknowledge that.
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Anna (19:23):
All right, so as we dig into more about burnout, you know, I think something
to think about too is that everyone isgonna be on their own journey all the
time when it comes to type one diabetes.
And I give a lot of talks, and I gaveone last weekend to a group of parents
(19:43):
called Parenting for Independence andone of the slides that I always emphasize
is that, you know, your schedule ofacceptance does not always equal others.
Whether it is you as an individualliving with diabetes and a parent
or a parent and their own parents.
Whenever we have relationships withothers, with other people, our, our
(20:07):
schedule of acceptance as, as it relatesto sort of the grieving process or
just processing what this diagnosismeans can be very, very different.
And therefore, you know, burnoutcan be very, very different.
And everyone may experience burnout atdifferent points of their diagnosis,
(20:27):
whether you're like emotionally burntout, whether you're physically burnt out,
and I think it's so, so important to beable to accept that this burnout is here
and putting this, you know, little labelon it because if you don't, you know,
burnout is sort of the gatekeeper orgateway towards, you know, things like
(20:51):
depression or severe anxiety avoidance ofthings like insulin administration, which
we know is critical for managing diabetes.
And if we don't recognize burnoutas that, that sort of first step
is where it starts to go south andwithout all of that lack of support.
So James, tell me how you feel like asa child, you and as a young adult now
(21:18):
are, are able to kind of, not necessarilycombat burnout, but recognize it and then
use that to cope, if that makes sense.
James (21:30):
Well, I think as a young child, obviously I was diagnosed
fairly young in my life.
I don't recall a period of mylife where I wasn't diabetic.
So yeah, there's notlike, I have a comparison.
So for me, I think in a way that's beenadvantageous throughout my, throughout
my life, dealing with diabetes,dealing with a, a chronic illness, but.
(21:53):
As a young child, you don't, I don't.
I genuinely don't believe you recognizeburnout, and unfortunately it means
that your caregivers, your guardians,your parents, they almost need to look
at you, see if you're understanding thegravity of being a type one diabetic,
needing a specific hormone to get energy.
So there unfortunately, a lot of theburden rests on the relationship between
(22:18):
you and your your family in doing so.
It's also on the adults in the room tokind of impress upon you how important
it is that you need to manage it,and you need to learn to manage it.
And as a child, I think it doesoften start at home and it, it
does often start having a reallygood pediatrician from a young age.
(22:40):
Because if you don't recognize theimportance of growing into your
diabetes, for lack of a betterphrase, you won't recognize it.
And unfortunately, your parents onlyknow how you're feeling if you tell
them and most of the time they won't beable to tell that you're running high
because you haven't been learning toinject yourself or doing it yourself.
(23:03):
So I think at a young age, I thinkburnout and fixing it rests on
that relationship between you andwhoever is helping you grow into it.
But as you get into get older, that'sthen when it becomes that person's
responsibility now, that's now,this is where it's different now.
It's learning to develop arelationship with yourself.
(23:26):
Being able to say, today I feel horriblementally, not physically from being
running high or running low, but I feelhorrible emotionally about having to deal
with the day to day now to deal with that.
I think you have to then look back atwhat you've learned about what happens if
(23:47):
you don't actually take care of yourself.
Now, it's easier said than done,but again, it's about trying to
develop a method of recognizingyou, you can't get away from it.
But there is also, there is slight leeway.
I, I'm, I'm not somebody that believesthat to be a well-functioning human
(24:11):
being, a healthy diabetic thatyou have to be spot on every day.
You have to learn to be, togive yourself a bit of grace.
So if you are having a bad day,you say, okay, what are the basics?
The basics are I need to inject myselfor I need to, I need to do a bolus
wizard on my insulin pp, whateveryou're using to administer insulin.
Anna (24:30):
Mm-hmm.
James (24:30):
And you need to, you need to step back and say, the
basics are, I need insulin.
To break down food for energy.
Now that is the key.
If you look at the basics, I do thinkthat the bigger picture and something
that you're particularly stressedabout, 'cause you know it's probably
not going anywhere, it makes itfar easier to to recenter yourself.
(24:56):
And that might take aday, it might take a week.
But going back to basics, I remembermy specialist, she said to me, in
her mind, the most practical way ofgrowing through your diabetes, living
through your diabetes and actuallythriving with it, is just trying
your very best to do the basics.
And when you look at diabetes froma high level point of view, that
(25:17):
is just administering insulin andrecognizing what you're eating.
It's a invisible enemy.
So it's not like you are gonna be ableto predict your day every day, but what
you can do is you can predict, I know Ineed 44 units of insulin, so I'm using
our metric from here, but I'm I'll, I willneed to administer 44 units, or I'll need
to have a basal rate at minim of 44 units.
(25:40):
Yeah.
To maintain some form ofstability going past that.
I know that.
Okay.
At lunch.
I'll eat a sandwich, I'llhave a coffee probably.
I don't personally put sugar inmy coffee, but I'll put, let's
say I have a teaspoon of sugar.
I'll literally look at it fromthe very, very bare minimum.
I'm not concerned about, I doing anextended bolus on my insulin pump.
(26:02):
I'm not concerned about running high.
I'm concerned about making sure thatwhat I put into my body I'm bolusing for.
That's the bare minim that's required.
Anna (26:12):
I love that.
I love that perspective because Ithink so, so many, so much of the
time, we now have, and it sounds likeyou do too, we now have the ability
to fine tune our management down tolike the 0.005, you know, increments.
Whether it's a basal rate, whetherthey're, whatever the strategy is that
(26:32):
you're using, whether it is the, youknow, DIY looping system or a basal rate
or a temporary basal rate, or automatedinsulin delivery, you wanna change a
target... We have the, we have the optionto manipulate this type of insulin,
but sometimes that can be overwhelming.
I wanna back up for a second because Icompletely agree with you about this sort
(26:56):
of transfer of ownership around burnout.
At what point did you feel like, you sortof, whether it was like this aha moment
or, because this is one of the thingsI'm most passionate about in terms of the
parent child dyad and the relationshipbetween parent child in terms of setting
(27:18):
boundaries and burnout prevention andreally just relationship management.
So when you know you are in your midtwenties, you can look back and have that
foundation built as strong as possible.
As, you know, grow older and we cansay why I am a resilient kid because
of the support I had from my parents.
Two follow up questions to that.
(27:39):
Have your parents ever said to you thatthey were burnt out and what advice would
you give parents today about trying tonot burn out as parents, whether they're
newly diagnosed or, you know, they're10 years in and they're working with a
child who, you know, may not wanna givetheir insulin or is just, doesn't wanna
(28:03):
even admit that they have diabetes,which are too very, you know, common,
you know, behaviors or feelings tohave, which are, you know, very normal.
James (28:12):
Yeah, no.
So I think on the first question,the transfer of ownership for me.
I think it was an innate thing.
Anna (28:20):
Mm-hmm.
James (28:20):
I think I was lucky in that aspect, but it's also my
parents have been together forever.
So for me it's not like I hadto also deal with two separate
parents, two separate households,two separate ways of doing things.
And they did, they did a, a brilliant jobin my mind in establishing how important
it is that you need to learn how toput your insulin, uh, put your port in.
(28:45):
These are things that when you move outof, when you move out of the house, and
I do believe I'm an abi, I'm an ambitiousperson, then that's what I did for me.
I, I knew I'm not gonna be ableto do anything on my own unless
I start doing it on my own.
And I think for me, it probably happenedaround about the age of 10 to 11.
I was, I was, , puttingin my ports myself.
(29:08):
But it, let's say that's not the case.
Let's say the child is just, forwhatever reason, an inverted
commas, a slow launcher.
They, or they, they, theydon't, they don't just fly
Anna (29:21):
love that, love that a slow launcher.
James (29:22):
They're a slow launcher and they slowly, but surely are getting into it.
It's about if let's say the parentis putting in the port and helping
them understand how much insulinthey need to do or how to carb
count or how to learn to carb count.
I do think there, when doing it, youneed to make sure in that moment, so if
(29:45):
you are putting in their insulin port oryou are putting in their GCM or their,
uh, their glucose monitoring port there,you need to basically take their hand,
their physical hand and put it thereand show them, look, it's this easy.
I don't know.
You also use the same pump as me.
We use the Tandem tSlimX2,but this is how you do it.
(30:05):
The best way of learning is by seeingit being done and showing the child
that it's, it's not a taboo thing.
It's not somethingthat's there to hurt you.
It's something that you need.
You need, you need to live withit and you need to learn to do it.
It's physically showing them todo it as if your dad would put you
in a car when you, when you areslightly younger, to learn to drive.
Anna (30:27):
Oh, absolutely.
The modeling, the modeling is key.
And if we don't have modeling.
Then it's, it's very hard to learn.
Yeah.
James (30:39):
And I think, and I think it's sometimes hard love could
work, but again, there, I'mtalking to the relationship again.
You, you know what your childis like and how they take
instruction or how to learn things.
And there you, you haveto have soft skills.
You have to have emotionalintelligence and look at how the
child typically learns things.
And you would probably learn aboutthat from when the child's an infant.
(31:02):
How the child learns how to walkand or first crawl, then walk.
You'll see how they pick up onthings in life and I think it's the
same way as they, as they grow up.
If they aren't somebody that justtakes it by the horns and wants
to do it themself, like for me,I hate having to ask for help.
In the most,
Anna (31:19):
I'm the same way,
James (31:20):
way possible.
So I knew I wanted to learn and I neededto do it, so I just started doing it.
If I had a problem, I would say,listen, mom, what this time it hurt me.
Why do you think?
And she would say, well, I thinkyou probably pressed too hard.
Or, uh, how are you like, I, Ipersonally put it on my buttocks.
So like on my bum cheeks, my, my,
(31:41):
she said, well,whereabouts did you put it?
And like, you just are askedquestions, the kid might not, and
you'll, you'll start to see slowlybut surely how they're learning it.
And then in terms of the secondquestion on potentially parents feeling.
Yeah.
I think you, I believe you saidparents feeling burnt up, burnt
out, or stressed, or quite frankly,it's a, that's a normal feeling.
(32:03):
, I know my mother,
Anna (32:05):
yeah,
James (32:05):
She, she cried.
She cried for days on end and she wasvery concerned about, she couldn't believe
that her son has to deal with this now.
But I do think it, peoplehave to recognize how well.
Managed type one diabetes hasactually become over time and how much
support has developed on it, how muchinformation there is available online.
(32:28):
There, support groups that people need it.
It's about, again, it's avery, it's a very common.
Recommendation to seek help, butI genuinely mean you don't have to
seek help with somebody physically,but you can seek help on your own.
You can genuinely learn and look at howpeople are dealing with it or how parents
are, and quite frankly, all parents willgo through the same mix of emotions.
(32:51):
Yeah, totally.
You'll feel like it's somehow your faultor you'll feel how feel like it's somehow.
God against you, or you'll feel like,you'll just feel me, your kid one, why me
Anna (33:04):
Question everything.
Yeah.
Yeah.
James (33:07):
That is just, and that is a process that people have
to acknowledge that is a thing.
It's, it's like losing aloved one or it's, it's like
losing a significant other.
It's unfortunately,
Anna (33:17):
it's supposed to feel hard.
It's, it's supposed to feel hard.
, yeah, because it's new and every timeour body experiences something new.
We wanna oftentimes just like suppressit and we can't, you know, we,
James (33:32):
I, I would say lean into the feelings.
I would say lean into thefeelings, acknowledge it.
Anna (33:35):
Love that, love that.
James (33:37):
But in doing so, they are also remedies.
I don't, I'm not a huge proponentof wallowing in that feeling.
I am a big proponent of recognizing it.
Yeah.
Recognizing how you typicallydeal with stress, anxiety.
Worries in general and trying to applythose concepts in your own personal life
that you have done as a parent in general,having a child to the current situation.
(34:00):
Absolutely.
Also, and also I do think, I just wannaraise this point, I, I think a lot of
parents, when they first hear that theirchild's being di has been diagnosed
with type one diabetes or is type one,the immediate reaction is a spiral
and you don't feel like you're ready.
And that's fine Nobody's ready.
(34:20):
That's why you have specialists alsowalk you through the process they've
trained their entire lives to do.
So.
You have yourself, Anna, you've,you've somebody that lives with it.
Yeah.
But also walk people through thatprocess and just recognizing that you're
not gonna get it right all the time.
And that's fine because.
It's new for everybodywhen they first get it.
(34:40):
But also recognizing that peoplewith type one diabetes can
live a long and healthy life.
It's just about doing thebasics as much as possible and
as consistently as possible.
And if you can somehow bringsome, a seance of calm,
like for on the, and humor.
Anna (34:57):
And a little bit of humor.
James (34:59):
A bit of humor and like, 'cause personally for me, my parents didn't show
me that they were concerned about it.
I didn't see it firsthand.
So perhaps that could be a good metric.
Maybe try not to freak outin front of your child.
'cause I think that wouldgenerally pass on to them.
But if you can somehow try andworry either with the specialist
(35:19):
separately or in your own time,it's probably best suited.
I don't think.
Freaking out in front of thechild is the best way of doing it.
But it might happen.
But again,
Anna (35:30):
it never, it never is.
Yeah.
I think there are some sort ofteachable moments that can come with
the spontaneity of, you know, emotionsthat come from diabetes, whether it's,
you know, I tears or fears or whatnot.
Uh, but I, I love what yousaid about asking questions.
You know, my mantra is always justlike, ask over, assume, you know?
(35:52):
And I wish more people ask me questionsabout diabetes just in the day-to-day
life as an adult, but I think parentssometimes can just feel so overwhelmed
because they're not yet confident.
The information, and we as asociety now have so much on
demand that we expect the answer.
You know, we ask Alexa, you know,what's the weather gonna be for today?
(36:15):
And she tells us, we wake up inthe morning, everything is on
demand and we wanna solve it.
That is just not how diabetes works.
And I think it takes a lifetime ofresiliency and experience to build up this
ability to not necessarily feel confident.
It's really this ability totrust ourselves that, and create
(36:37):
this ability to not constantlyself-doubt our decision making.
And that takes years as you know,before we sort of like wrap up, I did
wanna talk about, you know, again,this I whole idea of back to basics.
'cause I'm a, I'm a hugeproponent of technology.
It's great, you know,my phone is next to me.
I wear a watch, I havea pump, I've got my CGM.
(36:59):
You do too.
We're wearing the same systems.
It's amazing.
And.
It can also be a challenge for parentsand anyone living with type one to
kind of take it in the other direction,to the point where it is causing
burnout and it is causing issueswith a parent child relationship.
(37:21):
And that can create tension and separationof that reliability in the parent child,
parent child relationship from an earlyage, which you know, now we know some
seven, eight, nine, ten year olds arereceiving phones regardless of diabetes.
But with diabetes, it sort of forcesa jumpstart in technology introduction
(37:42):
that may likely have been, willhave been delayed several years.
So my question here to you is like,what advice do you have for anyone
as it relates to the relationshipwith technology to try to prevent
the mental burnout in the future?
James (38:03):
Yeah, no.
So I think you're totally correct,all of the nuance, , with technology,
you, as much as it might make peopleinitially feel very confident, they're
like, this is amazing because it does,it does change your, your daily routine.
Because if you have been usingrudimentary management, you would
(38:24):
either inject for the full day or youwould inject, inject intermittently
depending on what you're eating bloodglucose monitoring, you have a lot of
information coming through at all times.
Like for example, our blood sugarsread every five minutes and then that
is Bluetooth to your pump and to yourphone at any given moment, and it is
(38:44):
autonomously adjusting your basal rate.
Now again, the concept that we spokeabout earlier in my mind, to manage
your, your, your mental, when you take uptechnology so soon or rapidly because of
type one diabetes, again, apply the sameconcept of going back to basics, to what
(39:09):
is presented to you with the technology.
What I mean by that is just becauseyou have an insulin pump that is a
bit more autonomous to you physicallyinjecting yourself, and that effectively
operates as an external pancreas.
Don't get lulled into justaccepting the, the setup that
you're given with that pump.
(39:30):
Yeah, yeah.
Look at the basics.
You still need to remember that.
To prevent burnout, you have tostill be cognizant of the fact
that I need to be bolusing myself.
And again, I, I believe, to preventburnout with that technology.
Remember that it's stick to basics.
(39:50):
Do your bolus wizard.
Think logically with that, tryand continue carb counting,
like as much as possible.
Try and apply your mind to that, anddon't worry too much about why the basal's
correcting like this, why it's doing that.
Just do the bolusing.
Again, stick to the basicswith the technology.
When you build confidence in doing that,then you can start using all the nuance.
(40:15):
That's perfectly fine, but again, usingall the nuance and being lulled into.
Comfortability is what sometimes willtrigger burnout because you can't
understand or you'll look at other peoplethat are still maintaining a better, uh,
time and range than you, for example.
It's not a substitute for basics, and
Anna (40:33):
I love that it's not a substitute for basics.
Yeah.
It's just, and I see that especiallyis what I see when parents come to me
and they want, they fixate on the why.
Why is it going up?
Why is it going down?
And it's like, woo hoo.
Back up.
This is an autoimmune illness.
It is not our job toalways figure out the why.
(40:55):
We have no idea what ourliver is producing right now.
We have no idea what our smallintestine is doing right now.
Why should we know exactly every singlething that our pancreas is trying to do?
It is an impossible job.
And another point I wanna highlightfor our viewers too, is that.
(41:17):
It's supposed to be impossible,like, and if we, if we view it as a
fight, we're not gonna win if we viewit as a opportunity and an effort.
We're going to pat ourselves on theback more often and I hope that that
type of message and the go back tobasics method, if you are starting to
(41:39):
spiral into this mode of burnout, canreally dial you in because exactly.
Just give the insulin.
Don't worry about the minute carbcounting and measuring every single
goldfish that your child eats.
Give the insulin if that's all youcan do, and we'll figure it out.
I listened to one podcast recently witha parent and an endocrinologist, and the
(42:03):
endocrinologist was just saying, I, Ijust want you to thrive, and right now, if
thriving means not counting carbohydratesand just getting the insulin in the body,
that is more important than any numberpercentage in range or any A1C reduction.
I want you to give the insulin andI want you to think about safety.
(42:24):
Like this is about managingmedication and keeping you safe.
Let's focus on the big picture prioritiesbefore we nail down the advancements.
And so I really truly believe that,and the technology is not for everyone.
We still have the option to useinjections as many people prefer it.
(42:46):
I think when we talk aboutdia--diabetes too, from an identity
perspective, we assume that thistechnology is for everyone and there
is no one size fits all diabetes.
When it comes to connecting theperson, what their personality type
is, are you an, are you a data guy?
(43:06):
Are you a data nerd that likes dataall the time and can manage the input
or are you a mom that is managingfour other kids in the household?
And you need the ease of somethinglike the iLet or the Omnipod that
is just kind of plug and play.
You really have to think about,well, how, how is diabetes going
to be adapted into my alreadyestablished strengths in my home?
(43:29):
And I don't necessarily know if we.
Have those conversations often and enoughearly on in our diabetes management
today to really allow these decisionsto be fluid and prioritized based
on the family unit and the dynamicsand what is going to work with each
(43:52):
individual family, because it reallyis a huge lifestyle change and it can
be an amazing tool, but it can also.
Lead to burnout.
Yeah.
Final words.
James, what, what is your word,
James (44:09):
final words on this, on this topic?
Uh, I mean, obviously I was a, anavid tennis player when I was younger.
I happened to tear my ACL, so I stoppedplaying competitively, all of that.
Anna (44:18):
Bummer.
James (44:20):
Uh.
Like one of my, somebody that I really,really respect heavily is Alexander Zev.
Okay, he also is a, he'sin the top 10 in the world.
He's a type one diabetic.
And when in his younger years he wasusing, again, this is gonna go to a
burnout 'cause he actually touches on itand I'll have to find the interview, but
he touches on how he, when he was younger,because of all the data that he was
(44:44):
getting all the time from the technology,he actually stepped away because
he wanted to take tennis seriously.
But he actually found that trying toanalyze that too much was actually
detracting from him just being anathlete and, and try and living,
and he, he said he started to lookat himself as a type one diabetic.
And that's for me, somethingthat I just don't do either.
(45:05):
Yeah.
I look at myself as James, I lookat myself as a human being, and it's
just something I, it's part of my day.
But he moved back to rudimentarymanagement and he said that for him,
flipped the, uh, flipped the switchin his brain and he looked at laugh
completely differently again, and, yeah.
I really wanna say is type onediabetes is not a life sentence.
(45:27):
It's not something that you haveto actively look at as a negative.
If anything, I think I've developed a lotof life skills, soft skills, hard skills.
I've learned a lot.
And if anything, the doing the buy on yourbloods too is also a great thing to see.
Like I love being able to knowwhat's going on with myself doing
full, uh, some full hormone panelsjust because I want to know.
(45:51):
I would love to know my baselines, butthe long story short, stick to basics.
Don't, don't overanalyze yourself.
Your body is a weird and crazy thing.
It's not something that you'll understanda hundred percent of the time, and it's
something that medical specialists andpsychologists and psychiatrists try their
entire lives to physically understand,and that's a reason why they have a job.
(46:12):
Bodies do crazy things.
This job wouldn't exist if the bodywasn't a insanely complex thing.
You don't have to understand everything.
All you need to understandis that you need insulin to
manage your blood sugar levels.
Yeah.
That is what where you should start.
Always don't try and worry about howwill I manage more time and range.
(46:33):
Do not do that.
Know that all you need to dois bolus for carbohydrates.
That is the basic, and if you cando that as consistently as possible,
you'll lead a much happier life as atype one diabetic when you hit burnout.
Or when you rec or when you learn torecognize that you have management
burnout, for example, which is justnot do, do, uh, bolus incorrectly.
(46:57):
Just not really caring about whenyou change your port, for example.
'cause that can also be a, a factor.
Yeah, a huge factor.
Just go factor.
Just go back to the basics.
If you feel like the technologythat you're using is.
Really starting to stress you out ortake up too much of your time that
you feel like you want it for yourselfpersonally, and you don't want it
to be such a big thing in your life.
(47:18):
Then speak to your specialist and maybe,and they'll probably recommend that
you go back to rudimentary treatment.
Anna (47:24):
Yeah, take a break and
James (47:25):
keep recording.
Anna (47:26):
It's okay.
It's okay to take a break.
James (47:27):
Perfectly fine experience.
I just, I, I'm a big believer.
Not looking at diabetes as a, asa life sentence or as an identity.
And the sooner you do that and youlearn to do that and you talk about
it and you ask questions, the better.
Can't really stress it enough.
(47:48):
It's something that luckily, I thinkinnately, maybe thank God to my parents,
but it's something that I just learnedinnately, almost, or it just came, it
just came to me at a very young age.
But it's not to say that you needto know everything all the time,
and there are people around.
There's Anna Sabino, there's I,
Anna (48:08):
there's a James's, there's IDS, there's a Paula,
James (48:12):
there's people that are diabetic.
It's you.
You can just ask questions andquite frankly, don't try and
compete with everybody else.
It's not that,
Anna (48:20):
well, that was gonna be one, one, you know, as we, as we sort of summarize
like, you know, top three points here.
One, like lean in andreally like try to stop.
The, and accept, okay,it's new, it's hard.
Or maybe this is a new feeling andit might be hard, and that is okay.
(48:43):
Uh, and then two, back to basics.
I, I love, love the back to basics piece.
I've actually considered doing a sortof back to basics or diabetes 1 0 1
for adults with type one, because Ithink as adults and young adults who
are emerging into this adulthood.
My parents were the ones who wereeducated, you know, and likely yours too.
I was six.
(49:04):
You were young also.
I wasn't necessarily educatedon diabetes management.
I had to learn through experience, right?
Be like, oh, what's DKA?
I had to Google that.
My parents, my, probably shouldhave, but didn't sit me down and
be like, this is what DKA is.
They, they're still learning too.
And I think it's so important toknow the basics as you're moving
(49:24):
towards living on your own.
And I think a lot of times that can be abig challenge and just like knowing your
own triggers when it comes to what youfeel like is burnout, whether it's not
bolusing or just letting the pump draindown, or not really wanting to bolus
accurately what your version of burnoutis, might be different than than others.
(49:49):
And that's the last thing isthat really, really focus on you?
It's so, so hard to compare as amom, as a human, as whatever we
are, but you know, your diabetesis yours and only yours, like you
are the only one within your body.
Everyone's gonna take a differentamount of insulin for a slice of pizza
and figure out their own strategy.
(50:09):
This is like the number onetime where it's okay to focus on
you, whatever that looks like.
Peer support, leaning inward.
Leaning into the peoplewho are your strengths?
And I know this is four, but last butnot least, just like celebrate those
little strengths because I think itis so, so easy to flip a switch and
(50:29):
get into that mindset of burnout.
Oh, I should have done this.
Oh, I could have bolused for that.
Oh, maybe I should go for a walk.
What went well today, like evenjust like one meal or one section
of the day was flat overnight.
Pick apart the strengths ofyour day because those will help
(50:51):
jumpstart and fuel your engineto have more moments like that.
Gary Scheiner (50:57):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a Pancreas Podcast is broughtto you by Integrated Diabetes Service.
Where experience meets expertise,passion meets compassion and diabetes
(51:17):
care is personal because we live it too.
Our team of clinicians all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matterwhere you are in the world.
And glucose management, the self-carestrategies, the latest tech.
Sports and exercise.
Weight loss type one.
Pregnancy and emotional wellbeing.
(51:39):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com.
To schedule a consultation on behalfof Think Like a Pancreas, the podcast.
I'm Gary s Shiner, wishing you afantastic week ahead, and don't
(52:03):
forget to think like a pancreas.
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