August 19, 2025 • 35 mins
In Episode 48 of Think Like a Pancreas—The Podcast, host Dr. Paula Diab is joined by fellow clinician, Kristi Paguio. They draw powerful parallels between long-distance running—specifically the iconic Comrades Marathon—and the journey of managing diabetes. The conversation highlights the invisible challenges faced daily by people with diabetes, the essential role of support systems, and the importance of redefining success through small, meaningful victories.
Paula and Kristi highlight the fact that there is no perfect control in diabetes, and each individual's journey is unique, filled with personal wins and challenges.
Meet Your HostsDr Paula Diab PhD, CDCES is a Family Physician and Diabetologist who runs a multi-disciplinary practice specializing in the management of chronic diseases, particularly diabetes and obesity in South Africa. Her approach is to walk the journey with her patients and to allow them to manage their disease rather than allow the disease to define who they are.
Despite carrying the burden of being the only member of the IDS clinical team without type 1 Diabetes, her skills and passion for diabetes care & education are exemplary (she did successfully manage her own gestational diabetes during her pregnancies).
Kristi Paguio LMSW, CDCES, CSOWM is a licensed clinical social worker, diabetes care and education specialist, and certified specialist in obesity and weight management. Kristi has been working in the field of diabetes since 2007 and has had the privilege of working with people across the lifespan who are impacted by diabetes. She has experience working with adults, children, athletes, pregnancy, and weight management.
Kristi was diagnosed with type 1 diabetes in 2000 and has specialized in the mental and emotional aspects of diabetes since that time.
What you will learn:✔️ Support from others is crucial in managing diabetes.
✔️The power of positive words.
✔️There is no “cracking the code” to perfect diabetes management.
✔️ Compassionate curiosity can help in understanding diabetes challenges.
✔️ How to live in the messy middle with diabetes.
✔️ Diabetes will be with you on your best and your worst days.
✔️ Living with diabetes really is heroic.
✔️Self-management doesn’t mean self-blame.
✔️It's important to pace yourself through challenges.
Chapters:00:11 Welcome and introduction
00:37 Meet Dr. Diab
01:25 Meet Kristi Paguio
02:34 The Comrades Ultramarathon
05:28 How managing diabetes is like running an ultramarathon
08:28 The value of curating your fan base
11:01 The anxiety around perfect diabetes management
11:51 Type 1 diabetes in the wild
13:15 The of pendulum of perfect blood sugar readings
16:52 What your blood sugar readings could be telling you.
19:30 Using compassionate curiosity with your diabetes management
23:30 The value of pacing our diabetes care goals
28:01 Diabetes is the ultra-marathon
Resources MentionedDiabetes and Obesity: The Long Road of Chronic Disease Management
Connect with Us🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team , visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
Subscribe and ReviewIf you enjoyed this episode subscribe on Apple Podcasts, Spotify, or your favorite podcast platform to ensure that you never miss an episode.
Also, leave a review to let us know what you think, and share this episode with others who will enjoy it as well!
More great episodes like this✔️The Illusion of Glucose Control
✔️Integrated Diabetes Services Unfiltered! Life, Laughter, and Real Diabetes Care
✔️Integrated Diabetes Services Unfiltered! Life, Laughter, and Real Diabetes Care--Part 2
Disclaimer
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:11):
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
(00:31):
healthcare provider before implementing.
Paula Diab (00:34):
Welcome to Think Like a Pancreas, the podcast.
My name is Paulaa Diab and I'mjoined here today by Kristi, and
I'm going to introduce myself andthen I'm going to hand over to
Kristi so she can introduce herself.
So my background is that I'mactually a Diabetologist, a family
physician, and I work in South Africa.
About a year or two ago, I joined theteam at Integrated Diabetes Services,
(00:54):
IDS, and I've been working as a diabeteseducator and clinician with them.
I can't tell you how much I have learnedfrom listening to the IDS clinicians.
From hearing their experiences, butwe'll get more into that a bit later.
But my real passion ison diabetes education.
I recently wrote a newsletter articlethat was entitled The Long Road of Chronic
(01:15):
Disease Management, and so that's whatwe are gonna be chatting about today.
I will hand over to Kristiand then we'll flip back and
introduce the topic for today.
Hey, Kristi.
Kristi Paguio (01:27):
Hey, thanks Paula.
My name's Kristi Paguio and I am amental health specialist in diabetes.
Myself, I've lived with type onefor 25 years and I kind of stumbled
into working in the diabetesworld when I was in grad school.
I didn't even know that that existed.
Um, and I'm really grateful for my timeworking in a hospital, studying in the
(01:51):
diabetes, pediatric, and adult worldbefore going into my own private practice.
So my favorite thing to do inthe world is to talk about all
things diabetes, and especiallythe mental and the emotional side.
So I'm really excited to get to workwith Integrated Diabetes Services and
then also in my own private practice.
Paula Diab (02:10):
Awesome.
And thank you today for joining us.
I, it's always such apleasure to chat with Kristi.
We've done some collaboration in the pastand we've always had great chats together,
so it's so nice to connect again.
Our topic today is the Long Road ofChronic Disease Management or the
long road of diabetes management.
And in the article, I likened it to amarathon that we have in South Africa
that you may or may not have heard of.
(02:32):
That's called the Comrades Marathon.
And it is a 90 kilometer race.
Um, so that's about 55 miles runbetween Pietermaritzburg and Durban,
or Durban and Pietermaritzburg.
They alternate every year andit's basically the oldest and the
largest ultra marathon in the world.
Um, and the reason I'm so passionateabout it is because the marathon
(02:52):
actually runs right past our house.
So on the day of the marathon, they closeall the roads and we're kind of forced
to go and support it because we can'tmove out of our front doors, basically.
But I absolutely love it.
The reason I love it is because it's suchan awesome testimony to human endurance.
So the comrades were started.
1921. So just after the First WorldWar, and it was started by a World War
(03:16):
veteran by the name of Vic Clapham.
And he envisaged a race that would honorthe suffering and celebrate the human
spirit's ability to endure hardships.
And what began with 34 Runners1921, has since grown to over
20,000 runners that come every year.
And they come from allcorners of the globe.
Obviously there's a lot ofrunners that come from my home
(03:37):
province of KwaZulu-Natal.
There's a lot of SouthAfrican runners that come.
But I think last year therewas a, an American runner.
I think her name was Courtney Olson.
I don't even know if Kristi, if you'veheard of her, but I think she finished
third in the women's race last year.
I was trying to do some maths beforetoday, and I think her average
speed was over nine miles an hour.
(03:59):
Since the men's qualifying timeI read up for the Boston Marathon
is only eight and a half milesper hour for half the distance.
So it really is phenomenal to be able torun that speed for that distance of time.
They have this race that comesthrough from one city to another
city and the crowd support alongthe way is just phenomenal.
(04:19):
'cause as I said, it comes past, itgoes through the suburbs, it goes past
many people's homes, um, goes pastmany iconic buildings and schools and
various different charity organizations,and they all come out on the side
of the road and support the race.
The other thing I love about itis that you see people of all
shapes, sizes, ages, colors,everybody comes out to run the race.
(04:40):
And it always just amazes me.
And I look at those people and Ithink, wow, the training that went in.
What is that person's personal journey?
What is their personalmotivation for running this race?
What are they getting out of it?
Because obviously there's only one winner,so to speak, who wins the race and runs
the fastest, but there's 20,000 otherpeople who also running their own journey.
(05:01):
And that always just makes me thinkabout, you know, how these people
are doing and what motivates them?
And then just that absolute endurancethat comes in and plotting along on the,
on the tar for 90 kilometers or 55 miles.
Um, and there's no relapse.
You can't rest on the side and weights,so you have to pace yourself through the
rest, and you have to make sure you've gotthat endurance to get to the end of it.
(05:24):
And it suddenly dawned on me that thisis very much like managing diabetes.
Um.
You know, there's no timeout in diabetes.
There's no, I'll just go and sit hereon the side of the road and not be
diabetic for an hour or a day or a week.
Um, there's no winning in diabetes.
I don't think we ever getto that perfect control.
(05:44):
And I think a lot of what motivatesus to get to the end, well, to get
anywhere in diabetes, not necessarilyeven the end, is that support that
we get from the people around us.
So that's what I wanted to bring tothe table today and I think between
Kristi and myself, we gotta tounpack that a bit and chat about it.
Kristi Paguio (06:02):
What I love so much, Paula, one, this race.
Wow, how inspirational.
I mean, my goodness.
And I also love to connect with you.
Here we are in two different hemispheresand talking about diabetes, something
that we're both so passionate about.
What I love about your observations of thecrowd and connecting it with diabetes is.
(06:27):
This is often the invisiblepart of diabetes, right?
Is we've been burdened with thisjust outrageous self-care regimen,
um, that often has unexpected anddisappointing results despite our
best effort and we need peoplearound us to be cheering us on.
(06:47):
I've not personally run an Ultra-mara...,I've not run a marathon, but we know,
I would think that along the way there'sdifferent aches and pains and thoughts of
self-doubt, and the mental part of runninga race is, I think, is a really great
parallel to what it is with diabetes.
(07:08):
It's just that with a race, there'sthis natural drawing of, but no one's
inspired by somebody living with diabetes.
And yet we can build our crowd,we can build our own support.
People in our lives that do see us and doacknowledge the aches and the pains and
the self-doubt, but keep cheering us onand also recognize like, the extraordinary
(07:32):
effort that it is to live withdiabetes and to, yeah, to cheer us on.
I can't say how instrumentalthat's been in my life.
For somebody to just say, I'msorry that that's happening.
Like, you're amazing and not like in apatronizing way, but in a.... there's
very few people, so I really had to curateand educate and teach and explain and
(07:56):
I'm always really touched when somebody,when somebody does understand it, but
thinking about the race, how many ofus are around people with dia... for
those listening that, I would imagineanybody who's listening, listening to
this podcast probably loves somebodywith diabetes or lives with diabetes
themselves, but like think about howmany people live with diabetes around the
world and they're not getting that, right?
(08:18):
Like we often think about,
Paula Diab (08:20):
especially if we had a big crowd and we all, "Well done.
You've, you, you're doing a good job."
Kristi Paguio (08:26):
Yeah.
Yeah, yeah.
Paula Diab (08:27):
Yeah.
I mean you, me, you mentioned just nowwe are sitting in different hemispheres.
We are also sitting oncompletely different time zones.
I've already kind of finished myday and in fact the patient that
I was seeing just before we, wejoined now was a new young type one.
She's been diagnosed two years ago, andwhen she walked in I could just see a
whole, like demeanor was all bent overand she just felt crushed by all the
(08:48):
things that she had to do in diabetes.
And her mom was saying about how she'snot, um, keeping her insulin in the
fridge and she's not changing theneedles often enough, and she's not
changing her injection sites and she'snot doing this and she's not doing that.
And I could just see this poor littlegirl was all, I mean, she was 12 years
old and she was all sort of crumbled over.
And I just said to her, doyou give yourself injections
(09:10):
at school or what happens?
And she says, no, shegives it herself at school.
And then her mom said, "yeah, she wasdiagnosed at the time when her younger
sibling was just born, and so she hadto take control of her own diabetes",
and I think that's amazing that from dayone you were doing your own injections
and suddenly this child's face justlit up and instead of focusing on,
(09:32):
I can't.
I don't change my needles often enough,and I don't keep it in the fridge, and
I don't do this, and I don't do that.
Focus on what you are doing.
It's exactly the same when you, you'restanding on the side of the road in
the Comrades and you, you don't say tothe person, oh, you're not picking your
legs up properly, or you don't have theright shoes on that you're running with.
You know, you say, come on, let'skeep going, keep going, keep going.
Even though you can see that wholeperson is bent and crushed over.
Kristi Paguio (09:54):
Mm-hmm.
Paula Diab (09:54):
And I think the nice thing in diabetes is we get to choose our crowd.
You know, you can choose youreducator, you can choose your,
your doctor and your, uh, and yourteam that you build around you.
And I think that's what's so, so valuable.
Um, choose the right piece.
Kristi Paguio (10:07):
And to some, sometimes maybe you can't, you can and you can't.
Right?
Like we're working with it, but I thinkwe can... if you are able to choose
healthcare providers, then to someextent, right, that you can find the
ones that are the best fit for you.
But we know what we're workingwithin broken systems, right?
But you can cultivate that crowdin your own personal life, right?
(10:30):
Where maybe you've got alittle bit more control.
You can, if you're a kid, youcan choose friends that get it.
Um, if, if mom and dad arestruggling with that, um, mom
and dad can know like just...
Paula Diab (10:43):
And it's so important to focus on the positives as well in that,
you know, in that support team thereare, there can be so many negatives.
Kristi Paguio (10:51):
It's bananas what people with diabetes have to think
about, and it's so easy in everybody'sanxiety of how to perfect, or to do
everything right and that that's thatconstant maybe wind coming against us.
These, the winds blowingagainst us in life.
It's just extra with diabetes.
(11:12):
There's so much more wind resistance.
I wish the law, like I've had typeone for 25 years and you would think
that I would have this perfected.
It's just not how diabetes works.
Like there's no cracking the code really.
I mean without like fine tuningto the long race mentality
(11:33):
versus the short sprint.
I was, I was gonna say, I was thinking,my husband and I went out to eat, just
a quick little burger joint in town onFriday, and the woman that was helping
us, I saw a CGM patch on her armand my eyes just-- I'm a fan, right?
Like I'm her fan!
(11:54):
I am her crowd support.
And then I'm like, me too.
And like, well, all I did wasI said, do you have type one?
And I, I think I said,type one question mark.
And she was like, yeah.
And I'm like, I've had it for this longand like this little, like, I see you,
I see your gear and I see your devices.
Paula Diab (12:10):
But how awesome that you've got type one and you're still
having a burger, because a lot ofpeople think, I've got type one.
I can't have a burger.
Or, I can't go out, or I can'tdo this, or I can't do that.
And I think, I mean, half of the reasonthat I enjoy working at IDS so much, and
I think I connected so well with all theclinicians is because my mentality towards
diabetes has always been, let's seehow I can help you manage your diabetes
(12:33):
and not let your diabetes manage you.
And I think it's so incredibly powerfulwhen you've got so many clinicians
who are actually living with diabetes.
Um, who can help you to manage itand to say, this is my experience.
This is how I have a burger.
You know, um, and I can stilllive a so-called normal life.
I don't like that word at all,but a non-diabetic life, you know?
(12:56):
Um, I've just gotta know howto do it and I can do it.
I think it's extremely good.
Kristi Paguio (13:01):
There were definitely, there were definitely
seasons in my life where Ithought, I'm going to perfect this.
I am going to be so dialed in,and so... and it just, it didn't
last, it maybe lasted a couple ofyears and then the pendulum swung.
I always talk about it like,the pendulum will swing.
(13:22):
If you go too far one direction,it's only, it's just physics.
It's just a matter of time beforethe pendulum will swing the other.
So I've learned to-- that all foods fit.
Outside of foods that yourbody has an allergy to.
Or if it has poison on it, right?
This is the diabetesjoke, like all foods fit.
(13:43):
'cause as soon as we restrict something,it's going to lead to ruminations,
which gonna lead to an over... so Ijust have found to live in that messy
middle where the pendulum swingsand I listen to my body and so.
And because of that got to be acrowd fan to this amazing woman
(14:03):
working at the restaurant and...
Paula Diab (14:05):
it's amazing.
But isn't that exactly whatrunning a, an ultra marathon is
like, you've gotta pace yourself.
You can't sprint that entire 55 miles.
You're gonna kill yourself no matter how
Kristi Paguio (14:15):
and the thought of like never having a burger because you live
with diabetes for... like, or thatthat's bad, or that's doing something
Paula Diab (14:23):
Or ice cream.
You can't have burgers.
You can't have pizzas,you can't have sweetss.
That's nonsense.
Kristi Paguio (14:28):
That's just not that, that's not the mindset
for the long, for the long haul.
The long race.
Paula Diab (14:35):
Yeah.
And I mean, just, I mean in that pacingyou yourself, a sort of metaphor.
So I, I mentioned that the race goesbetween Durban and Pietermaritzburg,
and typically the race from Maritzburgto Durban is called the Down Run.
And the run from Durban toMaritzburg is called the Up Run
and because of the altitudes.
But actually even in the down run,there are still five major hills that
(14:57):
the athletes have to, to run up, andI think, again, like even in life,
you think, oh, it's all downhill andwe've got all the tools and diabetes.
I know exactly what I'm doing.
You're still gonna come across anobstacle somewhere along the line that
you're gonna have to deal with, whetherit's a pregnancy along the line, or
whether it's menopause along the line,or whether it's some type of crisis at
work or some type of life stressor or
Kristi Paguio (15:20):
mm-hmm.
Mm.
Paula Diab (15:21):
Illness or whatever it is.
You're gonna come across somelittle uphill that you're going
to have to pace yourself through.
Kristi Paguio (15:27):
Absolutely.
I mean, I've had diabeteson my wedding day.
I had diabetes on my honeymoon.
I had diabetes at funerals.
When I lost parent.
Like I've had diabetes when I wasrupturing an appendix and like I
had diabetes on my best and my worstdays, and then everything in between.
(15:52):
Very much to like that race, or evenin the simple part of thinking about
my little restaurant treat on Fridaywas, I had to use different strategies.
I picture it like, maybe it'sone of those hills, right?
Where I had to, maybe a runner has tochange pace or focus on something else
as, as the, the elevation gets moredifficult, for me, I had to employ a
(16:16):
different strategy for my diabetes, whichwas to take a lot more insulin, count,
way more carbs than I would typically do.
That's a little scary to see thosenumbers, but knowing-- it's not my first
rodeo, getting this sweet, this treat,but yeah, it's, it's thinking about
the hills that we can manage, right?
(16:37):
Whether it's up or down, and shiftingour strategy so we can keep running,
keep going, and not beat ourselves up forthings that we think we're doing wrong.
Paula Diab (16:48):
And the day that you have a ruptured appendix, that's gonna
take precedence of your diabetesbecause it's a life-threatening
emergency, and you need to sort it out.
And if your sugars are not perfectlycontrolled, I mean, obviously you want
to try and control them better and getrid of the infection, but if they're
not perfectly controlled, your focusneeds to turn to that ruptured appendix.
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Kristi Paguio (17:46):
And what happened for me with that example is that my blood sugars
were an indicator letting me know thatmy body was fighting a huge infection.
And so it wasn't that I was failing,it's that my body was communicating to
me some really important information.
And then I had to, I, I actuallyreached out to one of my dear
(18:06):
friends who's a diabetes educatorfrom the hospital and said, what do
I, how do I. How do I target this?
What do I do to change my settingswhile I'm dealing with this?
And so that was my crowd, right?
I, I reached out to somebody in mysupport system that I could text, right?
And then on a Sunday, like I don't havethat access to my healthcare provider.
Paula Diab (18:27):
Diabetes happens on a Sunday too.
Kristi Paguio (18:29):
It happens on a Sunday in the right, and so it wasn't
anything that I was doing wrong.
It was that my body wascommunicating something to me
and, and I had to manage that too.
I mean, not that maybe the hospitalcouldn't have helped, but like, I
just really had to, I don't know.
I, I'm so independent with it.
I had to figure it out.
(18:49):
Not only was I dealing with thislife-threatening emergency, I was
also managing my diabetes throughout.
Really heroic.
Living with diabetes is heroic.
Paula Diab (18:59):
It absolutely is.
But I mean, how important is that messageto say to people when your sugars are
not perfect like you want them to be?
Um, maybe just take a step backand look what is actually going on.
Like, am I getting a big infection?
Is it stress that's causingthe sugars to go up?
Is there a problem with my pump?
Is there a problem with my insulin pen?
(19:21):
And start and just start logicallygoing through all those things.
Kristi Paguio (19:24):
Some compassionate curiosity towards ourselves, can give
us... if we can take the judgment out andjust be curious about what's happening
and compassionate about, oh, this isnot all like, man, that just frees us
up to keep running, keep pace, right?
Expecting us to do it perfectlyor expecting diabetes to?
(19:48):
It just, it's just not life.
It, there's nowhere, any other partof life that anything is perfect,
but we expect this of ourselvesand we think it's like our personal
failure if something's not.
Paula Diab (20:01):
And it's so much easier when you've got a sore knee and you
running and you can feel the knee issore, it forces you to stop and it
forces you to do something about it.
'cause you can't physicallycarry on running anymore.
I think the problem in diabetes isyou see these elevated sugars or you
see some whatever problem it is withdiabetes and immediately you just sort
of internalize it and think, you know, itmust be something that I'm doing wrong.
(20:23):
And I think it's so importantto just take that step back and
have, what did you say that?
Kristi Paguio (20:28):
Compassionate curiousity.
Paula Diab (20:28):
Compassionate curiousity.
I love, I love that.
Kristi Paguio (20:32):
Yeah.
Paula Diab (20:32):
And just have this sort of compassionate curiosity to towards
what's going on and just interrogate ita little bit and pay attention to it.
Kristi Paguio (20:42):
And teach this to your crowd, right?
Teach this to the people in yoursupport system so that they know to have
compassion and to be curious, right?
That instead of it being like,well, what did you do wrong?
Or, What did you not do?
Right?
Or what, like there's so,there's only so many variables
that are within our control.
Paula Diab (21:00):
Yes.
Kristi Paguio (21:01):
So, but we often think because it's self-managed, that therefore
it must be myself or ourselves that we,we did something wrong and it's just not.
Yeah, I love to be able to work withpeople to, to help lighten their load.
What you were talking aboutwith that little girl, you
modeled that for mom, right?
Who's so worried about her daughterand wants the very best for her and
(21:24):
probably hates that, I would, I knownot even meeting her, I know she hates
that her daughter has to deal with thisand, but to lighten that load, right?
To see those shoulders come up ordown if there's tension, right?
Paula Diab (21:37):
But I think it's also, I mean, that for me, again, it's
those small wins that we make alongthe way that all build up together.
And I think one thing that strikesme, certainly when, when I watch
the race is, there's one winner.
You know, there's, they try to break itdown there, so this is the fastest male
and the fastest female, and then theybreak it down into age groups and the
(21:58):
fastest veteran and whatever and whatever.
Or the fastest South African runneror the fastest international runner.
You could break it down, but actuallythere's just one winner in the end.
But for me, it.
I look at all those people and eachperson has got their own journey and
each person is setting their own personalbest and, and improving on their own
time from last year or last year.
They, they did it all by themselves.
(22:20):
This year they, they're runningwith a friend, and I think
it's very similar in diabetes.
There is no one winnerat the end of the day.
I mean, who's the winner in diabetes?
I don't know.
The person who lives the longest?
The person who doesn'thave any complications?
For me, the winner is, in diabetes, is theperson who continuously builds on their
own personal journey every, every day.
And so for me, that little girlthat now knows how to inject
(22:41):
herself properly and she knows why.
She feels empowered by the factthat she can do it by herself.
That's a win for me, and we build on that.
I would
Kristi Paguio (22:50):
imagine running a race is similar to anything in life.
Like I know for me, if it's a, if I'vegot a busy day ahead of me, I will
focus on, you know, kind of chippingaway at the day and not just Friday.
Um, and I would imagine running anultra marathon or a marathon or a a
(23:11):
half marathon or a, whatever that is,10 K, 5K, that like you're focusing,
whatever the challenge is, you're justfocusing on like maybe the next mile
marker or the next kilometer mark, likeyou're focusing on something else or
counting mailboxes or whatever that is.
Paula Diab (23:29):
Um, mm-hmm.
Kristi Paguio (23:30):
So sometimes we have to, yes, like we are looking at the big
picture, but the problem is a lot oftimes we've gone too far out into where we
don't actually have, uh... like I can't,I can't try think of anything about Friday
right now, but-- but I can focus on today.
And I think that that'ssimilar with diabetes.
(23:51):
Its like yes, big picture isavoid complications when and
if all at all possible, and yetpeople still get complications
and that's not, not a failure.
Not their failure.
I think it's looking at this, likepacing ourselves and thinking about
the winning, is defining it maybeas our, what is our small little
(24:12):
goal, like that burger on Friday.
That was a, that was, I knew that thatwas gonna be a cha a, a challenge.
What tools would I needto employ to do that?
Paula Diab (24:23):
For each person it's slightly different.
You might want to just go out on Fridaynight with your husband and have a burger.
There might be a young teenager whowants to go and have pizza with her
friends, or there might be someonewho's just been diagnosed with diabetes,
who just wants to know how to getthis insulin into their body and
avoid going high and avoid going low.
So for each person, their, their targetis different and their, their win is
(24:44):
different from, from the next person.
And I think those winschange as we go along.
You know, you've haddiabetes now for 20 years.
You know how to inject the insulin.
That's no longer too much of an issue,but the other problems that come
along that you now have to deal with.
So I think
Kristi Paguio (24:59):
I think in, in the beginning of my diagnosis, like
it was, you know, it was a muchmore simpler, just to try to make
sure I knew how to stay alive.
It was pretty simple what I was tryingto focus on, so that I could start
to understand nutrition and, likeI feel like I had to become a nurse
and a dietician and a endocrine,like all in a very rapid time.
(25:23):
Where now I feel like Ican, I can expand out.
Do a lot more, and feelcomfortable pushing the limits of
things a little bit more.
Paula Diab (25:32):
And ultimately you just have to be Kristi and collect the
nurse and the dietician and theeducator and everybody around you.
And I think that's what a lot of peoplewith diabetes sometimes try and do is
they try and do everything themselvesand how can I fix it yesterday?
There's no fixing it yesterday.
There's learning on a daily basis andgetting that crowd around you and working
(25:53):
through the hard times together and justkeep chipping it away at it, as you say.
Kristi Paguio (25:57):
Yeah, for those listening that don't feel like they have enough
people in their life that understandwhat they're dealing with, or they
themselves don't totally understand,don't really even see themselves, right?
They're just, maybe stuck in that,I'm not doing this perfectly.
Find that support.
Reach out to Paula and myselfthrough Integrated Diabetes
(26:21):
or someone else on our team.
Like build that support system.
There, there are gonnabe diamonds in the rough.
Like they're gonna be needlesin haystack sometimes.
Like there's not, there's not a bajillionof us, but we're, we're out there.
Paula Diab (26:36):
Do you know what I really like about the IDS team is that
everyone's got their own sort ofpersonal journey and their own person.
It's, for me, it's like a puzzleand everyone kind of fits together.
Like Kristi, you, you've got a, abackground in mental health and, and
that's where your expertise lie, um.
My, my expertise on weight managementand dealing with people with type
(26:57):
two diabetes, starting on theinsulin journey, and other people
have got backgrounds in exercisemanagement or dietetics or, you know,
all the different perspectives.
And so often we see people and theysay, and, and we'll find clients
will bounce between us and, and get alittle bit of help from this person,
(27:19):
a little bit of help from that person.
And I think that's what's so,so awesome and worked so nicely.
And I think I was reflecting onthe beginning, I was just saying
how much I've learned from theIDS clinicians, just listening to
different people's perspectivesand different people's journeys and
there's always something new to learn.
There's always another hill to conquer.
There's always another mile aheadof you that you've gotta run.
(27:40):
And I think if we can gatherthat crowd and learn from
each other, it's so powerful.
Kristi Paguio (27:44):
Well, and I think that, as a mental health professional, there's so
much that-- I can only build upon so much.
Not that there's not alwayssomething to learn, but boy,
diabetes is just at a whole otherpace with technology and algorithm.
It just is, um, there in a lot of waysthat is the ultra marathon where like,
(28:04):
it just, it's like the finish linejust ,and what is the finish line?
The finish line for us is, whether that'sa cure or that is, um, our own, you know.
Like it just-- the finish line.
And so that, I don't know what thefinish line, I don't know where the, like
Paula Diab (28:20):
I don't know where this is going.
I just know I'm gonna keep.
Kristi Paguio (28:22):
Yeah, so it all just kinda circles back.
Build up your support systemand cultivate that over time.
Seek out outside resources, buildit up, um, to help you pace yourself
because it is... most people who don'tknow live with diabetes, if they had to
walk a week in our shoes, with actualblood sugar, like what we deal with?
(28:43):
They would crumble.
And what we make look invisible,is out, it's a like, it's
we're being our own pancreas!
Like that is on with, Ican't, I can't speak enough.
I think the biggest thing to protectagainst is thinking of this body as an
enemy instead of it being something thatwe approach with respect and compassion.
(29:07):
Right?
And we need other peoplearound us to do the same thing.
That it's not a personal failure,it is life with diabetes and it is
unlike anything else on this planet.
Paula Diab (29:17):
I wanna read to you something that I wrote in that, in that article,
and it's just listening to you now,it really just struck a chord with me.
So I said, think of the 400 millionpeople worldwide living with diabetes and
the 650 plus million people living withobesity in the world or pre pre-diabetes.
And I said, they tooare endurance athletes.
(29:37):
Their race is not televised.
They don't have water tables on theside to help them all the time, but they
wake up every day and just keep going.
And I said, let us honor theirjourney with the same admiration
that we give to those who crossthe finish line of the Comrades
marathon because managing a lifelongcondition with courage, commitments
and self-compassion is actually theultimate ultra marathon and I think
(30:00):
that's exactly what you were just saying.
It's, it's an invisible race thatwe are running, and I think it's so
important for people to just remember--it's, it's not a one size fits all.
There is no finish line that you'regonna cross and someone's gonna give
you a gold medal at the end of it.
You've gotta pace yourself.
The race isn't ending tomorrow, andyou've gotta gather that support around
(30:23):
you and choose your team and use yourteam to the best of your ability.
And I think for me, that's, that's themessage that I, I really wanna get out
there and get more people to understandpeople with diabetes and people who
on that support team to understand.
Kristi Paguio (30:38):
For those in the support system that are, that are potentially
listening to this, the, we know thatanything that would have a negative
bias towards it or where we know that,where there's, where there's a positive
belief in something, in someone,that is actually what draws them
more than that critical judgemental.
(31:00):
That deflates, and so it is soimportant to be-- think of strengths
and to think, I love what you wroteand that you read that again, right
now, like that, the psychology aroundthat is, is well published, right?
It's, it's that positive psychology.
It's the negative by, like, it's allwithin that, that we're gonna be drawn
(31:20):
to things that make us feel good.
We're gonna be drawn to, we'regonna do better when we feel
better about ourselves, and we'refocused on something positive, then
if we've got a negative emotion.
It's gonna draw us back or shrink back.
Our body actually responds to that sothat, that respect, that compassion,
(31:41):
that cur, like all of those things arewhat propel people with diabetes forward.
And if they're strugglingwith it themselves, be be that
person that cheers them on.
That says, how can I support?
Like, I'm so sorry thatyou're going through this.
This is, this is brutal.
See them.
Don't say, you know, well,what did you not do right?
(32:02):
What did you do wrong?
Like there may be something in that,maybe that was, but that's not gonna help.
That's not, gonna movethem forward in the race.
Paula Diab (32:11):
It's such a powerful message just to say, I see you.
I support you.
I'm here for you.
What can I do for you?
I acknowledge what you're going through.
Oh, Kristi, thank you so, so much.
I really appreciate the time.
Together today, and I think, I reallyhope that people listening, whether
you have diabetes or whether you'resupporting someone with diabetes,
(32:32):
that you, you acknowledge and seethat that incredible endurance and
incredible marathon that people arerunning and it's not about winning.
It's about those small wins alongthe way and just pacing yourself
and just getting to the finish line.
Improving on what happened yesterday,doing better for tomorrow, and just
finding the right people around youthat you can support yourself with.
(32:54):
I think if we could dothat, then we really want...
Kristi Paguio (32:57):
Make your goal attainable.
Don't make it so big,like finishing that race.
Make it incremental, right,and cheer yourself along.
Make sure that self-talkis cheering yourself on.
Good job.
Atta a girl.
Atta a boy.
Like, just keep, yeah,
Paula Diab (33:11):
keep going.
Kristi Paguio (33:13):
Yeah, keep going.
We see you.
Paula Diab (33:15):
So, I hope that this podcast today has inspired you.
Motivated you.
Put things into perspective.
Given you something to think about.
If you want to touch base witheither Kristi or myself, if you
need a really good crowd supporter.
I'm really good at crowdsupport, by the way.
I'm fantastic in handing out water and,and, and oranges on the side of the road.
Any of the IDS clinicians, I'm surewe've all got our own different strengths
(33:38):
and things that we enjoy doing, butwe hope to see and hear more of you.
Thank you very much.
Gary Scheiner (33:43):
Thanks for tuning in To think Like a Pancreas, The Podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think like a Pancreas, The Podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
(34:04):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech,
sports and exercise, weight loss,type one pregnancy and emotional
(34:25):
wellbeing, we've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email, and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, The Podcast.
(34:46):
I'm Gary Scheiner, wishing youa fantastic week ahead and don't
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
(00:31):
healthcare provider before implementing.
Paula Diab (00:34):
Welcome to Think Like a Pancreas, the podcast.
My name is Paulaa Diab and I'mjoined here today by Kristi, and
I'm going to introduce myself andthen I'm going to hand over to
Kristi so she can introduce herself.
So my background is that I'mactually a Diabetologist, a family
physician, and I work in South Africa.
About a year or two ago, I joined theteam at Integrated Diabetes Services,
(00:54):
IDS, and I've been working as a diabeteseducator and clinician with them.
I can't tell you how much I have learnedfrom listening to the IDS clinicians.
From hearing their experiences, butwe'll get more into that a bit later.
But my real passion ison diabetes education.
I recently wrote a newsletter articlethat was entitled The Long Road of Chronic
(01:15):
Disease Management, and so that's whatwe are gonna be chatting about today.
I will hand over to Kristiand then we'll flip back and
introduce the topic for today.
Hey, Kristi.
Kristi Paguio (01:27):
Hey, thanks Paula.
My name's Kristi Paguio and I am amental health specialist in diabetes.
Myself, I've lived with type onefor 25 years and I kind of stumbled
into working in the diabetesworld when I was in grad school.
I didn't even know that that existed.
Um, and I'm really grateful for my timeworking in a hospital, studying in the
(01:51):
diabetes, pediatric, and adult worldbefore going into my own private practice.
So my favorite thing to do inthe world is to talk about all
things diabetes, and especiallythe mental and the emotional side.
So I'm really excited to get to workwith Integrated Diabetes Services and
then also in my own private practice.
Paula Diab (02:10):
Awesome.
And thank you today for joining us.
I, it's always such apleasure to chat with Kristi.
We've done some collaboration in the pastand we've always had great chats together,
so it's so nice to connect again.
Our topic today is the Long Road ofChronic Disease Management or the
long road of diabetes management.
And in the article, I likened it to amarathon that we have in South Africa
that you may or may not have heard of.
(02:32):
That's called the Comrades Marathon.
And it is a 90 kilometer race.
Um, so that's about 55 miles runbetween Pietermaritzburg and Durban,
or Durban and Pietermaritzburg.
They alternate every year andit's basically the oldest and the
largest ultra marathon in the world.
Um, and the reason I'm so passionateabout it is because the marathon
(02:52):
actually runs right past our house.
So on the day of the marathon, they closeall the roads and we're kind of forced
to go and support it because we can'tmove out of our front doors, basically.
But I absolutely love it.
The reason I love it is because it's suchan awesome testimony to human endurance.
So the comrades were started.
1921. So just after the First WorldWar, and it was started by a World War
(03:16):
veteran by the name of Vic Clapham.
And he envisaged a race that would honorthe suffering and celebrate the human
spirit's ability to endure hardships.
And what began with 34 Runners1921, has since grown to over
20,000 runners that come every year.
And they come from allcorners of the globe.
Obviously there's a lot ofrunners that come from my home
(03:37):
province of KwaZulu-Natal.
There's a lot of SouthAfrican runners that come.
But I think last year therewas a, an American runner.
I think her name was Courtney Olson.
I don't even know if Kristi, if you'veheard of her, but I think she finished
third in the women's race last year.
I was trying to do some maths beforetoday, and I think her average
speed was over nine miles an hour.
(03:59):
Since the men's qualifying timeI read up for the Boston Marathon
is only eight and a half milesper hour for half the distance.
So it really is phenomenal to be able torun that speed for that distance of time.
They have this race that comesthrough from one city to another
city and the crowd support alongthe way is just phenomenal.
(04:19):
'cause as I said, it comes past, itgoes through the suburbs, it goes past
many people's homes, um, goes pastmany iconic buildings and schools and
various different charity organizations,and they all come out on the side
of the road and support the race.
The other thing I love about itis that you see people of all
shapes, sizes, ages, colors,everybody comes out to run the race.
(04:40):
And it always just amazes me.
And I look at those people and Ithink, wow, the training that went in.
What is that person's personal journey?
What is their personalmotivation for running this race?
What are they getting out of it?
Because obviously there's only one winner,so to speak, who wins the race and runs
the fastest, but there's 20,000 otherpeople who also running their own journey.
(05:01):
And that always just makes me thinkabout, you know, how these people
are doing and what motivates them?
And then just that absolute endurancethat comes in and plotting along on the,
on the tar for 90 kilometers or 55 miles.
Um, and there's no relapse.
You can't rest on the side and weights,so you have to pace yourself through the
rest, and you have to make sure you've gotthat endurance to get to the end of it.
(05:24):
And it suddenly dawned on me that thisis very much like managing diabetes.
Um.
You know, there's no timeout in diabetes.
There's no, I'll just go and sit hereon the side of the road and not be
diabetic for an hour or a day or a week.
Um, there's no winning in diabetes.
I don't think we ever getto that perfect control.
(05:44):
And I think a lot of what motivatesus to get to the end, well, to get
anywhere in diabetes, not necessarilyeven the end, is that support that
we get from the people around us.
So that's what I wanted to bring tothe table today and I think between
Kristi and myself, we gotta tounpack that a bit and chat about it.
Kristi Paguio (06:02):
What I love so much, Paula, one, this race.
Wow, how inspirational.
I mean, my goodness.
And I also love to connect with you.
Here we are in two different hemispheresand talking about diabetes, something
that we're both so passionate about.
What I love about your observations of thecrowd and connecting it with diabetes is.
(06:27):
This is often the invisiblepart of diabetes, right?
Is we've been burdened with thisjust outrageous self-care regimen,
um, that often has unexpected anddisappointing results despite our
best effort and we need peoplearound us to be cheering us on.
(06:47):
I've not personally run an Ultra-mara...,I've not run a marathon, but we know,
I would think that along the way there'sdifferent aches and pains and thoughts of
self-doubt, and the mental part of runninga race is, I think, is a really great
parallel to what it is with diabetes.
(07:08):
It's just that with a race, there'sthis natural drawing of, but no one's
inspired by somebody living with diabetes.
And yet we can build our crowd,we can build our own support.
People in our lives that do see us and doacknowledge the aches and the pains and
the self-doubt, but keep cheering us onand also recognize like, the extraordinary
(07:32):
effort that it is to live withdiabetes and to, yeah, to cheer us on.
I can't say how instrumentalthat's been in my life.
For somebody to just say, I'msorry that that's happening.
Like, you're amazing and not like in apatronizing way, but in a.... there's
very few people, so I really had to curateand educate and teach and explain and
(07:56):
I'm always really touched when somebody,when somebody does understand it, but
thinking about the race, how many ofus are around people with dia... for
those listening that, I would imagineanybody who's listening, listening to
this podcast probably loves somebodywith diabetes or lives with diabetes
themselves, but like think about howmany people live with diabetes around the
world and they're not getting that, right?
(08:18):
Like we often think about,
Paula Diab (08:20):
especially if we had a big crowd and we all, "Well done.
You've, you, you're doing a good job."
Kristi Paguio (08:26):
Yeah.
Yeah, yeah.
Paula Diab (08:27):
Yeah.
I mean you, me, you mentioned just nowwe are sitting in different hemispheres.
We are also sitting oncompletely different time zones.
I've already kind of finished myday and in fact the patient that
I was seeing just before we, wejoined now was a new young type one.
She's been diagnosed two years ago, andwhen she walked in I could just see a
whole, like demeanor was all bent overand she just felt crushed by all the
(08:48):
things that she had to do in diabetes.
And her mom was saying about how she'snot, um, keeping her insulin in the
fridge and she's not changing theneedles often enough, and she's not
changing her injection sites and she'snot doing this and she's not doing that.
And I could just see this poor littlegirl was all, I mean, she was 12 years
old and she was all sort of crumbled over.
And I just said to her, doyou give yourself injections
(09:10):
at school or what happens?
And she says, no, shegives it herself at school.
And then her mom said, "yeah, she wasdiagnosed at the time when her younger
sibling was just born, and so she hadto take control of her own diabetes",
and I think that's amazing that from dayone you were doing your own injections
and suddenly this child's face justlit up and instead of focusing on,
(09:32):
I can't.
I don't change my needles often enough,and I don't keep it in the fridge, and
I don't do this, and I don't do that.
Focus on what you are doing.
It's exactly the same when you, you'restanding on the side of the road in
the Comrades and you, you don't say tothe person, oh, you're not picking your
legs up properly, or you don't have theright shoes on that you're running with.
You know, you say, come on, let'skeep going, keep going, keep going.
Even though you can see that wholeperson is bent and crushed over.
Kristi Paguio (09:54):
Mm-hmm.
Paula Diab (09:54):
And I think the nice thing in diabetes is we get to choose our crowd.
You know, you can choose youreducator, you can choose your,
your doctor and your, uh, and yourteam that you build around you.
And I think that's what's so, so valuable.
Um, choose the right piece.
Kristi Paguio (10:07):
And to some, sometimes maybe you can't, you can and you can't.
Right?
Like we're working with it, but I thinkwe can... if you are able to choose
healthcare providers, then to someextent, right, that you can find the
ones that are the best fit for you.
But we know what we're workingwithin broken systems, right?
But you can cultivate that crowdin your own personal life, right?
(10:30):
Where maybe you've got alittle bit more control.
You can, if you're a kid, youcan choose friends that get it.
Um, if, if mom and dad arestruggling with that, um, mom
and dad can know like just...
Paula Diab (10:43):
And it's so important to focus on the positives as well in that,
you know, in that support team thereare, there can be so many negatives.
Kristi Paguio (10:51):
It's bananas what people with diabetes have to think
about, and it's so easy in everybody'sanxiety of how to perfect, or to do
everything right and that that's thatconstant maybe wind coming against us.
These, the winds blowingagainst us in life.
It's just extra with diabetes.
(11:12):
There's so much more wind resistance.
I wish the law, like I've had typeone for 25 years and you would think
that I would have this perfected.
It's just not how diabetes works.
Like there's no cracking the code really.
I mean without like fine tuningto the long race mentality
(11:33):
versus the short sprint.
I was, I was gonna say, I was thinking,my husband and I went out to eat, just
a quick little burger joint in town onFriday, and the woman that was helping
us, I saw a CGM patch on her armand my eyes just-- I'm a fan, right?
Like I'm her fan!
(11:54):
I am her crowd support.
And then I'm like, me too.
And like, well, all I did wasI said, do you have type one?
And I, I think I said,type one question mark.
And she was like, yeah.
And I'm like, I've had it for this longand like this little, like, I see you,
I see your gear and I see your devices.
Paula Diab (12:10):
But how awesome that you've got type one and you're still
having a burger, because a lot ofpeople think, I've got type one.
I can't have a burger.
Or, I can't go out, or I can'tdo this, or I can't do that.
And I think, I mean, half of the reasonthat I enjoy working at IDS so much, and
I think I connected so well with all theclinicians is because my mentality towards
diabetes has always been, let's seehow I can help you manage your diabetes
(12:33):
and not let your diabetes manage you.
And I think it's so incredibly powerfulwhen you've got so many clinicians
who are actually living with diabetes.
Um, who can help you to manage itand to say, this is my experience.
This is how I have a burger.
You know, um, and I can stilllive a so-called normal life.
I don't like that word at all,but a non-diabetic life, you know?
(12:56):
Um, I've just gotta know howto do it and I can do it.
I think it's extremely good.
Kristi Paguio (13:01):
There were definitely, there were definitely
seasons in my life where Ithought, I'm going to perfect this.
I am going to be so dialed in,and so... and it just, it didn't
last, it maybe lasted a couple ofyears and then the pendulum swung.
I always talk about it like,the pendulum will swing.
(13:22):
If you go too far one direction,it's only, it's just physics.
It's just a matter of time beforethe pendulum will swing the other.
So I've learned to-- that all foods fit.
Outside of foods that yourbody has an allergy to.
Or if it has poison on it, right?
This is the diabetesjoke, like all foods fit.
(13:43):
'cause as soon as we restrict something,it's going to lead to ruminations,
which gonna lead to an over... so Ijust have found to live in that messy
middle where the pendulum swingsand I listen to my body and so.
And because of that got to be acrowd fan to this amazing woman
(14:03):
working at the restaurant and...
Paula Diab (14:05):
it's amazing.
But isn't that exactly whatrunning a, an ultra marathon is
like, you've gotta pace yourself.
You can't sprint that entire 55 miles.
You're gonna kill yourself no matter how
Kristi Paguio (14:15):
and the thought of like never having a burger because you live
with diabetes for... like, or thatthat's bad, or that's doing something
Paula Diab (14:23):
Or ice cream.
You can't have burgers.
You can't have pizzas,you can't have sweetss.
That's nonsense.
Kristi Paguio (14:28):
That's just not that, that's not the mindset
for the long, for the long haul.
The long race.
Paula Diab (14:35):
Yeah.
And I mean, just, I mean in that pacingyou yourself, a sort of metaphor.
So I, I mentioned that the race goesbetween Durban and Pietermaritzburg,
and typically the race from Maritzburgto Durban is called the Down Run.
And the run from Durban toMaritzburg is called the Up Run
and because of the altitudes.
But actually even in the down run,there are still five major hills that
(14:57):
the athletes have to, to run up, andI think, again, like even in life,
you think, oh, it's all downhill andwe've got all the tools and diabetes.
I know exactly what I'm doing.
You're still gonna come across anobstacle somewhere along the line that
you're gonna have to deal with, whetherit's a pregnancy along the line, or
whether it's menopause along the line,or whether it's some type of crisis at
work or some type of life stressor or
Kristi Paguio (15:20):
mm-hmm.
Mm.
Paula Diab (15:21):
Illness or whatever it is.
You're gonna come across somelittle uphill that you're going
to have to pace yourself through.
Kristi Paguio (15:27):
Absolutely.
I mean, I've had diabeteson my wedding day.
I had diabetes on my honeymoon.
I had diabetes at funerals.
When I lost parent.
Like I've had diabetes when I wasrupturing an appendix and like I
had diabetes on my best and my worstdays, and then everything in between.
(15:52):
Very much to like that race, or evenin the simple part of thinking about
my little restaurant treat on Fridaywas, I had to use different strategies.
I picture it like, maybe it'sone of those hills, right?
Where I had to, maybe a runner has tochange pace or focus on something else
as, as the, the elevation gets moredifficult, for me, I had to employ a
(16:16):
different strategy for my diabetes, whichwas to take a lot more insulin, count,
way more carbs than I would typically do.
That's a little scary to see thosenumbers, but knowing-- it's not my first
rodeo, getting this sweet, this treat,but yeah, it's, it's thinking about
the hills that we can manage, right?
(16:37):
Whether it's up or down, and shiftingour strategy so we can keep running,
keep going, and not beat ourselves up forthings that we think we're doing wrong.
Paula Diab (16:48):
And the day that you have a ruptured appendix, that's gonna
take precedence of your diabetesbecause it's a life-threatening
emergency, and you need to sort it out.
And if your sugars are not perfectlycontrolled, I mean, obviously you want
to try and control them better and getrid of the infection, but if they're
not perfectly controlled, your focusneeds to turn to that ruptured appendix.
Gary Scheiner (17:07):
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Kristi Paguio (17:46):
And what happened for me with that example is that my blood sugars
were an indicator letting me know thatmy body was fighting a huge infection.
And so it wasn't that I was failing,it's that my body was communicating to
me some really important information.
And then I had to, I, I actuallyreached out to one of my dear
(18:06):
friends who's a diabetes educatorfrom the hospital and said, what do
I, how do I. How do I target this?
What do I do to change my settingswhile I'm dealing with this?
And so that was my crowd, right?
I, I reached out to somebody in mysupport system that I could text, right?
And then on a Sunday, like I don't havethat access to my healthcare provider.
Paula Diab (18:27):
Diabetes happens on a Sunday too.
Kristi Paguio (18:29):
It happens on a Sunday in the right, and so it wasn't
anything that I was doing wrong.
It was that my body wascommunicating something to me
and, and I had to manage that too.
I mean, not that maybe the hospitalcouldn't have helped, but like, I
just really had to, I don't know.
I, I'm so independent with it.
I had to figure it out.
(18:49):
Not only was I dealing with thislife-threatening emergency, I was
also managing my diabetes throughout.
Really heroic.
Living with diabetes is heroic.
Paula Diab (18:59):
It absolutely is.
But I mean, how important is that messageto say to people when your sugars are
not perfect like you want them to be?
Um, maybe just take a step backand look what is actually going on.
Like, am I getting a big infection?
Is it stress that's causingthe sugars to go up?
Is there a problem with my pump?
Is there a problem with my insulin pen?
(19:21):
And start and just start logicallygoing through all those things.
Kristi Paguio (19:24):
Some compassionate curiosity towards ourselves, can give
us... if we can take the judgment out andjust be curious about what's happening
and compassionate about, oh, this isnot all like, man, that just frees us
up to keep running, keep pace, right?
Expecting us to do it perfectlyor expecting diabetes to?
(19:48):
It just, it's just not life.
It, there's nowhere, any other partof life that anything is perfect,
but we expect this of ourselvesand we think it's like our personal
failure if something's not.
Paula Diab (20:01):
And it's so much easier when you've got a sore knee and you
running and you can feel the knee issore, it forces you to stop and it
forces you to do something about it.
'cause you can't physicallycarry on running anymore.
I think the problem in diabetes isyou see these elevated sugars or you
see some whatever problem it is withdiabetes and immediately you just sort
of internalize it and think, you know, itmust be something that I'm doing wrong.
(20:23):
And I think it's so importantto just take that step back and
have, what did you say that?
Kristi Paguio (20:28):
Compassionate curiousity.
Paula Diab (20:28):
Compassionate curiousity.
I love, I love that.
Kristi Paguio (20:32):
Yeah.
Paula Diab (20:32):
And just have this sort of compassionate curiosity to towards
what's going on and just interrogate ita little bit and pay attention to it.
Kristi Paguio (20:42):
And teach this to your crowd, right?
Teach this to the people in yoursupport system so that they know to have
compassion and to be curious, right?
That instead of it being like,well, what did you do wrong?
Or, What did you not do?
Right?
Or what, like there's so,there's only so many variables
that are within our control.
Paula Diab (21:00):
Yes.
Kristi Paguio (21:01):
So, but we often think because it's self-managed, that therefore
it must be myself or ourselves that we,we did something wrong and it's just not.
Yeah, I love to be able to work withpeople to, to help lighten their load.
What you were talking aboutwith that little girl, you
modeled that for mom, right?
Who's so worried about her daughterand wants the very best for her and
(21:24):
probably hates that, I would, I knownot even meeting her, I know she hates
that her daughter has to deal with thisand, but to lighten that load, right?
To see those shoulders come up ordown if there's tension, right?
Paula Diab (21:37):
But I think it's also, I mean, that for me, again, it's
those small wins that we make alongthe way that all build up together.
And I think one thing that strikesme, certainly when, when I watch
the race is, there's one winner.
You know, there's, they try to break itdown there, so this is the fastest male
and the fastest female, and then theybreak it down into age groups and the
(21:58):
fastest veteran and whatever and whatever.
Or the fastest South African runneror the fastest international runner.
You could break it down, but actuallythere's just one winner in the end.
But for me, it.
I look at all those people and eachperson has got their own journey and
each person is setting their own personalbest and, and improving on their own
time from last year or last year.
They, they did it all by themselves.
(22:20):
This year they, they're runningwith a friend, and I think
it's very similar in diabetes.
There is no one winnerat the end of the day.
I mean, who's the winner in diabetes?
I don't know.
The person who lives the longest?
The person who doesn'thave any complications?
For me, the winner is, in diabetes, is theperson who continuously builds on their
own personal journey every, every day.
And so for me, that little girlthat now knows how to inject
(22:41):
herself properly and she knows why.
She feels empowered by the factthat she can do it by herself.
That's a win for me, and we build on that.
I would
Kristi Paguio (22:50):
imagine running a race is similar to anything in life.
Like I know for me, if it's a, if I'vegot a busy day ahead of me, I will
focus on, you know, kind of chippingaway at the day and not just Friday.
Um, and I would imagine running anultra marathon or a marathon or a a
(23:11):
half marathon or a, whatever that is,10 K, 5K, that like you're focusing,
whatever the challenge is, you're justfocusing on like maybe the next mile
marker or the next kilometer mark, likeyou're focusing on something else or
counting mailboxes or whatever that is.
Paula Diab (23:29):
Um, mm-hmm.
Kristi Paguio (23:30):
So sometimes we have to, yes, like we are looking at the big
picture, but the problem is a lot oftimes we've gone too far out into where we
don't actually have, uh... like I can't,I can't try think of anything about Friday
right now, but-- but I can focus on today.
And I think that that'ssimilar with diabetes.
(23:51):
Its like yes, big picture isavoid complications when and
if all at all possible, and yetpeople still get complications
and that's not, not a failure.
Not their failure.
I think it's looking at this, likepacing ourselves and thinking about
the winning, is defining it maybeas our, what is our small little
(24:12):
goal, like that burger on Friday.
That was a, that was, I knew that thatwas gonna be a cha a, a challenge.
What tools would I needto employ to do that?
Paula Diab (24:23):
For each person it's slightly different.
You might want to just go out on Fridaynight with your husband and have a burger.
There might be a young teenager whowants to go and have pizza with her
friends, or there might be someonewho's just been diagnosed with diabetes,
who just wants to know how to getthis insulin into their body and
avoid going high and avoid going low.
So for each person, their, their targetis different and their, their win is
(24:44):
different from, from the next person.
And I think those winschange as we go along.
You know, you've haddiabetes now for 20 years.
You know how to inject the insulin.
That's no longer too much of an issue,but the other problems that come
along that you now have to deal with.
So I think
Kristi Paguio (24:59):
I think in, in the beginning of my diagnosis, like
it was, you know, it was a muchmore simpler, just to try to make
sure I knew how to stay alive.
It was pretty simple what I was tryingto focus on, so that I could start
to understand nutrition and, likeI feel like I had to become a nurse
and a dietician and a endocrine,like all in a very rapid time.
(25:23):
Where now I feel like Ican, I can expand out.
Do a lot more, and feelcomfortable pushing the limits of
things a little bit more.
Paula Diab (25:32):
And ultimately you just have to be Kristi and collect the
nurse and the dietician and theeducator and everybody around you.
And I think that's what a lot of peoplewith diabetes sometimes try and do is
they try and do everything themselvesand how can I fix it yesterday?
There's no fixing it yesterday.
There's learning on a daily basis andgetting that crowd around you and working
(25:53):
through the hard times together and justkeep chipping it away at it, as you say.
Kristi Paguio (25:57):
Yeah, for those listening that don't feel like they have enough
people in their life that understandwhat they're dealing with, or they
themselves don't totally understand,don't really even see themselves, right?
They're just, maybe stuck in that,I'm not doing this perfectly.
Find that support.
Reach out to Paula and myselfthrough Integrated Diabetes
(26:21):
or someone else on our team.
Like build that support system.
There, there are gonnabe diamonds in the rough.
Like they're gonna be needlesin haystack sometimes.
Like there's not, there's not a bajillionof us, but we're, we're out there.
Paula Diab (26:36):
Do you know what I really like about the IDS team is that
everyone's got their own sort ofpersonal journey and their own person.
It's, for me, it's like a puzzleand everyone kind of fits together.
Like Kristi, you, you've got a, abackground in mental health and, and
that's where your expertise lie, um.
My, my expertise on weight managementand dealing with people with type
(26:57):
two diabetes, starting on theinsulin journey, and other people
have got backgrounds in exercisemanagement or dietetics or, you know,
all the different perspectives.
And so often we see people and theysay, and, and we'll find clients
will bounce between us and, and get alittle bit of help from this person,
(27:19):
a little bit of help from that person.
And I think that's what's so,so awesome and worked so nicely.
And I think I was reflecting onthe beginning, I was just saying
how much I've learned from theIDS clinicians, just listening to
different people's perspectivesand different people's journeys and
there's always something new to learn.
There's always another hill to conquer.
There's always another mile aheadof you that you've gotta run.
(27:40):
And I think if we can gatherthat crowd and learn from
each other, it's so powerful.
Kristi Paguio (27:44):
Well, and I think that, as a mental health professional, there's so
much that-- I can only build upon so much.
Not that there's not alwayssomething to learn, but boy,
diabetes is just at a whole otherpace with technology and algorithm.
It just is, um, there in a lot of waysthat is the ultra marathon where like,
(28:04):
it just, it's like the finish linejust ,and what is the finish line?
The finish line for us is, whether that'sa cure or that is, um, our own, you know.
Like it just-- the finish line.
And so that, I don't know what thefinish line, I don't know where the, like
Paula Diab (28:20):
I don't know where this is going.
I just know I'm gonna keep.
Kristi Paguio (28:22):
Yeah, so it all just kinda circles back.
Build up your support systemand cultivate that over time.
Seek out outside resources, buildit up, um, to help you pace yourself
because it is... most people who don'tknow live with diabetes, if they had to
walk a week in our shoes, with actualblood sugar, like what we deal with?
(28:43):
They would crumble.
And what we make look invisible,is out, it's a like, it's
we're being our own pancreas!
Like that is on with, Ican't, I can't speak enough.
I think the biggest thing to protectagainst is thinking of this body as an
enemy instead of it being something thatwe approach with respect and compassion.
(29:07):
Right?
And we need other peoplearound us to do the same thing.
That it's not a personal failure,it is life with diabetes and it is
unlike anything else on this planet.
Paula Diab (29:17):
I wanna read to you something that I wrote in that, in that article,
and it's just listening to you now,it really just struck a chord with me.
So I said, think of the 400 millionpeople worldwide living with diabetes and
the 650 plus million people living withobesity in the world or pre pre-diabetes.
And I said, they tooare endurance athletes.
(29:37):
Their race is not televised.
They don't have water tables on theside to help them all the time, but they
wake up every day and just keep going.
And I said, let us honor theirjourney with the same admiration
that we give to those who crossthe finish line of the Comrades
marathon because managing a lifelongcondition with courage, commitments
and self-compassion is actually theultimate ultra marathon and I think
(30:00):
that's exactly what you were just saying.
It's, it's an invisible race thatwe are running, and I think it's so
important for people to just remember--it's, it's not a one size fits all.
There is no finish line that you'regonna cross and someone's gonna give
you a gold medal at the end of it.
You've gotta pace yourself.
The race isn't ending tomorrow, andyou've gotta gather that support around
(30:23):
you and choose your team and use yourteam to the best of your ability.
And I think for me, that's, that's themessage that I, I really wanna get out
there and get more people to understandpeople with diabetes and people who
on that support team to understand.
Kristi Paguio (30:38):
For those in the support system that are, that are potentially
listening to this, the, we know thatanything that would have a negative
bias towards it or where we know that,where there's, where there's a positive
belief in something, in someone,that is actually what draws them
more than that critical judgemental.
(31:00):
That deflates, and so it is soimportant to be-- think of strengths
and to think, I love what you wroteand that you read that again, right
now, like that, the psychology aroundthat is, is well published, right?
It's, it's that positive psychology.
It's the negative by, like, it's allwithin that, that we're gonna be drawn
(31:20):
to things that make us feel good.
We're gonna be drawn to, we'regonna do better when we feel
better about ourselves, and we'refocused on something positive, then
if we've got a negative emotion.
It's gonna draw us back or shrink back.
Our body actually responds to that sothat, that respect, that compassion,
(31:41):
that cur, like all of those things arewhat propel people with diabetes forward.
And if they're strugglingwith it themselves, be be that
person that cheers them on.
That says, how can I support?
Like, I'm so sorry thatyou're going through this.
This is, this is brutal.
See them.
Don't say, you know, well,what did you not do right?
(32:02):
What did you do wrong?
Like there may be something in that,maybe that was, but that's not gonna help.
That's not, gonna movethem forward in the race.
Paula Diab (32:11):
It's such a powerful message just to say, I see you.
I support you.
I'm here for you.
What can I do for you?
I acknowledge what you're going through.
Oh, Kristi, thank you so, so much.
I really appreciate the time.
Together today, and I think, I reallyhope that people listening, whether
you have diabetes or whether you'resupporting someone with diabetes,
(32:32):
that you, you acknowledge and seethat that incredible endurance and
incredible marathon that people arerunning and it's not about winning.
It's about those small wins alongthe way and just pacing yourself
and just getting to the finish line.
Improving on what happened yesterday,doing better for tomorrow, and just
finding the right people around youthat you can support yourself with.
(32:54):
I think if we could dothat, then we really want...
Kristi Paguio (32:57):
Make your goal attainable.
Don't make it so big,like finishing that race.
Make it incremental, right,and cheer yourself along.
Make sure that self-talkis cheering yourself on.
Good job.
Atta a girl.
Atta a boy.
Like, just keep, yeah,
Paula Diab (33:11):
keep going.
Kristi Paguio (33:13):
Yeah, keep going.
We see you.
Paula Diab (33:15):
So, I hope that this podcast today has inspired you.
Motivated you.
Put things into perspective.
Given you something to think about.
If you want to touch base witheither Kristi or myself, if you
need a really good crowd supporter.
I'm really good at crowdsupport, by the way.
I'm fantastic in handing out water and,and, and oranges on the side of the road.
Any of the IDS clinicians, I'm surewe've all got our own different strengths
(33:38):
and things that we enjoy doing, butwe hope to see and hear more of you.
Thank you very much.
Gary Scheiner (33:43):
Thanks for tuning in To think Like a Pancreas, The Podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think like a Pancreas, The Podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
(34:04):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech,
sports and exercise, weight loss,type one pregnancy and emotional
(34:25):
wellbeing, we've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email, and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, The Podcast.
(34:46):
I'm Gary Scheiner, wishing youa fantastic week ahead and don't
forget to think like a pancreas.
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