August 7, 2024 • 43 mins
Welcome to another empowering episode of Think Like a Pancreas! Join hosts Alicia Downs, RN, MSN, CDCES, BC-ADM, and Jenny Smith, RD, LD, CDCES, as they delve into the often-overlooked intersection of women’s health and diabetes management. In this episode, they bring their expertise and personal experiences to the forefront, addressing critical issues that affect women with diabetes.
In This Episode, You'll Learn:
- Women’s Health Issues and Lack of Understanding: Alicia and Jenny share their frustrations with the lack of education around women's health in the context of diabetes. They discuss the need for accurate and comprehensive information on menstrual cycles, hormonal changes, and their impact on blood sugar management.
- Menstrual Cycles and Diabetes Management: Discover how hormonal fluctuations during menstrual cycles can affect blood sugar levels and insulin needs. Learn the importance of open discussions and proper education from healthcare providers.
- Common Women’s Health Issues and Diabetes: Gain insights into common health issues like UTIs and yeast infections that are exacerbated by diabetes. The hosts provide practical advice on managing these conditions through proper hygiene and blood sugar control.
- Perimenopause, Menopause, and Diabetes: Understand the challenges women face during perimenopause and menopause, including the significant impact on blood sugar levels and insulin needs. Learn how to advocate for yourself and find knowledgeable healthcare providers.
- Embracing Body Changes and Acceptance: Alicia and Jenny emphasize the importance of accepting the natural changes in a woman's body over time. Discover the benefits of a mindset focused on health and well-being.
- Importance of Resistance Training and Screenings: Learn why resistance training and regular health screenings are crucial for women with diabetes, particularly as they age. The hosts explain how these practices help maintain bone health, muscle mass, and overall physical function.
- Challenges for Transgender Women with Diabetes: The hosts briefly address the unique challenges faced by transgender women with diabetes, emphasizing the need for more research and support.
Meet the Hosts: Alicia Downs and Jenny Smith bring a wealth of knowledge and experience from their work at Integrated Diabetes Services. Their commitment to educating and supporting women with diabetes is evident throughout this episode.
Conclusion and Resources: Don't miss this episode filled with invaluable advice and support! Reach out to Alicia, Jenny, or the Integrated Diabetes Services team with any questions or concerns. Explore the resources provided by the Diabetes Sisters organization for additional support.
Join Us: Subscribe now to Think Like a Pancreas for more episodes packed with expert advice and practical tips. Share this episode with fellow diabetes warriors, and leave a review to let us know your thoughts!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:07):
Welcome to Think Like a Pancreas, the podcast.
Our goal is to keep you informed, inspired,
and a little entertained on all things diabetes.
The information contained in the program is based on the
experience and opinions of the integrated diabetes services
clinical team.
Since this is a very individualized condition,
(00:27):
please check with your health care provider before
implementing any of the weird stuff we may have to share
with you today.
Hi, I'm Alicia Downs, R -N -M -S -N,
C -D -C -E -S -B -C -A -D -M.
So I'm one of the nurses with integrated diabetes services.
And we've got Jenny.
Can I go introduce yourself?
(00:49):
Sure,
I'm Jenny Smith and I'm a registered dietitian certified
diabetes care and education specialist.
I've been with integrated for almost as long or a little
bit longer than you, right, Alicia, a little bit longer.
But we have a,
we have a group of lots of women in our office.
(01:12):
And in terms of, you know, clinical staff,
I think Gary is really our only high testosterone.
And in that same line,
Alicia and I feel very strongly about women's health issues
because there's a lot that is not talked about,
really understood.
(01:32):
And people sort of just get the, well,
that's just what's supposed to happen, right?
Yeah.
Yeah.
A lot of my,
I have a passion for women's health just from my own
journey.
I think that's where, as a nurse,
my complex medical history, as a diabetes educator,
a person living with diabetes, and then women's health,
my own journey through women's health has not been,
(01:56):
I would say has not been typical,
but what I've come to find is that it has in fact been
typical.
It's just that the textbook is bunk and therefore I was led
to believe that the norm is a fairy tale.
(02:16):
It's like Disney wrote like what we know is like women's
health and what is normal.
And so I really had to do my, just like with diabetes,
I had to do my own self -education because my clinicians
come to find.
Didn't know enough.
Yeah, really weren't particularly educated.
(02:38):
Yeah.
Stumbling across the occasionally really well educated
clinician wasn't sufficient.
I had to really cobble together my own knowledge base.
And it's frustrating because, you know, not really,
not growing up with issues in terms of my own like,
female cycles and those types of things.
It really wasn't until I delved into the world of getting
(03:01):
ready to try to have a child that I realized how lacking
our current system really is.
I mean,
even with type 1 diabetes going to my endocrine team and
saying, Hey, we're planning this.
What, what should I really be prepared for?
Well,
you should be prepared for changes in your blood sugar and
(03:23):
your insulin needs are really going to rise.
That's,
that's pretty much the two seconds that I just said there.
That's what I was told.
And I was like, well,
it seems like there's going to be a whole lot more that's
going to shift over this like nine plus month time period
that things are happening in my body, right?
And nobody, nobody could prepare me for that.
(03:45):
And I was really frustrated as well in once I was pregnant,
how much I was thrown into the bucket of the information
that we have for those who are not well managed in
pregnancy with type 1 diabetes.
(04:05):
And I, that was not me.
Yeah, I had fully prepared.
I knew what I expected to kind of happen from the research
that I had personally done because nobody gave it to me
again, frustrating.
And so I'd go to my visits and they'd say, well,
you're like, you're like, I don't even, you know,
you wouldn't have to be here if you weren't high risk.
(04:27):
Like we have nothing to help you with.
And I was like, well, that's not helpful, right?
Yeah.
And it's,
we are often looked at as women in our medical world.
I mean, just from, from the medical perspective in general,
all of the sort of averages, the standards, the norms,
(04:49):
the typical within normal limits,
those are all based on 35 year old Caucasian.
Women weren't even required to be fully represented in
medical research and pharmaceutical clinical trials until
the mid 90s.
(05:10):
We're talking less than 30 years of appropriate
representation.
So we're talking like, I mean,
I was already in high school.
So like a good chunk of my medical world was done with
total blinders on as to my actual medical needs.
(05:33):
And so, you know,
my doctors were coming up with training that was not based
on accurate medical knowledge of the impacts of pharmac
genetics and, you know,
what medications were actually doing and what diseases were
actually doing to the female body.
And we're often looked at as there's like this.
(05:54):
nebulous time of stuff, pregnancy and reproductive years,
and then this nebulous time of stuff.
Right.
And only during our reproductive years is there really any
information, science, right?
(06:15):
And then when you then layer diabetes on top of that,
the only information there is information of if you're
wildly out of control, if you're wildly unhealthy.
Right, absolutely.
There is just nothing to go on for anyone else.
(06:39):
But there isn't.
That represents of the 1% of the population that has type 1
diabetes, of the 50% of those that are female,
of the 15% of those that are in their reproductive life,
what there's information out there for like nine people,
like how many actually are getting useful info there.
(06:59):
The rest of us are living the rest of our lives with just
total blinders on,
because it's supposed that your female health only impacts
pregnancy.
Right, absolutely.
And you face it, like, if you actually take into account,
(07:21):
okay, as a sort of adult -ish female,
as a post -pubescent female, I mean,
I am menstruating 20% of my life.
I am pre -menstrual, roughly 15% of that time.
(07:44):
I am post -menstrual, 15% of that time.
That is 50% of my time that I...
I am not hormonally and therefore glycemically speaking,
normal.
Right.
And that's the confusing thing,
especially once you bring in diabetes,
(08:05):
whether it's type one or type two diabetes,
when you bring that into the mix of something that's
already poorly explained.
And I firmly believe and try hard when I work with like the
teenage population, right?
And it's mostly parents of the teens.
But it's explaining to them, well,
(08:26):
why do things look so wonky?
They're all over the place.
I can never get a handle on it.
She needs more and then she needs less.
And then it's all over the place and we don't know what's
going on.
And I was like, well,
how about we start tracking some things, right?
Around a cycle.
And it's like a light bulb that goes on.
Oh, well maybe that does have something to do with it.
(08:47):
So when we layer on top of just overall poor information
starting in the early years when girls coming into that
sort of pre puberty time, and then the, the teen years,
and even the early twenties,
which can still be a little bit fluxing, there's,
there's very little education that's done.
(09:07):
It's the baseline education is you're a girl,
so you'll have a period and we don't want you to get
pregnant.
So try not to do this, or this is how to prevent it,
or we're going to start birth control.
I mean, that's, that's the extent.
It's like you were being female is just surrounded around
reproduction.
(09:28):
Correct.
What?
Yes.
When in fact the hormone cycle is it's a full, like,
let's call it 30 days, right?
28 to 32 or whatever it is, just average 30 day cycle.
And in that cycle, the hormones are always fluctuating.
They're, they're flat line.
They're rising.
Certain ones are rising.
Some ones are more, some of them are more stable.
(09:49):
Those drop off.
Other ones rise up.
And again, with diabetes,
that has a very direct impact on what's going to happen to
your blood sugar and your insulin needs and other
medications and how they work or get absorbed.
I mean,
And your emotions and we all stress has a massive impact on
blood sugar.
(10:09):
If I'm PMSing and I feel like I'm going to weep for no
reason or scream for no reason,
that emotional lability is going to have a huge impact on
my blood sugar.
Yes.
It's and,
and we can't just brush that under the table because we're
not comfortable with the conversation.
(10:30):
And like as an endocrinologist or diabetes educator,
we can't ignore it or say,
go talk to your GYN because in the GYN says, I don't know,
I'm not an endo.
And so now you've got a patient just in flux in this middle
ground where this doctor told me that they can't really
discuss that or don't, they don't know enough.
And this doctor says,
we'll go back to the other doctor because this is more in
(10:50):
the realm of this.
And again, none of them are really knowledgeable enough.
to say, hey, this is what you should expect.
And again, with diabetes,
that's where I think the conversation as uncomfortable as
it might be to sit down with a teenage female and say, hey,
this is what's going to happen.
It may be irregular.
(11:10):
If blood sugars are irregular,
your cycle might be more irregular.
So we're gonna try to navigate this together.
And I know it's weird to talk about,
this is important for you to know.
So going forward, as an adult, you know what to plan for.
Even if it never includes wanting to have a child,
(11:31):
this will help you understand why things are fluctuating
the way that they are and how to work it.
And I tell my young patients, like real talk, diabetes,
we're talking all the time about blood and hormones,
blood sugar, insulin.
(11:51):
Let's talk about your period.
It's blood and hormones, estrogen, progesterone,
and menses.
Why is that weird?
Why is it totally socially acceptable for us to talk blood
sugar in the produce aisle at the grocery store?
But to talk menses is like, it's like, oh,
(12:11):
50% of the planet's doing it.
Exactly.
At any given time,
whatever woman you're talking to at the bank could be
probably participating.
Yes, exactly.
Maybe if it wasn't so taboo, we'd have more science.
I think that's it.
(12:31):
It's unfortunate that even with in the past 10, 15 years,
a little bit more visibility and whatnot sure to evening of
the ground between male, female, so to speak,
this whole topic around this hormone cycling is still very,
(12:53):
like you said, taboo.
It's still very hard in a conversation.
Nobody wants to hear about a women, women bleeding.
Nobody wants to touch it hard.
I think it's,
it's hard on one side because it's been a thing of that
women were supposed to not talk about.
And it was in some cultures,
(13:15):
it's a thing that's very protected and it's a very special
time that's supposed to be honored and treasured and kept
very sort of sacred.
And in others,
it's a thing that's considered unclean and shameful and not
to be touched.
And so there's a lot of, on both sides,
there's just a lot of silence that can can lead to a lot of
stigma and taboo.
(13:36):
But then I think in our sort of Western,
very sort of American post feminist revolution,
I think there's this thing of like, well,
if we're going to be equal,
then we all have to kind of come at it the same,
which means women have to pretend they did it.
they don't have periods and they don't have hormones and
they don't have, I'm like, well,
(13:57):
why don't we just pretend that men do?
I mean, because like we all,
if anybody really pays attention, men kind of menstruate.
So like,
why don't we all just pretend that our hormones swing and
fluctuate and affect our world?
Because the reality is they do, they do, you know,
men have ebbs and flows in their hormonal cycles that
affect their energy levels and their confidence levels and
(14:19):
their body image levels and things like that as well.
Absolutely.
I think if we all kind of tuned into that,
it would be better.
I think another thing that we really don't get data on is
outside of that, even things like, for example,
we know women are more prone to UTIs,
just the structure of our urinary structure and things like
(14:46):
when we get UTIs, because we urinate out more glucose,
than women who don't have diabetes.
Often it will take more than one round of antibiotics to
fully clear a UTI, right?
So we get one round, we become non -symptomatic.
(15:08):
So the pain goes away, so we think we're good.
But our blood sugars don't normalize.
The blood sugars stay high at erratic.
We might even still have ketones.
And here we are about two weeks later.
Symptoms start coming in.
It's still there.
And so we get these UTIs that are really difficult to treat
and can really become problematic.
(15:29):
And we can end up going from UTI to bladder infection,
to renal infection, to, I mean, really a health crisis.
Same thing with like a yeast infection.
Yeah.
Yeast infections, again,
because we're urinating out glucose and the genitals and
the urinary tract are all right, just right there together.
We're feeding that yeast infection,
(15:50):
the sugar that it makes it grow.
So yeast infections, first of all, ladies, moms of littles.
Okay, moms of little girls with diabetes, bubble baths.
Bubble baths are like problem, problem number one.
If you really want your little girl to indulge in the joy
of a childhood bubble bath, make sure she is,
you're rinsing post, really, really well.
(16:12):
Make sure you're teaching little girls to wipe front to
back when they use the bathroom.
Please, please, please, to avoid infections.
But if their blood sugars are high and erratic and you're
not really sure why, yeast infections are so,
so common in little girls with type one diabetes,
(16:32):
but skip the monostat, skip the vagicil,
all that over -the -counter stuff.
Those stuff, that stuff's great just for comfort,
but it is not going to work in a woman with type one.
It's just gonna get you asymptomatic.
It's not gonna treat it.
And again, we usually need two rounds.
I always tell any woman with type one, on an antibiotic.
(16:53):
That's another one.
Ask your doctor for two rounds of the,
the fluoxetine or the diflican pill.
Take one, wait seven to 10 days.
Take the other one, even if you're asymptomatic,
because it's going to take the two rounds.
Otherwise symptoms go away,
but your blood sugars are going to stay high.
Which is kind of a cyclic nature too.
(17:16):
I mean,
the high blood sugars are not helping clear it from the
first round anyway.
And so then, like you said,
you may be asymptomatic blood sugars are still high.
That's a lot of the questions I get from women who are
like, I was treated and my blood sugars are still high.
Has something just shifted now because I was sick and I'm
like, no, there's something still hanging on there.
(17:36):
We need to like reevaluate, go back to the doctor.
Like you said,
you're very likely to need another round of management.
And if I always tell patients,
if you've had the first round, like if it's a UTI,
you've had that first round.
Your blood sugars are still running high,
especially if you're still passing ketones.
Ask them to do a CNS, a culture and sensitivity.
(18:03):
That way they can check and make sure they've got the right
antibiotic for the right bacteria.
Because you don't always just want to go broadband.
Because that can be problematic because we are more prone
to UTIs.
Using broadband all the time can be problematic.
Ask your doctor for that second round to get specific on
that second round.
(18:23):
Don't just broadband it.
Tighten in their scope.
And that way you're not always just hitting your body with
that broadband antibiotic.
You want to keep that one.
Well, unfortunately, if you're prone to them too,
and you're always using that broadband,
your body's not going to respond then because it's been
treated with everything.
And you want to keep that broadband in your back pocket for
(18:44):
pneumonia or MRSA or like when the big baddies hit.
Yeah, for UTIs,
we want to keep it dialed in on the ones that are specific
to what we've got going on.
But that double round, I mean,
I have had patients that have ended up months and months
and months of just, and they'll go, UTI, high blood sugars,
(19:10):
yeast infection, high blood sugars, UTI, high blood sugars.
And their doctors just treating them one round on each.
And they're like, my doctor's not listening.
And I mean, four or five months.
And now they end up with like scarring and damage and just
massive, massive, like skin,
(19:32):
because a yeast infection doesn't seem like a big deal.
But if it's going on and on, it can really be very,
very damaging.
I mean,
it can lead to pelvic inflammatory disease and stuff like
that if it's really ravaging itself.
So really, and I would say talk to your doctors.
in advance when you're healthy, have the conversation.
(19:54):
Hey, I have type one.
And so here's what, what I know and what we see.
So can this be the plan of treatment when these things
happen?
That way they know that they're not just dealing with
somebody who's like upset and uncomfortable and wants to
just do everything in the moment.
Right.
They know, okay, we've had this discussion already.
Here's the plan.
(20:14):
Yeah.
And I think, I mean, you bring up, you know,
the younger generation,
but I think as well as women age and get beyond the
childbearing years, moving into para menopause, menopause,
the changes in moisture level and the changes like that can
also bring about a time of more infections,
(20:37):
more prone to infections, big shifts in blood sugar levels,
because hormones are shifting in a very downward.
in different way than a woman has grown used to, right?
And that can be another time of very significant confusion.
Because again, I think of any of the stages of life,
perimenopause and menopause are,
(21:00):
I feel like doctors without doing it,
sort of you ask the question and it's almost like their
hands just get thrown up.
And they're like, well,
this is the stage of life that you're in and this is what's
supposed to be happening.
But no, you haven't defined that what,
you haven't defined how should I navigate through this?
And then the layer again of diabetes, what should I expect?
(21:24):
What can, I'm seeing irregularity,
I'm seeing shifts that I can't any longer spot a cycle
coming, right?
I was used to this happening and it's not really happening
anymore every single time.
And that's where the hands go up and they're just,
they just start to tell you to work it as you work it.
(21:46):
That's not helpful.
And it's terrible because when you come, hopefully, I mean,
it's definitely not true of all young women,
some of us have very difficult journeys but generally,
coming through puberty, it's a time of at least, I mean,
at least now in public schools, there's education.
(22:08):
And you've got parents or caregivers and then you come
through your childbearing years and hopefully you've got
again,
relationships around you that are supporting and encouraging.
Perimenopausal years is a time in life when you are kind of
expected to be self -supporting,
(22:28):
self -sufficient on your own.
Right.
But the reality is that most of us have far fewer friends.
A lot of us in our modern world are single or divorced or,
you know, we're- In our career.
or maybe even retirees at that point,
we might be empty nesters.
(22:49):
We're just going through transitions in life where we just
have fewer and fewer supports and encouragements.
And all of a sudden I've been doing diabetes for decades
and all the things that I've been doing start failing me.
Like I thought I knew what I was doing and I'm failing.
(23:13):
And it's getting worse and I'm gaining weight even though
I'm working out more than I've ever worked out in my life.
And I'm eating less and my appetite isn't the same.
And my cholesterol is going up and my blood pressure is
going up and my vision's getting worse.
(23:37):
And my doctor just handed me another diagnosis and another
pill.
And so it's like my self image.
is steadily crumbling.
Yep.
And here's just my diabetes,
this thing that I have worked so hard to understand,
to build and yeah, to maintain.
(23:59):
That is just like defying all logic in the middle of it.
And I go to my doctor and I go help.
And they go and so many of our doctors, you know,
we're going to our PCP going, help me with my weight.
And they're going, just move more and eat less.
Right.
And we go to our GYN and we're going, I can't enjoy, like,
(24:21):
I love, I love my partner,
but I don't enjoy sex the way I used to.
And they're going, well, you know,
just use more lube and take more time and get in socialis.
And you're like, you're like, no,
we just get so many like pat on the head, move on or like,
you're, you're just getting older.
And you're like, I'm only 43.
(24:42):
Are you telling me the next 50 years of my life are going
to be, I'm not even to the halfway point.
Right.
Yep.
Yeah, absolutely.
So you don't have to accept that,
because that's not the reality.
None of that is normal aging.
(25:04):
And the reality is the answers that you're getting are from
people who don't have the humility to look at you and say,
we don't know,
because science has ignored you for too long.
What we do know is this.
And so let's look at you as an individual,
and make your situation your body the science.
(25:27):
And, and study that and figure out what's going on.
Let's work.
Let's work together.
Right.
I mean, that's really, I was listening not too long ago,
to another podcast,
that was really talking about women's hormones,
especially coming into, you know, this,
this later life kind of past,
I want to have kids or I never wanted to have kids.
(25:48):
And now I'm moving beyond that sort of time period and what
to expect.
And we really every day we're moving forward in age, right?
And so we should,
we should know that as you mentioned early on,
some cultures actually treat this time of a woman's life
with a lot of respect,
(26:08):
and a lot of understanding that this is, this is how it's,
it is supposed to happen.
Your body is supposed to move through these changes and
some cultures support it very gracefully.
And,
and the woman feels very happy and healthy in this change
in life, wherein again, our more Western eyes,
(26:31):
I would say even Americanized quite honestly,
culture that we have culture.
We are.
And so we feel like once we get to 45 plus and these shifts
may start happening, especially with diabetes,
women end up moving into para menopause and menopause
sometimes earlier than women without diabetes.
And so we'll see like semically, often see it glycemically,
(26:55):
people, women are like, well, no,
I'm still getting my menses.
Maybe it's not as regular as it used to be,
but I'm still getting it,
but our blood sugars will usually tell us what is going on.
Things aren't the same years before what's happening.
Like what, yes,
I can usually let a parent know that their daughter is
(27:16):
going to start her menses months and months before it
actually starts happening.
Because we start to see those premenstrual patterns emerge
way before we actually see menses on set.
And so we, again,
we start to see peculiarities of insulin need.
(27:39):
Months, weeks,
years before we see men's or menopause actually start to,
and sometimes it's the insulin amount, right?
Where you said, you know, you know,
daily dose starts going despite not changing any other
variables in your life,
you're all of a sudden more resistant.
(28:01):
You need more insulin and it's odd how your blood sugar
reacts to typical foods and the things that you're an
exercise every day used to do this.
And I don't think it's helping as much as it used to help
me, you know, and again,
these are all changes that should be coming,
even without diabetes,
a female body should be moving through these changes,
(28:22):
but I think we are.
are, we're so focused on remaining the way that we were,
that it's hard to see that it's okay that you're changing.
It's okay that you're moving into this time of life because
that's what should be happening.
And I think women are,
they're too focused on trying to retain, I'm 30.
(28:42):
And that moves people into considering some of the,
and I truly believe that HRT is beneficial for those that
really need it.
But I think it's one of those things that's sort of a band
-aid thrown into the mix.
When somebody comes into a practitioner with complaints,
let's call them, or concerns.
And the first response is, well, let's just try this,
(29:04):
because this will take care of all of the insomnia.
It'll take care of the hot flashes.
It'll take care of the skin changes and the, you know,
how your anxiety level is and everything.
They throw it all in the basket.
Well, that may not be the tool that you needed.
Right.
All right.
something else may end, or maybe just the discussion that,
Hey, you know what,
you're supposed to be moving into this time of change.
(29:26):
And while we don't really, like you said,
we don't really understand it as much as we should,
because we haven't really studied as well as we should,
I'm here to help you move through this.
I think a lot of women just want a hand holding them.
Sometimes, sometimes the acceptance of our bodies,
sometimes the anxiety and the nausea or the anxiety and the
(29:48):
insomnia and the depression and some of the weight gain,
and a lot of those symptoms are the fighting against the
reality of my body changing without my permission.
(30:12):
Right.
And it's not even that I'm getting older,
it's that my body is changing without my permission,
that my whole life,
I have actively worked to make my body be what I want it to
be.
And now, despite my best efforts,
it has decided that I am no longer the captain of that,
and that is really, really hard for a lot of us.
(30:35):
And it's hard,
and that is the story of kind of the rest of our lives.
Is our body progressively timed progressively and
progressively telling more of that tale,
and us having less and less of a say so.
But I think that when we can change that mindset to one of
(30:56):
a beautiful acceptance and a partnership with our bodies,
when you meet people who have done that, and they say, no,
I'm going to embrace the beauty and the wisdom and the
grace and the flexibility that comes in that,
that's when you meet the people that are like yogis in
their 90s, right?
(31:17):
And they're like, run.
runners in their eighties and they're because they're not
wasting all of their time and energy trying to be someone
they can't be anymore.
Right.
They're just focused on taking what they have and just
exploring who and what this new body can really be.
Right.
(31:37):
And that's when it comes to blood sugar,
I see the same thing.
I see a lot of patients saying, you know,
I've gone from 30 units a day to I'm up to almost 50 units
a day now.
Oh my gosh, how do I get that back down?
And I go, well, but, you know, your blood sugars are good.
You're just,
you're 85% in range and standard deviations 32 and,
(31:59):
and you're very rarely about of, you know,
you're very rarely above a 160 and right.
And,
and you're no hypos and you're not having to work really
hard to do that.
And so what, so let's not worry about the daily dose.
They're like, well, if I have a lot of insulin,
I'm going to start gaining weight.
And I'm like, well.
I mean, but and or but you're not right.
(32:21):
I'm like,
but you probably will gain probably 5% body weight that is
typically that is that is developmentally appropriate.
We just say that with children, right?
At what point do we stop saying that?
If my seven year old son gains 15% body mass,
(32:45):
that is developmentally appropriate for him.
I wouldn't be upset.
And therefore his insulin needs should also change
accordingly.
I as a 43 year old woman should see a shift in body mass
from my 40s into my 50s.
That is developmentally appropriate.
(33:06):
Right.
And therefore my insulin needs should also shift.
That's developmentally appropriate.
And then as I shift from my 50s into my 60s and through my
70s, I should actually then see another shift down.
I should see a shift from lean muscle mass shifts down fat
mass shifts down insulin needs actually then shift down.
(33:28):
If I actually don't see that shift up through my 50s,
I might actually end up underweight to my 70s.
Right.
And I might be too lean and have a lot of health risks
there.
So keep in mind, you know, as women, we are,
we are growers and developers.
(33:48):
We, we grew and developed as children,
we grew and cultivated other people as, as younger women.
Now, as we're older women, we are still,
we now switch back to growing and cultivating ourselves
again.
And that's okay for that person to grow and change.
There's this huge billboard for like a cardiac rehab center
(34:11):
for the local ginormous hospital system.
And I hate it so much.
because it's this guy and it's like silver fox like ha ha
and it's like under armor you know right and it says get
back to who you used to be oh and i hate it so much because
(34:34):
every time i pass it i think who needs to get back to who
they used to be who you used to be landed you in a hospital
bed with a heart attack and a quintuple bypass and in
cardiac rehab how about you get to who you could be that
you haven't even met yet well i think that's an
(34:55):
evolutionary like that's another step in in thought and you
have to get there at a mental level to realize again that
you're changing you're moving we're all evolving whether
you're accepting of it or pushing back against it and that
billboard is kind of the push against that evolution it's a
(35:15):
push back against Don't you really want to be back at 25 or
30,
right?
Maybe not.
I actually,
I quite honestly think- For all our listeners who are 25
and 30, it's glorious, it's beautiful,
you're amazing flowers, bloom, blossom, and love it.
Yes, I always tell people though, like, you know what,
silly people are like, whoa, you know,
(35:37):
what age would you land at if you could just be forever,
quote unquote, young, right?
And I always feel like 37.
That's if number wise, I wouldn't be 20, I wouldn't be 25.
Man, I was dumb.
Dumb.
I want to be nine.
You want to be nine?
I want to be nine,
you're old enough to say- You want to have no
(35:58):
responsibility.
Yeah, you're old enough to stay up past eight o 'clock,
but way too young for anyone to expect you to pay your own
bills.
To pay, yeah, or understand any of that.
Yes, I mean, young age, I would agree,
maybe about tennis would be really, really lovely,
but I think as an adult,
there's a lot of intelligence somewhere in the 35 plus
years that comes only from life experience.
(36:21):
And when you build on that and keep moving forward with the
understanding, I am changing.
I have to learn how to evolve with this,
how to move forward.
You know, women's health includes, unfortunately,
a lot of what should be talked about in terms of bone
health, right?
You talk about those changes that you should expect,
this percent change here, this percent change here,
(36:44):
but if we really want to retain bone health,
calcium stores and those kinds of things,
it is really in our early years that we should focus on
resistance training and we should continue those into the
years that we're going through these other hormonal
changes, because if we don't,
that change from muscle mass post 55,
(37:07):
60 into the later years of life,
you're gonna be at a much higher risk.
So, resistance training is.
hugely important for women, adult women, all stages.
I can never encourage women enough.
(37:29):
Women tend to over focus on cardio and under focus on
resistance training.
Resistance training is what is going to keep you heart
healthy.
It is what is going to keep your bones strong.
It is what is going to keep your joints strong.
It is when it's going to avoid injury.
It is what is going to keep you glycemically well.
(37:49):
It is what it's the more we learn and the more studies
there are on resistance training,
the more important it is as we age,
flexibility and and resistance training are so important.
Yeah, where it's at, where that keep your heart moving.
But if you're doing flexibility and resistance training,
your heart's going to be pumping as much as it needs
(38:11):
exactly.
Yep, you're not you're not going to miss those beats.
And and getting that in there, getting screenings,
double -check with your doctors.
Having type 1 diabetes means that we might need to use
screenings earlier.
Things like osteoporosis screenings.
We might wanna start those earlier.
(38:34):
Things like breast cancer screenings,
things like cervical cancer screenings,
things like we might wanna skew those a little earlier for
women with type 1,
depending on your family history and so forth.
And the screening ages and spacing is always a moving
target in women's health.
(38:57):
And that's all nice big red button political issues.
So talk with your doctor about what's most appropriate for
you, but make sure you're asking your GYN, hey,
specifically, I'm a woman with type 1 diabetes,
should we be adjusting these times because there is a
slightly higher risk for me with this going on.
(39:21):
And we haven't even had time to touch on trans women,
trans health, talk about an area with no science.
Right?
My goodness.
Especially, and then with diabetes can be very frustrating.
And risks of diabetes.
I mean,
(39:42):
trans women are twice as likely to have diabetes as non
-trans women and twice as likely to have diabetes as trans
men.
So I'm very humbly proud to say that is an area of personal
research that I have made a point to educate myself in and
(40:05):
get my hands on what.
What is there data?
There is to offer support and to pull together what.
educated persons in the fields.
There are,
it's really been making contacts with people in the
diabetes field.
And then in, in the gender affirming medicine fields,
(40:29):
and sort of bringing them together and going, Hey guys,
let's put heads together.
Like, you guys don't necessarily know each other's fields.
So let's come together and compare notes and see where we
can learn from one another and what's missing,
what needs to be added and start filling in some gaps and
just supporting patients and,
and just kind of sharing patient case files where we can to
(40:52):
learn and,
and aggregate data so we can start supporting patients more
effectively.
Because when we, you know, again,
we start taking physiology plus hormones,
plus diabetes equals a whole lot of variables to consider.
(41:16):
It does.
And we've got a lot, a lot to learn,
because we are centuries and centuries behind.
We've had insulin for over a century now.
We've had females since the dawn of time.
Right.
Yes.
We've got some catching up to do.
(41:38):
We definitely have a lot of catching up to do.
So and I think that means we also have more conversations
to have about it because capturing it in a short little
blip of time is certainly not enough.
So hopefully we, you know,
hopefully lots of questions kind of come to us that we can
maybe even include the other educators in our practice as
(42:02):
well and have we'll leave Gary out of it this time.
Yeah, you can head straight to straight to our our site.
We're at integrated diabetes services dot com.
You can find Jenny and I there on our about tab.
You can feel free to fire us questions.
You can also follow us, obviously our podcast.
(42:27):
Also, I wanted to throw a shout out to DiabetesSisters,
speaking of diabetes and women's health.
They're a fantastic organization that is really focuses in
on the needs of women with diabetes and getting women with
diabetes connected.
So shout out to DiabetesSisters.
And we work with them a lot.
(42:48):
We do a lot of speaking with their group and supporting.
We do.
And vice versa.
Yes.
So awesome.
Good talk, Jenny.
Yes.
Thank you so much.
I feel like this might be dangerous.
When Jenny and I talk,
we tend to light little fires and then little side projects
start shooting off.
End up coming up.
Exactly.
I know we could certainly with more time,
we could certainly talk for probably another hour all about
(43:09):
and then just find more things to talk about.
So yeah, endless.
Yeah.
So I don't know.
I feel I don't know.
there's a book in there or something.
Oh, a book that has not been written,
thus like my pregnancy book that nobody put any information
together.
So there it is.
Yeah, I don't know.
I think it needs, I think it needs to happen.
I don't know.
Maybe, maybe the, the two super busy moms in the practice,
(43:33):
maybe, maybe shouldn't take that on right now.
Maybe you shouldn't know, but you know, maybe that's a,
we gather some information and then eventually put it
together in a book.
They're coming.
There you go.
Good idea.
I think Beyonce said it best when she said girls,
we rule the world.
Without a girl, there wouldn't be more.
(43:54):
Thank you very much, Alicia.
Have a great day.
Bye.
Welcome to Think Like a Pancreas, the podcast.
Our goal is to keep you informed, inspired,
and a little entertained on all things diabetes.
The information contained in the program is based on the
experience and opinions of the integrated diabetes services
clinical team.
Since this is a very individualized condition,
(00:27):
please check with your health care provider before
implementing any of the weird stuff we may have to share
with you today.
Hi, I'm Alicia Downs, R -N -M -S -N,
C -D -C -E -S -B -C -A -D -M.
So I'm one of the nurses with integrated diabetes services.
And we've got Jenny.
Can I go introduce yourself?
(00:49):
Sure,
I'm Jenny Smith and I'm a registered dietitian certified
diabetes care and education specialist.
I've been with integrated for almost as long or a little
bit longer than you, right, Alicia, a little bit longer.
But we have a,
we have a group of lots of women in our office.
(01:12):
And in terms of, you know, clinical staff,
I think Gary is really our only high testosterone.
And in that same line,
Alicia and I feel very strongly about women's health issues
because there's a lot that is not talked about,
really understood.
(01:32):
And people sort of just get the, well,
that's just what's supposed to happen, right?
Yeah.
Yeah.
A lot of my,
I have a passion for women's health just from my own
journey.
I think that's where, as a nurse,
my complex medical history, as a diabetes educator,
a person living with diabetes, and then women's health,
my own journey through women's health has not been,
(01:56):
I would say has not been typical,
but what I've come to find is that it has in fact been
typical.
It's just that the textbook is bunk and therefore I was led
to believe that the norm is a fairy tale.
(02:16):
It's like Disney wrote like what we know is like women's
health and what is normal.
And so I really had to do my, just like with diabetes,
I had to do my own self -education because my clinicians
come to find.
Didn't know enough.
Yeah, really weren't particularly educated.
(02:38):
Yeah.
Stumbling across the occasionally really well educated
clinician wasn't sufficient.
I had to really cobble together my own knowledge base.
And it's frustrating because, you know, not really,
not growing up with issues in terms of my own like,
female cycles and those types of things.
It really wasn't until I delved into the world of getting
(03:01):
ready to try to have a child that I realized how lacking
our current system really is.
I mean,
even with type 1 diabetes going to my endocrine team and
saying, Hey, we're planning this.
What, what should I really be prepared for?
Well,
you should be prepared for changes in your blood sugar and
(03:23):
your insulin needs are really going to rise.
That's,
that's pretty much the two seconds that I just said there.
That's what I was told.
And I was like, well,
it seems like there's going to be a whole lot more that's
going to shift over this like nine plus month time period
that things are happening in my body, right?
And nobody, nobody could prepare me for that.
(03:45):
And I was really frustrated as well in once I was pregnant,
how much I was thrown into the bucket of the information
that we have for those who are not well managed in
pregnancy with type 1 diabetes.
(04:05):
And I, that was not me.
Yeah, I had fully prepared.
I knew what I expected to kind of happen from the research
that I had personally done because nobody gave it to me
again, frustrating.
And so I'd go to my visits and they'd say, well,
you're like, you're like, I don't even, you know,
you wouldn't have to be here if you weren't high risk.
(04:27):
Like we have nothing to help you with.
And I was like, well, that's not helpful, right?
Yeah.
And it's,
we are often looked at as women in our medical world.
I mean, just from, from the medical perspective in general,
all of the sort of averages, the standards, the norms,
(04:49):
the typical within normal limits,
those are all based on 35 year old Caucasian.
Women weren't even required to be fully represented in
medical research and pharmaceutical clinical trials until
the mid 90s.
(05:10):
We're talking less than 30 years of appropriate
representation.
So we're talking like, I mean,
I was already in high school.
So like a good chunk of my medical world was done with
total blinders on as to my actual medical needs.
(05:33):
And so, you know,
my doctors were coming up with training that was not based
on accurate medical knowledge of the impacts of pharmac
genetics and, you know,
what medications were actually doing and what diseases were
actually doing to the female body.
And we're often looked at as there's like this.
(05:54):
nebulous time of stuff, pregnancy and reproductive years,
and then this nebulous time of stuff.
Right.
And only during our reproductive years is there really any
information, science, right?
(06:15):
And then when you then layer diabetes on top of that,
the only information there is information of if you're
wildly out of control, if you're wildly unhealthy.
Right, absolutely.
There is just nothing to go on for anyone else.
(06:39):
But there isn't.
That represents of the 1% of the population that has type 1
diabetes, of the 50% of those that are female,
of the 15% of those that are in their reproductive life,
what there's information out there for like nine people,
like how many actually are getting useful info there.
(06:59):
The rest of us are living the rest of our lives with just
total blinders on,
because it's supposed that your female health only impacts
pregnancy.
Right, absolutely.
And you face it, like, if you actually take into account,
(07:21):
okay, as a sort of adult -ish female,
as a post -pubescent female, I mean,
I am menstruating 20% of my life.
I am pre -menstrual, roughly 15% of that time.
(07:44):
I am post -menstrual, 15% of that time.
That is 50% of my time that I...
I am not hormonally and therefore glycemically speaking,
normal.
Right.
And that's the confusing thing,
especially once you bring in diabetes,
(08:05):
whether it's type one or type two diabetes,
when you bring that into the mix of something that's
already poorly explained.
And I firmly believe and try hard when I work with like the
teenage population, right?
And it's mostly parents of the teens.
But it's explaining to them, well,
(08:26):
why do things look so wonky?
They're all over the place.
I can never get a handle on it.
She needs more and then she needs less.
And then it's all over the place and we don't know what's
going on.
And I was like, well,
how about we start tracking some things, right?
Around a cycle.
And it's like a light bulb that goes on.
Oh, well maybe that does have something to do with it.
(08:47):
So when we layer on top of just overall poor information
starting in the early years when girls coming into that
sort of pre puberty time, and then the, the teen years,
and even the early twenties,
which can still be a little bit fluxing, there's,
there's very little education that's done.
(09:07):
It's the baseline education is you're a girl,
so you'll have a period and we don't want you to get
pregnant.
So try not to do this, or this is how to prevent it,
or we're going to start birth control.
I mean, that's, that's the extent.
It's like you were being female is just surrounded around
reproduction.
(09:28):
Correct.
What?
Yes.
When in fact the hormone cycle is it's a full, like,
let's call it 30 days, right?
28 to 32 or whatever it is, just average 30 day cycle.
And in that cycle, the hormones are always fluctuating.
They're, they're flat line.
They're rising.
Certain ones are rising.
Some ones are more, some of them are more stable.
(09:49):
Those drop off.
Other ones rise up.
And again, with diabetes,
that has a very direct impact on what's going to happen to
your blood sugar and your insulin needs and other
medications and how they work or get absorbed.
I mean,
And your emotions and we all stress has a massive impact on
blood sugar.
(10:09):
If I'm PMSing and I feel like I'm going to weep for no
reason or scream for no reason,
that emotional lability is going to have a huge impact on
my blood sugar.
Yes.
It's and,
and we can't just brush that under the table because we're
not comfortable with the conversation.
(10:30):
And like as an endocrinologist or diabetes educator,
we can't ignore it or say,
go talk to your GYN because in the GYN says, I don't know,
I'm not an endo.
And so now you've got a patient just in flux in this middle
ground where this doctor told me that they can't really
discuss that or don't, they don't know enough.
And this doctor says,
we'll go back to the other doctor because this is more in
(10:50):
the realm of this.
And again, none of them are really knowledgeable enough.
to say, hey, this is what you should expect.
And again, with diabetes,
that's where I think the conversation as uncomfortable as
it might be to sit down with a teenage female and say, hey,
this is what's going to happen.
It may be irregular.
(11:10):
If blood sugars are irregular,
your cycle might be more irregular.
So we're gonna try to navigate this together.
And I know it's weird to talk about,
this is important for you to know.
So going forward, as an adult, you know what to plan for.
Even if it never includes wanting to have a child,
(11:31):
this will help you understand why things are fluctuating
the way that they are and how to work it.
And I tell my young patients, like real talk, diabetes,
we're talking all the time about blood and hormones,
blood sugar, insulin.
(11:51):
Let's talk about your period.
It's blood and hormones, estrogen, progesterone,
and menses.
Why is that weird?
Why is it totally socially acceptable for us to talk blood
sugar in the produce aisle at the grocery store?
But to talk menses is like, it's like, oh,
(12:11):
50% of the planet's doing it.
Exactly.
At any given time,
whatever woman you're talking to at the bank could be
probably participating.
Yes, exactly.
Maybe if it wasn't so taboo, we'd have more science.
I think that's it.
(12:31):
It's unfortunate that even with in the past 10, 15 years,
a little bit more visibility and whatnot sure to evening of
the ground between male, female, so to speak,
this whole topic around this hormone cycling is still very,
(12:53):
like you said, taboo.
It's still very hard in a conversation.
Nobody wants to hear about a women, women bleeding.
Nobody wants to touch it hard.
I think it's,
it's hard on one side because it's been a thing of that
women were supposed to not talk about.
And it was in some cultures,
(13:15):
it's a thing that's very protected and it's a very special
time that's supposed to be honored and treasured and kept
very sort of sacred.
And in others,
it's a thing that's considered unclean and shameful and not
to be touched.
And so there's a lot of, on both sides,
there's just a lot of silence that can can lead to a lot of
stigma and taboo.
(13:36):
But then I think in our sort of Western,
very sort of American post feminist revolution,
I think there's this thing of like, well,
if we're going to be equal,
then we all have to kind of come at it the same,
which means women have to pretend they did it.
they don't have periods and they don't have hormones and
they don't have, I'm like, well,
(13:57):
why don't we just pretend that men do?
I mean, because like we all,
if anybody really pays attention, men kind of menstruate.
So like,
why don't we all just pretend that our hormones swing and
fluctuate and affect our world?
Because the reality is they do, they do, you know,
men have ebbs and flows in their hormonal cycles that
affect their energy levels and their confidence levels and
(14:19):
their body image levels and things like that as well.
Absolutely.
I think if we all kind of tuned into that,
it would be better.
I think another thing that we really don't get data on is
outside of that, even things like, for example,
we know women are more prone to UTIs,
just the structure of our urinary structure and things like
(14:46):
when we get UTIs, because we urinate out more glucose,
than women who don't have diabetes.
Often it will take more than one round of antibiotics to
fully clear a UTI, right?
So we get one round, we become non -symptomatic.
(15:08):
So the pain goes away, so we think we're good.
But our blood sugars don't normalize.
The blood sugars stay high at erratic.
We might even still have ketones.
And here we are about two weeks later.
Symptoms start coming in.
It's still there.
And so we get these UTIs that are really difficult to treat
and can really become problematic.
(15:29):
And we can end up going from UTI to bladder infection,
to renal infection, to, I mean, really a health crisis.
Same thing with like a yeast infection.
Yeah.
Yeast infections, again,
because we're urinating out glucose and the genitals and
the urinary tract are all right, just right there together.
We're feeding that yeast infection,
(15:50):
the sugar that it makes it grow.
So yeast infections, first of all, ladies, moms of littles.
Okay, moms of little girls with diabetes, bubble baths.
Bubble baths are like problem, problem number one.
If you really want your little girl to indulge in the joy
of a childhood bubble bath, make sure she is,
you're rinsing post, really, really well.
(16:12):
Make sure you're teaching little girls to wipe front to
back when they use the bathroom.
Please, please, please, to avoid infections.
But if their blood sugars are high and erratic and you're
not really sure why, yeast infections are so,
so common in little girls with type one diabetes,
(16:32):
but skip the monostat, skip the vagicil,
all that over -the -counter stuff.
Those stuff, that stuff's great just for comfort,
but it is not going to work in a woman with type one.
It's just gonna get you asymptomatic.
It's not gonna treat it.
And again, we usually need two rounds.
I always tell any woman with type one, on an antibiotic.
(16:53):
That's another one.
Ask your doctor for two rounds of the,
the fluoxetine or the diflican pill.
Take one, wait seven to 10 days.
Take the other one, even if you're asymptomatic,
because it's going to take the two rounds.
Otherwise symptoms go away,
but your blood sugars are going to stay high.
Which is kind of a cyclic nature too.
(17:16):
I mean,
the high blood sugars are not helping clear it from the
first round anyway.
And so then, like you said,
you may be asymptomatic blood sugars are still high.
That's a lot of the questions I get from women who are
like, I was treated and my blood sugars are still high.
Has something just shifted now because I was sick and I'm
like, no, there's something still hanging on there.
(17:36):
We need to like reevaluate, go back to the doctor.
Like you said,
you're very likely to need another round of management.
And if I always tell patients,
if you've had the first round, like if it's a UTI,
you've had that first round.
Your blood sugars are still running high,
especially if you're still passing ketones.
Ask them to do a CNS, a culture and sensitivity.
(18:03):
That way they can check and make sure they've got the right
antibiotic for the right bacteria.
Because you don't always just want to go broadband.
Because that can be problematic because we are more prone
to UTIs.
Using broadband all the time can be problematic.
Ask your doctor for that second round to get specific on
that second round.
(18:23):
Don't just broadband it.
Tighten in their scope.
And that way you're not always just hitting your body with
that broadband antibiotic.
You want to keep that one.
Well, unfortunately, if you're prone to them too,
and you're always using that broadband,
your body's not going to respond then because it's been
treated with everything.
And you want to keep that broadband in your back pocket for
(18:44):
pneumonia or MRSA or like when the big baddies hit.
Yeah, for UTIs,
we want to keep it dialed in on the ones that are specific
to what we've got going on.
But that double round, I mean,
I have had patients that have ended up months and months
and months of just, and they'll go, UTI, high blood sugars,
(19:10):
yeast infection, high blood sugars, UTI, high blood sugars.
And their doctors just treating them one round on each.
And they're like, my doctor's not listening.
And I mean, four or five months.
And now they end up with like scarring and damage and just
massive, massive, like skin,
(19:32):
because a yeast infection doesn't seem like a big deal.
But if it's going on and on, it can really be very,
very damaging.
I mean,
it can lead to pelvic inflammatory disease and stuff like
that if it's really ravaging itself.
So really, and I would say talk to your doctors.
in advance when you're healthy, have the conversation.
(19:54):
Hey, I have type one.
And so here's what, what I know and what we see.
So can this be the plan of treatment when these things
happen?
That way they know that they're not just dealing with
somebody who's like upset and uncomfortable and wants to
just do everything in the moment.
Right.
They know, okay, we've had this discussion already.
Here's the plan.
(20:14):
Yeah.
And I think, I mean, you bring up, you know,
the younger generation,
but I think as well as women age and get beyond the
childbearing years, moving into para menopause, menopause,
the changes in moisture level and the changes like that can
also bring about a time of more infections,
(20:37):
more prone to infections, big shifts in blood sugar levels,
because hormones are shifting in a very downward.
in different way than a woman has grown used to, right?
And that can be another time of very significant confusion.
Because again, I think of any of the stages of life,
perimenopause and menopause are,
(21:00):
I feel like doctors without doing it,
sort of you ask the question and it's almost like their
hands just get thrown up.
And they're like, well,
this is the stage of life that you're in and this is what's
supposed to be happening.
But no, you haven't defined that what,
you haven't defined how should I navigate through this?
And then the layer again of diabetes, what should I expect?
(21:24):
What can, I'm seeing irregularity,
I'm seeing shifts that I can't any longer spot a cycle
coming, right?
I was used to this happening and it's not really happening
anymore every single time.
And that's where the hands go up and they're just,
they just start to tell you to work it as you work it.
(21:46):
That's not helpful.
And it's terrible because when you come, hopefully, I mean,
it's definitely not true of all young women,
some of us have very difficult journeys but generally,
coming through puberty, it's a time of at least, I mean,
at least now in public schools, there's education.
(22:08):
And you've got parents or caregivers and then you come
through your childbearing years and hopefully you've got
again,
relationships around you that are supporting and encouraging.
Perimenopausal years is a time in life when you are kind of
expected to be self -supporting,
(22:28):
self -sufficient on your own.
Right.
But the reality is that most of us have far fewer friends.
A lot of us in our modern world are single or divorced or,
you know, we're- In our career.
or maybe even retirees at that point,
we might be empty nesters.
(22:49):
We're just going through transitions in life where we just
have fewer and fewer supports and encouragements.
And all of a sudden I've been doing diabetes for decades
and all the things that I've been doing start failing me.
Like I thought I knew what I was doing and I'm failing.
(23:13):
And it's getting worse and I'm gaining weight even though
I'm working out more than I've ever worked out in my life.
And I'm eating less and my appetite isn't the same.
And my cholesterol is going up and my blood pressure is
going up and my vision's getting worse.
(23:37):
And my doctor just handed me another diagnosis and another
pill.
And so it's like my self image.
is steadily crumbling.
Yep.
And here's just my diabetes,
this thing that I have worked so hard to understand,
to build and yeah, to maintain.
(23:59):
That is just like defying all logic in the middle of it.
And I go to my doctor and I go help.
And they go and so many of our doctors, you know,
we're going to our PCP going, help me with my weight.
And they're going, just move more and eat less.
Right.
And we go to our GYN and we're going, I can't enjoy, like,
(24:21):
I love, I love my partner,
but I don't enjoy sex the way I used to.
And they're going, well, you know,
just use more lube and take more time and get in socialis.
And you're like, you're like, no,
we just get so many like pat on the head, move on or like,
you're, you're just getting older.
And you're like, I'm only 43.
(24:42):
Are you telling me the next 50 years of my life are going
to be, I'm not even to the halfway point.
Right.
Yep.
Yeah, absolutely.
So you don't have to accept that,
because that's not the reality.
None of that is normal aging.
(25:04):
And the reality is the answers that you're getting are from
people who don't have the humility to look at you and say,
we don't know,
because science has ignored you for too long.
What we do know is this.
And so let's look at you as an individual,
and make your situation your body the science.
(25:27):
And, and study that and figure out what's going on.
Let's work.
Let's work together.
Right.
I mean, that's really, I was listening not too long ago,
to another podcast,
that was really talking about women's hormones,
especially coming into, you know, this,
this later life kind of past,
I want to have kids or I never wanted to have kids.
(25:48):
And now I'm moving beyond that sort of time period and what
to expect.
And we really every day we're moving forward in age, right?
And so we should,
we should know that as you mentioned early on,
some cultures actually treat this time of a woman's life
with a lot of respect,
(26:08):
and a lot of understanding that this is, this is how it's,
it is supposed to happen.
Your body is supposed to move through these changes and
some cultures support it very gracefully.
And,
and the woman feels very happy and healthy in this change
in life, wherein again, our more Western eyes,
(26:31):
I would say even Americanized quite honestly,
culture that we have culture.
We are.
And so we feel like once we get to 45 plus and these shifts
may start happening, especially with diabetes,
women end up moving into para menopause and menopause
sometimes earlier than women without diabetes.
And so we'll see like semically, often see it glycemically,
(26:55):
people, women are like, well, no,
I'm still getting my menses.
Maybe it's not as regular as it used to be,
but I'm still getting it,
but our blood sugars will usually tell us what is going on.
Things aren't the same years before what's happening.
Like what, yes,
I can usually let a parent know that their daughter is
(27:16):
going to start her menses months and months before it
actually starts happening.
Because we start to see those premenstrual patterns emerge
way before we actually see menses on set.
And so we, again,
we start to see peculiarities of insulin need.
(27:39):
Months, weeks,
years before we see men's or menopause actually start to,
and sometimes it's the insulin amount, right?
Where you said, you know, you know,
daily dose starts going despite not changing any other
variables in your life,
you're all of a sudden more resistant.
(28:01):
You need more insulin and it's odd how your blood sugar
reacts to typical foods and the things that you're an
exercise every day used to do this.
And I don't think it's helping as much as it used to help
me, you know, and again,
these are all changes that should be coming,
even without diabetes,
a female body should be moving through these changes,
(28:22):
but I think we are.
are, we're so focused on remaining the way that we were,
that it's hard to see that it's okay that you're changing.
It's okay that you're moving into this time of life because
that's what should be happening.
And I think women are,
they're too focused on trying to retain, I'm 30.
(28:42):
And that moves people into considering some of the,
and I truly believe that HRT is beneficial for those that
really need it.
But I think it's one of those things that's sort of a band
-aid thrown into the mix.
When somebody comes into a practitioner with complaints,
let's call them, or concerns.
And the first response is, well, let's just try this,
(29:04):
because this will take care of all of the insomnia.
It'll take care of the hot flashes.
It'll take care of the skin changes and the, you know,
how your anxiety level is and everything.
They throw it all in the basket.
Well, that may not be the tool that you needed.
Right.
All right.
something else may end, or maybe just the discussion that,
Hey, you know what,
you're supposed to be moving into this time of change.
(29:26):
And while we don't really, like you said,
we don't really understand it as much as we should,
because we haven't really studied as well as we should,
I'm here to help you move through this.
I think a lot of women just want a hand holding them.
Sometimes, sometimes the acceptance of our bodies,
sometimes the anxiety and the nausea or the anxiety and the
(29:48):
insomnia and the depression and some of the weight gain,
and a lot of those symptoms are the fighting against the
reality of my body changing without my permission.
(30:12):
Right.
And it's not even that I'm getting older,
it's that my body is changing without my permission,
that my whole life,
I have actively worked to make my body be what I want it to
be.
And now, despite my best efforts,
it has decided that I am no longer the captain of that,
and that is really, really hard for a lot of us.
(30:35):
And it's hard,
and that is the story of kind of the rest of our lives.
Is our body progressively timed progressively and
progressively telling more of that tale,
and us having less and less of a say so.
But I think that when we can change that mindset to one of
(30:56):
a beautiful acceptance and a partnership with our bodies,
when you meet people who have done that, and they say, no,
I'm going to embrace the beauty and the wisdom and the
grace and the flexibility that comes in that,
that's when you meet the people that are like yogis in
their 90s, right?
(31:17):
And they're like, run.
runners in their eighties and they're because they're not
wasting all of their time and energy trying to be someone
they can't be anymore.
Right.
They're just focused on taking what they have and just
exploring who and what this new body can really be.
Right.
(31:37):
And that's when it comes to blood sugar,
I see the same thing.
I see a lot of patients saying, you know,
I've gone from 30 units a day to I'm up to almost 50 units
a day now.
Oh my gosh, how do I get that back down?
And I go, well, but, you know, your blood sugars are good.
You're just,
you're 85% in range and standard deviations 32 and,
(31:59):
and you're very rarely about of, you know,
you're very rarely above a 160 and right.
And,
and you're no hypos and you're not having to work really
hard to do that.
And so what, so let's not worry about the daily dose.
They're like, well, if I have a lot of insulin,
I'm going to start gaining weight.
And I'm like, well.
I mean, but and or but you're not right.
(32:21):
I'm like,
but you probably will gain probably 5% body weight that is
typically that is that is developmentally appropriate.
We just say that with children, right?
At what point do we stop saying that?
If my seven year old son gains 15% body mass,
(32:45):
that is developmentally appropriate for him.
I wouldn't be upset.
And therefore his insulin needs should also change
accordingly.
I as a 43 year old woman should see a shift in body mass
from my 40s into my 50s.
That is developmentally appropriate.
(33:06):
Right.
And therefore my insulin needs should also shift.
That's developmentally appropriate.
And then as I shift from my 50s into my 60s and through my
70s, I should actually then see another shift down.
I should see a shift from lean muscle mass shifts down fat
mass shifts down insulin needs actually then shift down.
(33:28):
If I actually don't see that shift up through my 50s,
I might actually end up underweight to my 70s.
Right.
And I might be too lean and have a lot of health risks
there.
So keep in mind, you know, as women, we are,
we are growers and developers.
(33:48):
We, we grew and developed as children,
we grew and cultivated other people as, as younger women.
Now, as we're older women, we are still,
we now switch back to growing and cultivating ourselves
again.
And that's okay for that person to grow and change.
There's this huge billboard for like a cardiac rehab center
(34:11):
for the local ginormous hospital system.
And I hate it so much.
because it's this guy and it's like silver fox like ha ha
and it's like under armor you know right and it says get
back to who you used to be oh and i hate it so much because
(34:34):
every time i pass it i think who needs to get back to who
they used to be who you used to be landed you in a hospital
bed with a heart attack and a quintuple bypass and in
cardiac rehab how about you get to who you could be that
you haven't even met yet well i think that's an
(34:55):
evolutionary like that's another step in in thought and you
have to get there at a mental level to realize again that
you're changing you're moving we're all evolving whether
you're accepting of it or pushing back against it and that
billboard is kind of the push against that evolution it's a
(35:15):
push back against Don't you really want to be back at 25 or
30,
right?
Maybe not.
I actually,
I quite honestly think- For all our listeners who are 25
and 30, it's glorious, it's beautiful,
you're amazing flowers, bloom, blossom, and love it.
Yes, I always tell people though, like, you know what,
silly people are like, whoa, you know,
(35:37):
what age would you land at if you could just be forever,
quote unquote, young, right?
And I always feel like 37.
That's if number wise, I wouldn't be 20, I wouldn't be 25.
Man, I was dumb.
Dumb.
I want to be nine.
You want to be nine?
I want to be nine,
you're old enough to say- You want to have no
(35:58):
responsibility.
Yeah, you're old enough to stay up past eight o 'clock,
but way too young for anyone to expect you to pay your own
bills.
To pay, yeah, or understand any of that.
Yes, I mean, young age, I would agree,
maybe about tennis would be really, really lovely,
but I think as an adult,
there's a lot of intelligence somewhere in the 35 plus
years that comes only from life experience.
(36:21):
And when you build on that and keep moving forward with the
understanding, I am changing.
I have to learn how to evolve with this,
how to move forward.
You know, women's health includes, unfortunately,
a lot of what should be talked about in terms of bone
health, right?
You talk about those changes that you should expect,
this percent change here, this percent change here,
(36:44):
but if we really want to retain bone health,
calcium stores and those kinds of things,
it is really in our early years that we should focus on
resistance training and we should continue those into the
years that we're going through these other hormonal
changes, because if we don't,
that change from muscle mass post 55,
(37:07):
60 into the later years of life,
you're gonna be at a much higher risk.
So, resistance training is.
hugely important for women, adult women, all stages.
I can never encourage women enough.
(37:29):
Women tend to over focus on cardio and under focus on
resistance training.
Resistance training is what is going to keep you heart
healthy.
It is what is going to keep your bones strong.
It is what is going to keep your joints strong.
It is when it's going to avoid injury.
It is what is going to keep you glycemically well.
(37:49):
It is what it's the more we learn and the more studies
there are on resistance training,
the more important it is as we age,
flexibility and and resistance training are so important.
Yeah, where it's at, where that keep your heart moving.
But if you're doing flexibility and resistance training,
your heart's going to be pumping as much as it needs
(38:11):
exactly.
Yep, you're not you're not going to miss those beats.
And and getting that in there, getting screenings,
double -check with your doctors.
Having type 1 diabetes means that we might need to use
screenings earlier.
Things like osteoporosis screenings.
We might wanna start those earlier.
(38:34):
Things like breast cancer screenings,
things like cervical cancer screenings,
things like we might wanna skew those a little earlier for
women with type 1,
depending on your family history and so forth.
And the screening ages and spacing is always a moving
target in women's health.
(38:57):
And that's all nice big red button political issues.
So talk with your doctor about what's most appropriate for
you, but make sure you're asking your GYN, hey,
specifically, I'm a woman with type 1 diabetes,
should we be adjusting these times because there is a
slightly higher risk for me with this going on.
(39:21):
And we haven't even had time to touch on trans women,
trans health, talk about an area with no science.
Right?
My goodness.
Especially, and then with diabetes can be very frustrating.
And risks of diabetes.
I mean,
(39:42):
trans women are twice as likely to have diabetes as non
-trans women and twice as likely to have diabetes as trans
men.
So I'm very humbly proud to say that is an area of personal
research that I have made a point to educate myself in and
(40:05):
get my hands on what.
What is there data?
There is to offer support and to pull together what.
educated persons in the fields.
There are,
it's really been making contacts with people in the
diabetes field.
And then in, in the gender affirming medicine fields,
(40:29):
and sort of bringing them together and going, Hey guys,
let's put heads together.
Like, you guys don't necessarily know each other's fields.
So let's come together and compare notes and see where we
can learn from one another and what's missing,
what needs to be added and start filling in some gaps and
just supporting patients and,
and just kind of sharing patient case files where we can to
(40:52):
learn and,
and aggregate data so we can start supporting patients more
effectively.
Because when we, you know, again,
we start taking physiology plus hormones,
plus diabetes equals a whole lot of variables to consider.
(41:16):
It does.
And we've got a lot, a lot to learn,
because we are centuries and centuries behind.
We've had insulin for over a century now.
We've had females since the dawn of time.
Right.
Yes.
We've got some catching up to do.
(41:38):
We definitely have a lot of catching up to do.
So and I think that means we also have more conversations
to have about it because capturing it in a short little
blip of time is certainly not enough.
So hopefully we, you know,
hopefully lots of questions kind of come to us that we can
maybe even include the other educators in our practice as
(42:02):
well and have we'll leave Gary out of it this time.
Yeah, you can head straight to straight to our our site.
We're at integrated diabetes services dot com.
You can find Jenny and I there on our about tab.
You can feel free to fire us questions.
You can also follow us, obviously our podcast.
(42:27):
Also, I wanted to throw a shout out to DiabetesSisters,
speaking of diabetes and women's health.
They're a fantastic organization that is really focuses in
on the needs of women with diabetes and getting women with
diabetes connected.
So shout out to DiabetesSisters.
And we work with them a lot.
(42:48):
We do a lot of speaking with their group and supporting.
We do.
And vice versa.
Yes.
So awesome.
Good talk, Jenny.
Yes.
Thank you so much.
I feel like this might be dangerous.
When Jenny and I talk,
we tend to light little fires and then little side projects
start shooting off.
End up coming up.
Exactly.
I know we could certainly with more time,
we could certainly talk for probably another hour all about
(43:09):
and then just find more things to talk about.
So yeah, endless.
Yeah.
So I don't know.
I feel I don't know.
there's a book in there or something.
Oh, a book that has not been written,
thus like my pregnancy book that nobody put any information
together.
So there it is.
Yeah, I don't know.
I think it needs, I think it needs to happen.
I don't know.
Maybe, maybe the, the two super busy moms in the practice,
(43:33):
maybe, maybe shouldn't take that on right now.
Maybe you shouldn't know, but you know, maybe that's a,
we gather some information and then eventually put it
together in a book.
They're coming.
There you go.
Good idea.
I think Beyonce said it best when she said girls,
we rule the world.
Without a girl, there wouldn't be more.
(43:54):
Thank you very much, Alicia.
Have a great day.
Bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!