September 11, 2024 • 30 mins
Welcome to another enlightening episode of Think Like a Pancreas! This week, listen in as Tavia, Anna, and Kristi dive into the intricate world of managing both type 1 diabetes and Attention Deficit Hyperactivity Disorder (ADHD). With their combined expertise in diabetes care and education, social work, and personal experiences, they offer invaluable insights and practical strategies for those navigating these dual challenges.
In This Episode, You'll Learn:
- Introduction and Background: Meet our hosts—Tavia, Anna, and Kristi—as they introduce themselves and their roles as diabetes educators and social workers. They explain the increasing prevalence of individuals living with both type 1 diabetes and ADHD and emphasize the importance of raising awareness and providing validation.
- Common Symptoms and Challenges: The hosts discuss common symptoms and challenges faced by individuals with ADHD, such as difficulties with executive functioning, decision-making, and task completion. They share personal anecdotes about observing these challenges in their children and clients, highlighting the impact on diabetes management tasks like checking blood sugar and changing pump sites.
- Strategies and Support: Discover effective strategies for supporting individuals with ADHD and diabetes. The hosts emphasize the importance of structure, routines, and environmental modifications. They provide examples of using visual aids, breaking tasks into smaller steps, and involving family members for reminders and support. They also discuss the value of positive reinforcement, validation, and the necessity of avoiding internalization of struggles.
- Closing Thoughts: The hosts share their closing thoughts on the ongoing challenges of managing their own diabetes, stressing that perfection is not the goal. They encourage listeners to reach out for support and resources, promoting the idea that no one should feel isolated in their experiences. They also mention upcoming caregiver support programs and provide information on how to connect with them.
Meet the Hosts: Join hosts Tavia Vital, Anna Sabino, and Kristi Paguio as they share their expertise and personal experiences in managing type 1 diabetes and ADHD. Their compassionate and practical advice offers valuable support for anyone living with these conditions.
Conclusion and Resources: Don't miss this episode packed with expert advice and practical tips! Reach out to the hosts or the Integrated Diabetes Services team for personalized guidance on managing type 1 diabetes and ADHD. Explore additional resources and support networks to enhance your diabetes management journey.
Join Us: Subscribe now to Think Like a Pancreas for more episodes filled with expert advice and practical strategies. Share this episode with fellow diabetes and ADHD warriors, and leave a review to let us know your thoughts!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
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,
(00:25):
please check with your healthcare provider before
implementing any of the weird stuff we may happen to share
with you today.
Welcome.
Thanks for joining us today.
My name is Tavia Vital. I'm a registered nurse and a
certified diabetes care and education specialist with
Integrated Diabetes Services,
and I am joined by two of our clinical social workers who
(00:49):
are also CDCESs, diabetes educators like me,
but with a background in social work,
and they work with families, kids, adults,
families living with type 1 diabetes,
and I will let them introduce themselves and tell a little
bit more about what they do.
So, Anna. Hi.
(01:09):
Excited to be, I guess,
back on the Think Like a Pancreas podcast,
but my name is Anna Sabino.
I also live with type 1.
I have a master's in social work and I'm a CDCES,
and I truly focus on the family dynamic piece of it,
understanding the stressors that the entire family has
(01:30):
after a diagnosis and how to sort of best navigate through
the psychosocial, emotional aspects of that,
and sometimes that means dealing with comorbidities and
additional diagnoses that I think we'll get into today.
Kristi. Yeah.
Hi, everybody.
I'm Kristi Paguio. I'm a clinical social worker, CDCES,
(01:53):
and my specialization area is in the mental health side of
diabetes.
And so topic of ADHD and diabetes is why we're here.
I'm looking forward to our conversation.
Great.
Yeah, so thanks for joining us on our podcast today,
those who are listening.
And our focus is what we're gonna talk all about type 1
(02:16):
diabetes and ADHD together.
So just starting,
let's talk a little bit about what do you guys think,
do you see people living with ADHD and type 1 diabetes?
Is that something you guys see?
Because I see it on my side with the clinical diabetes
education side of it.
Yeah, both nodding yes.
(02:37):
Yeah,
I've seen a huge influx of kiddos and families with both,
whether one comes before the other,
I don't think we know enough info about that yet.
I think something that we do know is that there is an
increase in research out there that indicates that volatile
(02:57):
blood sugars.
like DKA, severe DKA diagnosis,
severe low blood sugars can have an impact on the gray
matter in our brains,
which impacts our ability for these levels of executive
functioning skills to be present,
which we all know we need so much of to manage the day -to
(03:19):
-day in diabetes.
So, Kristi, what else do you see a lot of overlap?
I think what I see in my practice is more the challenges of
just staying on task with the diabetes,
just life in general is so difficult.
(03:39):
And then adding in the layer of all of what the diabetes
regimen brings is so hard.
I think in general,
people with diabetes don't feel like they nail it every
day.
And I think people with ADHD even more feel like they've
got more stacked against them.
(04:00):
But yeah,
definitely it's like the decision overload almost of trying
to factor in like what's happening in,
what am I doing right now?
What am I pre -bolus?
And like, what am I doing?
And like,
just the nature of diabetes kind of makes everybody feel
like we've got some attention deficit stuff,
(04:21):
let alone technology.
I mean,
I feel like I have diabetes and even just giving one dose
of insulin,
there's like seven or eight different internal monologues
happening in my brain.
Do I give this much?
Am I walking the dog now?
Am I walking him later?
You know, where does that come in?
(04:42):
And every decision we make has an opportunity for guilt,
for shame, for regret.
And I think some of those negative connotations in terms of
the impact of those decision -making,
if you have something like an ADHD,
ADHD are going to make the irritability and the frustration
(05:03):
and the outbursts, like any type of hyperactivity,
it's just going to be exacerbated if you already have that
on board.
Now, Tavia, you are living with diabetes yourself,
but also have it in your family.
Can you share with us, like from your son's perspective,
your perspective,
(05:24):
what are some of these sort of like symptoms overlapping
that you may see on a day -to -day basis?
I think one thing before I do that,
I was thinking about as we were talking is maybe we should
go over just a little bit,
what are we talking about with ADHD?
Now, one thing, if you describe any condition or disease,
(05:45):
there is a much bigger list of symptoms or common
experiences than any three people could just list out in a
couple of minutes,
and each person's experience with living with.
We could be talking about type 1 diabetes.
We could be talking about ADHD.
Every person's experience or their level of symptoms or
frequency or maybe distressing symptoms, that's gonna vary.
(06:09):
So we did talk before this and we wanna make sure that
everybody's clear that we cannot diagnose ADHD.
As we're describing some common features of ADHD,
we aren't trying to give you a checklist for you to go down
and be like, oh my gosh, I have ADHD.
That's not our goal.
So we're just talking about what- We're bringing the
awareness.
(06:29):
We're having a conversation about it because we are
starting to see it more often.
And wanna validate that if you're out there and you are
dealing with it as a parent, that you're not alone.
Because we from our side at IDS, we see a lot of it too.
All right, Tavia, back to you.
All right, so we were gonna talk about some of this,
(06:51):
the common symptoms.
So I could just kick it off with what I saw that led me to
go get my son evaluated to see if he had ADHD.
So you mentioned executive functioning.
And so what that involves typically some of the symptoms
that we notice anyway,
where if you give a young child three instructions,
go pick up your shoes,
(07:12):
go put them on the shelf and then close the door.
He would get one of those, but the other two,
it'd be like we didn't have a conversation.
He just couldn't.
And I kept getting frustrated because I'd be like,
put your shoes away, grab your backpack, let's go.
He'd come with his backpack and no shoes,
or he'd come with his shoes and be sitting on the couch.
And I'd be like, what are you doing?
(07:32):
You'd be like, what, I put my shoes away, right?
And so it just,
that's the executive functioning piece of being able to
listen and follow through.
And then the decision -making.
So if you know you need to get ready in the morning,
you know the steps.
You gotta brush your teeth, eat, get dressed,
put your shoes on, get your things ready.
(07:53):
There's a certain timeframe you're working within to get
out the door on time without being late.
right,
which is a challenge for everybody and especially kids,
or parents of kids, right,
but but somebody with ADHD may not be able to do those
things, like they just can't on their own.
So we had to do things like put his clothes in little bins
(08:14):
ahead of time, Monday, Tuesday, Wednesday, Thursday,
Friday, we had to label shoes go here.
And then we had to be the timekeepers because he just,
he couldn't do it, even as he got older.
And then with school work, you know,
if you have a semester long project,
and they give you instructions, the teachers, they say,
(08:35):
start with an outline, do your research, then do this,
he couldn't do those projects.
So he'd just get overwhelmed,
and then he'd wait till the last second.
And then he'd be struggling the last few days trying to get
it all done, which is nearly impossible.
So we got him evaluated.
So that's what we were seeing at home.
Yeah.
(08:55):
And I think the you for sharing all of that because yes,
it's very common in kids.
And like you said,
those are only like some of the characteristics of ADHD.
I think a lot of people think that the impulse,
lack of impulse control,
dysregulation in terms of going from like zero to 100 from
(09:18):
an emotional standpoint is very common.
And I also know that hyperactivity doesn't always mean an
automatic ADHD diagnosis.
But when we talk about diabetes,
could you share some of those sort of like diabetes related
tasks or executive functioning type, you know,
(09:41):
behaviors that you felt like were really challenging?
Yeah, I think it is.
It's interesting because when he was younger,
his ADHD symptoms were more pronounced and got in the way
of his quality of life, his happiness, his joy,
and his ability to feel like he could do whatever he set
(10:04):
his mind out to do.
And as he's gotten some tools and training and learned
about ADHD and the symptoms and some options for
management,
his ability to do the tasks in a timely way has really
dramatically improved over the last few years.
So he was diagnosed with type 1 diabetes at age 12.
He's 16 now.
(10:25):
And so in the beginning, when someone is first diagnosed,
you're not going to expect them to like do all the things.
They can't check their blood sugar and know what the
glucose result means and know that every three days there's
a cancer.
You have to learn all that and it's a process for anybody.
(10:47):
So once he was through kind of the new learning phase,
then what we did is we set up structure because he couldn't
he would do his pump change at like 10 59 pm when he was
supposed to go to bed at 10.
Right.
Like those were the things that kept happening or he'd be
like, Oh, I used all the insulin.
(11:07):
I forgot to tell you, and I have to change my pump site.
And I'd be like, but you know, he was young.
So once he was, we were transitioning,
that was about age 13 to 14, where he was like,
I can do these things.
That's where we started seeing some of the gaps that were
like using the last bit of insulin.
So then I had to make sure I was really overseeing it from
(11:28):
the background,
letting him do the work that he was ready to do.
But I really had to make sure my calendar showed me when
it's time to change a sensor and a pump site and renew his
insulin a week before he would get around to telling me he
might be running low.
He would forget his bag.
He'd forget his diabetes kit everywhere.
So we had extras.
(11:49):
We left one of the nurses office, one in his locker,
one for his backpack.
one and one at home.
And then there's a spare one for wherever he's at without
it, because he just would forget it all the time.
And he goes somewhere without his when he wasn't on a pump,
he didn't have his insulin with him half the time.
So I'd have to double check my husband's taking him.
(12:10):
Like, I know if you ask him if he has it, he'll say yes,
but he needs to show it to you.
Because he would think he got it because he'd think about
the task, and then not do it.
But because he thought of it, he thought he did it.
That is another really common frustration.
And then he would be frustrated with himself, like,
why can't I get this right?
But yeah.
(12:30):
Yeah,
I was thinking to you about how much diabetes is like this
planning ahead all the time.
And how that how hard that is to do without an attention,
you know, difficulty, neural diversity, and like,
any kids and just adult, like,
it's just really hard to do diabetes and always be 10 steps
(12:53):
ahead.
And then to have this, this like, in some ways,
I don't like this extra ability to like multi like I was
thinking about ADHD is like not necessarily a bad thing,
but it certainly can in like our current culture and the
way that we work that we're trying to like,
(13:15):
streamline things and how internalized that can be that
like,
what's wrong with me that I just keep failing at all of
these tasks.
And what I hear you doing,
Talia is like trying to help him trying to set him up for
success and like increase the environment to set him up for
success because diabetes,
(13:35):
ADHD is a something that's working against him,
but then add diabetes and that regimen on to it.
And I think one thing that you said there that resonated
with me, Kristi, is th
at something that I try really hard to do with my own kids,
(13:56):
kids, when I'm frustrated, I mean, they're,
they're very little, they're six and four, so they,
they need a lot more help, but, um,
making sure that we're offering as much praise as possible,
because like you said, you know,
diabetes is an auto -immune disease,
a lot of times ADHD can be genetic,
they didn't ask for any of these types of, you know,
(14:19):
lack of sort of organ function for better or worse term.
And so how can we help them, you know,
how can we be their best cheerleader on the sidelines as
they like navigate this like constant,
both external and internal frustration and the kids that I
(14:39):
see that do well have like one -on -one,
a lot of one -on -one time with parents and like very
structured environment and opportunities to sort of just
like learn from the mistakes.
So as we're talking about just like, okay, well,
what works like, what does success look like?
(15:01):
And what are some of those strategies?
Like, how do I fix my kid?
And it's like, well, you can't fix the kid,
but we can fix how we interact.
Um, so, you know,
something that I really try to do with any and all kids,
my own and, and, and inspire parents to do is like,
really take a step back and think about, you know,
(15:23):
the validation piece and the, the, you know,
the praise and just like acknowledge over assumption.
You know,
we assume all the time that either we ourselves or somebody
else did something to cause a high or a low blood sugar.
And we all know living with diabetes, there's 80 ,000
(15:43):
variables in blood sugar fluctuation,
and it can be so easy to blame the person and not the
problem, which is obviously the autoimmune function, blah,
blah, blah.
So making sure that we're just like, Hey,
thanks for checking your blood sugar, buddy.
Um, and, and acknowledge yourself that like, wow, I did a,
(16:04):
I did a lot of work today in my diabetes.
Um, and I think like in addition to that,
it's like the numb, because so often, right?
We respond to the numbers, right?
Like, like, I love that.
Like phrasing the behavior,
reinforced in the behavior with positive affirmation and
then thinking, Oh man, but what's the number going to be?
Right.
(16:24):
And then the thought of like trying to neutralize that
number of like,
it's data and we're going to use it to make decisions,
to try to not have this internal reaction to like, Oh,
why is it like this or like that?
Which is so easy for any of us to fall into.
Right.
Yep.
And that's one thing.
(16:44):
I mean, so if there is a benefit, right?
So in my son's case,
I've lived with type one diabetes for 150 ,000 years.
So it wasn't like a brand new concept to him, right?
So he had some built -in support that other families
didn't.
I'm familiar with ADHD and could recognize the symptoms and
it was a process to get him to the right place to get a
diagnosis.
(17:06):
And it took way longer than it should have because of all
the fun with insurance and no, you can't go there.
Yes, you can go there, just kidding.
You can't go there after you waited for three months.
Now we're calling you to let you know that no,
not covered and you have to find it, right?
All the mess.
Oh yeah.
And so knowing about those things from my nursing
background and life experiences then gave me the ability as
(17:30):
a parent to help educate the family members around us about
what,
so he has inattentive type ADHD versus the hyperactivity
part of it.
What does that look like day to day?
How can we communicate more effectively with him?
What do we do if we're feeling frustrated because he didn't
do what we said to do even though he looked right at me and
said, yeah, I'll do that, right?
(17:52):
because his personality is, he's a very good kid.
He's a very genuine person.
He really wants to please others.
Like that's his nature.
So we know benefit of the doubt if he didn't do something
right, quote unquote, right.
He didn't do it on purpose.
He didn't do it to like show us he's a teenage boss man or
something, you know?
Like it just is not a mission usually.
(18:14):
So I think, you know,
he's in a family environment where most of us get that and
can help facilitate it.
So like even his younger brother will be like,
you got your bag?
You have Smarties?
Okay, let's go play soccer.
Because he knows if he doesn't ask,
they're gonna have to stop soccer.
He's gonna have to come back.
And you know, so I think having that,
(18:34):
the built -in parameters and planning tools are the big
pieces.
And for, you know,
I work with a lot of college students that have the dual
diagnosis of ADHD and type 1 diabetes.
And it's very challenging for many of those students to do
college, right?
They're living on their own.
They're responsible for their own actions, going to bed,
(18:56):
getting up, eating, taking insulin, all of the things,
and keeping their diabetes safe.
Because a lot of people with ADHD are really good in the
moment.
Right then, hyper -focus, we can figure this problem out.
But then it's the future and the past that are just not in
(19:17):
that decision that's being made,
which really would take when diabetes can really bite you.
You know, I think it's a huge point.
I was just gonna say, I think,
especially for parents listening, you know,
assuming most of us are like 25 or older as parents,
like our brains are fully developed.
(19:38):
We have a full brain there that can think if this,
then that.
And unfortunately, you know, impulse control,
overall emotional regulation,
those are some of the last parts of the brain.
to be developed and that usually doesn't happen until like
age 20 to 25,
even a little bit longer for young boys and men.
(20:01):
So we have to remember that even without a formal ADHD
diagnosis,
managing diabetes is just like we can't have the same level
of expectations,
even like four or five years after they move out than we
would for ourselves.
I know for me personally, I was diagnosed at six.
(20:22):
I didn't think about my long -term future until college.
Um, I realized now, wow,
my brain really wasn't developed and that is all normal.
It's not ideal, but it's all normal.
Yes.
Yes.
As I listened, as I listened to you both,
I think about a lot of my work is about helping separate
(20:43):
like people's identity from.
diabetes,
or and just how how more difficult I was diagnosed with
type one at 26.
So I had gotten through all of that,
like things were gelled, right?
But like,
it was still absolutely I was starting grad school,
(21:07):
lived alone, like, it was a very stressful, traumatic time.
But,
but what I was talking about a little earlier is like that,
that so much of what happens is these things get
internalized, the challenges of diabetes,
the challenges of ADHD, or any other thing that like,
it's,
(21:27):
and so so much of my work is trying to disentangle that and
unburden so that there's the coping strategies,
but then there's also the impact on our self esteem.
Yeah,
and trying to lift that off of people so that they don't
think lesser of themselves whether doing these heroic tasks
(21:48):
and trying to get things in place.
I'm going to share,
you just made me think about something that we that we've
been doing that we found helpful to sort of lighten the
mood, but also to validate the experience, right?
Because you can get super isolated thinking,
living with type one diabetes, living with ADHD,
put them together and like you must be the only person,
right?
No, actually,
(22:08):
there's a very high number of people who live with both
conditions.
But so one thing in this, my son found this,
and I think it's pretty, it's pretty fun.
It's kind of a it's an out of the box thing.
But there are plenty of people on tik tok,
who make videos of what their life is like with ADHD,
like how they go through their day.
And if you are not a neurodiverse person watching them,
(22:32):
you would think differently than somebody who is
neurodiverse in a similar way.
So we've been finding extreme joy in watching a few
specific people because they'll say,
here's how I go to work each day.
And and what it looks like like and what their internal
dialogue is and how they go from one place to another and
then there's some people who are you know they're
(22:54):
exaggerating it so they'll show like here I am cleaning the
house for five seconds and I set my room down here in the
middle of the floor and then I go get a drink of water
leave the cap oh it went under the stove and then the phone
rang and so then I forgot my keys so I had to come back in
and then like it like goes on and on anyway but we found
that to be super helpful because certain people show their
(23:18):
maybe they do awkward things with their body they hold
funny postures compared to quote unquote normal and then
they'll say this is me unmasking walking down the street
this is me saying what's just on my mind instead of not
talking the whole day and and this is what I did today that
was not what other people did today and so that experience
(23:42):
is it was just My,
my son loves them.
He finds these videos and he shares them and we sit and
watch them and we're like, Oh, Oh, Hey, look, you know,
and that's been very helpful.
I think to see them.
So glad that you shared that Tavia, because I,
I still think they're,
despite how much we have normalized like mental health and
(24:06):
all of, you know, therapy and reaching out for support.
I, you know,
ADHD and diabetes are both like very invisible.
You know, it, you can very much internalize them easily,
take medication or easily change a pump site and nobody
knows that you're processing and dealing with all of that.
(24:28):
So I think it's just, it's so important,
especially if you have kids for them to understand like,
Hey, it's cool.
Like this is, this is what we do.
This is what it's about.
And,
and for him to be able to understand what tools work for
him and, and verbalize that.
So I love that.
I love that.
Um, Kristi, any, you know,
(24:50):
before we kind of start to wrap up any other like tools
that you feel like are just so important for people to have
in their back pocket, um,
or that you have heard clients say work really well out in
the real world.
I can't think of anything off the top of my head at the
(25:10):
moment,
but the thing I was thinking about in our conversation
today is, and I think TikTok is doing this a little bit,
it's like a support system.
It's like, how do we, like,
I think TikTok can help explain, you know, social,
like these little clips, right?
That can help demonstrate and teach the invisibility of
(25:32):
what's happening in a person with ADHD or with diabetes.
Right.
Like, but then there's also, um,
I think about like how to educate,
but then also activate that support.
system,
which is really hard to do with emerging adulthood and that
desire for independence and that goal of being independent,
but also maybe peeling back the layers that some of that
(25:56):
just comes from our individualized,
obsessed culture that is not the way that a lot of other
cultures come from,
more of a collective.
So we need each other.
We need the youth and we shouldn't internalize the fact
that we need each other.
We need the support.
But I bet you that that's part of this internalization from
(26:19):
our culture of like, pull yourself up by your bootstraps.
You can do it.
You can do anything.
That's right.
Instead of like, we need each other.
We need each other desperate, whether it's ADHD, diabetes,
cancer, like, going through...
Yeah.
Yes.
Yeah.
(26:39):
Like you said, like the sort of like desire to be...
perfect and ideal.
And, you know,
one of the best skills I feel like we can teach the younger
generations is like this ability to self -advocate.
And I feel like even as an adult,
someone that has lived with diabetes over 35 years,
really since I can remember,
(27:01):
the biggest burden for me still is this burden of self
-advocacy,
whether it is the vulnerability of having to just
constantly explain diabetes or pick and choose how and when
to share what,
or I don't know.
Like yesterday, somebody asked me,
the coach at the gym was like, what does that beat mean?
And I'm just like, not right now.
(27:23):
I suspended it so I won't go low.
It's fine.
For whatever reason, it was like six in the morning,
I was at the gym and it bothered me.
But you know, it's like,
but I always have to remember that they don't know.
And it's an opportunity as we sort of reframe all of this,
it's that it's an opportunity.
It is an opportunity for us to share,
(27:43):
for us to grow and form this better connection with the
people that love us and ultimately just with ourselves.
Great.
All right.
I think that our time is up already.
I can't believe it.
It seems like we just started talking.
Are there any parting words or anything that you were
thinking, I need to share this today.
(28:05):
And I didn't get a chance to.
I think the only thing I would say was that, you know,
Tavia, I know you and I, and you know, a bunch of us,
we offered these, you know,
timeout for caregivers programs.
They are free support opportunities for parents to sort of
have this live Q &A.
(28:25):
We meet monthly,
so definitely stay tuned for our next program,
which I think is going to be in September.
Follow us along and make sure you get updated.
Great.
Yeah.
The only other.
thing I was going to share is I think sometimes people can
have the sense that the three of us must have our diabetes
(28:49):
perfected and I just have to share this story.
So we recently were in the process of selling our home and
it was our first showing and I had all my pets in our car
and we had to be out of the house for a couple of hours and
it was and I was pre -bolusing because it was during the
dinnertime and I was pre -bolusing and during the pre
(29:10):
-bolus my pod failed and so I'm reaching into the backseat
yes and all my insulin is safely tucked away in the
refrigerator,
drawer at home and just a human like these are the things
that are coming at us and doing everything right and yet
(29:31):
diabetes in life just still happens and so fortunately I
was okay.
I got enough of the pre -bolus that I could limp along for
the next hour before I got back.
But I was reaching in the back seat.
Where do I have all my backup gear and thinking I didn't
bring extra insulin.
(29:52):
But this is life.
We're just human, yeah.
Yeah, great.
Thanks you guys.
All right, well,
we hope you guys enjoyed our podcast today and we hope you
guys who are listening will share the information and join
into future sessions and feel free to send us emails.
(30:12):
Go to our website, integrateddiabetes.com.
You'll find a lot of additional information that can be
helpful.
And our contact info is all on our website as well.
So if you have any, you want to reach out to Anna, myself,
Tavia, or Kristi, you c
an look at our About Us information and there's a contact
button there.
So have a great day, thanks.
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,
(00:25):
please check with your healthcare provider before
implementing any of the weird stuff we may happen to share
with you today.
Welcome.
Thanks for joining us today.
My name is Tavia Vital. I'm a registered nurse and a
certified diabetes care and education specialist with
Integrated Diabetes Services,
and I am joined by two of our clinical social workers who
(00:49):
are also CDCESs, diabetes educators like me,
but with a background in social work,
and they work with families, kids, adults,
families living with type 1 diabetes,
and I will let them introduce themselves and tell a little
bit more about what they do.
So, Anna. Hi.
(01:09):
Excited to be, I guess,
back on the Think Like a Pancreas podcast,
but my name is Anna Sabino.
I also live with type 1.
I have a master's in social work and I'm a CDCES,
and I truly focus on the family dynamic piece of it,
understanding the stressors that the entire family has
(01:30):
after a diagnosis and how to sort of best navigate through
the psychosocial, emotional aspects of that,
and sometimes that means dealing with comorbidities and
additional diagnoses that I think we'll get into today.
Kristi. Yeah.
Hi, everybody.
I'm Kristi Paguio. I'm a clinical social worker, CDCES,
(01:53):
and my specialization area is in the mental health side of
diabetes.
And so topic of ADHD and diabetes is why we're here.
I'm looking forward to our conversation.
Great.
Yeah, so thanks for joining us on our podcast today,
those who are listening.
And our focus is what we're gonna talk all about type 1
(02:16):
diabetes and ADHD together.
So just starting,
let's talk a little bit about what do you guys think,
do you see people living with ADHD and type 1 diabetes?
Is that something you guys see?
Because I see it on my side with the clinical diabetes
education side of it.
Yeah, both nodding yes.
(02:37):
Yeah,
I've seen a huge influx of kiddos and families with both,
whether one comes before the other,
I don't think we know enough info about that yet.
I think something that we do know is that there is an
increase in research out there that indicates that volatile
(02:57):
blood sugars.
like DKA, severe DKA diagnosis,
severe low blood sugars can have an impact on the gray
matter in our brains,
which impacts our ability for these levels of executive
functioning skills to be present,
which we all know we need so much of to manage the day -to
(03:19):
-day in diabetes.
So, Kristi, what else do you see a lot of overlap?
I think what I see in my practice is more the challenges of
just staying on task with the diabetes,
just life in general is so difficult.
(03:39):
And then adding in the layer of all of what the diabetes
regimen brings is so hard.
I think in general,
people with diabetes don't feel like they nail it every
day.
And I think people with ADHD even more feel like they've
got more stacked against them.
(04:00):
But yeah,
definitely it's like the decision overload almost of trying
to factor in like what's happening in,
what am I doing right now?
What am I pre -bolus?
And like, what am I doing?
And like,
just the nature of diabetes kind of makes everybody feel
like we've got some attention deficit stuff,
(04:21):
let alone technology.
I mean,
I feel like I have diabetes and even just giving one dose
of insulin,
there's like seven or eight different internal monologues
happening in my brain.
Do I give this much?
Am I walking the dog now?
Am I walking him later?
You know, where does that come in?
(04:42):
And every decision we make has an opportunity for guilt,
for shame, for regret.
And I think some of those negative connotations in terms of
the impact of those decision -making,
if you have something like an ADHD,
ADHD are going to make the irritability and the frustration
(05:03):
and the outbursts, like any type of hyperactivity,
it's just going to be exacerbated if you already have that
on board.
Now, Tavia, you are living with diabetes yourself,
but also have it in your family.
Can you share with us, like from your son's perspective,
your perspective,
(05:24):
what are some of these sort of like symptoms overlapping
that you may see on a day -to -day basis?
I think one thing before I do that,
I was thinking about as we were talking is maybe we should
go over just a little bit,
what are we talking about with ADHD?
Now, one thing, if you describe any condition or disease,
(05:45):
there is a much bigger list of symptoms or common
experiences than any three people could just list out in a
couple of minutes,
and each person's experience with living with.
We could be talking about type 1 diabetes.
We could be talking about ADHD.
Every person's experience or their level of symptoms or
frequency or maybe distressing symptoms, that's gonna vary.
(06:09):
So we did talk before this and we wanna make sure that
everybody's clear that we cannot diagnose ADHD.
As we're describing some common features of ADHD,
we aren't trying to give you a checklist for you to go down
and be like, oh my gosh, I have ADHD.
That's not our goal.
So we're just talking about what- We're bringing the
awareness.
(06:29):
We're having a conversation about it because we are
starting to see it more often.
And wanna validate that if you're out there and you are
dealing with it as a parent, that you're not alone.
Because we from our side at IDS, we see a lot of it too.
All right, Tavia, back to you.
All right, so we were gonna talk about some of this,
(06:51):
the common symptoms.
So I could just kick it off with what I saw that led me to
go get my son evaluated to see if he had ADHD.
So you mentioned executive functioning.
And so what that involves typically some of the symptoms
that we notice anyway,
where if you give a young child three instructions,
go pick up your shoes,
(07:12):
go put them on the shelf and then close the door.
He would get one of those, but the other two,
it'd be like we didn't have a conversation.
He just couldn't.
And I kept getting frustrated because I'd be like,
put your shoes away, grab your backpack, let's go.
He'd come with his backpack and no shoes,
or he'd come with his shoes and be sitting on the couch.
And I'd be like, what are you doing?
(07:32):
You'd be like, what, I put my shoes away, right?
And so it just,
that's the executive functioning piece of being able to
listen and follow through.
And then the decision -making.
So if you know you need to get ready in the morning,
you know the steps.
You gotta brush your teeth, eat, get dressed,
put your shoes on, get your things ready.
(07:53):
There's a certain timeframe you're working within to get
out the door on time without being late.
right,
which is a challenge for everybody and especially kids,
or parents of kids, right,
but but somebody with ADHD may not be able to do those
things, like they just can't on their own.
So we had to do things like put his clothes in little bins
(08:14):
ahead of time, Monday, Tuesday, Wednesday, Thursday,
Friday, we had to label shoes go here.
And then we had to be the timekeepers because he just,
he couldn't do it, even as he got older.
And then with school work, you know,
if you have a semester long project,
and they give you instructions, the teachers, they say,
(08:35):
start with an outline, do your research, then do this,
he couldn't do those projects.
So he'd just get overwhelmed,
and then he'd wait till the last second.
And then he'd be struggling the last few days trying to get
it all done, which is nearly impossible.
So we got him evaluated.
So that's what we were seeing at home.
Yeah.
(08:55):
And I think the you for sharing all of that because yes,
it's very common in kids.
And like you said,
those are only like some of the characteristics of ADHD.
I think a lot of people think that the impulse,
lack of impulse control,
dysregulation in terms of going from like zero to 100 from
(09:18):
an emotional standpoint is very common.
And I also know that hyperactivity doesn't always mean an
automatic ADHD diagnosis.
But when we talk about diabetes,
could you share some of those sort of like diabetes related
tasks or executive functioning type, you know,
(09:41):
behaviors that you felt like were really challenging?
Yeah, I think it is.
It's interesting because when he was younger,
his ADHD symptoms were more pronounced and got in the way
of his quality of life, his happiness, his joy,
and his ability to feel like he could do whatever he set
(10:04):
his mind out to do.
And as he's gotten some tools and training and learned
about ADHD and the symptoms and some options for
management,
his ability to do the tasks in a timely way has really
dramatically improved over the last few years.
So he was diagnosed with type 1 diabetes at age 12.
He's 16 now.
(10:25):
And so in the beginning, when someone is first diagnosed,
you're not going to expect them to like do all the things.
They can't check their blood sugar and know what the
glucose result means and know that every three days there's
a cancer.
You have to learn all that and it's a process for anybody.
(10:47):
So once he was through kind of the new learning phase,
then what we did is we set up structure because he couldn't
he would do his pump change at like 10 59 pm when he was
supposed to go to bed at 10.
Right.
Like those were the things that kept happening or he'd be
like, Oh, I used all the insulin.
(11:07):
I forgot to tell you, and I have to change my pump site.
And I'd be like, but you know, he was young.
So once he was, we were transitioning,
that was about age 13 to 14, where he was like,
I can do these things.
That's where we started seeing some of the gaps that were
like using the last bit of insulin.
So then I had to make sure I was really overseeing it from
(11:28):
the background,
letting him do the work that he was ready to do.
But I really had to make sure my calendar showed me when
it's time to change a sensor and a pump site and renew his
insulin a week before he would get around to telling me he
might be running low.
He would forget his bag.
He'd forget his diabetes kit everywhere.
So we had extras.
(11:49):
We left one of the nurses office, one in his locker,
one for his backpack.
one and one at home.
And then there's a spare one for wherever he's at without
it, because he just would forget it all the time.
And he goes somewhere without his when he wasn't on a pump,
he didn't have his insulin with him half the time.
So I'd have to double check my husband's taking him.
(12:10):
Like, I know if you ask him if he has it, he'll say yes,
but he needs to show it to you.
Because he would think he got it because he'd think about
the task, and then not do it.
But because he thought of it, he thought he did it.
That is another really common frustration.
And then he would be frustrated with himself, like,
why can't I get this right?
But yeah.
(12:30):
Yeah,
I was thinking to you about how much diabetes is like this
planning ahead all the time.
And how that how hard that is to do without an attention,
you know, difficulty, neural diversity, and like,
any kids and just adult, like,
it's just really hard to do diabetes and always be 10 steps
(12:53):
ahead.
And then to have this, this like, in some ways,
I don't like this extra ability to like multi like I was
thinking about ADHD is like not necessarily a bad thing,
but it certainly can in like our current culture and the
way that we work that we're trying to like,
(13:15):
streamline things and how internalized that can be that
like,
what's wrong with me that I just keep failing at all of
these tasks.
And what I hear you doing,
Talia is like trying to help him trying to set him up for
success and like increase the environment to set him up for
success because diabetes,
(13:35):
ADHD is a something that's working against him,
but then add diabetes and that regimen on to it.
And I think one thing that you said there that resonated
with me, Kristi, is th
at something that I try really hard to do with my own kids,
(13:56):
kids, when I'm frustrated, I mean, they're,
they're very little, they're six and four, so they,
they need a lot more help, but, um,
making sure that we're offering as much praise as possible,
because like you said, you know,
diabetes is an auto -immune disease,
a lot of times ADHD can be genetic,
they didn't ask for any of these types of, you know,
(14:19):
lack of sort of organ function for better or worse term.
And so how can we help them, you know,
how can we be their best cheerleader on the sidelines as
they like navigate this like constant,
both external and internal frustration and the kids that I
(14:39):
see that do well have like one -on -one,
a lot of one -on -one time with parents and like very
structured environment and opportunities to sort of just
like learn from the mistakes.
So as we're talking about just like, okay, well,
what works like, what does success look like?
(15:01):
And what are some of those strategies?
Like, how do I fix my kid?
And it's like, well, you can't fix the kid,
but we can fix how we interact.
Um, so, you know,
something that I really try to do with any and all kids,
my own and, and, and inspire parents to do is like,
really take a step back and think about, you know,
(15:23):
the validation piece and the, the, you know,
the praise and just like acknowledge over assumption.
You know,
we assume all the time that either we ourselves or somebody
else did something to cause a high or a low blood sugar.
And we all know living with diabetes, there's 80 ,000
(15:43):
variables in blood sugar fluctuation,
and it can be so easy to blame the person and not the
problem, which is obviously the autoimmune function, blah,
blah, blah.
So making sure that we're just like, Hey,
thanks for checking your blood sugar, buddy.
Um, and, and acknowledge yourself that like, wow, I did a,
(16:04):
I did a lot of work today in my diabetes.
Um, and I think like in addition to that,
it's like the numb, because so often, right?
We respond to the numbers, right?
Like, like, I love that.
Like phrasing the behavior,
reinforced in the behavior with positive affirmation and
then thinking, Oh man, but what's the number going to be?
Right.
(16:24):
And then the thought of like trying to neutralize that
number of like,
it's data and we're going to use it to make decisions,
to try to not have this internal reaction to like, Oh,
why is it like this or like that?
Which is so easy for any of us to fall into.
Right.
Yep.
And that's one thing.
(16:44):
I mean, so if there is a benefit, right?
So in my son's case,
I've lived with type one diabetes for 150 ,000 years.
So it wasn't like a brand new concept to him, right?
So he had some built -in support that other families
didn't.
I'm familiar with ADHD and could recognize the symptoms and
it was a process to get him to the right place to get a
diagnosis.
(17:06):
And it took way longer than it should have because of all
the fun with insurance and no, you can't go there.
Yes, you can go there, just kidding.
You can't go there after you waited for three months.
Now we're calling you to let you know that no,
not covered and you have to find it, right?
All the mess.
Oh yeah.
And so knowing about those things from my nursing
background and life experiences then gave me the ability as
(17:30):
a parent to help educate the family members around us about
what,
so he has inattentive type ADHD versus the hyperactivity
part of it.
What does that look like day to day?
How can we communicate more effectively with him?
What do we do if we're feeling frustrated because he didn't
do what we said to do even though he looked right at me and
said, yeah, I'll do that, right?
(17:52):
because his personality is, he's a very good kid.
He's a very genuine person.
He really wants to please others.
Like that's his nature.
So we know benefit of the doubt if he didn't do something
right, quote unquote, right.
He didn't do it on purpose.
He didn't do it to like show us he's a teenage boss man or
something, you know?
Like it just is not a mission usually.
(18:14):
So I think, you know,
he's in a family environment where most of us get that and
can help facilitate it.
So like even his younger brother will be like,
you got your bag?
You have Smarties?
Okay, let's go play soccer.
Because he knows if he doesn't ask,
they're gonna have to stop soccer.
He's gonna have to come back.
And you know, so I think having that,
(18:34):
the built -in parameters and planning tools are the big
pieces.
And for, you know,
I work with a lot of college students that have the dual
diagnosis of ADHD and type 1 diabetes.
And it's very challenging for many of those students to do
college, right?
They're living on their own.
They're responsible for their own actions, going to bed,
(18:56):
getting up, eating, taking insulin, all of the things,
and keeping their diabetes safe.
Because a lot of people with ADHD are really good in the
moment.
Right then, hyper -focus, we can figure this problem out.
But then it's the future and the past that are just not in
(19:17):
that decision that's being made,
which really would take when diabetes can really bite you.
You know, I think it's a huge point.
I was just gonna say, I think,
especially for parents listening, you know,
assuming most of us are like 25 or older as parents,
like our brains are fully developed.
(19:38):
We have a full brain there that can think if this,
then that.
And unfortunately, you know, impulse control,
overall emotional regulation,
those are some of the last parts of the brain.
to be developed and that usually doesn't happen until like
age 20 to 25,
even a little bit longer for young boys and men.
(20:01):
So we have to remember that even without a formal ADHD
diagnosis,
managing diabetes is just like we can't have the same level
of expectations,
even like four or five years after they move out than we
would for ourselves.
I know for me personally, I was diagnosed at six.
(20:22):
I didn't think about my long -term future until college.
Um, I realized now, wow,
my brain really wasn't developed and that is all normal.
It's not ideal, but it's all normal.
Yes.
Yes.
As I listened, as I listened to you both,
I think about a lot of my work is about helping separate
(20:43):
like people's identity from.
diabetes,
or and just how how more difficult I was diagnosed with
type one at 26.
So I had gotten through all of that,
like things were gelled, right?
But like,
it was still absolutely I was starting grad school,
(21:07):
lived alone, like, it was a very stressful, traumatic time.
But,
but what I was talking about a little earlier is like that,
that so much of what happens is these things get
internalized, the challenges of diabetes,
the challenges of ADHD, or any other thing that like,
it's,
(21:27):
and so so much of my work is trying to disentangle that and
unburden so that there's the coping strategies,
but then there's also the impact on our self esteem.
Yeah,
and trying to lift that off of people so that they don't
think lesser of themselves whether doing these heroic tasks
(21:48):
and trying to get things in place.
I'm going to share,
you just made me think about something that we that we've
been doing that we found helpful to sort of lighten the
mood, but also to validate the experience, right?
Because you can get super isolated thinking,
living with type one diabetes, living with ADHD,
put them together and like you must be the only person,
right?
No, actually,
(22:08):
there's a very high number of people who live with both
conditions.
But so one thing in this, my son found this,
and I think it's pretty, it's pretty fun.
It's kind of a it's an out of the box thing.
But there are plenty of people on tik tok,
who make videos of what their life is like with ADHD,
like how they go through their day.
And if you are not a neurodiverse person watching them,
(22:32):
you would think differently than somebody who is
neurodiverse in a similar way.
So we've been finding extreme joy in watching a few
specific people because they'll say,
here's how I go to work each day.
And and what it looks like like and what their internal
dialogue is and how they go from one place to another and
then there's some people who are you know they're
(22:54):
exaggerating it so they'll show like here I am cleaning the
house for five seconds and I set my room down here in the
middle of the floor and then I go get a drink of water
leave the cap oh it went under the stove and then the phone
rang and so then I forgot my keys so I had to come back in
and then like it like goes on and on anyway but we found
that to be super helpful because certain people show their
(23:18):
maybe they do awkward things with their body they hold
funny postures compared to quote unquote normal and then
they'll say this is me unmasking walking down the street
this is me saying what's just on my mind instead of not
talking the whole day and and this is what I did today that
was not what other people did today and so that experience
(23:42):
is it was just My,
my son loves them.
He finds these videos and he shares them and we sit and
watch them and we're like, Oh, Oh, Hey, look, you know,
and that's been very helpful.
I think to see them.
So glad that you shared that Tavia, because I,
I still think they're,
despite how much we have normalized like mental health and
(24:06):
all of, you know, therapy and reaching out for support.
I, you know,
ADHD and diabetes are both like very invisible.
You know, it, you can very much internalize them easily,
take medication or easily change a pump site and nobody
knows that you're processing and dealing with all of that.
(24:28):
So I think it's just, it's so important,
especially if you have kids for them to understand like,
Hey, it's cool.
Like this is, this is what we do.
This is what it's about.
And,
and for him to be able to understand what tools work for
him and, and verbalize that.
So I love that.
I love that.
Um, Kristi, any, you know,
(24:50):
before we kind of start to wrap up any other like tools
that you feel like are just so important for people to have
in their back pocket, um,
or that you have heard clients say work really well out in
the real world.
I can't think of anything off the top of my head at the
(25:10):
moment,
but the thing I was thinking about in our conversation
today is, and I think TikTok is doing this a little bit,
it's like a support system.
It's like, how do we, like,
I think TikTok can help explain, you know, social,
like these little clips, right?
That can help demonstrate and teach the invisibility of
(25:32):
what's happening in a person with ADHD or with diabetes.
Right.
Like, but then there's also, um,
I think about like how to educate,
but then also activate that support.
system,
which is really hard to do with emerging adulthood and that
desire for independence and that goal of being independent,
but also maybe peeling back the layers that some of that
(25:56):
just comes from our individualized,
obsessed culture that is not the way that a lot of other
cultures come from,
more of a collective.
So we need each other.
We need the youth and we shouldn't internalize the fact
that we need each other.
We need the support.
But I bet you that that's part of this internalization from
(26:19):
our culture of like, pull yourself up by your bootstraps.
You can do it.
You can do anything.
That's right.
Instead of like, we need each other.
We need each other desperate, whether it's ADHD, diabetes,
cancer, like, going through...
Yeah.
Yes.
Yeah.
(26:39):
Like you said, like the sort of like desire to be...
perfect and ideal.
And, you know,
one of the best skills I feel like we can teach the younger
generations is like this ability to self -advocate.
And I feel like even as an adult,
someone that has lived with diabetes over 35 years,
really since I can remember,
(27:01):
the biggest burden for me still is this burden of self
-advocacy,
whether it is the vulnerability of having to just
constantly explain diabetes or pick and choose how and when
to share what,
or I don't know.
Like yesterday, somebody asked me,
the coach at the gym was like, what does that beat mean?
And I'm just like, not right now.
(27:23):
I suspended it so I won't go low.
It's fine.
For whatever reason, it was like six in the morning,
I was at the gym and it bothered me.
But you know, it's like,
but I always have to remember that they don't know.
And it's an opportunity as we sort of reframe all of this,
it's that it's an opportunity.
It is an opportunity for us to share,
(27:43):
for us to grow and form this better connection with the
people that love us and ultimately just with ourselves.
Great.
All right.
I think that our time is up already.
I can't believe it.
It seems like we just started talking.
Are there any parting words or anything that you were
thinking, I need to share this today.
(28:05):
And I didn't get a chance to.
I think the only thing I would say was that, you know,
Tavia, I know you and I, and you know, a bunch of us,
we offered these, you know,
timeout for caregivers programs.
They are free support opportunities for parents to sort of
have this live Q &A.
(28:25):
We meet monthly,
so definitely stay tuned for our next program,
which I think is going to be in September.
Follow us along and make sure you get updated.
Great.
Yeah.
The only other.
thing I was going to share is I think sometimes people can
have the sense that the three of us must have our diabetes
(28:49):
perfected and I just have to share this story.
So we recently were in the process of selling our home and
it was our first showing and I had all my pets in our car
and we had to be out of the house for a couple of hours and
it was and I was pre -bolusing because it was during the
dinnertime and I was pre -bolusing and during the pre
(29:10):
-bolus my pod failed and so I'm reaching into the backseat
yes and all my insulin is safely tucked away in the
refrigerator,
drawer at home and just a human like these are the things
that are coming at us and doing everything right and yet
(29:31):
diabetes in life just still happens and so fortunately I
was okay.
I got enough of the pre -bolus that I could limp along for
the next hour before I got back.
But I was reaching in the back seat.
Where do I have all my backup gear and thinking I didn't
bring extra insulin.
(29:52):
But this is life.
We're just human, yeah.
Yeah, great.
Thanks you guys.
All right, well,
we hope you guys enjoyed our podcast today and we hope you
guys who are listening will share the information and join
into future sessions and feel free to send us emails.
(30:12):
Go to our website, integrateddiabetes.com.
You'll find a lot of additional information that can be
helpful.
And our contact info is all on our website as well.
So if you have any, you want to reach out to Anna, myself,
Tavia, or Kristi, you c
an look at our About Us information and there's a contact
button there.
So have a great day, thanks.
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