July 15, 2025 • 48 mins
In Episode 43 of Think Like a Pancreas—The Podcast, we open pull back the curtain and share the fabulous personalities of the Integrated Diabetes Services clinicians.
In part one of our three part series, meet:
Gary Scheiner, MS, CDCES, is the award-winning author of Think Like a Pancreas as well as numerous other books that act as guides for people living with diabetes. A Certified Diabetes Care & Education, Masters-level Exercise Physiologist, and person living with type 1 diabetes since 1985,
Tavia Vital BSN, BA, RN, CDCES is the Director of Intensive Diabetes Management for Integrated Diabetes Services. Tavia is a Registered Nurse, Certified Diabetes Care and Education Specialist, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She was diagnosed with type 1 diabetes over forty years ago.
Kristi Paguio LMSW, CDCES, CSOWM is a licensed clinical social worker, diabetes care and education specialist, and certified specialist in obesity and weight management. Kristi was diagnosed with type 1 diabetes in 2000 and has specialized in the mental and emotional aspects of diabetes since that time
Learn why they became diabetes clinicians, the challenges that they help their clients overcome, who enjoys listening to Boyz II Men, and which team member would first die in a Zombie apocalypse!
What you’ll learn:✔️The importance of personal experiences in diabetes management.
✔️Mental health plays a significant role in diabetes care.
✔️Teamwork enhances the effectiveness of diabetes education.
✔️Planning is essential to avoid challenges in diabetes management.
✔️All foods can fit into a diabetes-friendly diet.
✔️Support groups provide valuable resources for caregivers.
✔️Continuous learning and adaptation are key in diabetes care.
Chapters00:15 Welcome and Introduction
01:36 Kristi's diabetes diagnosis
03:12 Tavia's diabetes diagnosis
08:53 Gary's diabetes diagnosis
10:34 What tools do the IDS team use in their own diabetes care?
14:27 What is the biggest challenge they face in managing their diabetes?
19:33 How do the Integrated Diabetes Clinicians stay in shape?
23:04 Why did you become a Certified Diabetes Care and Education Specialist?
29:15 What challenges do you help your patients overcome?
34:56 What you didn't know about the Integrated Diabetes Services team
45:25 Tavia shares support for parents of children with type 1 diabetes
Resources MentionedGlow gummies https://glowgummies.com/
Connect with Us🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team , visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
Subscribe and ReviewIf you enjoyed this episode subscribe on Apple Podcasts, Spotify, or your favorite podcast platform to ensure that you never miss an episode.
Also, leave a review to let us know what you think, and share this episode with others who will enjoy it as well!
More great episodes like thisIDS Diabetes Experts, The Trynamic Trio Share Personal Experiences with Open Sourced Insulin Pump Systems
And then there were two! When your child is also diagnosed with diabetes.
3 Moms and a Diabetes Diagnosis: From “Oh no!” to “Nailed it!”
Coping with Burnout in Diabetes Management: Strategies for Success
Disclaimer
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:16):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:37):
healthcare provider before implementing.
Welcome to Think Like aPancreas, the podcast.
I'm your host, Gary Scheiner, and I'mproud to kick off a series of, uh, podcast
episodes to give you a chance to get toknow our team on a more personal level.
And I'm joined by two ofour ace clinicians today.
(00:58):
Uh, Tavia Vial, who'sa, a nurse, and CDCES.
And Kristi Paguio, who isan, uh, LCSW, and a CDCES.
So, uh, welcome the two of you.
Glad to have you here.
Tavia Vital (01:12):
Thank you.
Glad to be.
Gary Scheiner (01:15):
So we're going to talk a little bit first about your
backgrounds and, and then get intosome more personal areas involving
diabetes and get some opinions youhave about the rest of the team.
It's gonna be fun.
I'll try my best not to embarrass anybody.
Okay?
Tavia Vital (01:31):
That's appreciated.
Gary Scheiner (01:33):
So, hey Kristi, start with you, uh, what year, remember
what year you were diagnosed.
Kristi Paguio (01:38):
Actually, I just had my 25th anniversary.
My diaversary, it was June.
Um, it was early June of 2000.
Gary Scheiner (01:46):
Yeah.
I used to get, I didn't know how to, youknow, respond to people who congratulated
me for making 30 or 40 years, and thenI realized it beats the alternative.
When you were first diagnosed, uh,what were some of the management
tools that you were using, Kristi?
Kristi Paguio (02:04):
When I was first diagnosed, I didn't totally realize
this, but it was just as Lantus had comeonto the market, so I was doing, um, I
don't know if it was NovoLog, Lantus.
It's been such a long time ago,and then I transitioned to an
insulin pump a few years later.
But, um, when I left the hospital,I was on Lantus and NovoLog, and
(02:26):
then the endocrinologist I wasseeing transferred me to the, um,
transition me to the fancy 75/25.
And I was on that for a few years.
Really...
Gary Scheiner (02:36):
pretty mixed insulin as a type one.
Kristi Paguio (02:40):
Yep, and I adhered to that, but it just ended up not
offering the flexibility that I needed.
And so I was, I transitioned to a pump.
Well, I transitioned toMDI and then to a pump.
'cause I needed,
Gary Scheiner (02:57):
I was originally gonna say, you never got to enjoy the beauty
of NPH, but with 75/25, you wereon NPH not once, but twice a day.
Kristi Paguio (03:07):
Yeah.
Yeah.
I never thought aboutit like that, but yeah.
Yeah,
Gary Scheiner (03:11):
yeah.
Tavia, you were diagnosedearlier than Kristi, right?
Tavia Vital (03:15):
Yep.
1981, April, 1981.
So I was two and a half and I stillhave a little flashback memory from
that diagnosis, which I don't reallyremember anything else from that age.
But we were in the hospital and theytaught my mom how to do insulin injections
with it, with a syringe in it orange.
(03:36):
And the day she was supposed to give memy first injection, there was a tornado.
So they were taking all of the patientsand putting them into the central
hallways of the hospital system.
And someone comes in and says,quick, give this insulin injection
to your daughter before you, beforewe have to evacuate for the tornado.
(03:57):
And my mom said, no, yousaid inject then eat.
It's very important
or she'll have a low blood sugar notknowing what any of this means, right?
And the nurse was panicking, apparently,and said, no, you have to inject it quick.
And my mom was freakedout and said, I can't!
And so anxiety won there and we gotto the hallway and I didn't have a
fatal insulin injection the firsttime my mom tried, which is good.
(04:20):
Um, and then in the hallway, a lady was ina rocking chair and rocked on my big toe.
That's what I remember.
I remember sitting in a rockingchair with my mom and crying, and
somebody had rocked up my big toe.
I don't remember the diabetes part at all.
Gary Scheiner (04:32):
All with a tornado bearing down on you.
Tavia Vital (04:36):
I don't know where the tornado was.
I just know that there was awarning, which means somebody saw
one in the nearby, nearby area.
Yeah.
Gary Scheiner (04:42):
Were things flying around the halls of
the hospital from the tornado?
Tavia Vital (04:46):
They may have been, but I just remembered my big toe hurt.
So no idea!
Gary Scheiner (04:50):
You were two, you know,
Tavia Vital (04:52):
we, we started on my mom, I asked my mom about
this, uh, a little while back.
They started me on dilutedinsulin of some sort.
So.
They, uh, mom had a diluted at home,and at that time it was animal insulin.
We started, uh, with, I started withcow insulin and had giant welts and
lumps and bumps and, and then switchedto pig insulin, which ended up causing
(05:19):
a lot of hard areas, real, like mylegs felt like wood, like blocks
of wood for most of my childhood.
Um, and at some point in time duringmy childhood, then there was, you
know, the recumbent DNA, we switchedto good old NPH and regular.
Um, and I don't remember ifwe ever did mixed or not.
(05:41):
I don't that, you know, so long ago.
I just know that there, I had to takeinsulin in the morning and in the evening.
I don't think I had to take a lunchdose while I was in school until it was.
I think Lantus and Humalog,when I was in high school,
Gary Scheiner (05:59):
the NPH in the morning would quote unquote, cover your lunch.
Tavia Vital (06:04):
Right?
I'm sure it did a great job, and I knowI had to check my sugar, so I had to
go to the office and check my bloodsugar on a manual finger testing strip.
There were no digital meters untilsometime in later grade school.
Then I got a digital one.
I was still little like young kid, but.
Um, yeah, it was a big thing.
(06:25):
I had a big, it was abrown Tupperware box.
I hated that thing.
It was so ugly.
It was huge.
It was like this tall and this big.
Can't even show you in my, my windowhow big it was, and it had the meter
and the cleaning and the strips and thegiant guillotine finger poker thing.
That's what we used.
Gary Scheiner (06:43):
Being a nurse, do you know what NPH really stands for?
Tavia Vital (06:48):
What are you saying?
You're gonna make a joke, so youtell me what you think it means.
What, what does it..
Gary Scheiner (06:52):
As a nurse, you know what it actually stands for.
Tavia Vital (06:54):
Oh gosh.
The protum-- I don't remember right now.
Gary Scheiner (06:58):
N-Neutral.
Tavia Vital (06:59):
I'm on.
I'm on the spot.
I can't do it.
Gary Scheiner (07:02):
Neutral Protamine Hagedorn
Tavia Vital (07:04):
There you go.
What he said.
Yep.
Gary Scheiner (07:06):
But not particularly helpful is what
we all refer to that as now.
Tavia Vital (07:10):
That's what I was waiting for.
I could see the twinkle.
I knew you had something up your sleeve.
Gary Scheiner (07:13):
Yeah, Kristi, when you talked about how it
didn't allow you flexibility.
Oh it is.
It is a rigid, rigid insulin to use.
Kristi Paguio (07:21):
You know, at the time for me, I think it, what I was doing,
I just start and I was probablyhoneymooning for a while, like.
So it worked until it didn't work anymore.
And then I just really felt like Iwas failing at it and I'm so grateful.
'cause then I moved to Chicago andI started working with, with Dr.
(07:41):
Corcoran was my endocrinologist.
And so he just started toopen up the floodgates for me.
And the care, the level ofcare just changed dramatically.
And so I'm forever grateful for that.
But I followed that.
If I was told to eat breakfast,I was not a breakfast person.
I found a way to eat breakfast.
(08:03):
This car.., Like I followed it to a T.
My, one of my memories ofdiagnosis time was test strip
were not covered by insurance.
Tavia Vital (08:11):
True.
They weren't when I was diagnosed either.
Kristi Paguio (08:14):
So for me, now as a young adult, like, so, oh gosh,
I gotta test six times a day.
Not all of them, you know, you don'talways get a full sample in it, right?
Or it reads error, but somehow I am,I'm adding up the math right, and
was having some emotional reactionsto this brutal reality, and it was a
(08:37):
preexisting condition, so not coveredby insurance for the first year.
It was not nice
Gary Scheiner (08:45):
Tavia, when you mentioned the orange that reminded me... what I
remember most about insulin syringes.
I was a freshman in collegewhen I was diagnosed.
Uh, when I went back for sophomore year.
I was diagnosed in the summertime,so I went back for sophomore year.
Uh, my friends try to make light of it,and what we would do is I would take
(09:10):
my insulin syringes and draw up vodkawith them and inject them into oranges
to make screwdrivers still in the rind.
Tavia Vital (09:21):
So your friends didn't respond negatively to your diagnosis
then won 'em over by using..
Gary Scheiner (09:26):
No, no.
We had fun with it becauseI, I try to keep, you know,
doing everything I like to.
In fact, before dinner, the guysthat in my suite where I lived, we,
they would kind of bet on what myblood sugar was and some of them
would start asking me questions.
They got smart like, Hey,did you work out today?
You know, what'd you eat for lunch?
Was it like, all you can eat taco day?
(09:46):
Because they'd know my sugar would behigher if I ate that kind of stuff.
So they'd off put a dollar in theybet on who could guess my blood sugar.
And I had one of, you know, one ofthe early meters in the mid eighties,
uh, that, you know, it took about, youknow, a minute and a half to do the
reading, but it did, gave you something.
I went home from the hospital witha, you know, the vial of strips
(10:07):
that had a color chart on it.
You bleed on the strip andmatch the color change.
And yeah, that's very subtle colorchanges between a 150 and a 250 and a 300.
Very subtle differences.
So, you know, nowadays we're reallysplitting hairs and giving insulin and
micro doses with, with the pumps andeven with the smart pens that we use now.
(10:31):
So let, let's, let's shift to today.
Kristi, you're off 75/25, twice a day.
Uh, how are you, uh, what tools areyou using to manage your diabetes now?
Kristi Paguio (10:42):
I use the Dexcom G7 and I use the Omnipod Dash, but I Loop.
A friend of mine helped mebuild the Loop and that's what
I've been doing for the past?
Five years.
I built the loop in the middle of thepandemic in 2000 and, what was that?
(11:04):
22? No,
Gary Scheiner (11:05):
2020
20.
Kristi Paguio (11:07):
Right, right, right.
2020. Yeah.
Gary Scheiner (11:09):
I always remember COVID-19 is when it started.
So 20, 2020 is when itreally hit the brunt force.
Kristi Paguio (11:16):
Yeah.
Yeah.
So,
Gary Scheiner (11:18):
so you're looping, uh, which insulin are you using?
Kristi Paguio (11:22):
I use NovoLog.
That's what my insurance prefers.
So, and I do also use Afrezza.
I do that for the postprandial.
Gary Scheiner (11:32):
When do you use Afrezza?
Kristi Paguio (11:35):
I use that inhaled insulin to help when I've got a squirrelly blood
sugar that's double arrows up just tobring it down without, without a tail.
That's a newer therapy that I,I'm grateful my doctor was willing
to prescribe for me and let meplay around with it a little bit.
Another little tip and trick Ilearned from some of my friends
(11:58):
at diabetes training camp that
mm-hmm.
Gary Scheiner (12:00):
It's a long, long way from 75/25, isn't it?
Kristi Paguio (12:05):
Yeah.
I would say, I mean,that's so long ago, right?
Like I'm at the point now where someof that's like, I can remember when
I was first diagnosed, hearing peoplesay they don't really remember a time.
And that's kind of where I'm at too,is I've noticed in the last decade
or so, I don't really remember alot of what that was like, but for a
while it was very fresh, very real.
(12:27):
What it was like to not have diabetesand then what it was like to have it.
Gary Scheiner (12:31):
Yeah.
We used to have to make our lifeconform to our insulin program.
Kristi Paguio (12:36):
Right.
Gary Scheiner (12:36):
Now it's the opposite.
Kristi Paguio (12:38):
Right.
Gary Scheiner (12:38):
We, we live the life we wanna live and we make the insulin
program fit that and match it.
Ultimately, that's,that's what we try to do.
Tavia, how about you?
What are you, uh, usingto manage yourself?
Tavia Vital (12:53):
Um, I have, I am using Dexcom G6 and I use Omnipod.
I actually have a stash of arrows pods,and they, some may or may not be expired,
but they still seem to work okay.
So I'm using them, um, and thatRiley link and I, and I use that
to use a system called trio,which is like Loop, but different.
(13:18):
It's another, um, hybrid closedloop system that you can control
on an app on your cell phone.
And it has a lot, it offers alot of flexibility and tools that
help me manage my diabetes better.
Once they're set up and finetuned, then it does a lot of work
for me, which is why I like it.
Gary Scheiner (13:38):
Yeah.
So are both of you still able to enjoythe foods you like and the activities
you like and still manage your glucose?
Tavia Vital (13:47):
Yeah.
Yeah.
Does it always work out?
No.
Gary Scheiner (13:51):
Well, what doesn't work?
What kind of, what thingschallenge you still?
Tavia Vital (13:56):
Well, I think, I think lack of planning is my biggest challenge.
So I like to do things spontaneously.
So if I just eat a big lunch andthen I notice the weather is nice
on the weekend and I wanna godo something physical outside.
That's a challenge because now Ihave food digesting at who knows how
long it's gonna take, and the insulinis gonna be peaking probably about
(14:20):
when I'm ready to get out there.
So that's a challengethat I face for sure.
Gary Scheiner (14:25):
Kristi, do you have an Achilles heel with your
diabetes that still challenges you?
Kristi Paguio (14:29):
You know, I love what Tavi said.
I think for me, the, the place thatI'm at in my life, and it's not
always been this way, there weretimes that I was very erring on the
side of obsessive about really tryingto dial in my diabetes, but now and,
and conforming food to match that.
Now I'm at a place where I very muchjust want my life to be what is enjoyable
(14:56):
to me and all foods fit and, and muchTavia's point, I'll just clean up the
mess with different, whether it's movingmy body more or some Afrezza or hydrate
or whatever, like, whatever that is.
But I no longer want to have this rigidrelationship with blood sugars or food.
Gary Scheiner (15:22):
I love how you've learned to adapt.
That's that the adoption is key.
Kristi Paguio (15:28):
I guess I have, there's different feelings of life
that you've gotta focus differentlysometimes with diabetes, right?
This is not, yeah, but at thestage of life that I'm in right
now, that's something that Iam per-- really protective of.
Yeah.
That my relationshipto food and myself is.
Gary Scheiner (15:46):
My two big challenges.
Uh, one is when I do golow, I can't stop eating.
I mean, I, I preach to ourclients night and day about
proper treatment of hypoglycemia.
I talk about that till I'm blue inthe face and I, I'm pretty convincing
when I tell them, but when it comes tomy own hypoglycemia, I am the worst.
(16:10):
I just eat everything and anything Ican get my hands on, and oftentimes
it's not the kind of stuff that'llraise your blood sugar quickly.
It's, as I said, everything and anything Ican get my hands on and I have not figured
out a, a very effective solution to that.
Kristi Paguio (16:27):
I struggle with that too, where like, I, I feel like
with the tools that we have now,the hybrid closed loops, like, I
probably need four grams of somethingto deal with a blood sugar, a low.
But like I, my body does notfeel satisfied with four grams.
So I've got like this little lovely soda.
(16:50):
That's nice.
'cause it's got a little screw top andI can, you know, but I have a hard time
Gary Scheiner (16:56):
Tavia's showing her glow gummies.
Tavia Vital (16:58):
These are my favorites because you have to, you chew
'em for a couple of seconds.
So the part of your brain that tells youyou need to be chewing food, you get that.
Um, and they kick in fast.
So I don't have that prolonged,I still need to eat more food to
feel better or feeling as often.
Does it, does it never happen whereI do what Gary just talked about?
(17:20):
Well, that wouldn't be true, but,but most of the time if I stick with
those or I stick with smarties, thenI'm not inclined to eat more food.
I just, I get betterfaster and then I move on.
Gary Scheiner (17:32):
Yeah, I know these,
Tavia Vital (17:32):
but like in the middle of the night or late at night, man.
Gary Scheiner (17:37):
I know these, these glucose melts, uh, I find work
faster than anything else I've found.
Liquid?
Solid?
Doesn't matter.
These, these are quick, and if Iuse them, usually I'll just take
a couple of these and I'm good.
But then if I'm around any kind offood, and like you said, Kristi,
it, it's not so much what treatsthe low, it's what satisfies me.
(18:00):
I, when, when I'm low,I just, food feels good.
It's just, it's verysatisfying to just keep eating.
So that's the challenge.
The other challenge is theimpact of physical activity.
'cause I work out in differentways, on different days, at
different times, but almost everyday I'm getting some activity.
The effects of that don't justoccur during the activity.
(18:23):
They, they go on well beyond that.
So the more active I am, themore sensitive I am to insulin
for a while, but the less activeI am, the less sensitive I am.
So I. It's a tough thing to adjust tobecause every minute of every day my
sensitivity to insulin is changing.
Uh, I think we need the, the, uh,software engineers to come up with an al
(18:46):
an algorithm adaption for how physicallyactive you've been in the recent past.
'cause I don't wanna bethinking about that constantly.
Kristi Paguio (18:54):
I wish there was also an algorithm or some sort of like,
I mean, they don't want more datastreaming my way, that is for sure.
Um, not with already getting255 blood sugar readings a day.
Right.
But I, I wish there was somethingfor like adrenaline and cortisol,
'cause I definitely will notice littlebumps or spikes in blood sugars.
(19:15):
I wish I knew how long, how muchthat that was happening so that
I could factor in my response.
As I'm watching, my blood sugars changed.
Gary Scheiner (19:26):
That would be a neat trick, Kristi, to figure that part out.
Tavia Vital (19:29):
Yeah, for sure.
Gary Scheiner (19:31):
What do, what do you both do to stay in shape?
Tavia Vital (19:34):
Um, I do, right at this time of year, there's a lot of
yard work and pool work, so I havemy pool cleaning guns available now
for, can't see 'em on the computer,on the screen very well, but yeah,
Gary Scheiner (19:45):
we're we're talking arm muscles.
Not military.
Tavia Vital (19:48):
Not military guns.
Correct.
Right.
Yeah, yeah.
So that, and walking regularly.
Those are my two big ones.
And then swimming in thesummertime, bike riding.
But the ones I do regularlywalking and yard work and working
on that dang swimming pool.
Gary Scheiner (20:06):
Yeah.
As an Iowa girl, did youever have to do farm work?
Tavia Vital (20:10):
I did not have to do livestock farm farm work.
I did row beans.
We decided I was too short to rowcorn, so, or detassel corn, so I row
beans where you walk through the, therows and get out all the weeds that
shouldn't be there with the hoe andsome gloves and try not to get bit by
any spiders or snakes or mosquitoes.
Gary Scheiner (20:33):
Yeah, it sounds like a workout.
Tavia Vital (20:36):
And I had no, no modern technology available at that time.
No sensor, no pump.
It was just Lantus and Humalog andI think we knew that at that point
in time, carb counting mattered.
It was the exchange diet for a long time.
I, I just brought a cooler with meand it had regular Mountain Dew and
Oreos in it, and every couple ofrows I'd just take some and then
(20:59):
I keep going and then take some.
Yep, that's what I did.
Gary Scheiner (21:03):
Mountain dew and Oreo diet.
I like that.
Tavia Vital (21:06):
I was, I was, I was, what can I fit how into this cooler?
Kristi Paguio (21:11):
I love that.
I'm definitely more active in the summer.
I love gardening.
I love being outside.
I don't mind pulling weeds, justanything that moves my body.
Um, bike rides has been really fun lately.
We're in a new neighborhood, soit's been fun to go and explore.
We've got some nice hills around us,so that's been good to feel that.
Gary Scheiner (21:33):
And you're in western Michigan, right?
Kristi Paguio (21:35):
Yeah.
Yep, yep.
In the Grand Rapids area.
I also love walking and swimming.
I don't have great access toswimming, but that would be, I would
be all over a pool if I had one.
Like Tavia does, but
Gary Scheiner (21:52):
Nice.
Yeah, so it's nice to lead by example.
You know hopefully our patients,uh, see how we benefit and follow.
Uh, but, and we all have ourspecialties, nursing, mental health
exercise, physiology in my case,but something we have in common.
We're all certified diabetes careand education specialists as well.
(22:13):
So what, why did you get intothat field and, and what do you
like about working as a CDCES?
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(22:57):
And now back to our program.
Kristi, why don't you tell us first?
Kristi Paguio (23:02):
So I stumbled into it.
Um, I, my husband and I moved tothis area from, moved to Grand Rapids
from Chicago, and we thought we weregonna be here very temporarily and
there was an acquaintance that we hadthat worked for the local hospital.
And the first job that I had withthe hospital was not a great fit.
(23:24):
It was doing home visit, high riskpregnancy, so kind of overlapped
with, but in my graduate program Ihad no idea about anything in the
medical field and, and psychology.
Um, but there was a position fora pediatric, um, social worker
or, a social worker in ped endo,in pediatric endocrinology.
And so I applied.
(23:45):
I was like, I don't even knowwhat, I didn't even know what that
was 'cause I was, I didn't know Isaw a pediatric endocrinologist.
I was diagnosed as an adult with typeone, so it just, I spent the first five
years in pediatric side and then inthe adults side, they, the adult wanted
to grow something a little bit moresophisticated and they recruited me to
(24:09):
build the mental health part of that.
And so it just kind ofkept going from there.
And really, the credentials didn'tnecessarily mean a whole lot to me.
I think it was just more about feelingseen and the specialty area that I have
just didn't, wasn't represented in my, mysocial work licensure, so I wanted this
(24:33):
other one to show that I specialized.
Gary Scheiner (24:35):
It's grown.
Now you know, the ADA has awhole directory of mental health
professionals in the diabetes space.
You know, it's finally getting, it'sjust due after many, many years.
Kristi Paguio (24:46):
Yeah,
Gary Scheiner (24:47):
I, I developed my interest because I met a guy, literally, I, I was,
it was a few years after my diagnosis.
I was having a lot of blood sugar issues.
I had some serious lows becauseI, I play a lot of basketball.
I was getting lows in the middleof the night after playing,
and I went to a, a hospital.
Con, uh, uh, class about diabetes andI met a guy named Tom Kowalski who
(25:10):
was an exercise physiologist and healso had type one, and he was teaching
everyone about, uh, you know, thingsyou can do to manage your blood
sugar during and after exercise.
And it just blew my mind.
I, I mean, I had never heard atthat point about self-adjusting
insulin, about, you know, havingextra carbs and things like that.
(25:31):
And I said, I wanna do this.
I, I, I, this is, thisis what I want to do.
I want to get good at it andbe able to teach other people.
So that's when I went and got mymaster's in exercise physiology and
landed a job with the Joslin Clinic,and it kind of grew from there.
Tavia, what got you started?
Tavia Vital (25:49):
Sounds sort of similar to your story.
Gary.
I had to go...
Gary Scheiner (25:52):
you met Tom Kowalski also?
Tavia Vital (25:54):
Well, except mine, mine wasn't named Tom, but I was forced
to go to a hospital based, uh,diabetes education series of group
classes in order to get my firstappointment with the endo there.
When I moved to, um, Colorado areaand I was really kind of salty and
irritated of having, I'd alreadyhad diabetes for 25 stinking years.
(26:17):
Now you're making me take workoff and go to these classes.
In one of the classes, the educator at thetime, her name is Terri Ryan-Turek, um,
she worked at the University of ColoradoHospital and now she's in Hawaii doing
her diabetes educator goodness there.
Um, she was teaching the classand it was time for a break and
she was checking her blood sugarand said, oh, I'm a little low.
(26:39):
And I looked around theroom and nobody freaked out.
Nobody was like, oh, do you need moreinsulin or Should I call an ambulance?
Or all the things that, you know,people who don't know anything about
diabetes or inclined to say to you inthat moment, which is super not helpful
and I thought, this is a, a clinicdesignated, at least in large part,
to people who take insulin and havediabetes, and I wanna do what she's doing.
(27:04):
It would be so great to be able to, andI actually learned some things in the
classes, so it was worth my time, eventhough I didn't know it was going to be.
And I thought if, if I could give back toother people so that they could live well.
I'm only here because I had smartdoctors and smart parents that pushed
(27:25):
the bounds on what you can and can't do.
And somebody says, you can't do it.
Well, why can't we just do it this way?
I think we could, right?
And, and I could do this, and that'swhere my light bulb moment was.
And so I went back to school to become anurse so that I could become a certified
diabetes care and education specialist.
And they thankfully hired me in thatsame clinic several years later.
(27:48):
Um, and that's where I got my, my start.
Gary Scheiner (27:50):
Awesome.
Kristi Paguio (27:51):
And when I think about,
for me, uh, I, I had no role model.
I never met anybody that did what I wishso much there would've been somebody
like me at my diagnosis or anywherealong my journey to come in and being
(28:15):
like, just talk to me about any of themental and emotional parts of diabetes.
So that, that I think was a big driverfor me when I didn't see any examples
was, I know what it feels, I know whatit's like to not ha... and, and I've
(28:37):
worked with amazing people over mycareer, like as a patient, but, and
professionally, but I wish there would'vebeen somebody like me to talk to.
Gary Scheiner (28:48):
Yeah.
And the, the patients that we work with,uh, I mean, I love this work because we
develop relationships with our patientsthat go on long term, and we really do
get to experience the, the changes thatthey go through and, and the benefits that
they reap from the work we do together.
There's also, there are theirshare of weird oddities that we
(29:10):
have to deal with in our work.
We used to think that our bigchallenge was getting patients
to get their blood sugars down.
Nowadays I see more patientswho are just suffering from, so
much hypoglycemia because I don'tknow if they're misinformed or
misguided, but they feel like anyhigh glucose is just killing them.
(29:30):
And, and they, they can'tsurvive anything above normal.
So helping them understand thatlow blood sugar is also their enemy
and it needs to be dealt with.
Uh, but you know, Kristi, what are someof the strange oddities that you have
to deal with in your day-to-day work?
Kristi Paguio (29:50):
I think the biggest, um, I think the, a lot of the conversations
that I focus on with clients is helpingreduce shame in a sense of failure around
diabetes that are outside of range.
and that blood sugars can fluctuateand they're not in any danger as well.
Of course, we're aware of the risk ofcomplications, we're aware of, right?
(30:17):
Like there is, there is some levelof danger that is inherent to type
one diabetes, but I think a bigpart of my work I see is just really
helping people either loosen their,
loosen their grip a little bit withhow perfect they want things to be.
(30:37):
'cause it just can wreak havoc,um, in a multitude of ways.
And or if somebody's reallystruggling to embrace it, reducing
that shame as well to like help themunderstand this is how to stay safe.
So it's really kind ofcoming at it from either,
(30:58):
either extreme and meetingsomebody where they're at and
figuring out what helps them.
What helps them thinkabout it in a way that,
Gary Scheiner (31:06):
yeah, it, it helps them to see the bigger picture.
I mean, we're in this for qualityof life ultimately, and part of
that is managing your diabetes soyou don't develop health problems.
But part of it, al also having a qualityof life now where you're not being,
uh, you know, subjugated to low bloodsugars frequently, and you're not
(31:27):
obsessing over your diabetes and missingsleep and not enjoying foods and the
activities that that you really love?
'cause it just happens far too often.
Do you agree with that?
Kristi Paguio (31:40):
Yeah, yeah.
Absolutely.
Yeah.
Gary Scheiner (31:43):
Yeah.
Tavia, are there any odd, unusualthings you have to deal with?
Tavia Vital (31:49):
I don't, I don't know about odd, but I think maybe challenging when
working with clients who are also dealingwith other complicated health issues.
Or complex, if not, not necessarilycomplicated but complex health issues
such as undergoing chemo or radiationtherapy or someone who's going through
(32:15):
getting eggs, the egg retrievalprocess and getting ready for IVF
and going through IVF to try to getto a healthy pregnancy standpoint.
Or another one I think where thingsget, where it's more challenging is
when someone comes in that has, uh, ahistory of a, an eating disorder, not
(32:38):
even somebody who's currently activelysuffering from an eating disorder
because that's front and center.
If they've come and they've putit on their paper, they're at the
stage that they can talk about it,and they're actively working with
a therapist and they are takingsteps that are already in place.
That's pretty structured.
It's for people who have sort of resolvedthe acute phases of their eating disorder,
(33:01):
but it's still there and it makes it morechallenging to be direct about healthy
eating, taking doses, and not omittingdoses because you don't wanna own up to
the fact you eat something or not wantingto keep detailed records for a few days
so we can do great basal testing and carbratio adjustments because there's so much
(33:23):
potentially shame or guilt or those othernegative emotions that get really big when
you're really focusing in on your diabeteseducation and and adjustments and things.
So I think those are, I don'tknow that they're odd, but
they're challenging for me
um, and for the clients, that'swhy they signed up for visits so
we can navigate through together.
Kristi Paguio (33:42):
Sure, yeah.
They really kind of workagainst each other, right?
Because when you're trying to resolvedisordered eating, you're trying to not
count and measure everything, right?
But then insert diabetes that if you'retrying to really dial it in, you're doing
counting, measuring, weight, like itis, it's a, it's a conundrum to be in.
(34:07):
It is not...
Tavia Vital (34:09):
and now typically, if they aren't already working with a
healthcare provider that, that theyknow is well versed with type one,
then I will pause and say, I reallyhighly recommend, go see Kristi.
Go see, um Anna, because you want thiswith your diabetes and this other area
is a struggle and we need to find away to connect them so that we can
(34:33):
get you what you're trying to achieve.
There's a way, yeah.
I think you do...
Gary Scheiner (34:37):
I love that we have such a nice multidisciplinary team here at
Integrated Diabetes and it allows us to,you know, bounce ideas off each other,
uh, gain the expertise from each other.
But let's have a little funabout, with our teammates.
Uh, we, we work with a fairlyeclectic group of, of Type 1 CDCESs,
(35:01):
so I just wanna get your opinion.
Which member of the IDS teamwould be the first to die if
there was a zombie apocalypse?
I'll tell you mine, I think it wouldbe Nancy, our office administrator.
Tavia Vital (35:15):
That's who I was thinking of.
Oh, no, poor Nancy.
Gary Scheiner (35:17):
Only because Nancy is terrified of horror movies.
She's never seen, she doesn't knowyou gotta, you gotta get the brain,
you gotta stab the brain to kill them.
And I, I just, I can't see her survivingvery long in that kind of environment.
Do you agree with me, Tavia?
Tavia Vital (35:34):
That's who I thought of first and I thought, do we have to limit
it to the CDCESc or can I pick Nancy?
Gary Scheiner (35:39):
It could be anyone on the team.
Kristi, who do you think?
Kristi Paguio (35:42):
Well, I would, I would add myself.
Nancy, and I will be the first ones to go.
'cause I don't do horror either.
So we would probably both beparalyzed, frozen in fear and.
We'll just, we'll, they'll justget two at a two at a time.
Gary Scheiner (35:57):
Fair enough.
When you think of a type A personality,who on the IDS team comes to mind first?
Tavia Vital (36:06):
Me?
Maybe
it's me.
Gary Scheiner (36:09):
I would agree.
I concur with that choice.
Tavia Vital (36:13):
Maybe Jenny is my second runner up.
Kristi Paguio (36:17):
Yeah.
Maybe Jenny too, maybe,
Gary Scheiner (36:20):
right.
Who do you think is thebest culinary skills?
Tavia Vital (36:26):
Maybe, maybe, um, Dana.
Only because I've seen morepictures of Dana's cooking events.
So..
What do you think, Christy,
Kristi Paguio (36:36):
Dana?
Sure.
She gets the award.
Mm-hmm.
Gary Scheiner (36:40):
I'll take Jenny.
Only because Dana's in Texasand Texas cooking is odd.
I don't know, Jenny.
Yeah, Jenny's done some prettycreative stuff from that standpoint.
Tavia Vital (36:50):
Does, that's true.
Gary Scheiner (36:51):
Um, who do you think has the best humor, sense
of humor of anybody on our team?
Tavia Vital (36:56):
That's a tough one.
I feel like one of the things I reallyenjoy about our team, besides the
important things for doing our jobwell, right, is how much humor we can
throw into whatever we're dealing with.
I really appreciate Alicia's.
It's strong.
It just pops into any momentshe can just, there's some
(37:17):
stress or we're hyper-focused.
It just, it comes in andI can't stop laughing.
Kristi Paguio (37:23):
I think you can be very funny too, Gary.
Tavia Vital (37:26):
Yes.
Gary Scheiner (37:26):
Thank you.
That's true.
I was thinking Alicia, uh, she, yeah.
Yeah, she breaks me up sometimes.
Kristi Paguio (37:32):
I would say between you and Alicia.
Yeah, you definitely can bring the,
Gary Scheiner (37:36):
well,
Kristi Paguio (37:36):
the defector thing
Gary Scheiner (37:37):
Speaking of competition, who, who on our team
would win an arm wrestling contest?
Kristi Paguio (37:43):
I would never go up against Alicia.
Tavia Vital (37:47):
Gosh.
But you know, Anna does all ofthat like P 90 X, kettlebell.
I don't know.
I don't, I bet, I bet it would be Anna.
Gary Scheiner (37:56):
I was thinking Anna and Kathryn,
Tavia Vital (37:58):
yeah.
Gary Scheiner (38:00):
Kathryn's in good shape.
She used to be in, I mean,she could lift a truck.
I mean, that that girl is strong.
Kristi Paguio (38:07):
Well, some secret ninjas on the team.
I was not.
Gary Scheiner (38:09):
Who do you think is most organized on our team?
Kind of goes with the type A personality.
Tavia Vital (38:18):
Uh.
I give the illusion of being organized.
Certain things are extremelyorganized in my life.
Yes.
Gary Scheiner (38:25):
Nevertheless, whether it's the illusion or not, you're organized.
Tavia Vital (38:29):
I would say Jenny as well.
Like if you ever, she stops and tells youall of the things she's doing in a day.
You have to have things inorder to do all of those things.
So yeah.
Gary Scheiner (38:41):
Who would you most like to get drunk with?
Tavia Vital (38:45):
I need a new question.
I don't wanna get drunk.
Um, but maybe Kristi, because Kristi wasjust talking about that earlier I guess
Kristi Paguio (38:53):
I'm gonna have an adult beverage with a
friend later this afternoon.
Um, pre national holiday.
Um, but I'm a lightweight.
But I was thinking you TAvia itwould be really fun for to watch
the two of us barely get throughprobably one adult beverage and
Tavia Vital (39:10):
We could share one.
Kristi Paguio (39:12):
Yeah, we'll share one.
Can you pour into two glasses?
Gary Scheiner (39:15):
Yeah.
I would love to see Kristi drunk,just to get you to open up, but
Dana I think would be a lot of fun.
Tavia Vital (39:23):
Dana would be fun.
Gary Scheiner (39:24):
She's fun to begin with.
Tavia Vital (39:25):
Yeah.
Kristi Paguio (39:26):
Probably just fall asleep.
Not that I couldn'tget a little wacky, but
Tavia Vital (39:32):
if there was, if there were dancing involved,
then I wouldn't fall asleep.
But I'm with you, Kristi.
If we're sitting down andwe're talking and it's relaxed.
You get more than a drink in me and then
Kristi Paguio (39:42):
I'm thinking food happening.
Yeah.
Keep some food flowing and yeah.
Mm-hmm.
Gary Scheiner (39:48):
Okay.
Fair enough.
Okay, now there are some rapid fire.
Just get your quick responses to these.
So first, when it comes to fingerstick glucose monitoring, lick or wipe.
Tavia Vital (40:02):
Wipe.
Kristi Paguio (40:03):
Wipe.
Tavia Vital (40:04):
Gross.
Gary Scheiner (40:05):
Lick.
Lick.
Tavia Vital (40:06):
Oh gosh, no.
Never.
Um,
Kristi Paguio (40:09):
I have lovely friends that I watch Lick and, I, that are in the
medical field and I don't understand, butI, to each their own, no judgment, but
Gary Scheiner (40:19):
DIY or commercial system,
Tavia Vital (40:23):
DIY
Kristi Paguio (40:25):
DIY, but to again.
In the situation, there's some
Gary Scheiner (40:30):
DIY.
This is you personally with you.
DIY.
Tavia Vital (40:34):
Yeah.
Gary Scheiner (40:35):
Coffee or tea?
Tavia Vital (40:37):
Coffee.
Kristi Paguio (40:38):
Coffee.
Tavia Vital (40:39):
Tea is lovely.
Coffee wins.
Gary Scheiner (40:41):
Diet soda.
I don't like hot drinks.
Oh, I'll abdicate from that question.
Um, mountains or prairies.
Who came up with these?
Tavia Vital (40:53):
Beaches, beaches or tropical rainforest.
That's what I pick.
Kristi Paguio (41:02):
So Ty, I would do mountains.
Mountains are beaches.
I mean, anything may, I mean, prairiesare beautiful, but you know, yawn.
Tavia Vital (41:10):
But I live in a prairie sort of.
Gary Scheiner (41:11):
You live in a prairie.
Tavia, I'll take bike trail.
Uh uh, let's see.
Uh, favorite color for a pump?
Tavia Vital (41:20):
I would say turquoise or bright yellow,
like a metallic bright yellow
Gary Scheiner (41:27):
Kristi, you got a color?
Kristi Paguio (41:29):
You know, purple or like invisible.
Just can it just,
Gary Scheiner (41:34):
Hmm.
Kristi Paguio (41:35):
be transparent?
Tavia Vital (41:36):
Well just, you know, be non, it could be like a
hologram, like when it changes thelight, then it changes the color.
I would do that.
Gary Scheiner (41:47):
That's pretty high tech.
I would take a PhiladelphiaEagles midnight green color.
I use that color in alot of my house painting.
Debbie's always on me for that,but best concert you ever saw?
Tavia Vital (42:03):
Gosh, that's a tough one because it was a long time ago
when I saw it, so I have to think.
I think probably Boys to Men.
Loved that.
Gary Scheiner (42:14):
My whole image of you is blown.
Boys to Men.
Okay.
Alright.
Alright.
Kristi, what do you got?
Kristi Paguio (42:22):
I saw the cranberries at, um, at an amphitheater area, um, in
Michigan and that was pretty phenomenal.
Gary Scheiner (42:33):
Okay.
I'm, I'm, I'll take StevieRay Vaughan incredible show.
Favorite snack?
Kristi Paguio (42:40):
Popcorn.
Tavia Vital (42:42):
I don't have one.
How do you have one favorite snack?
Come on.
Gary Scheiner (42:46):
Okay.
I really like you're watching Boys to Men.
You're hungry.
What are you eating?
Tavia Vital (42:50):
Oh, how about what I eat at home at night?
Snack of popcorn or the littlepackets of, um, trail mix that
have a variety of different kindsof nuts and dried blueberries
and little pieces of chocolate.
Gary Scheiner (43:03):
Yeah, I like that.
All right.
I like those jacks cheese curls.
Those are great.
Your favorite low carb snack.
Tavia Vital (43:10):
Low carb?
I don't eat low-carb.
Gary Scheiner (43:13):
No.
Yeah.
I don't have one.
Tavia Vital (43:14):
A cheese stick.
I mean, I like cheese.
So cheese stick or
Kristi Paguio (43:19):
veggies and hummus.
Tavia Vital (43:21):
Yeah.
That's good.
Some carrots.
Gary Scheiner (43:23):
You can tell This is a carb loving crowd.
Kristi Paguio (43:25):
Yeah.
Tavia Vital (43:25):
Yeah.
Oh, carrots.
All right.
Staycation or foreign travel?
What do you like?
Kristi Paguio (43:31):
What?
Foreign travel.
Gary Scheiner (43:33):
I'm not much of a tourist.
I don't like looking at sights andtourism things, but I like to travel.
I like to see new places, butnot looking at touristy stuff.
Tavia Vital (43:46):
I say foreign travel and eat the food in the different places.
That's what I, I like that
Gary Scheiner (43:51):
Now you're talking and
Tavia Vital (43:52):
seeing the different landscapes or different,
Gary Scheiner (43:54):
do a food tour of the world.
Tavia Vital (43:56):
Yeah, that would be good.
Gary Scheiner (43:58):
Okay.
Tavia Vital (43:59):
Excellent.
All right.
Favorite kind of movie?
Is it horror?
Is it comedy, drama, orlike a Hallmark movie?
Kristi Paguio (44:07):
Documentary or comedy.
Gary Scheiner (44:10):
Um, I like the genre of, uh, what do you call
it, organized crime Movies.
Like the Godfather type.
Kristi Paguio (44:19):
Mm-hmm.
Gary Scheiner (44:21):
What about you, Tavia?
I like
Tavia Vital (44:22):
drama and suspense.
That's not gory.
Keeps you on the edge of your seat.
Gary Scheiner (44:28):
Well, I feel like I know you two so much better now and,
uh, I'm glad we had a chance to spendsome time discussing this stuff.
I'm a little scared about what ourcolleagues on our team are gonna,
how they're gonna answer some ofthose questions that we asked before.
I can't wait to see the podcastswith, uh, with them on 'em.
(44:48):
Yeah, those will be coming out.
Ours comes first, so we get tosay and do whatever we feel like.
But thank you both for joining in, uh,Kristi Paguio, who provides counseling
services for our patients, and TaviaVital, who is a bilingual CDCES and
(45:09):
nurse, and does an outstanding job withall levels of patient care, including all
the high tech stuff that's available now.
Uh, the open source systems and, uh, wedidn't even mention Tavia, you also have
a son with type one, so you're very intouch with the needs of, uh, parents and
family members of those with type one.
Tavia Vital (45:30):
Yep.
Gary Scheiner (45:31):
And the, tell us, mention the, the program
that you run for support people.
Tavia Vital (45:36):
We have a timeout for caregivers and it meets
every couple of months.
It is free and it's a space where parentscan come to see other parents face to
face virtually, and get that supportthat you need because most parents
are doing this really on their own.
It's just a safe space.
We usually have a, a focus area thatwe plan to talk about, but also we open
(46:01):
it up for questions or frustrationsor things that are coming up that
parents might be nervous or, or, orwhatever the emotion of the day is.
It's where we meet together and kindof work through this thing together.
Gary Scheiner (46:15):
And how much does it cost to participate?
Tavia Vital (46:17):
It's free.
Gary Scheiner (46:19):
That's a good price.
I like that.
Tavia Vital (46:20):
It is a good price.
Gary Scheiner (46:22):
And I even, I'll give people a discount on that if they need it.
Tavia Vital (46:26):
Yeah, just ask Gary for the discount.
Gary Scheiner (46:28):
Got it.
Alright.
Well, again, thank you Kristiand Tavia for joining me today.
Uh, links about that programwill be in the show notes.
And I'm Gary Scheiner remindingeveryone out there to keep
thinking like a pancreas.
Thanks for tuning in to ThinkLike a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow or subscribe
(46:51):
on your favorite podcast app.
Think Like a Pancreas-- the podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
care is personal because we live it too.
Our team of clinicians, all livingwith type one diabetes understands
the challenges firsthand.
(47:12):
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech, sports
and exercise, weight loss, type onepregnancy and emotional wellbeing.
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
(47:32):
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, the podcast.
I'm Gary Scheiner.
Wishing you a fantastic week ahead.
Don't forget to think like a pancreas.
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:37):
healthcare provider before implementing.
Welcome to Think Like aPancreas, the podcast.
I'm your host, Gary Scheiner, and I'mproud to kick off a series of, uh, podcast
episodes to give you a chance to get toknow our team on a more personal level.
And I'm joined by two ofour ace clinicians today.
(00:58):
Uh, Tavia Vial, who'sa, a nurse, and CDCES.
And Kristi Paguio, who isan, uh, LCSW, and a CDCES.
So, uh, welcome the two of you.
Glad to have you here.
Tavia Vital (01:12):
Thank you.
Glad to be.
Gary Scheiner (01:15):
So we're going to talk a little bit first about your
backgrounds and, and then get intosome more personal areas involving
diabetes and get some opinions youhave about the rest of the team.
It's gonna be fun.
I'll try my best not to embarrass anybody.
Okay?
Tavia Vital (01:31):
That's appreciated.
Gary Scheiner (01:33):
So, hey Kristi, start with you, uh, what year, remember
what year you were diagnosed.
Kristi Paguio (01:38):
Actually, I just had my 25th anniversary.
My diaversary, it was June.
Um, it was early June of 2000.
Gary Scheiner (01:46):
Yeah.
I used to get, I didn't know how to, youknow, respond to people who congratulated
me for making 30 or 40 years, and thenI realized it beats the alternative.
When you were first diagnosed, uh,what were some of the management
tools that you were using, Kristi?
Kristi Paguio (02:04):
When I was first diagnosed, I didn't totally realize
this, but it was just as Lantus had comeonto the market, so I was doing, um, I
don't know if it was NovoLog, Lantus.
It's been such a long time ago,and then I transitioned to an
insulin pump a few years later.
But, um, when I left the hospital,I was on Lantus and NovoLog, and
(02:26):
then the endocrinologist I wasseeing transferred me to the, um,
transition me to the fancy 75/25.
And I was on that for a few years.
Really...
Gary Scheiner (02:36):
pretty mixed insulin as a type one.
Kristi Paguio (02:40):
Yep, and I adhered to that, but it just ended up not
offering the flexibility that I needed.
And so I was, I transitioned to a pump.
Well, I transitioned toMDI and then to a pump.
'cause I needed,
Gary Scheiner (02:57):
I was originally gonna say, you never got to enjoy the beauty
of NPH, but with 75/25, you wereon NPH not once, but twice a day.
Kristi Paguio (03:07):
Yeah.
Yeah.
I never thought aboutit like that, but yeah.
Yeah,
Gary Scheiner (03:11):
yeah.
Tavia, you were diagnosedearlier than Kristi, right?
Tavia Vital (03:15):
Yep.
1981, April, 1981.
So I was two and a half and I stillhave a little flashback memory from
that diagnosis, which I don't reallyremember anything else from that age.
But we were in the hospital and theytaught my mom how to do insulin injections
with it, with a syringe in it orange.
(03:36):
And the day she was supposed to give memy first injection, there was a tornado.
So they were taking all of the patientsand putting them into the central
hallways of the hospital system.
And someone comes in and says,quick, give this insulin injection
to your daughter before you, beforewe have to evacuate for the tornado.
(03:57):
And my mom said, no, yousaid inject then eat.
It's very important
or she'll have a low blood sugar notknowing what any of this means, right?
And the nurse was panicking, apparently,and said, no, you have to inject it quick.
And my mom was freakedout and said, I can't!
And so anxiety won there and we gotto the hallway and I didn't have a
fatal insulin injection the firsttime my mom tried, which is good.
(04:20):
Um, and then in the hallway, a lady was ina rocking chair and rocked on my big toe.
That's what I remember.
I remember sitting in a rockingchair with my mom and crying, and
somebody had rocked up my big toe.
I don't remember the diabetes part at all.
Gary Scheiner (04:32):
All with a tornado bearing down on you.
Tavia Vital (04:36):
I don't know where the tornado was.
I just know that there was awarning, which means somebody saw
one in the nearby, nearby area.
Yeah.
Gary Scheiner (04:42):
Were things flying around the halls of
the hospital from the tornado?
Tavia Vital (04:46):
They may have been, but I just remembered my big toe hurt.
So no idea!
Gary Scheiner (04:50):
You were two, you know,
Tavia Vital (04:52):
we, we started on my mom, I asked my mom about
this, uh, a little while back.
They started me on dilutedinsulin of some sort.
So.
They, uh, mom had a diluted at home,and at that time it was animal insulin.
We started, uh, with, I started withcow insulin and had giant welts and
lumps and bumps and, and then switchedto pig insulin, which ended up causing
(05:19):
a lot of hard areas, real, like mylegs felt like wood, like blocks
of wood for most of my childhood.
Um, and at some point in time duringmy childhood, then there was, you
know, the recumbent DNA, we switchedto good old NPH and regular.
Um, and I don't remember ifwe ever did mixed or not.
(05:41):
I don't that, you know, so long ago.
I just know that there, I had to takeinsulin in the morning and in the evening.
I don't think I had to take a lunchdose while I was in school until it was.
I think Lantus and Humalog,when I was in high school,
Gary Scheiner (05:59):
the NPH in the morning would quote unquote, cover your lunch.
Tavia Vital (06:04):
Right?
I'm sure it did a great job, and I knowI had to check my sugar, so I had to
go to the office and check my bloodsugar on a manual finger testing strip.
There were no digital meters untilsometime in later grade school.
Then I got a digital one.
I was still little like young kid, but.
Um, yeah, it was a big thing.
(06:25):
I had a big, it was abrown Tupperware box.
I hated that thing.
It was so ugly.
It was huge.
It was like this tall and this big.
Can't even show you in my, my windowhow big it was, and it had the meter
and the cleaning and the strips and thegiant guillotine finger poker thing.
That's what we used.
Gary Scheiner (06:43):
Being a nurse, do you know what NPH really stands for?
Tavia Vital (06:48):
What are you saying?
You're gonna make a joke, so youtell me what you think it means.
What, what does it..
Gary Scheiner (06:52):
As a nurse, you know what it actually stands for.
Tavia Vital (06:54):
Oh gosh.
The protum-- I don't remember right now.
Gary Scheiner (06:58):
N-Neutral.
Tavia Vital (06:59):
I'm on.
I'm on the spot.
I can't do it.
Gary Scheiner (07:02):
Neutral Protamine Hagedorn
Tavia Vital (07:04):
There you go.
What he said.
Yep.
Gary Scheiner (07:06):
But not particularly helpful is what
we all refer to that as now.
Tavia Vital (07:10):
That's what I was waiting for.
I could see the twinkle.
I knew you had something up your sleeve.
Gary Scheiner (07:13):
Yeah, Kristi, when you talked about how it
didn't allow you flexibility.
Oh it is.
It is a rigid, rigid insulin to use.
Kristi Paguio (07:21):
You know, at the time for me, I think it, what I was doing,
I just start and I was probablyhoneymooning for a while, like.
So it worked until it didn't work anymore.
And then I just really felt like Iwas failing at it and I'm so grateful.
'cause then I moved to Chicago andI started working with, with Dr.
(07:41):
Corcoran was my endocrinologist.
And so he just started toopen up the floodgates for me.
And the care, the level ofcare just changed dramatically.
And so I'm forever grateful for that.
But I followed that.
If I was told to eat breakfast,I was not a breakfast person.
I found a way to eat breakfast.
(08:03):
This car.., Like I followed it to a T.
My, one of my memories ofdiagnosis time was test strip
were not covered by insurance.
Tavia Vital (08:11):
True.
They weren't when I was diagnosed either.
Kristi Paguio (08:14):
So for me, now as a young adult, like, so, oh gosh,
I gotta test six times a day.
Not all of them, you know, you don'talways get a full sample in it, right?
Or it reads error, but somehow I am,I'm adding up the math right, and
was having some emotional reactionsto this brutal reality, and it was a
(08:37):
preexisting condition, so not coveredby insurance for the first year.
It was not nice
Gary Scheiner (08:45):
Tavia, when you mentioned the orange that reminded me... what I
remember most about insulin syringes.
I was a freshman in collegewhen I was diagnosed.
Uh, when I went back for sophomore year.
I was diagnosed in the summertime,so I went back for sophomore year.
Uh, my friends try to make light of it,and what we would do is I would take
(09:10):
my insulin syringes and draw up vodkawith them and inject them into oranges
to make screwdrivers still in the rind.
Tavia Vital (09:21):
So your friends didn't respond negatively to your diagnosis
then won 'em over by using..
Gary Scheiner (09:26):
No, no.
We had fun with it becauseI, I try to keep, you know,
doing everything I like to.
In fact, before dinner, the guysthat in my suite where I lived, we,
they would kind of bet on what myblood sugar was and some of them
would start asking me questions.
They got smart like, Hey,did you work out today?
You know, what'd you eat for lunch?
Was it like, all you can eat taco day?
(09:46):
Because they'd know my sugar would behigher if I ate that kind of stuff.
So they'd off put a dollar in theybet on who could guess my blood sugar.
And I had one of, you know, one ofthe early meters in the mid eighties,
uh, that, you know, it took about, youknow, a minute and a half to do the
reading, but it did, gave you something.
I went home from the hospital witha, you know, the vial of strips
(10:07):
that had a color chart on it.
You bleed on the strip andmatch the color change.
And yeah, that's very subtle colorchanges between a 150 and a 250 and a 300.
Very subtle differences.
So, you know, nowadays we're reallysplitting hairs and giving insulin and
micro doses with, with the pumps andeven with the smart pens that we use now.
(10:31):
So let, let's, let's shift to today.
Kristi, you're off 75/25, twice a day.
Uh, how are you, uh, what tools areyou using to manage your diabetes now?
Kristi Paguio (10:42):
I use the Dexcom G7 and I use the Omnipod Dash, but I Loop.
A friend of mine helped mebuild the Loop and that's what
I've been doing for the past?
Five years.
I built the loop in the middle of thepandemic in 2000 and, what was that?
(11:04):
22? No,
Gary Scheiner (11:05):
2020
20.
Kristi Paguio (11:07):
Right, right, right.
2020. Yeah.
Gary Scheiner (11:09):
I always remember COVID-19 is when it started.
So 20, 2020 is when itreally hit the brunt force.
Kristi Paguio (11:16):
Yeah.
Yeah.
So,
Gary Scheiner (11:18):
so you're looping, uh, which insulin are you using?
Kristi Paguio (11:22):
I use NovoLog.
That's what my insurance prefers.
So, and I do also use Afrezza.
I do that for the postprandial.
Gary Scheiner (11:32):
When do you use Afrezza?
Kristi Paguio (11:35):
I use that inhaled insulin to help when I've got a squirrelly blood
sugar that's double arrows up just tobring it down without, without a tail.
That's a newer therapy that I,I'm grateful my doctor was willing
to prescribe for me and let meplay around with it a little bit.
Another little tip and trick Ilearned from some of my friends
(11:58):
at diabetes training camp that
mm-hmm.
Gary Scheiner (12:00):
It's a long, long way from 75/25, isn't it?
Kristi Paguio (12:05):
Yeah.
I would say, I mean,that's so long ago, right?
Like I'm at the point now where someof that's like, I can remember when
I was first diagnosed, hearing peoplesay they don't really remember a time.
And that's kind of where I'm at too,is I've noticed in the last decade
or so, I don't really remember alot of what that was like, but for a
while it was very fresh, very real.
(12:27):
What it was like to not have diabetesand then what it was like to have it.
Gary Scheiner (12:31):
Yeah.
We used to have to make our lifeconform to our insulin program.
Kristi Paguio (12:36):
Right.
Gary Scheiner (12:36):
Now it's the opposite.
Kristi Paguio (12:38):
Right.
Gary Scheiner (12:38):
We, we live the life we wanna live and we make the insulin
program fit that and match it.
Ultimately, that's,that's what we try to do.
Tavia, how about you?
What are you, uh, usingto manage yourself?
Tavia Vital (12:53):
Um, I have, I am using Dexcom G6 and I use Omnipod.
I actually have a stash of arrows pods,and they, some may or may not be expired,
but they still seem to work okay.
So I'm using them, um, and thatRiley link and I, and I use that
to use a system called trio,which is like Loop, but different.
(13:18):
It's another, um, hybrid closedloop system that you can control
on an app on your cell phone.
And it has a lot, it offers alot of flexibility and tools that
help me manage my diabetes better.
Once they're set up and finetuned, then it does a lot of work
for me, which is why I like it.
Gary Scheiner (13:38):
Yeah.
So are both of you still able to enjoythe foods you like and the activities
you like and still manage your glucose?
Tavia Vital (13:47):
Yeah.
Yeah.
Does it always work out?
No.
Gary Scheiner (13:51):
Well, what doesn't work?
What kind of, what thingschallenge you still?
Tavia Vital (13:56):
Well, I think, I think lack of planning is my biggest challenge.
So I like to do things spontaneously.
So if I just eat a big lunch andthen I notice the weather is nice
on the weekend and I wanna godo something physical outside.
That's a challenge because now Ihave food digesting at who knows how
long it's gonna take, and the insulinis gonna be peaking probably about
(14:20):
when I'm ready to get out there.
So that's a challengethat I face for sure.
Gary Scheiner (14:25):
Kristi, do you have an Achilles heel with your
diabetes that still challenges you?
Kristi Paguio (14:29):
You know, I love what Tavi said.
I think for me, the, the place thatI'm at in my life, and it's not
always been this way, there weretimes that I was very erring on the
side of obsessive about really tryingto dial in my diabetes, but now and,
and conforming food to match that.
Now I'm at a place where I very muchjust want my life to be what is enjoyable
(14:56):
to me and all foods fit and, and muchTavia's point, I'll just clean up the
mess with different, whether it's movingmy body more or some Afrezza or hydrate
or whatever, like, whatever that is.
But I no longer want to have this rigidrelationship with blood sugars or food.
Gary Scheiner (15:22):
I love how you've learned to adapt.
That's that the adoption is key.
Kristi Paguio (15:28):
I guess I have, there's different feelings of life
that you've gotta focus differentlysometimes with diabetes, right?
This is not, yeah, but at thestage of life that I'm in right
now, that's something that Iam per-- really protective of.
Yeah.
That my relationshipto food and myself is.
Gary Scheiner (15:46):
My two big challenges.
Uh, one is when I do golow, I can't stop eating.
I mean, I, I preach to ourclients night and day about
proper treatment of hypoglycemia.
I talk about that till I'm blue inthe face and I, I'm pretty convincing
when I tell them, but when it comes tomy own hypoglycemia, I am the worst.
(16:10):
I just eat everything and anything Ican get my hands on, and oftentimes
it's not the kind of stuff that'llraise your blood sugar quickly.
It's, as I said, everything and anything Ican get my hands on and I have not figured
out a, a very effective solution to that.
Kristi Paguio (16:27):
I struggle with that too, where like, I, I feel like
with the tools that we have now,the hybrid closed loops, like, I
probably need four grams of somethingto deal with a blood sugar, a low.
But like I, my body does notfeel satisfied with four grams.
So I've got like this little lovely soda.
(16:50):
That's nice.
'cause it's got a little screw top andI can, you know, but I have a hard time
Gary Scheiner (16:56):
Tavia's showing her glow gummies.
Tavia Vital (16:58):
These are my favorites because you have to, you chew
'em for a couple of seconds.
So the part of your brain that tells youyou need to be chewing food, you get that.
Um, and they kick in fast.
So I don't have that prolonged,I still need to eat more food to
feel better or feeling as often.
Does it, does it never happen whereI do what Gary just talked about?
(17:20):
Well, that wouldn't be true, but,but most of the time if I stick with
those or I stick with smarties, thenI'm not inclined to eat more food.
I just, I get betterfaster and then I move on.
Gary Scheiner (17:32):
Yeah, I know these,
Tavia Vital (17:32):
but like in the middle of the night or late at night, man.
Gary Scheiner (17:37):
I know these, these glucose melts, uh, I find work
faster than anything else I've found.
Liquid?
Solid?
Doesn't matter.
These, these are quick, and if Iuse them, usually I'll just take
a couple of these and I'm good.
But then if I'm around any kind offood, and like you said, Kristi,
it, it's not so much what treatsthe low, it's what satisfies me.
(18:00):
I, when, when I'm low,I just, food feels good.
It's just, it's verysatisfying to just keep eating.
So that's the challenge.
The other challenge is theimpact of physical activity.
'cause I work out in differentways, on different days, at
different times, but almost everyday I'm getting some activity.
The effects of that don't justoccur during the activity.
(18:23):
They, they go on well beyond that.
So the more active I am, themore sensitive I am to insulin
for a while, but the less activeI am, the less sensitive I am.
So I. It's a tough thing to adjust tobecause every minute of every day my
sensitivity to insulin is changing.
Uh, I think we need the, the, uh,software engineers to come up with an al
(18:46):
an algorithm adaption for how physicallyactive you've been in the recent past.
'cause I don't wanna bethinking about that constantly.
Kristi Paguio (18:54):
I wish there was also an algorithm or some sort of like,
I mean, they don't want more datastreaming my way, that is for sure.
Um, not with already getting255 blood sugar readings a day.
Right.
But I, I wish there was somethingfor like adrenaline and cortisol,
'cause I definitely will notice littlebumps or spikes in blood sugars.
(19:15):
I wish I knew how long, how muchthat that was happening so that
I could factor in my response.
As I'm watching, my blood sugars changed.
Gary Scheiner (19:26):
That would be a neat trick, Kristi, to figure that part out.
Tavia Vital (19:29):
Yeah, for sure.
Gary Scheiner (19:31):
What do, what do you both do to stay in shape?
Tavia Vital (19:34):
Um, I do, right at this time of year, there's a lot of
yard work and pool work, so I havemy pool cleaning guns available now
for, can't see 'em on the computer,on the screen very well, but yeah,
Gary Scheiner (19:45):
we're we're talking arm muscles.
Not military.
Tavia Vital (19:48):
Not military guns.
Correct.
Right.
Yeah, yeah.
So that, and walking regularly.
Those are my two big ones.
And then swimming in thesummertime, bike riding.
But the ones I do regularlywalking and yard work and working
on that dang swimming pool.
Gary Scheiner (20:06):
Yeah.
As an Iowa girl, did youever have to do farm work?
Tavia Vital (20:10):
I did not have to do livestock farm farm work.
I did row beans.
We decided I was too short to rowcorn, so, or detassel corn, so I row
beans where you walk through the, therows and get out all the weeds that
shouldn't be there with the hoe andsome gloves and try not to get bit by
any spiders or snakes or mosquitoes.
Gary Scheiner (20:33):
Yeah, it sounds like a workout.
Tavia Vital (20:36):
And I had no, no modern technology available at that time.
No sensor, no pump.
It was just Lantus and Humalog andI think we knew that at that point
in time, carb counting mattered.
It was the exchange diet for a long time.
I, I just brought a cooler with meand it had regular Mountain Dew and
Oreos in it, and every couple ofrows I'd just take some and then
(20:59):
I keep going and then take some.
Yep, that's what I did.
Gary Scheiner (21:03):
Mountain dew and Oreo diet.
I like that.
Tavia Vital (21:06):
I was, I was, I was, what can I fit how into this cooler?
Kristi Paguio (21:11):
I love that.
I'm definitely more active in the summer.
I love gardening.
I love being outside.
I don't mind pulling weeds, justanything that moves my body.
Um, bike rides has been really fun lately.
We're in a new neighborhood, soit's been fun to go and explore.
We've got some nice hills around us,so that's been good to feel that.
Gary Scheiner (21:33):
And you're in western Michigan, right?
Kristi Paguio (21:35):
Yeah.
Yep, yep.
In the Grand Rapids area.
I also love walking and swimming.
I don't have great access toswimming, but that would be, I would
be all over a pool if I had one.
Like Tavia does, but
Gary Scheiner (21:52):
Nice.
Yeah, so it's nice to lead by example.
You know hopefully our patients,uh, see how we benefit and follow.
Uh, but, and we all have ourspecialties, nursing, mental health
exercise, physiology in my case,but something we have in common.
We're all certified diabetes careand education specialists as well.
(22:13):
So what, why did you get intothat field and, and what do you
like about working as a CDCES?
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4 and select option three.
(22:57):
And now back to our program.
Kristi, why don't you tell us first?
Kristi Paguio (23:02):
So I stumbled into it.
Um, I, my husband and I moved tothis area from, moved to Grand Rapids
from Chicago, and we thought we weregonna be here very temporarily and
there was an acquaintance that we hadthat worked for the local hospital.
And the first job that I had withthe hospital was not a great fit.
(23:24):
It was doing home visit, high riskpregnancy, so kind of overlapped
with, but in my graduate program Ihad no idea about anything in the
medical field and, and psychology.
Um, but there was a position fora pediatric, um, social worker
or, a social worker in ped endo,in pediatric endocrinology.
And so I applied.
(23:45):
I was like, I don't even knowwhat, I didn't even know what that
was 'cause I was, I didn't know Isaw a pediatric endocrinologist.
I was diagnosed as an adult with typeone, so it just, I spent the first five
years in pediatric side and then inthe adults side, they, the adult wanted
to grow something a little bit moresophisticated and they recruited me to
(24:09):
build the mental health part of that.
And so it just kind ofkept going from there.
And really, the credentials didn'tnecessarily mean a whole lot to me.
I think it was just more about feelingseen and the specialty area that I have
just didn't, wasn't represented in my, mysocial work licensure, so I wanted this
(24:33):
other one to show that I specialized.
Gary Scheiner (24:35):
It's grown.
Now you know, the ADA has awhole directory of mental health
professionals in the diabetes space.
You know, it's finally getting, it'sjust due after many, many years.
Kristi Paguio (24:46):
Yeah,
Gary Scheiner (24:47):
I, I developed my interest because I met a guy, literally, I, I was,
it was a few years after my diagnosis.
I was having a lot of blood sugar issues.
I had some serious lows becauseI, I play a lot of basketball.
I was getting lows in the middleof the night after playing,
and I went to a, a hospital.
Con, uh, uh, class about diabetes andI met a guy named Tom Kowalski who
(25:10):
was an exercise physiologist and healso had type one, and he was teaching
everyone about, uh, you know, thingsyou can do to manage your blood
sugar during and after exercise.
And it just blew my mind.
I, I mean, I had never heard atthat point about self-adjusting
insulin, about, you know, havingextra carbs and things like that.
(25:31):
And I said, I wanna do this.
I, I, I, this is, thisis what I want to do.
I want to get good at it andbe able to teach other people.
So that's when I went and got mymaster's in exercise physiology and
landed a job with the Joslin Clinic,and it kind of grew from there.
Tavia, what got you started?
Tavia Vital (25:49):
Sounds sort of similar to your story.
Gary.
I had to go...
Gary Scheiner (25:52):
you met Tom Kowalski also?
Tavia Vital (25:54):
Well, except mine, mine wasn't named Tom, but I was forced
to go to a hospital based, uh,diabetes education series of group
classes in order to get my firstappointment with the endo there.
When I moved to, um, Colorado areaand I was really kind of salty and
irritated of having, I'd alreadyhad diabetes for 25 stinking years.
(26:17):
Now you're making me take workoff and go to these classes.
In one of the classes, the educator at thetime, her name is Terri Ryan-Turek, um,
she worked at the University of ColoradoHospital and now she's in Hawaii doing
her diabetes educator goodness there.
Um, she was teaching the classand it was time for a break and
she was checking her blood sugarand said, oh, I'm a little low.
(26:39):
And I looked around theroom and nobody freaked out.
Nobody was like, oh, do you need moreinsulin or Should I call an ambulance?
Or all the things that, you know,people who don't know anything about
diabetes or inclined to say to you inthat moment, which is super not helpful
and I thought, this is a, a clinicdesignated, at least in large part,
to people who take insulin and havediabetes, and I wanna do what she's doing.
(27:04):
It would be so great to be able to, andI actually learned some things in the
classes, so it was worth my time, eventhough I didn't know it was going to be.
And I thought if, if I could give back toother people so that they could live well.
I'm only here because I had smartdoctors and smart parents that pushed
(27:25):
the bounds on what you can and can't do.
And somebody says, you can't do it.
Well, why can't we just do it this way?
I think we could, right?
And, and I could do this, and that'swhere my light bulb moment was.
And so I went back to school to become anurse so that I could become a certified
diabetes care and education specialist.
And they thankfully hired me in thatsame clinic several years later.
(27:48):
Um, and that's where I got my, my start.
Gary Scheiner (27:50):
Awesome.
Kristi Paguio (27:51):
And when I think about,
for me, uh, I, I had no role model.
I never met anybody that did what I wishso much there would've been somebody
like me at my diagnosis or anywherealong my journey to come in and being
(28:15):
like, just talk to me about any of themental and emotional parts of diabetes.
So that, that I think was a big driverfor me when I didn't see any examples
was, I know what it feels, I know whatit's like to not ha... and, and I've
(28:37):
worked with amazing people over mycareer, like as a patient, but, and
professionally, but I wish there would'vebeen somebody like me to talk to.
Gary Scheiner (28:48):
Yeah.
And the, the patients that we work with,uh, I mean, I love this work because we
develop relationships with our patientsthat go on long term, and we really do
get to experience the, the changes thatthey go through and, and the benefits that
they reap from the work we do together.
There's also, there are theirshare of weird oddities that we
(29:10):
have to deal with in our work.
We used to think that our bigchallenge was getting patients
to get their blood sugars down.
Nowadays I see more patientswho are just suffering from, so
much hypoglycemia because I don'tknow if they're misinformed or
misguided, but they feel like anyhigh glucose is just killing them.
(29:30):
And, and they, they can'tsurvive anything above normal.
So helping them understand thatlow blood sugar is also their enemy
and it needs to be dealt with.
Uh, but you know, Kristi, what are someof the strange oddities that you have
to deal with in your day-to-day work?
Kristi Paguio (29:50):
I think the biggest, um, I think the, a lot of the conversations
that I focus on with clients is helpingreduce shame in a sense of failure around
diabetes that are outside of range.
and that blood sugars can fluctuateand they're not in any danger as well.
Of course, we're aware of the risk ofcomplications, we're aware of, right?
(30:17):
Like there is, there is some levelof danger that is inherent to type
one diabetes, but I think a bigpart of my work I see is just really
helping people either loosen their,
loosen their grip a little bit withhow perfect they want things to be.
(30:37):
'cause it just can wreak havoc,um, in a multitude of ways.
And or if somebody's reallystruggling to embrace it, reducing
that shame as well to like help themunderstand this is how to stay safe.
So it's really kind ofcoming at it from either,
(30:58):
either extreme and meetingsomebody where they're at and
figuring out what helps them.
What helps them thinkabout it in a way that,
Gary Scheiner (31:06):
yeah, it, it helps them to see the bigger picture.
I mean, we're in this for qualityof life ultimately, and part of
that is managing your diabetes soyou don't develop health problems.
But part of it, al also having a qualityof life now where you're not being,
uh, you know, subjugated to low bloodsugars frequently, and you're not
(31:27):
obsessing over your diabetes and missingsleep and not enjoying foods and the
activities that that you really love?
'cause it just happens far too often.
Do you agree with that?
Kristi Paguio (31:40):
Yeah, yeah.
Absolutely.
Yeah.
Gary Scheiner (31:43):
Yeah.
Tavia, are there any odd, unusualthings you have to deal with?
Tavia Vital (31:49):
I don't, I don't know about odd, but I think maybe challenging when
working with clients who are also dealingwith other complicated health issues.
Or complex, if not, not necessarilycomplicated but complex health issues
such as undergoing chemo or radiationtherapy or someone who's going through
(32:15):
getting eggs, the egg retrievalprocess and getting ready for IVF
and going through IVF to try to getto a healthy pregnancy standpoint.
Or another one I think where thingsget, where it's more challenging is
when someone comes in that has, uh, ahistory of a, an eating disorder, not
(32:38):
even somebody who's currently activelysuffering from an eating disorder
because that's front and center.
If they've come and they've putit on their paper, they're at the
stage that they can talk about it,and they're actively working with
a therapist and they are takingsteps that are already in place.
That's pretty structured.
It's for people who have sort of resolvedthe acute phases of their eating disorder,
(33:01):
but it's still there and it makes it morechallenging to be direct about healthy
eating, taking doses, and not omittingdoses because you don't wanna own up to
the fact you eat something or not wantingto keep detailed records for a few days
so we can do great basal testing and carbratio adjustments because there's so much
(33:23):
potentially shame or guilt or those othernegative emotions that get really big when
you're really focusing in on your diabeteseducation and and adjustments and things.
So I think those are, I don'tknow that they're odd, but
they're challenging for me
um, and for the clients, that'swhy they signed up for visits so
we can navigate through together.
Kristi Paguio (33:42):
Sure, yeah.
They really kind of workagainst each other, right?
Because when you're trying to resolvedisordered eating, you're trying to not
count and measure everything, right?
But then insert diabetes that if you'retrying to really dial it in, you're doing
counting, measuring, weight, like itis, it's a, it's a conundrum to be in.
(34:07):
It is not...
Tavia Vital (34:09):
and now typically, if they aren't already working with a
healthcare provider that, that theyknow is well versed with type one,
then I will pause and say, I reallyhighly recommend, go see Kristi.
Go see, um Anna, because you want thiswith your diabetes and this other area
is a struggle and we need to find away to connect them so that we can
(34:33):
get you what you're trying to achieve.
There's a way, yeah.
I think you do...
Gary Scheiner (34:37):
I love that we have such a nice multidisciplinary team here at
Integrated Diabetes and it allows us to,you know, bounce ideas off each other,
uh, gain the expertise from each other.
But let's have a little funabout, with our teammates.
Uh, we, we work with a fairlyeclectic group of, of Type 1 CDCESs,
(35:01):
so I just wanna get your opinion.
Which member of the IDS teamwould be the first to die if
there was a zombie apocalypse?
I'll tell you mine, I think it wouldbe Nancy, our office administrator.
Tavia Vital (35:15):
That's who I was thinking of.
Oh, no, poor Nancy.
Gary Scheiner (35:17):
Only because Nancy is terrified of horror movies.
She's never seen, she doesn't knowyou gotta, you gotta get the brain,
you gotta stab the brain to kill them.
And I, I just, I can't see her survivingvery long in that kind of environment.
Do you agree with me, Tavia?
Tavia Vital (35:34):
That's who I thought of first and I thought, do we have to limit
it to the CDCESc or can I pick Nancy?
Gary Scheiner (35:39):
It could be anyone on the team.
Kristi, who do you think?
Kristi Paguio (35:42):
Well, I would, I would add myself.
Nancy, and I will be the first ones to go.
'cause I don't do horror either.
So we would probably both beparalyzed, frozen in fear and.
We'll just, we'll, they'll justget two at a two at a time.
Gary Scheiner (35:57):
Fair enough.
When you think of a type A personality,who on the IDS team comes to mind first?
Tavia Vital (36:06):
Me?
Maybe
it's me.
Gary Scheiner (36:09):
I would agree.
I concur with that choice.
Tavia Vital (36:13):
Maybe Jenny is my second runner up.
Kristi Paguio (36:17):
Yeah.
Maybe Jenny too, maybe,
Gary Scheiner (36:20):
right.
Who do you think is thebest culinary skills?
Tavia Vital (36:26):
Maybe, maybe, um, Dana.
Only because I've seen morepictures of Dana's cooking events.
So..
What do you think, Christy,
Kristi Paguio (36:36):
Dana?
Sure.
She gets the award.
Mm-hmm.
Gary Scheiner (36:40):
I'll take Jenny.
Only because Dana's in Texasand Texas cooking is odd.
I don't know, Jenny.
Yeah, Jenny's done some prettycreative stuff from that standpoint.
Tavia Vital (36:50):
Does, that's true.
Gary Scheiner (36:51):
Um, who do you think has the best humor, sense
of humor of anybody on our team?
Tavia Vital (36:56):
That's a tough one.
I feel like one of the things I reallyenjoy about our team, besides the
important things for doing our jobwell, right, is how much humor we can
throw into whatever we're dealing with.
I really appreciate Alicia's.
It's strong.
It just pops into any momentshe can just, there's some
(37:17):
stress or we're hyper-focused.
It just, it comes in andI can't stop laughing.
Kristi Paguio (37:23):
I think you can be very funny too, Gary.
Tavia Vital (37:26):
Yes.
Gary Scheiner (37:26):
Thank you.
That's true.
I was thinking Alicia, uh, she, yeah.
Yeah, she breaks me up sometimes.
Kristi Paguio (37:32):
I would say between you and Alicia.
Yeah, you definitely can bring the,
Gary Scheiner (37:36):
well,
Kristi Paguio (37:36):
the defector thing
Gary Scheiner (37:37):
Speaking of competition, who, who on our team
would win an arm wrestling contest?
Kristi Paguio (37:43):
I would never go up against Alicia.
Tavia Vital (37:47):
Gosh.
But you know, Anna does all ofthat like P 90 X, kettlebell.
I don't know.
I don't, I bet, I bet it would be Anna.
Gary Scheiner (37:56):
I was thinking Anna and Kathryn,
Tavia Vital (37:58):
yeah.
Gary Scheiner (38:00):
Kathryn's in good shape.
She used to be in, I mean,she could lift a truck.
I mean, that that girl is strong.
Kristi Paguio (38:07):
Well, some secret ninjas on the team.
I was not.
Gary Scheiner (38:09):
Who do you think is most organized on our team?
Kind of goes with the type A personality.
Tavia Vital (38:18):
Uh.
I give the illusion of being organized.
Certain things are extremelyorganized in my life.
Yes.
Gary Scheiner (38:25):
Nevertheless, whether it's the illusion or not, you're organized.
Tavia Vital (38:29):
I would say Jenny as well.
Like if you ever, she stops and tells youall of the things she's doing in a day.
You have to have things inorder to do all of those things.
So yeah.
Gary Scheiner (38:41):
Who would you most like to get drunk with?
Tavia Vital (38:45):
I need a new question.
I don't wanna get drunk.
Um, but maybe Kristi, because Kristi wasjust talking about that earlier I guess
Kristi Paguio (38:53):
I'm gonna have an adult beverage with a
friend later this afternoon.
Um, pre national holiday.
Um, but I'm a lightweight.
But I was thinking you TAvia itwould be really fun for to watch
the two of us barely get throughprobably one adult beverage and
Tavia Vital (39:10):
We could share one.
Kristi Paguio (39:12):
Yeah, we'll share one.
Can you pour into two glasses?
Gary Scheiner (39:15):
Yeah.
I would love to see Kristi drunk,just to get you to open up, but
Dana I think would be a lot of fun.
Tavia Vital (39:23):
Dana would be fun.
Gary Scheiner (39:24):
She's fun to begin with.
Tavia Vital (39:25):
Yeah.
Kristi Paguio (39:26):
Probably just fall asleep.
Not that I couldn'tget a little wacky, but
Tavia Vital (39:32):
if there was, if there were dancing involved,
then I wouldn't fall asleep.
But I'm with you, Kristi.
If we're sitting down andwe're talking and it's relaxed.
You get more than a drink in me and then
Kristi Paguio (39:42):
I'm thinking food happening.
Yeah.
Keep some food flowing and yeah.
Mm-hmm.
Gary Scheiner (39:48):
Okay.
Fair enough.
Okay, now there are some rapid fire.
Just get your quick responses to these.
So first, when it comes to fingerstick glucose monitoring, lick or wipe.
Tavia Vital (40:02):
Wipe.
Kristi Paguio (40:03):
Wipe.
Tavia Vital (40:04):
Gross.
Gary Scheiner (40:05):
Lick.
Lick.
Tavia Vital (40:06):
Oh gosh, no.
Never.
Um,
Kristi Paguio (40:09):
I have lovely friends that I watch Lick and, I, that are in the
medical field and I don't understand, butI, to each their own, no judgment, but
Gary Scheiner (40:19):
DIY or commercial system,
Tavia Vital (40:23):
DIY
Kristi Paguio (40:25):
DIY, but to again.
In the situation, there's some
Gary Scheiner (40:30):
DIY.
This is you personally with you.
DIY.
Tavia Vital (40:34):
Yeah.
Gary Scheiner (40:35):
Coffee or tea?
Tavia Vital (40:37):
Coffee.
Kristi Paguio (40:38):
Coffee.
Tavia Vital (40:39):
Tea is lovely.
Coffee wins.
Gary Scheiner (40:41):
Diet soda.
I don't like hot drinks.
Oh, I'll abdicate from that question.
Um, mountains or prairies.
Who came up with these?
Tavia Vital (40:53):
Beaches, beaches or tropical rainforest.
That's what I pick.
Kristi Paguio (41:02):
So Ty, I would do mountains.
Mountains are beaches.
I mean, anything may, I mean, prairiesare beautiful, but you know, yawn.
Tavia Vital (41:10):
But I live in a prairie sort of.
Gary Scheiner (41:11):
You live in a prairie.
Tavia, I'll take bike trail.
Uh uh, let's see.
Uh, favorite color for a pump?
Tavia Vital (41:20):
I would say turquoise or bright yellow,
like a metallic bright yellow
Gary Scheiner (41:27):
Kristi, you got a color?
Kristi Paguio (41:29):
You know, purple or like invisible.
Just can it just,
Gary Scheiner (41:34):
Hmm.
Kristi Paguio (41:35):
be transparent?
Tavia Vital (41:36):
Well just, you know, be non, it could be like a
hologram, like when it changes thelight, then it changes the color.
I would do that.
Gary Scheiner (41:47):
That's pretty high tech.
I would take a PhiladelphiaEagles midnight green color.
I use that color in alot of my house painting.
Debbie's always on me for that,but best concert you ever saw?
Tavia Vital (42:03):
Gosh, that's a tough one because it was a long time ago
when I saw it, so I have to think.
I think probably Boys to Men.
Loved that.
Gary Scheiner (42:14):
My whole image of you is blown.
Boys to Men.
Okay.
Alright.
Alright.
Kristi, what do you got?
Kristi Paguio (42:22):
I saw the cranberries at, um, at an amphitheater area, um, in
Michigan and that was pretty phenomenal.
Gary Scheiner (42:33):
Okay.
I'm, I'm, I'll take StevieRay Vaughan incredible show.
Favorite snack?
Kristi Paguio (42:40):
Popcorn.
Tavia Vital (42:42):
I don't have one.
How do you have one favorite snack?
Come on.
Gary Scheiner (42:46):
Okay.
I really like you're watching Boys to Men.
You're hungry.
What are you eating?
Tavia Vital (42:50):
Oh, how about what I eat at home at night?
Snack of popcorn or the littlepackets of, um, trail mix that
have a variety of different kindsof nuts and dried blueberries
and little pieces of chocolate.
Gary Scheiner (43:03):
Yeah, I like that.
All right.
I like those jacks cheese curls.
Those are great.
Your favorite low carb snack.
Tavia Vital (43:10):
Low carb?
I don't eat low-carb.
Gary Scheiner (43:13):
No.
Yeah.
I don't have one.
Tavia Vital (43:14):
A cheese stick.
I mean, I like cheese.
So cheese stick or
Kristi Paguio (43:19):
veggies and hummus.
Tavia Vital (43:21):
Yeah.
That's good.
Some carrots.
Gary Scheiner (43:23):
You can tell This is a carb loving crowd.
Kristi Paguio (43:25):
Yeah.
Tavia Vital (43:25):
Yeah.
Oh, carrots.
All right.
Staycation or foreign travel?
What do you like?
Kristi Paguio (43:31):
What?
Foreign travel.
Gary Scheiner (43:33):
I'm not much of a tourist.
I don't like looking at sights andtourism things, but I like to travel.
I like to see new places, butnot looking at touristy stuff.
Tavia Vital (43:46):
I say foreign travel and eat the food in the different places.
That's what I, I like that
Gary Scheiner (43:51):
Now you're talking and
Tavia Vital (43:52):
seeing the different landscapes or different,
Gary Scheiner (43:54):
do a food tour of the world.
Tavia Vital (43:56):
Yeah, that would be good.
Gary Scheiner (43:58):
Okay.
Tavia Vital (43:59):
Excellent.
All right.
Favorite kind of movie?
Is it horror?
Is it comedy, drama, orlike a Hallmark movie?
Kristi Paguio (44:07):
Documentary or comedy.
Gary Scheiner (44:10):
Um, I like the genre of, uh, what do you call
it, organized crime Movies.
Like the Godfather type.
Kristi Paguio (44:19):
Mm-hmm.
Gary Scheiner (44:21):
What about you, Tavia?
I like
Tavia Vital (44:22):
drama and suspense.
That's not gory.
Keeps you on the edge of your seat.
Gary Scheiner (44:28):
Well, I feel like I know you two so much better now and,
uh, I'm glad we had a chance to spendsome time discussing this stuff.
I'm a little scared about what ourcolleagues on our team are gonna,
how they're gonna answer some ofthose questions that we asked before.
I can't wait to see the podcastswith, uh, with them on 'em.
(44:48):
Yeah, those will be coming out.
Ours comes first, so we get tosay and do whatever we feel like.
But thank you both for joining in, uh,Kristi Paguio, who provides counseling
services for our patients, and TaviaVital, who is a bilingual CDCES and
(45:09):
nurse, and does an outstanding job withall levels of patient care, including all
the high tech stuff that's available now.
Uh, the open source systems and, uh, wedidn't even mention Tavia, you also have
a son with type one, so you're very intouch with the needs of, uh, parents and
family members of those with type one.
Tavia Vital (45:30):
Yep.
Gary Scheiner (45:31):
And the, tell us, mention the, the program
that you run for support people.
Tavia Vital (45:36):
We have a timeout for caregivers and it meets
every couple of months.
It is free and it's a space where parentscan come to see other parents face to
face virtually, and get that supportthat you need because most parents
are doing this really on their own.
It's just a safe space.
We usually have a, a focus area thatwe plan to talk about, but also we open
(46:01):
it up for questions or frustrationsor things that are coming up that
parents might be nervous or, or, orwhatever the emotion of the day is.
It's where we meet together and kindof work through this thing together.
Gary Scheiner (46:15):
And how much does it cost to participate?
Tavia Vital (46:17):
It's free.
Gary Scheiner (46:19):
That's a good price.
I like that.
Tavia Vital (46:20):
It is a good price.
Gary Scheiner (46:22):
And I even, I'll give people a discount on that if they need it.
Tavia Vital (46:26):
Yeah, just ask Gary for the discount.
Gary Scheiner (46:28):
Got it.
Alright.
Well, again, thank you Kristiand Tavia for joining me today.
Uh, links about that programwill be in the show notes.
And I'm Gary Scheiner remindingeveryone out there to keep
thinking like a pancreas.
Thanks for tuning in to ThinkLike a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow or subscribe
(46:51):
on your favorite podcast app.
Think Like a Pancreas-- the podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
care is personal because we live it too.
Our team of clinicians, all livingwith type one diabetes understands
the challenges firsthand.
(47:12):
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech, sports
and exercise, weight loss, type onepregnancy and emotional wellbeing.
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
(47:32):
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, the podcast.
I'm Gary Scheiner.
Wishing you a fantastic week ahead.
Don't forget to think like a pancreas.
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