August 12, 2025 • 45 mins
In Episode 47 of Think Like a Pancreas—The Podcast, we once again pull back the curtain and share the fabulous personalities of the Integrated Diabetes Services clinicians.
In part two of our three-part series, meet:
Alicia Downs, RN, MSN, CDCES, BC-ADM experienced years of mis-diagnoses and ineffective treatments that gave her the incentive to take the lead in her own health care and educate those around her. Areas of clinical specialty for Alicia include working with patients through cancer treatment, Type 3C diabetes, Diabetes management along with complex medical challenges, diabetes management in combination with behavioral and mental health challenges, as well as Tandem diabetes device optimization. Alicia is also passionate about providing educated compassionate informed and equitable care to all people. Her specialized experience in gender diverse care, LGBTQ care areas, as well as experience in diverse ethnic and faith backgrounds is Alicia’s greatest pride in her professional career.
Anna Sabino MSW, CDCES has been living with T1D for over 30 years and proudly offers expert emotional health counseling for children, adults, and families with T1D. She is a graduate of Syracuse University with a dual degree in psychology and child and family studies. She earned her Masters in Social Work from Washington University in St. Louis. Her areas of expertise include family dynamics, crisis management, anxiety, depression, burnout, and post-traumatic stress.
Anna’s greatest passion is helping individuals and families build a sense of confidence and comfort with their diabetes management.
Dr Paula Diab PhD, CDCES is a Family Physician and Diabetologist who runs a multi-disciplinary practice specializing in the management of chronic diseases, particularly diabetes and obesity in South Africa. Her approach is to walk the journey with her patients and to allow them to manage their disease rather than allow the disease to define who they are. She earned her undergraduate medical degree from the University of Cape Town in 2000 and then returned to her home province of KwaZulu-Natal to establish her career and continue her post-graduate studies. She is certified as a Diabetes Care and Education Specialist in the US.
Despite carrying the burden of being the only member of the IDS clinical team without type 1 Diabetes, her skills and passion for diabetes care & education are exemplary (she did successfully manage her own gestational diabetes during her pregnancies).
What you will learn:✔️ How Alicia, Anna, and Paula came to be members of the Integrated Diabetes Services team.
✔️ How patient care is enhanced by blending clinical expertise and lived experience.
✔️ The value of having certified diabetes care and education specialists in multiple disciplines.
✔️ Which IDS team clinician would win in an arm-wrestling contest and who uses the most emojis in their correspondence!
Chapters:00:15 Welcome and Introduction
00:40 Say hello to Alicia, Anna, and Paula
01:27 How Dr. Paula Diab came to be a part of the IDS team
02:31 How Anna Sabino became a part of the Integrated Diabetes Services team
03:46 Fangirl turned IDS clinician
08:02 Why helping other people with diabetes is so important to Anna, Paula, and Alicia
14:40 How Integrated Diabetes Services gives back to the diabetes community
19:42 Managing whole-person care.
35:40 What you didn't know about the Integrated Diabetes Services team
Resources Mentioned:Think Like a Pancreas—The book
The Diabetic Athlete’s Handbook
Pumping Insulin by John Walsh
Accepting and Normalizing Anxiety While Living With Diabetes
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
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:14):
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
(00:35):
healthcare provider before implementing.
Alicia Downs (00:37):
Thank you so much for joining us for Think
Like a Pancreas podcast.
You are here with Alicia.
I am one of the nurses here at IDS.
With Anna Sabino, one of ouramazing mental health specialist,
and with Dr. Paula Diab.
Yes, that last name is not...like, I think she chose, like
(01:01):
she actually married into that.
Crazy!
So and so she's joiningus from across the pond.
Uh, she is a diabetologist in SouthAfrica that works with our team.
Um, and so we are in for anotherepisode where you get to meet
us, get to know us a little bit.
Um, so I'd love to kind of justthrow around and just, uh, kind
(01:24):
of what brought you to IDS?
Dr. Paula Diab (01:27):
So I, as, as you said, I work with, uh, as a diabetologist in
South Africa, and I was interested in,I'm very interested, although I'm a
doctor, I'm very interested in diabeteseducation and I was Googling diabetes
education online, and I came up upon,upon Gary and IDS and then we had a
Skype, uh, video consult in those days.
(01:47):
Um, at first, and thenwe just kept in contact.
And then I was coming to Boston to comeand visit a family member there, and I
phoned him and I said, can I hop on aplane to Philadelphia and come visit you?
And Oh, that's how I got involvedwith IDS, jumped through lots of hoops
to become a CDCES, but here I am.
Alicia Downs (02:06):
Yeah.
You would think as a doctor they'djust be like, yeah, come on in.
Yeah.
But, but no, they put moreroadblocks in front of Paula than
they put in front of most anybody.
Dr. Paula Diab (02:14):
Yeah.
Anna Sabino (02:15):
Well, we're glad you went all the way to Philly.
Dr. Paula Diab (02:19):
Philadelphia's a beautiful city.
I really enjoyed it.
Alicia Downs (02:22):
As I am going to go off camera for just a second so I
can turn off this light that hasdecided to start strobing behind me.
Um, but Anna, how did
you get
Anna Sabino (02:29):
Sure.
Alicia Downs (02:30):
Picked up with IDS.
Anna Sabino (02:31):
I'm, um, I mean, so many people have heard of Gary Scheiner.
He was the, you know, diabetes educatorof the year and he is written like,
you know, the iconic, Think Like aPancreas and when I went out on my own
and started my own private practice,I almost sort of like modeled my
practice after what Gary had started.
(02:51):
I just think he is the bee's knees,and so I had connected with him
and worked with him on a coupledifferent like, you know, conferences.
The diabetes world islike super duper small.
I think I commented on a Facebook postabout some timeout for caregivers class
and then he was like, oh, why don't youcome join one of the calls and chime in.
(03:14):
And then he called me upand was like, we need you.
And so it's been so much fun to workwith a team, you know, albeit virtually.
For the last, I don'tknow, almost three years.
Two, three years.
Alicia Downs (03:28):
Time flies.
Anna Sabino (03:29):
Yeah.
Helping like, you know, families and kidsand young adults and adults too, just
like navigate all the invisible stuffthat we don't see that we know exists.
Um.
In the back, back in frontof our minds with T1D.
It's fun.
Alicia Downs (03:45):
I had the weirdest connection to IDS so far on our team.
I had, I was, I was diagnosed asan adult and my PCP who diagnosed
me with LADA said, here are threebooks that you need to read.
Um, and I still to this day refer to,I refer other patients to them and I
(04:07):
refer to them as my Trinity of diabetes.
And they are, uh, Sherry Kohlberg's,the Diabetic Athlete Handbook because
I'm an athlete and they were, okay... Ialways mix up John Walsh and Joe Walsh.
One of them is a diabetes expert.
The other one is the guitarist for theEagles, John Walsh, Pumping Insulin, uh,
(04:33):
because she knew I was gonna need a pumppretty quick and Think Like a Pancreas.
And so I read that bookuntil the cover fell off.
I probably read it 14 times.
I just read it and read itand read it and read it.
And every time a problem would comeup in my blood sugar life, I'd go, ah!
That was in the book and I wouldgo back and I would read it again.
(04:55):
And so eventually I decidedto become a diabetes educator.
And long as, you know, timepassed, I got my CDE in May
and in June my son came along.
So I was out on maternity leave.
And my leave was up in July and I wasjust, I was like, well, I got my CDE
(05:18):
now let's keep an eye on CDE jobs.
And I happened to get on LinkedIn anda job popped up for CDE in Philly for
Integrated Diabetes Services and itsounded like exactly what I wanted to do.
'cause I always felt like, it'd be greatif I could just help people with insulin.
Like if I, like, I could justlike have this like really
(05:38):
tight niche, it'd be amazing.
But like, you can't reallydo that as a nurse, right?
And I was like, um, let's see.
And I clicked on, not the link, but asyou do on LinkedIn, you then stalk the
job and like, who else is connected to it?
And Integrated Diabetes took me to GaryScheiner and I was like, Gary Scheiner?
(06:02):
And my husband walked through the roombehind me and he kinda looked and he
went, isn't that the guy on your book?
I was like, so, I just totally fangirled.
I was like, I'm notqualified for this job.
I'm not gonna get this job.
I don't know enough for this job.
I just got my CDE.
The ink is not dry yet.
I don't think they had even sentme the actual certificate yet.
Anna Sabino (06:23):
Yep.
Alicia Downs (06:25):
And so I applied and I was like, best case scenario?
I get an interview, I get to goand shake the man's hand and say,
thank you for writing the book.
And I went in and I just,uh, kind of vomited all of my
diabetes knowledge in an interview
and, uh, realized, you know, thatfeeling guys, that we get when you
(06:46):
go to see your doctors and youreducators and you feel like you know
more about diabetes than they do.
Yeah.
Sometimes it's accurate andsometimes you get hired as a
diabetes educator at a lead practice.
Anna Sabino (06:59):
Well, that honestly, Alicia, it probably worked in your
favor having just taken the exam, you'relike, and I know this about that, and
this side effect about this drug and...
Alicia Downs (07:09):
The exam?
Honestly, the exam was borderline useless.
The exam really was.
I always say what you learn inschool, should be called how to
not kill people with insulin.
Um, because you don't really learn anyfunctional useful things like as you
and as you take the exam, you actuallyhave had to keep the mindset, like,
don't put the answer that is what youwould actually do to help someone.
(07:34):
Put the answer that iscorrect for the test.
Anna Sabino (07:38):
Yeah.
Alicia Downs (07:38):
And so it was, but what was really my benefit was-- a, not having
to learn unlearn a lot of stuff fromhaving like worked in a hospital system
for 20 years and doing it the way theydo it and all of that kind of thing.
But also just, and it's, it'ssomething that makes our team
(07:58):
amazing is just the passion.
'cause the reason I went, the reason Ibecame a nurse was because I saw other
people who needed to know more to livethis life well, and I'm a born student and
if it was this hard for me, what happensto people who aren't a born student?
And that gap was not okay.
(08:19):
And so I wanted access tobe able to help people.
And so for me, that was nursing.
And so for me, that was IDS.
Um, to be able to use my strugglesand what I've had to learn to help me.
If I only learn it to helpme, what's the point, right?
Because I'm temporary.
And, and that means it's a lot ofwork for like very little output.
(08:42):
But if I learn it to thendisseminate it, share it, and
make other people's lives better.
Dr. Paula Diab (08:49):
It's interesting that difference between, between experiential
knowledge and academic knowledge.
Alicia Downs (08:55):
Yeah.
Anna Sabino (08:55):
Oh yeah.
Dr. Paula Diab (08:56):
And I mean that was, I think, my driving factor in
getting me involved in diabetes.
We had, I think literally in thewhole of medical school, two less,
two lectures on, on diabetes.
And all that told us was 90% ofpeople have type two diabetes,
10% of type one diabetes.
Um.
If you fail at everything else intype two diabetes, there's always
(09:16):
insulin, which is completely thewrong message to give to people.
Um, and we only learned abouttwo different oral agents,
and you can take basal bolusinsulin or you can take a premix.
And that was it.
For about five years in clinicalpractice after I'd qualified, that
was my diabetes knowledge thatfitted onto two, like A4 pages.
And after seeing so many patients,I thought, this is ridiculous.
(09:39):
And every patient that was comingwas coming with complications and
amputations and heart attacks andstrokes and uh, lack of vision
and... I was like, this is crazy.
This is, you know, and that's whenI decided to do my masters in family
medicine and then do an advanceddiploma in diabetes and actually start.
Understanding more about the disease.
(09:59):
And when I look back now at what we weretaught and the difference between your
experiential knowledge and what we weretaught at university, it's frightening.
And it's frightening to think thatthere still are primary healthcare
providers who come outta medical schooland even 20, 30 years down the line.
Unfortunately, it's not that different.
Anna Sabino (10:19):
No.
Dr. Paula Diab (10:19):
Um,
Anna Sabino (10:20):
I had a, I had a new client just yesterday, and she
was diagnosed in her mid sixties.
And with, you know, with, with LADA whereshe's still, you know, she's titrating
up on her insulin needs very low, kindof compared to someone like me who
was in full-blown DKA at my diagnosis.
But, you know, her PCP calledher back, blood sugar 450.
(10:43):
Go to the ICU.
They didn't know what to do with her.
And this was a year and a half ago.
And this is in Boston.
Alicia Downs (10:49):
And just sitting in the ICU and the ICUs is
like, we don't deal with people.
We talk
Anna Sabino (10:52):
Well, yeah, and they, and they admitted, they're like,
we are not diabetes educators.
They stabe, you know, they hadher on an, you know, insulin drip.
They stabilized blood sugar.
Stabilized potassium.
You know, all the things, but then what?
And the one thing she said to me was like,I don't know how to do blood sugars and
I think, you know, for me and you andall of us, this experiential learning.
(11:16):
Diabetes is a, it's a lifestyle and youknow, I was diagnosed as a 6-year-old,
so I was just telling Paula before westarted, you know, yes, we've come so far.
The first meter I have, Ithink I have it upstairs.
I wish I could go grab it, but it,it took 120 seconds to get a reading.
(11:37):
It was the AccuCheck two.
Alicia Downs (11:38):
That's two full minutes.
Anna Sabino (11:40):
Two full minutes.
And now we don't have to do anything.
I haven't pricked my finger in weeks.
Maybe don't record that,but, um, I don't need to.
Alicia Downs (11:51):
But like literally whats my blood sugar?
I now just look at my watch.
Anna Sabino (11:54):
Yeah.
And so it took.
You had to get a crap ton of blood.
Like I'm talking, it was a whole... mymom would bring me a tray in the morning.
There was a cotton ball, thealcohol swab, the meter, the strips.
It was like a thing.
It was like a whole thing.
But we were only requiredto do it four times a day.
And anything that happened inbetween was like, you don't know.
(12:18):
And I think for me, one of the mainreasons I, you know, decided to give back.
And we talk about experiential learningis, you know, I, because I was diagnosed
in the late eighties, early nineties,you know, I didn't know anyone.
There were no visible devices to feelthat sort of sense of connection,
even just walking through the mallor in the parking lot or wherever.
(12:39):
I went to camp.
And for me, that was my bubble.
And I grew up going every summer, and itwas sort of like those two weeks were my
opportunity to feel seen to feel safe,and I know so many kids also get that
opportunity today, but there's also somuch more opportunity for connection.
However, it was my, I was in, it was 2005.
(13:04):
I was the assistant camp director for theday camps, and I had to go to New York
City and pick up some kids and bring themto camp, and that's when I realized my,
you know... socioeconomic or whatnot,family situation with diabetes and support
was not the same as everyone else's.
(13:27):
And that there were a lot of otherfactors that contributed to people
feeling okay with diabetes, and Iwanted to get underneath all of that
to every family and, and make sure thateven if they didn't have the support,
and even if they came from potentiallya broken home or had other underlying,
(13:50):
you know, mental health or comorbiditiesor whatever it is, that they still
felt like they belonged somewhereand someone would listen to them.
I feel like, for me,like I'm living my dream.
I'm living my passionbecause that's what drove me.
You know, those experientials to gointo, get my master's in social work.
(14:10):
And then I was like, oh, wellI can have a CDE and be an MSW.
Dream job!
For all of the people out there whoare like, how do I become a CDCES?
Or, you know, you can, youcan use your, yeah, call me.
Call me maybe.
Um, you can use your, your skillsand dream it and, and do it.
And that's.
(14:31):
Most people at camp, like they wannabecome nurses, they wanna become
teachers, they wanna become this likeservice oriented skill level of, of
career path, which is just so, so cool.
I'm here for it.
We're, I think we're all here for it.
And I think we would all do anything,Gary included, to be the, to, to mentor
and, and have people work alongside.
Alicia Downs (14:52):
That's, we at IDS to... mentoring and raising up
other CDEs is like our side passion.
IDS, like helping our community,serving our community, educating people
with type one is clearly what we do,but we are very aware that we're not
getting any younger for one thing.
Anna Sabino (15:11):
Yeah.
Alicia Downs (15:11):
Uhhuh, uh, you know, we're not gonna be here forever
and hopefully type one isn't hereforever either, but just in case.
Anna Sabino (15:16):
Yeah.
Alicia Downs (15:16):
We need other people to fill in.
But also just ratios, I mean, there issomething like, one endo for every 800
people with diabetes in this country,and one educator for something like 300.
I can't educate 300 people,at least not do it well.
And that's assuming thateverybody's spread out evenly,
(15:38):
which we know they aren't.
So we really need a lot more great people.
Becasue even if we did cure typeone, we still need the health
education on staying healthy as well.
Anna Sabino (15:49):
And I was told the average CDCES when I took my exam,
which I took it at 32 weeks pregnant,
Alicia Downs (15:56):
Ugh.
Anna Sabino (15:56):
With diabetes.
Alicia Downs (15:57):
The fact that you've retained anything is magical.
Anna Sabino (16:00):
Yep.
The average age was 55, and hopefullyit's gone down, but take the exam!
Alicia Downs (16:09):
Diabetes, diabetes education is very much viewed, at least in the
nursing world, less so amongst dieticians,um, but in the nursing world, it's very
much viewed as sort of what you do onyour way out of, sort of active practice.
Anna Sabino (16:23):
Yeah.
Alicia Downs (16:23):
So when you're kind of burnt out on the physical demands or
the psychological demands of directpatient care, you transition into an
education role as sort of a supportcare person on your way out the door.
Which is bonkers bananas becausediabetes management is now a high paced,
(16:45):
high, fast change over tech world.
Anna Sabino (16:48):
Yeah.
Alicia Downs (16:49):
That the, but
Dr. Paula Diab (16:50):
that's the thing.
Alicia Downs (16:50):
The average person on their way out is not prepared for.
And we don't want people on their way out.
We want people on their way in togrow with the need of the community.
Anna Sabino (17:01):
That's, I'll say, there's so many more opportunities now and
pathways in order to get there.
So, anyway, go ahead Paula.
Dr. Paula Diab (17:09):
Um, about diabetes education, it's so frustrating.
People often say to me,oh, you're a doctor.
Why on Earth, are youdoing diabetes education?
And my response to that is, look, if Iwas diagnosed with diabetes today, I would
go and see the educator a hundred timesover before I'd go and see the doctor.
Anyone can write a script for insulin, butthere are only very few people that can
(17:30):
explain to you how to use that insulin.
And I think for me, one of the nicestthings is actually learning from my
patients and learning and... so educatingthem, but learning back from them.
I remember an incident where a patientcame to me and she said, oh, if I eat
all my vegetables and my, my meat first,my sugars don't tend to go up as much
as if I eat my carbohydrates first.
(17:51):
And I said, okay, well that's great.
This was about 10 years ago.
And I said, that's great.
If that's how you want to eatyour food and you can do that.
A few months later, I was ata conference and they were
talking about food sequencing.
And I was like, what onearth is food sequencing?
And I was like, oh, that'swhat my patient was telling me.
And it's amazing!
Alicia Downs (18:09):
You'll come back and teach a, teach a class.
Dr. Paula Diab (18:13):
But it's amazing how if you just listen to people,
share experiences with them andI think I've, I've got a huge
amount of that from the IDS team.
And you guys were talking abouthow a side passion is mentoring.
It's the most incredible thing to be partof a team where you're being supported
and you're constantly being given newinformation and being uplifted and, and
(18:34):
given, pushed in a certain direction.
And that's what I absolutely love.
About the education side of things
Gary Scheiner (18:41):
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Alicia Downs (19:19):
Okay guys, I gotta, I got a break because we are CDCES
fanning and we are IDS fangirling, butum, we got, we gotta get real 'cause
they're supposed to get to know us too.
And we obviously love our jobs.
News flash.
Hi.
Anna Sabino (19:36):
Yep.
Alicia Downs (19:36):
We're at IDS.
We love our jobs and we lovepeople with diabetes and yeah, so.
But, but who are these, whoare these random persons here?
So.
Gonna, gonna throw out somediabetes tangential, but
sliding more and more into it.
Anna Sabino (19:53):
Oh boy.
Alicia Downs (19:54):
We are gonna get realer and realer.
Dr. Paula Diab (19:56):
Are we getting a, are we getting an exam question?
Alicia Downs (19:59):
Uh, no.
No.
I'm not gonna go full on exam.
We were joking with Paula before this.
We were like, we're like trivia questions.
I hope it's not like, what,what are the three leading side
effects of this medication go?
Like, it's too stressfulfor this time of day.
Here's one to get a little morepersonal, like diabetes management.
Whether it's self or patient.
(20:21):
Uh, personally I find helpingpatients manage often more
stressful than managing myself.
'cause I could put myself onautopilot, but putting other people
on autopilot's, not an option.
Um, but so being a clinician,we're also all moms.
We're busy peoples.
We all have our own health tomanage as, as well as helping
(20:41):
other people manage theirs.
How do you do self care?
Anna Sabino (20:46):
No.
Alicia Downs (20:46):
How do you, uh, how do you balance and, and manage things
and make sure that you stay healthy?
How do you, how do you walk thewalk while you talk the talk?
Anna Sabino (20:57):
Uh, I'll, I'll take this one first.
Uh, because I feel like, and Imight have written a blog about this
recently, I can't remember, you know,being diagnosed in kindergarten.
I've done a lot of the phases andtransitions of life with diabetes.
Going to school.
Going to college.
Graduating college.
(21:17):
Grad school.
Moving.
Getting married.
Having kids.
And now I'm kind of inlike this maintenance mode.
I've tried all the tech.
I've used all the different devices.
I, right now have, I'm finding themost success using the the tSlimX2.
Parenting?
Knock on wood.
My kids do not live with type one.
(21:38):
They're five and seven, almost eight.
But trying to prioritize my own healthneeds while constantly anticipating
their needs has been the biggestchallenge, especially because,
being pregnant with diabetes andpostpartum with diabetes, you know,
(21:59):
there's all these hormonal fluctuationsand you're constantly adjusting doses.
But now I'm at the pointin my life where like.
I haven't really changed abasal rate in like years.
And I'm back to my like sort ofpost puberty rates and ratios and
this, that and the other thing.
And you know, I go to my endoand they're like, all right, what
did you do the last three months?
(22:19):
Anything different?
I'm like, well, I tried the iLet.
I did this.
And they're like, oh my God, Anna!
Which pump are you gonna stick with?
I'm like, I don't know.
Um, try 'em all right?
I'm doing this trial next month, butbalancing and, and with this, the
whole self-care is like, I reallytruly feel like, and I say this to my
patients all the time, the burden ofself-advocacy with diabetes is something
(22:44):
that is the most consistent and mostchallenging part of having diabetes.
Because you think about self-advocacyand you're like, you're, I'm
now at the point where like.
The little five year olds at a birthdayparty are like, what's on your arm?
And, oh, why can't you go swimming?
Or why, why do you have a tube on you?
And it's, it's like, okay,who do I explain this to?
(23:06):
And as an adult, you know,we're never not meeting people.
We're never not in an opportunity where,is diabetes gonna screw up my day?
Or, you know, am I at a point whereI feel super comfortable explaining
what diabetes is every time you entera new room or a networking opportunity
or whatever it is, we all know it'san, it's an opportunity to learn to
(23:27):
teach, but it's also a mental blah--achallenge and, and it's exhausting.
It's an amazing experience to teach mykids, you know, diabetes like yay Barbie,
but at the same time it is, it's reallyexhausting because there are days where,
oops, my pump's out of insulin, but my kidis like screaming in the bath upstairs.
(23:51):
So it's those little momentsthat just are like, woooo!
Must regulate all the things and alsoprioritize my own health at the same time.
And it's a lot!
Alicia Downs (24:03):
Sometimes just the self-awareness.
Anna Sabino (24:04):
Yeah.
And I know I'm not alone there.
Um, but so far, parenting with diabetesand I, and I don't mean having a
newborn because that comes with its ownchallenges, but it's almost harder now.
Because they're, yeah, they wannago places, do things, fight with
each other, kick each other in theface, you know, and there're a lot.
(24:25):
I know Alicia has one of them.
Um,
Alicia Downs (24:28):
One that seems like nine.
Anna Sabino (24:31):
My 5-year-old boy, literally like ninjas on top of my CGM.
Like, buddy, slow down!
Making pedicure appointments, goingfor walks, listening to podcasts,
like just making sure there's enough,like alone time, whatever that may be.
Whether you're doing like typicalyoga, pedicure, whatever, but just do
(24:54):
something that you like to do for you.
That has to be part of it, for sure.
Alicia Downs (24:59):
That's... momming as a whole?
Tough.
Remember I first,
Anna Sabino (25:05):
And we don't talk about it.
It's all about pregnancy.
It's all about menopause.
But like just parenting while you'redoing diabetes is like BLAHHHHH!
Alicia Downs (25:14):
Well, and you've got a certain amount of brain space, right.
I call it, I call it RAM, right?
You've got wrapped.
Anna Sabino (25:18):
Yeah!
Alicia Downs (25:19):
Like active memory, available memory.
Anna Sabino (25:21):
RAM?
Active memory?
Yeah, yeah, yeah.
Alicia Downs (25:22):
And so you would, before parenthood, a hundred
percent of your RAM is yours.
Anna Sabino (25:30):
Yep.
Alicia Downs (25:30):
When you have type one diabetes, when you're an insulin
user in general, and when you haveany chronic disease, a portion of
that RAM now gets allotted to themaintenance of that disease, and we
know that diabetes is a very large one,and then insulin use is even larger.
And so that's already likepartitioned off, right?
(25:51):
That's part of just like theoperating system, like you don't
get to delete or touch this part.
And then another humancomes into your life.
Women with type one in particularly, likewe're told like a pregnancy is gonna be
the hardest part of your diabetes life.
It's gonna be so hard to manage.
It's gonna be so hard.
So hard.
It's hard.
And it's like, you know what?
I can do anything for a year, right?
I could suck it up.
I could do anything for a year.
(26:13):
But we're not taught is that the you,you do all that, but that part that's
like partitioned off for like yourdiabetes management for that year?
You don't get it back becausenow that goes to that other human
for the rest of your existence.
Dr. Paula Diab (26:32):
Not just for five years.
Alicia Downs (26:33):
I remember, I remember asking my friend, like I, I feel
dumber than I was before thislittle human came into my world.
Is that baby brain?
And she was like, yeah.
And I was like, so when does it come back?
When do I get to be like me again?
And she was like, it doesn't,this is the new, you.
(26:55):
Adjust and behave accordingly.
And I was like,
oh.
And like you said, like nowit's almost harder because now
he has like opinions and stuff.
Anna Sabino (27:08):
Yeah.
Dr. Paula Diab (27:09):
Wait till they get teenagers.
I've got a 15 and a 17-year-old,and they're full of ideas.
Alicia Downs (27:14):
Well, they're already, he, he's, uh, we call my, we tell
say that my son is eight-- 18 ish.
Dr. Paula Diab (27:21):
No, I really have 15 and a 17-year-old.
And they have really goodopinions and they're not always,
Alicia Downs (27:27):
So how do you do it, Paula?
How do you self care?
Because you're, because you'rea doctor and you've got staff
and a clinic and like staff!
I got one human dependent on me.
Dr. Paula Diab (27:37):
I feel guilty on a, I feel guilty on a daily basis because
I'm constantly saying to people,you must exercise every day and
you must, and you must eat healthy.
And then I don't do the same thing myself.
But I think for me,
Alicia Downs (27:48):
Well the hypocrisy of being a clinician, right?
Nobody is more overweight and outtashape and stressed out than nurses.
Dr. Paula Diab (27:59):
I think, I mean for me, exercise is not fun, so it has to
be part a, a social occasion for me.
So I love walking with friendsor joining a Pilates class.
I'll go hiking with the family or walkingon the beach with family or something.
And I think that's what I sort oftry to advocate to patients as well.
And to say every, it's part ofyour daily routine and it's part
(28:19):
of your social socialization.
It becomes so much easier.
I still haven't figured it outfor how to eat healthily because,
contrary to what Alicia said at thebeginning, I did not choose my surname.
I was born with that surname.
Um,
Alicia Downs (28:34):
Oh, I thought it was your married name.
Dr. Paula Diab (28:36):
No, it's, it's, it's my, my maiden surname.
And the funny story is, so it's aLebanese surname, my dad's Lebanese.
I actually chose to keep my maiden.
Alicia Downs (28:45):
Now that explain is why you, you have trouble eating.
Well 'cause that is
Dr. Paula Diab (28:48):
exactly
Alicia Downs (28:49):
some cuisine right there.
Dr. Paula Diab (28:50):
Exactly
Anna Sabino (28:51):
Homemade hummus baby.
Dr. Paula Diab (28:54):
I actually decided to keep my maiden surname
before I specialize in diabetes.
And then at the first presentationthat I gave at a Congress, it was this
big National Diabetes Congress, andI stood up and I did my presentation.
I thought I was so smart.
And then the first question Igot asked, this guy stood up and
he said, is that your real name?
I was like, are you kidding me?
Is that the question thatyou're coming up with?
And then only did I realize thatmaybe I was sort of predestined
(29:17):
to, to, to, to work in diabetes.
Eating?
Eating is a, is a pastime of mine.
I can, I can do it quite well.
I've got lots of tips and tricks that Ican tell people about how to eat better.
Because I've tried them all.
Alicia Downs (29:33):
Yeah.
Because I use.
Dr. Paula Diab (29:36):
I've used all of them.
Yeah.
Alicia Downs (29:37):
All the time.
Dr. Paula Diab (29:39):
I know exactly.
Alicia Downs (29:39):
Sometimes some of them are really effective.
Dr. Paula Diab (29:42):
Exactly.
Alicia Downs (29:44):
I'm like, I'm the weight loss expert.
I have lost easily 800 pounds, 20 poundsat a time, 40 or 50 times in my life.
No, somebody could do the, youknow, actually making that stick
part, although I'm getting thereand, uh, our team is part of that.
Yes.
Yeah, for me, similar.
(30:07):
You know, just, I always tellmy patients, because we live
in a really high stress world.
We live in a very time greedy world.
Uh, we have all these things thatare supposed to save our time, but it
actually just opens up a place, a voidfor us to shove more crazy stuff into.
But I tell my patients, you don'thave time to not take the time.
(30:27):
Hmm.
Because if I don't take the time totake care of myself, I'm gonna get sick.
And if I'm sick, there's nobodyto take care of everybody else.
If I'm sick, my patients are let down.
If I'm sick, my son is abandoned.
If I'm sick, my faith communitynow has a gap that they have
(30:47):
to figure out how to fill.
If I'm sick places, I volunteer?
Now people aren't getting services.
It's when we look, we are all justalarmingly more important than we
realize that we are in other people'sworlds, which means it's important
that we maintain ourselves as anact of service to them as well.
Anna Sabino (31:11):
Yep.
Alicia Downs (31:12):
Um, so that has become a really big thing for me.
Like Paula, my family is, myfamily is Asian, Greek, and
Southern, which means rice,
Anna Sabino (31:25):
Lots of food!
Alicia Downs (31:26):
Rice and biscuits and frappe, and like, nothing conducive
to good blood sugar management.
That's where, and it meanscardiac disease out the wazoo.
Food is, food was, uh a social aspect.
It's family history being passed down.
(31:46):
It's a coping mechanism,big time in my world.
Um, and then that hit up against diabetes.
I remember my first, my firstappointment with a dietician.
They were like, okay, so you wannaavoid white rice and you wanna avoid,
or they were like, you wanna avoid rice?
And I was like, time out.
Anna Sabino (32:04):
Yeah.
Alicia Downs (32:05):
That's not possible.
Anna Sabino (32:06):
Pasta.
Anything with cheese and bread.
And I'm like, what?
Alicia Downs (32:09):
Right.
They were like, they were like, youwanna avoid bread, you wanna avoid
pasta, you wanna avoid, I was like
Anna Sabino (32:14):
Ice cream.
Alicia Downs (32:15):
My family is Asian, Greek, and Southern.
And the dietician, bless her,literally took, she looked down at
everything she had on the table andshe went and just cleared the table.
She was like, this is not gonna work.
And I was like, thanks, 'causeyeah, I'm not doing any of that.
It's not applicable.
So I have found ways to work in what Icall moments of purposeful self neglect.
(32:39):
To get really real, really honestwith myself and go, okay, you
know what I need in my world?
I need a frappe, the size of my head.
What's it gonna take to havethat and not be unhealthy?
Well, first Alicia, it takes lookingat your world and figuring out why you
(33:00):
need a frappe, the size of your head.
'cause there's a stressor there.
Anna Sabino (33:03):
Yeah.
Alicia Downs (33:04):
So let's, let's deal with that as a coping skill.
And I identify the cause ofthe stress and deal with that.
But then how can you manage yourblood sugar to make sure you're
not at 400 with your frappe?
How can you get some more physicalactivity in your day to make sure
that this 900 calorie frappe is notabout to completely undermine your
(33:24):
weight loss work that you're doing?
And how can you then make sure thatyou do really good sleep hygiene
because you know the caffeine from thatfrappe is about to destroy your world.
I need to learn, I need to know and beempowered so that I can have the, the
self-care moments without destroyingthe world that I've built around.
(33:47):
And then that makes them make the worldaround stronger and so weaker and then
I can have more of them and make morespace, but I have to have the knowledge.
Dr. Paula Diab (33:57):
Yeah.
I always say to people that 80/20rule of like doing what you know you
should be doing 80% of the time andallowing yourself 20% of the time to
not do what you know you meant to do.
Alicia Downs (34:08):
Yeah.
And if you look around and you'redoing what you're supposed to, like
95% of the time, it's probably timeto go out there and mess it up.
You've got homework, go mess it up.
Take a day off.
Like do the thing and, and I knowsome of my patients, I'm like, you are
a textbook, doing everything right.
I would like you to go bea D- for like 48 hours.
(34:33):
Like, and they're like a D minus?
I'm like, yes, I'm saying D. 'cause I knowthat on a best day you might hit a C plus.
Like, but aim for D minus.
Like you, we have to have those timeswhere we can just aim for the 20%.
We, we have to letourselves have self-care.
Self-care is part of care.
(34:53):
It's kinda like, I hate that we've likepartitioned off health and mental health.
No, they're the same thing.
You can't without the other health.
Yeah.
You can't, especially can'thave care without self care.
I can't care for someone elseif I'm not caring for myself.
That's not even different things.
Dr. Paula Diab (35:12):
But its not just physical health and mental health.
It's emotional health, virtualhealth, everything all combined.
Alicia Downs (35:16):
Just health, like I can't have financial health and physical
health separate from each other.
They, try being deeply indebt, broke and healthy.
No, that's not a thing.
I've been there.
They don't cohabitate, they mightappear to for a short period of
time, but it's, it is an illusion.
It's not an actual thing.
(35:37):
Let's do some rapid fire.
We're gonna go, we'll just gofor, for the sake of rapid fire.
We'll go Anna, Paula, Alicia onanswers, and we'll see how fast.
Oh boy.
We can go around.
We'll start with, uh, we'llstart with some IDS rapid fire.
Anna Sabino (35:53):
Okay.
Alicia Downs (35:54):
All right.
Zombie apocalypse.
Who's first person on your team?
Anna Sabino (35:58):
Gary.
Dr. Paula Diab (36:00):
Not me.
Alicia Downs (36:02):
Not me.
Paula just wants out!
I got Dana.
Uh, who's the best cook on the IDS team?
Anna Sabino (36:10):
Jenny.
Dr. Paula Diab (36:12):
Jenny.
Alicia Downs (36:14):
Dana.
Again, her spreads crazy.
Dr. Paula Diab (36:16):
Oh.
Alicia Downs (36:17):
Uh, most efficient packer when they travel?
Anna Sabino (36:20):
Not Kathryn.
Alicia Downs (36:22):
Kathryn.
Forget everything.
Kathryn will get to a diabetesconference and forget her
insulin, like the poor child.
Anna Sabino (36:30):
I, I, I've been there, done that.
Yeah.
Dr. Paula Diab (36:33):
I think I'll probably go with Dana.
Alicia Downs (36:35):
Gary, he's a guy.
He could pack it for a week in this.
Um, who uses the most emojiswhen they communicate?
Anna Sabino (36:44):
Tavia.
Dr. Paula Diab (36:45):
Tavia.
Alicia Downs (36:46):
Tavia for sure.
Um, who's the most organized person?
Anna Sabino (36:58):
Uh, probably Tavia, not Kathryn.
Dr. Paula Diab (37:04):
I think I'd go with Jenny.
Anna Sabino (37:06):
Jenny.
Maybe
Alicia Downs (37:07):
that's a good one.
But I'm gonna say, I'm gonna sayPaula just 'cause we got a tour of
Paula's house and it looked on point.
You could see mine in the background.
Anna Sabino (37:17):
I got a Barbie dream house right there, so we're not me.
Alicia Downs (37:21):
And nobody, notice, nobody even paused on
Alicia or Anna for a moment.
Anna Sabino (37:25):
Nope, nope, nope.
I'm a nothing.
Alicia Downs (37:27):
Who would win an armed wrestling contest?
Anna Sabino (37:30):
Oh, Gary or Kathryn.
Dr. Paula Diab (37:33):
Kathryn.
Alicia Downs (37:35):
Yeah, I was actually gonna say it could be
close between Anna and Kathryn.
Anna Sabino (37:38):
Oh!
Alicia Downs (37:38):
These girls be putting down some pounds.
Anna Sabino (37:41):
Yeah.
Alicia Downs (37:42):
Well, don't, don't mess with our team!
If you see us in a dark alley run.
All right.
Rapid fire, self and diabetes management.
Paula.
You ready?
You ready to bring it?
I hope so.
We love Paula.
Paula is the only member of our clinicalteam who doesn't have type one, but
we consider her an official, uh, uh,an adult of nonfunctional pancreas.
(38:06):
Um, we, we have faith that someday shewill, uh, wake up without a pancreas
or that someday, uh, be, she'll juststart growing extra ones and just start
handing them out at company events.
That'll be great.
We'll, we'll reverse the order.
We'll go Paula, Anna, Alicia.
Anna Sabino (38:25):
Okay.
Alicia Downs (38:26):
Alright.
Finger sticks.
Lick or wipe?
Dr. Paula Diab (38:30):
Probably wipe.
Anna Sabino (38:33):
Lick.
One hundred percent.
Alicia Downs (38:35):
Wipe if I'm wearing pants, it's on the inside of my
cuff, on the bottom of my pants.
Otherwise lick.
Open source or FDA approved?
Dr. Paula Diab (38:47):
Definitely FDA approved.
'cause I hardly knowanything about open source.
Alicia Downs (38:50):
There you go.
Anna Sabino (38:51):
FDA, approved.
I'm a rule follower.
Alicia Downs (38:54):
Uh, FDA, approved.
I'm way too lazy to keepup with the updates and the
branches and the Google stuff.
Anna Sabino (38:59):
Yeah.
Alicia Downs (39:00):
Coffee or tea?
Dr. Paula Diab (39:02):
Coffee.
Anna Sabino (39:03):
Coffee.
Alicia Downs (39:04):
Caffeine, please.
I don't even care how it gets in.
It just needs to get in.
Uh, mountains or beaches.
Dr. Paula Diab (39:11):
Oh, definitely both.
Anna Sabino (39:15):
I need, I need both, but Ocean is, yeah.
There's something about the infiniteview thoughts of what the ocean brings.
Yeah.
I live four miles from four milesfrom the ocean and 40 miles from
the mountains, so I'm spoiled.
Alicia Downs (39:34):
Why are we not, uh, company picnicking at Anna's house?
Anna Sabino (39:37):
You're welcome to come to New England.
It's pretty, pretty here.
Alicia Downs (39:41):
Summer through fall?
Ocean.
Fall through winter?
Mountain or fall through Spring Mountains.
So more mountain person than a, than a,
Anna Sabino (39:52):
yeah.
Alicia Downs (39:52):
Beach person.
Best concert you've been to?
Dr. Paula Diab (39:56):
Neil Diamond.
Madison Square Gardens.
Alicia Downs (40:01):
We got Anna.
Anna Sabino (40:02):
Probably, probably U2.
Alicia Downs (40:03):
Nice.
Uh, mine is, uh, I gotta handit to Queen with Adam Lambert.
Anna Sabino (40:12):
Oh, stop.
Alicia Downs (40:13):
Uh, yeah.
And I was like four rows off the front.
It was.
Epic.
Epic.
If you can go, go before thosemen are no longer with us.
And low carb or all the carb?
Dr. Paula Diab (40:27):
All the carb.
Anna Sabino (40:29):
Load it up baby.
Alicia Downs (40:31):
What do you, what did you have, Paula?
Dr. Paula Diab (40:34):
All the carb.
Definitely.
Anna Sabino (40:36):
Yeah.
There's, there's no loss ofsweet tooth in my, over here.
Alicia Downs (40:41):
There are no dieticians in this room, y'all.
No dieticians.
Anna Sabino (40:44):
No.
No.
There's no such thing as low carb.
No.
No.
Alicia Downs (40:48):
Thank you guys so much for coming, for sharing.
Anna Sabino (40:51):
Oh, this is so fun.
Yeah, I had a blast.
Dr. Paula Diab (40:53):
Thank you.
Alicia Downs (40:54):
Um, thank you Paula, for staying up a little, little past
normal clinical office hours with us.
Anna Sabino (40:59):
Paula, what time is it there?
Alicia Downs (41:01):
What time is it right now?
Paula?
What?
Like six?
Dr. Paula Diab (41:03):
5:00 PM
5:00 PM
Alicia Downs (41:05):
Oh, I was off by an hour.
I always think you're fartherwest than, than you are.
Dr. Paula Diab (41:11):
It's not too bad.
I was just, I was just gonna say though,the reason I can choose, um, the mountains
and the beach is because in our provincewe've actually got the mountains, the
beach, and the bush all in one province.
Alicia Downs (41:23):
Oh.
Dr. Paula Diab (41:23):
So one day when you all come and visit me,
then you'll come and see them.
Alicia Downs (41:28):
It's kinda like PA. I don't know what actually constitutes the bush.
I mean, we have, bushes,but I don't think.
Big open flat space.
Not quite prairie, but it's just flat.
But we've got, the ocean is likean hour and a half that way.
The mountains are liketwo, three hours that way.
That's why I like this area.
(41:49):
It's kind of not, not quite,not quite the four miles anna's
working with over there though.
But, but thank you guys.
We wanted to share this becausewhat we love about IDS is just
being real people who are walkingthe walk and talking the talk.
We're not gurus on the mountaintop.
Sometimes life is a red,hot, flaming dumpster fire.
Anna Sabino (42:07):
It is, yeah.
Alicia Downs (42:07):
And sometimes what makes the difference between
us and the doctor is living it.
Being just neck deep init, 24/7, 365 for years.
And what makes the difference betweenus and our patients is just the
knowledge of being able to bounce.
Anna Sabino (42:28):
Yeah.
We have what?
We have like hundreds of years ofdiabetes experience and like we get it.
And I think
Alicia Downs (42:34):
Combined?
Yeah.
Hundreds of years.
Anna Sabino (42:38):
I think that's why people, I think that's why I love this team.
I learned something our, ourlike text thread is a whole
set of dumpster fire, like.
Questions.
Who needs an extra sensor?
Um, we're, we're like real people.
Alicia Downs (42:51):
Yeah.
And, and ongoing growing because, becausewe aren't perfect, we're always sharing.
Um, and because we live it and weknow that there is no right way.
There is no one way.
We're always growing because we're alwayson the search for just that, that thing
(43:15):
that's just gonna make today a littleeasier and tomorrow a little better.
And we are not gatekeepingit, we are just sharing it.
We are getting it out there and, and welove our, we sincerely love our community.
So we hope to see you.
We hope you join us on the nextpodcast, and we hope that you
(43:35):
reach out for your diabetes needsto get education and empowerment.
And if you're interested, come join us.
Gary Scheiner (43:43):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think Like a Pancreas, the podcast, isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion and diabetes
(44:04):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech, sports,
and exercise, weight loss, type onepregnancy, and emotional wellbeing.
(44:25):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas,the podcast, I'm Gary Scheiner,
(44:47):
wishing you a fantastic week ahead.
And don't forget to think like a pancreas.
Welcome to Think Like a Pancreas, The Podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:35):
healthcare provider before implementing.
Alicia Downs (00:37):
Thank you so much for joining us for Think
Like a Pancreas podcast.
You are here with Alicia.
I am one of the nurses here at IDS.
With Anna Sabino, one of ouramazing mental health specialist,
and with Dr. Paula Diab.
Yes, that last name is not...like, I think she chose, like
(01:01):
she actually married into that.
Crazy!
So and so she's joiningus from across the pond.
Uh, she is a diabetologist in SouthAfrica that works with our team.
Um, and so we are in for anotherepisode where you get to meet
us, get to know us a little bit.
Um, so I'd love to kind of justthrow around and just, uh, kind
(01:24):
of what brought you to IDS?
Dr. Paula Diab (01:27):
So I, as, as you said, I work with, uh, as a diabetologist in
South Africa, and I was interested in,I'm very interested, although I'm a
doctor, I'm very interested in diabeteseducation and I was Googling diabetes
education online, and I came up upon,upon Gary and IDS and then we had a
Skype, uh, video consult in those days.
(01:47):
Um, at first, and thenwe just kept in contact.
And then I was coming to Boston to comeand visit a family member there, and I
phoned him and I said, can I hop on aplane to Philadelphia and come visit you?
And Oh, that's how I got involvedwith IDS, jumped through lots of hoops
to become a CDCES, but here I am.
Alicia Downs (02:06):
Yeah.
You would think as a doctor they'djust be like, yeah, come on in.
Yeah.
But, but no, they put moreroadblocks in front of Paula than
they put in front of most anybody.
Dr. Paula Diab (02:14):
Yeah.
Anna Sabino (02:15):
Well, we're glad you went all the way to Philly.
Dr. Paula Diab (02:19):
Philadelphia's a beautiful city.
I really enjoyed it.
Alicia Downs (02:22):
As I am going to go off camera for just a second so I
can turn off this light that hasdecided to start strobing behind me.
Um, but Anna, how did
you get
Anna Sabino (02:29):
Sure.
Alicia Downs (02:30):
Picked up with IDS.
Anna Sabino (02:31):
I'm, um, I mean, so many people have heard of Gary Scheiner.
He was the, you know, diabetes educatorof the year and he is written like,
you know, the iconic, Think Like aPancreas and when I went out on my own
and started my own private practice,I almost sort of like modeled my
practice after what Gary had started.
(02:51):
I just think he is the bee's knees,and so I had connected with him
and worked with him on a coupledifferent like, you know, conferences.
The diabetes world islike super duper small.
I think I commented on a Facebook postabout some timeout for caregivers class
and then he was like, oh, why don't youcome join one of the calls and chime in.
(03:14):
And then he called me upand was like, we need you.
And so it's been so much fun to workwith a team, you know, albeit virtually.
For the last, I don'tknow, almost three years.
Two, three years.
Alicia Downs (03:28):
Time flies.
Anna Sabino (03:29):
Yeah.
Helping like, you know, families and kidsand young adults and adults too, just
like navigate all the invisible stuffthat we don't see that we know exists.
Um.
In the back, back in frontof our minds with T1D.
It's fun.
Alicia Downs (03:45):
I had the weirdest connection to IDS so far on our team.
I had, I was, I was diagnosed asan adult and my PCP who diagnosed
me with LADA said, here are threebooks that you need to read.
Um, and I still to this day refer to,I refer other patients to them and I
(04:07):
refer to them as my Trinity of diabetes.
And they are, uh, Sherry Kohlberg's,the Diabetic Athlete Handbook because
I'm an athlete and they were, okay... Ialways mix up John Walsh and Joe Walsh.
One of them is a diabetes expert.
The other one is the guitarist for theEagles, John Walsh, Pumping Insulin, uh,
(04:33):
because she knew I was gonna need a pumppretty quick and Think Like a Pancreas.
And so I read that bookuntil the cover fell off.
I probably read it 14 times.
I just read it and read itand read it and read it.
And every time a problem would comeup in my blood sugar life, I'd go, ah!
That was in the book and I wouldgo back and I would read it again.
(04:55):
And so eventually I decidedto become a diabetes educator.
And long as, you know, timepassed, I got my CDE in May
and in June my son came along.
So I was out on maternity leave.
And my leave was up in July and I wasjust, I was like, well, I got my CDE
(05:18):
now let's keep an eye on CDE jobs.
And I happened to get on LinkedIn anda job popped up for CDE in Philly for
Integrated Diabetes Services and itsounded like exactly what I wanted to do.
'cause I always felt like, it'd be greatif I could just help people with insulin.
Like if I, like, I could justlike have this like really
(05:38):
tight niche, it'd be amazing.
But like, you can't reallydo that as a nurse, right?
And I was like, um, let's see.
And I clicked on, not the link, but asyou do on LinkedIn, you then stalk the
job and like, who else is connected to it?
And Integrated Diabetes took me to GaryScheiner and I was like, Gary Scheiner?
(06:02):
And my husband walked through the roombehind me and he kinda looked and he
went, isn't that the guy on your book?
I was like, so, I just totally fangirled.
I was like, I'm notqualified for this job.
I'm not gonna get this job.
I don't know enough for this job.
I just got my CDE.
The ink is not dry yet.
I don't think they had even sentme the actual certificate yet.
Anna Sabino (06:23):
Yep.
Alicia Downs (06:25):
And so I applied and I was like, best case scenario?
I get an interview, I get to goand shake the man's hand and say,
thank you for writing the book.
And I went in and I just,uh, kind of vomited all of my
diabetes knowledge in an interview
and, uh, realized, you know, thatfeeling guys, that we get when you
(06:46):
go to see your doctors and youreducators and you feel like you know
more about diabetes than they do.
Yeah.
Sometimes it's accurate andsometimes you get hired as a
diabetes educator at a lead practice.
Anna Sabino (06:59):
Well, that honestly, Alicia, it probably worked in your
favor having just taken the exam, you'relike, and I know this about that, and
this side effect about this drug and...
Alicia Downs (07:09):
The exam?
Honestly, the exam was borderline useless.
The exam really was.
I always say what you learn inschool, should be called how to
not kill people with insulin.
Um, because you don't really learn anyfunctional useful things like as you
and as you take the exam, you actuallyhave had to keep the mindset, like,
don't put the answer that is what youwould actually do to help someone.
(07:34):
Put the answer that iscorrect for the test.
Anna Sabino (07:38):
Yeah.
Alicia Downs (07:38):
And so it was, but what was really my benefit was-- a, not having
to learn unlearn a lot of stuff fromhaving like worked in a hospital system
for 20 years and doing it the way theydo it and all of that kind of thing.
But also just, and it's, it'ssomething that makes our team
(07:58):
amazing is just the passion.
'cause the reason I went, the reason Ibecame a nurse was because I saw other
people who needed to know more to livethis life well, and I'm a born student and
if it was this hard for me, what happensto people who aren't a born student?
And that gap was not okay.
(08:19):
And so I wanted access tobe able to help people.
And so for me, that was nursing.
And so for me, that was IDS.
Um, to be able to use my strugglesand what I've had to learn to help me.
If I only learn it to helpme, what's the point, right?
Because I'm temporary.
And, and that means it's a lot ofwork for like very little output.
(08:42):
But if I learn it to thendisseminate it, share it, and
make other people's lives better.
Dr. Paula Diab (08:49):
It's interesting that difference between, between experiential
knowledge and academic knowledge.
Alicia Downs (08:55):
Yeah.
Anna Sabino (08:55):
Oh yeah.
Dr. Paula Diab (08:56):
And I mean that was, I think, my driving factor in
getting me involved in diabetes.
We had, I think literally in thewhole of medical school, two less,
two lectures on, on diabetes.
And all that told us was 90% ofpeople have type two diabetes,
10% of type one diabetes.
Um.
If you fail at everything else intype two diabetes, there's always
(09:16):
insulin, which is completely thewrong message to give to people.
Um, and we only learned abouttwo different oral agents,
and you can take basal bolusinsulin or you can take a premix.
And that was it.
For about five years in clinicalpractice after I'd qualified, that
was my diabetes knowledge thatfitted onto two, like A4 pages.
And after seeing so many patients,I thought, this is ridiculous.
(09:39):
And every patient that was comingwas coming with complications and
amputations and heart attacks andstrokes and uh, lack of vision
and... I was like, this is crazy.
This is, you know, and that's whenI decided to do my masters in family
medicine and then do an advanceddiploma in diabetes and actually start.
Understanding more about the disease.
(09:59):
And when I look back now at what we weretaught and the difference between your
experiential knowledge and what we weretaught at university, it's frightening.
And it's frightening to think thatthere still are primary healthcare
providers who come outta medical schooland even 20, 30 years down the line.
Unfortunately, it's not that different.
Anna Sabino (10:19):
No.
Dr. Paula Diab (10:19):
Um,
Anna Sabino (10:20):
I had a, I had a new client just yesterday, and she
was diagnosed in her mid sixties.
And with, you know, with, with LADA whereshe's still, you know, she's titrating
up on her insulin needs very low, kindof compared to someone like me who
was in full-blown DKA at my diagnosis.
But, you know, her PCP calledher back, blood sugar 450.
(10:43):
Go to the ICU.
They didn't know what to do with her.
And this was a year and a half ago.
And this is in Boston.
Alicia Downs (10:49):
And just sitting in the ICU and the ICUs is
like, we don't deal with people.
We talk
Anna Sabino (10:52):
Well, yeah, and they, and they admitted, they're like,
we are not diabetes educators.
They stabe, you know, they hadher on an, you know, insulin drip.
They stabilized blood sugar.
Stabilized potassium.
You know, all the things, but then what?
And the one thing she said to me was like,I don't know how to do blood sugars and
I think, you know, for me and you andall of us, this experiential learning.
(11:16):
Diabetes is a, it's a lifestyle and youknow, I was diagnosed as a 6-year-old,
so I was just telling Paula before westarted, you know, yes, we've come so far.
The first meter I have, Ithink I have it upstairs.
I wish I could go grab it, but it,it took 120 seconds to get a reading.
(11:37):
It was the AccuCheck two.
Alicia Downs (11:38):
That's two full minutes.
Anna Sabino (11:40):
Two full minutes.
And now we don't have to do anything.
I haven't pricked my finger in weeks.
Maybe don't record that,but, um, I don't need to.
Alicia Downs (11:51):
But like literally whats my blood sugar?
I now just look at my watch.
Anna Sabino (11:54):
Yeah.
And so it took.
You had to get a crap ton of blood.
Like I'm talking, it was a whole... mymom would bring me a tray in the morning.
There was a cotton ball, thealcohol swab, the meter, the strips.
It was like a thing.
It was like a whole thing.
But we were only requiredto do it four times a day.
And anything that happened inbetween was like, you don't know.
(12:18):
And I think for me, one of the mainreasons I, you know, decided to give back.
And we talk about experiential learningis, you know, I, because I was diagnosed
in the late eighties, early nineties,you know, I didn't know anyone.
There were no visible devices to feelthat sort of sense of connection,
even just walking through the mallor in the parking lot or wherever.
(12:39):
I went to camp.
And for me, that was my bubble.
And I grew up going every summer, and itwas sort of like those two weeks were my
opportunity to feel seen to feel safe,and I know so many kids also get that
opportunity today, but there's also somuch more opportunity for connection.
However, it was my, I was in, it was 2005.
(13:04):
I was the assistant camp director for theday camps, and I had to go to New York
City and pick up some kids and bring themto camp, and that's when I realized my,
you know... socioeconomic or whatnot,family situation with diabetes and support
was not the same as everyone else's.
(13:27):
And that there were a lot of otherfactors that contributed to people
feeling okay with diabetes, and Iwanted to get underneath all of that
to every family and, and make sure thateven if they didn't have the support,
and even if they came from potentiallya broken home or had other underlying,
(13:50):
you know, mental health or comorbiditiesor whatever it is, that they still
felt like they belonged somewhereand someone would listen to them.
I feel like, for me,like I'm living my dream.
I'm living my passionbecause that's what drove me.
You know, those experientials to gointo, get my master's in social work.
(14:10):
And then I was like, oh, wellI can have a CDE and be an MSW.
Dream job!
For all of the people out there whoare like, how do I become a CDCES?
Or, you know, you can, youcan use your, yeah, call me.
Call me maybe.
Um, you can use your, your skillsand dream it and, and do it.
And that's.
(14:31):
Most people at camp, like they wannabecome nurses, they wanna become
teachers, they wanna become this likeservice oriented skill level of, of
career path, which is just so, so cool.
I'm here for it.
We're, I think we're all here for it.
And I think we would all do anything,Gary included, to be the, to, to mentor
and, and have people work alongside.
Alicia Downs (14:52):
That's, we at IDS to... mentoring and raising up
other CDEs is like our side passion.
IDS, like helping our community,serving our community, educating people
with type one is clearly what we do,but we are very aware that we're not
getting any younger for one thing.
Anna Sabino (15:11):
Yeah.
Alicia Downs (15:11):
Uhhuh, uh, you know, we're not gonna be here forever
and hopefully type one isn't hereforever either, but just in case.
Anna Sabino (15:16):
Yeah.
Alicia Downs (15:16):
We need other people to fill in.
But also just ratios, I mean, there issomething like, one endo for every 800
people with diabetes in this country,and one educator for something like 300.
I can't educate 300 people,at least not do it well.
And that's assuming thateverybody's spread out evenly,
(15:38):
which we know they aren't.
So we really need a lot more great people.
Becasue even if we did cure typeone, we still need the health
education on staying healthy as well.
Anna Sabino (15:49):
And I was told the average CDCES when I took my exam,
which I took it at 32 weeks pregnant,
Alicia Downs (15:56):
Ugh.
Anna Sabino (15:56):
With diabetes.
Alicia Downs (15:57):
The fact that you've retained anything is magical.
Anna Sabino (16:00):
Yep.
The average age was 55, and hopefullyit's gone down, but take the exam!
Alicia Downs (16:09):
Diabetes, diabetes education is very much viewed, at least in the
nursing world, less so amongst dieticians,um, but in the nursing world, it's very
much viewed as sort of what you do onyour way out of, sort of active practice.
Anna Sabino (16:23):
Yeah.
Alicia Downs (16:23):
So when you're kind of burnt out on the physical demands or
the psychological demands of directpatient care, you transition into an
education role as sort of a supportcare person on your way out the door.
Which is bonkers bananas becausediabetes management is now a high paced,
(16:45):
high, fast change over tech world.
Anna Sabino (16:48):
Yeah.
Alicia Downs (16:49):
That the, but
Dr. Paula Diab (16:50):
that's the thing.
Alicia Downs (16:50):
The average person on their way out is not prepared for.
And we don't want people on their way out.
We want people on their way in togrow with the need of the community.
Anna Sabino (17:01):
That's, I'll say, there's so many more opportunities now and
pathways in order to get there.
So, anyway, go ahead Paula.
Dr. Paula Diab (17:09):
Um, about diabetes education, it's so frustrating.
People often say to me,oh, you're a doctor.
Why on Earth, are youdoing diabetes education?
And my response to that is, look, if Iwas diagnosed with diabetes today, I would
go and see the educator a hundred timesover before I'd go and see the doctor.
Anyone can write a script for insulin, butthere are only very few people that can
(17:30):
explain to you how to use that insulin.
And I think for me, one of the nicestthings is actually learning from my
patients and learning and... so educatingthem, but learning back from them.
I remember an incident where a patientcame to me and she said, oh, if I eat
all my vegetables and my, my meat first,my sugars don't tend to go up as much
as if I eat my carbohydrates first.
(17:51):
And I said, okay, well that's great.
This was about 10 years ago.
And I said, that's great.
If that's how you want to eatyour food and you can do that.
A few months later, I was ata conference and they were
talking about food sequencing.
And I was like, what onearth is food sequencing?
And I was like, oh, that'swhat my patient was telling me.
And it's amazing!
Alicia Downs (18:09):
You'll come back and teach a, teach a class.
Dr. Paula Diab (18:13):
But it's amazing how if you just listen to people,
share experiences with them andI think I've, I've got a huge
amount of that from the IDS team.
And you guys were talking abouthow a side passion is mentoring.
It's the most incredible thing to be partof a team where you're being supported
and you're constantly being given newinformation and being uplifted and, and
(18:34):
given, pushed in a certain direction.
And that's what I absolutely love.
About the education side of things
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Alicia Downs (19:19):
Okay guys, I gotta, I got a break because we are CDCES
fanning and we are IDS fangirling, butum, we got, we gotta get real 'cause
they're supposed to get to know us too.
And we obviously love our jobs.
News flash.
Hi.
Anna Sabino (19:36):
Yep.
Alicia Downs (19:36):
We're at IDS.
We love our jobs and we lovepeople with diabetes and yeah, so.
But, but who are these, whoare these random persons here?
So.
Gonna, gonna throw out somediabetes tangential, but
sliding more and more into it.
Anna Sabino (19:53):
Oh boy.
Alicia Downs (19:54):
We are gonna get realer and realer.
Dr. Paula Diab (19:56):
Are we getting a, are we getting an exam question?
Alicia Downs (19:59):
Uh, no.
No.
I'm not gonna go full on exam.
We were joking with Paula before this.
We were like, we're like trivia questions.
I hope it's not like, what,what are the three leading side
effects of this medication go?
Like, it's too stressfulfor this time of day.
Here's one to get a little morepersonal, like diabetes management.
Whether it's self or patient.
(20:21):
Uh, personally I find helpingpatients manage often more
stressful than managing myself.
'cause I could put myself onautopilot, but putting other people
on autopilot's, not an option.
Um, but so being a clinician,we're also all moms.
We're busy peoples.
We all have our own health tomanage as, as well as helping
(20:41):
other people manage theirs.
How do you do self care?
Anna Sabino (20:46):
No.
Alicia Downs (20:46):
How do you, uh, how do you balance and, and manage things
and make sure that you stay healthy?
How do you, how do you walk thewalk while you talk the talk?
Anna Sabino (20:57):
Uh, I'll, I'll take this one first.
Uh, because I feel like, and Imight have written a blog about this
recently, I can't remember, you know,being diagnosed in kindergarten.
I've done a lot of the phases andtransitions of life with diabetes.
Going to school.
Going to college.
Graduating college.
(21:17):
Grad school.
Moving.
Getting married.
Having kids.
And now I'm kind of inlike this maintenance mode.
I've tried all the tech.
I've used all the different devices.
I, right now have, I'm finding themost success using the the tSlimX2.
Parenting?
Knock on wood.
My kids do not live with type one.
(21:38):
They're five and seven, almost eight.
But trying to prioritize my own healthneeds while constantly anticipating
their needs has been the biggestchallenge, especially because,
being pregnant with diabetes andpostpartum with diabetes, you know,
(21:59):
there's all these hormonal fluctuationsand you're constantly adjusting doses.
But now I'm at the pointin my life where like.
I haven't really changed abasal rate in like years.
And I'm back to my like sort ofpost puberty rates and ratios and
this, that and the other thing.
And you know, I go to my endoand they're like, all right, what
did you do the last three months?
(22:19):
Anything different?
I'm like, well, I tried the iLet.
I did this.
And they're like, oh my God, Anna!
Which pump are you gonna stick with?
I'm like, I don't know.
Um, try 'em all right?
I'm doing this trial next month, butbalancing and, and with this, the
whole self-care is like, I reallytruly feel like, and I say this to my
patients all the time, the burden ofself-advocacy with diabetes is something
(22:44):
that is the most consistent and mostchallenging part of having diabetes.
Because you think about self-advocacyand you're like, you're, I'm
now at the point where like.
The little five year olds at a birthdayparty are like, what's on your arm?
And, oh, why can't you go swimming?
Or why, why do you have a tube on you?
And it's, it's like, okay,who do I explain this to?
(23:06):
And as an adult, you know,we're never not meeting people.
We're never not in an opportunity where,is diabetes gonna screw up my day?
Or, you know, am I at a point whereI feel super comfortable explaining
what diabetes is every time you entera new room or a networking opportunity
or whatever it is, we all know it'san, it's an opportunity to learn to
(23:27):
teach, but it's also a mental blah--achallenge and, and it's exhausting.
It's an amazing experience to teach mykids, you know, diabetes like yay Barbie,
but at the same time it is, it's reallyexhausting because there are days where,
oops, my pump's out of insulin, but my kidis like screaming in the bath upstairs.
(23:51):
So it's those little momentsthat just are like, woooo!
Must regulate all the things and alsoprioritize my own health at the same time.
And it's a lot!
Alicia Downs (24:03):
Sometimes just the self-awareness.
Anna Sabino (24:04):
Yeah.
And I know I'm not alone there.
Um, but so far, parenting with diabetesand I, and I don't mean having a
newborn because that comes with its ownchallenges, but it's almost harder now.
Because they're, yeah, they wannago places, do things, fight with
each other, kick each other in theface, you know, and there're a lot.
(24:25):
I know Alicia has one of them.
Um,
Alicia Downs (24:28):
One that seems like nine.
Anna Sabino (24:31):
My 5-year-old boy, literally like ninjas on top of my CGM.
Like, buddy, slow down!
Making pedicure appointments, goingfor walks, listening to podcasts,
like just making sure there's enough,like alone time, whatever that may be.
Whether you're doing like typicalyoga, pedicure, whatever, but just do
(24:54):
something that you like to do for you.
That has to be part of it, for sure.
Alicia Downs (24:59):
That's... momming as a whole?
Tough.
Remember I first,
Anna Sabino (25:05):
And we don't talk about it.
It's all about pregnancy.
It's all about menopause.
But like just parenting while you'redoing diabetes is like BLAHHHHH!
Alicia Downs (25:14):
Well, and you've got a certain amount of brain space, right.
I call it, I call it RAM, right?
You've got wrapped.
Anna Sabino (25:18):
Yeah!
Alicia Downs (25:19):
Like active memory, available memory.
Anna Sabino (25:21):
RAM?
Active memory?
Yeah, yeah, yeah.
Alicia Downs (25:22):
And so you would, before parenthood, a hundred
percent of your RAM is yours.
Anna Sabino (25:30):
Yep.
Alicia Downs (25:30):
When you have type one diabetes, when you're an insulin
user in general, and when you haveany chronic disease, a portion of
that RAM now gets allotted to themaintenance of that disease, and we
know that diabetes is a very large one,and then insulin use is even larger.
And so that's already likepartitioned off, right?
(25:51):
That's part of just like theoperating system, like you don't
get to delete or touch this part.
And then another humancomes into your life.
Women with type one in particularly, likewe're told like a pregnancy is gonna be
the hardest part of your diabetes life.
It's gonna be so hard to manage.
It's gonna be so hard.
So hard.
It's hard.
And it's like, you know what?
I can do anything for a year, right?
I could suck it up.
I could do anything for a year.
(26:13):
But we're not taught is that the you,you do all that, but that part that's
like partitioned off for like yourdiabetes management for that year?
You don't get it back becausenow that goes to that other human
for the rest of your existence.
Dr. Paula Diab (26:32):
Not just for five years.
Alicia Downs (26:33):
I remember, I remember asking my friend, like I, I feel
dumber than I was before thislittle human came into my world.
Is that baby brain?
And she was like, yeah.
And I was like, so when does it come back?
When do I get to be like me again?
And she was like, it doesn't,this is the new, you.
(26:55):
Adjust and behave accordingly.
And I was like,
oh.
And like you said, like nowit's almost harder because now
he has like opinions and stuff.
Anna Sabino (27:08):
Yeah.
Dr. Paula Diab (27:09):
Wait till they get teenagers.
I've got a 15 and a 17-year-old,and they're full of ideas.
Alicia Downs (27:14):
Well, they're already, he, he's, uh, we call my, we tell
say that my son is eight-- 18 ish.
Dr. Paula Diab (27:21):
No, I really have 15 and a 17-year-old.
And they have really goodopinions and they're not always,
Alicia Downs (27:27):
So how do you do it, Paula?
How do you self care?
Because you're, because you'rea doctor and you've got staff
and a clinic and like staff!
I got one human dependent on me.
Dr. Paula Diab (27:37):
I feel guilty on a, I feel guilty on a daily basis because
I'm constantly saying to people,you must exercise every day and
you must, and you must eat healthy.
And then I don't do the same thing myself.
But I think for me,
Alicia Downs (27:48):
Well the hypocrisy of being a clinician, right?
Nobody is more overweight and outtashape and stressed out than nurses.
Dr. Paula Diab (27:59):
I think, I mean for me, exercise is not fun, so it has to
be part a, a social occasion for me.
So I love walking with friendsor joining a Pilates class.
I'll go hiking with the family or walkingon the beach with family or something.
And I think that's what I sort oftry to advocate to patients as well.
And to say every, it's part ofyour daily routine and it's part
(28:19):
of your social socialization.
It becomes so much easier.
I still haven't figured it outfor how to eat healthily because,
contrary to what Alicia said at thebeginning, I did not choose my surname.
I was born with that surname.
Um,
Alicia Downs (28:34):
Oh, I thought it was your married name.
Dr. Paula Diab (28:36):
No, it's, it's, it's my, my maiden surname.
And the funny story is, so it's aLebanese surname, my dad's Lebanese.
I actually chose to keep my maiden.
Alicia Downs (28:45):
Now that explain is why you, you have trouble eating.
Well 'cause that is
Dr. Paula Diab (28:48):
exactly
Alicia Downs (28:49):
some cuisine right there.
Dr. Paula Diab (28:50):
Exactly
Anna Sabino (28:51):
Homemade hummus baby.
Dr. Paula Diab (28:54):
I actually decided to keep my maiden surname
before I specialize in diabetes.
And then at the first presentationthat I gave at a Congress, it was this
big National Diabetes Congress, andI stood up and I did my presentation.
I thought I was so smart.
And then the first question Igot asked, this guy stood up and
he said, is that your real name?
I was like, are you kidding me?
Is that the question thatyou're coming up with?
And then only did I realize thatmaybe I was sort of predestined
(29:17):
to, to, to, to work in diabetes.
Eating?
Eating is a, is a pastime of mine.
I can, I can do it quite well.
I've got lots of tips and tricks that Ican tell people about how to eat better.
Because I've tried them all.
Alicia Downs (29:33):
Yeah.
Because I use.
Dr. Paula Diab (29:36):
I've used all of them.
Yeah.
Alicia Downs (29:37):
All the time.
Dr. Paula Diab (29:39):
I know exactly.
Alicia Downs (29:39):
Sometimes some of them are really effective.
Dr. Paula Diab (29:42):
Exactly.
Alicia Downs (29:44):
I'm like, I'm the weight loss expert.
I have lost easily 800 pounds, 20 poundsat a time, 40 or 50 times in my life.
No, somebody could do the, youknow, actually making that stick
part, although I'm getting thereand, uh, our team is part of that.
Yes.
Yeah, for me, similar.
(30:07):
You know, just, I always tellmy patients, because we live
in a really high stress world.
We live in a very time greedy world.
Uh, we have all these things thatare supposed to save our time, but it
actually just opens up a place, a voidfor us to shove more crazy stuff into.
But I tell my patients, you don'thave time to not take the time.
(30:27):
Hmm.
Because if I don't take the time totake care of myself, I'm gonna get sick.
And if I'm sick, there's nobodyto take care of everybody else.
If I'm sick, my patients are let down.
If I'm sick, my son is abandoned.
If I'm sick, my faith communitynow has a gap that they have
(30:47):
to figure out how to fill.
If I'm sick places, I volunteer?
Now people aren't getting services.
It's when we look, we are all justalarmingly more important than we
realize that we are in other people'sworlds, which means it's important
that we maintain ourselves as anact of service to them as well.
Anna Sabino (31:11):
Yep.
Alicia Downs (31:12):
Um, so that has become a really big thing for me.
Like Paula, my family is, myfamily is Asian, Greek, and
Southern, which means rice,
Anna Sabino (31:25):
Lots of food!
Alicia Downs (31:26):
Rice and biscuits and frappe, and like, nothing conducive
to good blood sugar management.
That's where, and it meanscardiac disease out the wazoo.
Food is, food was, uh a social aspect.
It's family history being passed down.
(31:46):
It's a coping mechanism,big time in my world.
Um, and then that hit up against diabetes.
I remember my first, my firstappointment with a dietician.
They were like, okay, so you wannaavoid white rice and you wanna avoid,
or they were like, you wanna avoid rice?
And I was like, time out.
Anna Sabino (32:04):
Yeah.
Alicia Downs (32:05):
That's not possible.
Anna Sabino (32:06):
Pasta.
Anything with cheese and bread.
And I'm like, what?
Alicia Downs (32:09):
Right.
They were like, they were like, youwanna avoid bread, you wanna avoid
pasta, you wanna avoid, I was like
Anna Sabino (32:14):
Ice cream.
Alicia Downs (32:15):
My family is Asian, Greek, and Southern.
And the dietician, bless her,literally took, she looked down at
everything she had on the table andshe went and just cleared the table.
She was like, this is not gonna work.
And I was like, thanks, 'causeyeah, I'm not doing any of that.
It's not applicable.
So I have found ways to work in what Icall moments of purposeful self neglect.
(32:39):
To get really real, really honestwith myself and go, okay, you
know what I need in my world?
I need a frappe, the size of my head.
What's it gonna take to havethat and not be unhealthy?
Well, first Alicia, it takes lookingat your world and figuring out why you
(33:00):
need a frappe, the size of your head.
'cause there's a stressor there.
Anna Sabino (33:03):
Yeah.
Alicia Downs (33:04):
So let's, let's deal with that as a coping skill.
And I identify the cause ofthe stress and deal with that.
But then how can you manage yourblood sugar to make sure you're
not at 400 with your frappe?
How can you get some more physicalactivity in your day to make sure
that this 900 calorie frappe is notabout to completely undermine your
(33:24):
weight loss work that you're doing?
And how can you then make sure thatyou do really good sleep hygiene
because you know the caffeine from thatfrappe is about to destroy your world.
I need to learn, I need to know and beempowered so that I can have the, the
self-care moments without destroyingthe world that I've built around.
(33:47):
And then that makes them make the worldaround stronger and so weaker and then
I can have more of them and make morespace, but I have to have the knowledge.
Dr. Paula Diab (33:57):
Yeah.
I always say to people that 80/20rule of like doing what you know you
should be doing 80% of the time andallowing yourself 20% of the time to
not do what you know you meant to do.
Alicia Downs (34:08):
Yeah.
And if you look around and you'redoing what you're supposed to, like
95% of the time, it's probably timeto go out there and mess it up.
You've got homework, go mess it up.
Take a day off.
Like do the thing and, and I knowsome of my patients, I'm like, you are
a textbook, doing everything right.
I would like you to go bea D- for like 48 hours.
(34:33):
Like, and they're like a D minus?
I'm like, yes, I'm saying D. 'cause I knowthat on a best day you might hit a C plus.
Like, but aim for D minus.
Like you, we have to have those timeswhere we can just aim for the 20%.
We, we have to letourselves have self-care.
Self-care is part of care.
(34:53):
It's kinda like, I hate that we've likepartitioned off health and mental health.
No, they're the same thing.
You can't without the other health.
Yeah.
You can't, especially can'thave care without self care.
I can't care for someone elseif I'm not caring for myself.
That's not even different things.
Dr. Paula Diab (35:12):
But its not just physical health and mental health.
It's emotional health, virtualhealth, everything all combined.
Alicia Downs (35:16):
Just health, like I can't have financial health and physical
health separate from each other.
They, try being deeply indebt, broke and healthy.
No, that's not a thing.
I've been there.
They don't cohabitate, they mightappear to for a short period of
time, but it's, it is an illusion.
It's not an actual thing.
(35:37):
Let's do some rapid fire.
We're gonna go, we'll just gofor, for the sake of rapid fire.
We'll go Anna, Paula, Alicia onanswers, and we'll see how fast.
Oh boy.
We can go around.
We'll start with, uh, we'llstart with some IDS rapid fire.
Anna Sabino (35:53):
Okay.
Alicia Downs (35:54):
All right.
Zombie apocalypse.
Who's first person on your team?
Anna Sabino (35:58):
Gary.
Dr. Paula Diab (36:00):
Not me.
Alicia Downs (36:02):
Not me.
Paula just wants out!
I got Dana.
Uh, who's the best cook on the IDS team?
Anna Sabino (36:10):
Jenny.
Dr. Paula Diab (36:12):
Jenny.
Alicia Downs (36:14):
Dana.
Again, her spreads crazy.
Dr. Paula Diab (36:16):
Oh.
Alicia Downs (36:17):
Uh, most efficient packer when they travel?
Anna Sabino (36:20):
Not Kathryn.
Alicia Downs (36:22):
Kathryn.
Forget everything.
Kathryn will get to a diabetesconference and forget her
insulin, like the poor child.
Anna Sabino (36:30):
I, I, I've been there, done that.
Yeah.
Dr. Paula Diab (36:33):
I think I'll probably go with Dana.
Alicia Downs (36:35):
Gary, he's a guy.
He could pack it for a week in this.
Um, who uses the most emojiswhen they communicate?
Anna Sabino (36:44):
Tavia.
Dr. Paula Diab (36:45):
Tavia.
Alicia Downs (36:46):
Tavia for sure.
Um, who's the most organized person?
Anna Sabino (36:58):
Uh, probably Tavia, not Kathryn.
Dr. Paula Diab (37:04):
I think I'd go with Jenny.
Anna Sabino (37:06):
Jenny.
Maybe
Alicia Downs (37:07):
that's a good one.
But I'm gonna say, I'm gonna sayPaula just 'cause we got a tour of
Paula's house and it looked on point.
You could see mine in the background.
Anna Sabino (37:17):
I got a Barbie dream house right there, so we're not me.
Alicia Downs (37:21):
And nobody, notice, nobody even paused on
Alicia or Anna for a moment.
Anna Sabino (37:25):
Nope, nope, nope.
I'm a nothing.
Alicia Downs (37:27):
Who would win an armed wrestling contest?
Anna Sabino (37:30):
Oh, Gary or Kathryn.
Dr. Paula Diab (37:33):
Kathryn.
Alicia Downs (37:35):
Yeah, I was actually gonna say it could be
close between Anna and Kathryn.
Anna Sabino (37:38):
Oh!
Alicia Downs (37:38):
These girls be putting down some pounds.
Anna Sabino (37:41):
Yeah.
Alicia Downs (37:42):
Well, don't, don't mess with our team!
If you see us in a dark alley run.
All right.
Rapid fire, self and diabetes management.
Paula.
You ready?
You ready to bring it?
I hope so.
We love Paula.
Paula is the only member of our clinicalteam who doesn't have type one, but
we consider her an official, uh, uh,an adult of nonfunctional pancreas.
(38:06):
Um, we, we have faith that someday shewill, uh, wake up without a pancreas
or that someday, uh, be, she'll juststart growing extra ones and just start
handing them out at company events.
That'll be great.
We'll, we'll reverse the order.
We'll go Paula, Anna, Alicia.
Anna Sabino (38:25):
Okay.
Alicia Downs (38:26):
Alright.
Finger sticks.
Lick or wipe?
Dr. Paula Diab (38:30):
Probably wipe.
Anna Sabino (38:33):
Lick.
One hundred percent.
Alicia Downs (38:35):
Wipe if I'm wearing pants, it's on the inside of my
cuff, on the bottom of my pants.
Otherwise lick.
Open source or FDA approved?
Dr. Paula Diab (38:47):
Definitely FDA approved.
'cause I hardly knowanything about open source.
Alicia Downs (38:50):
There you go.
Anna Sabino (38:51):
FDA, approved.
I'm a rule follower.
Alicia Downs (38:54):
Uh, FDA, approved.
I'm way too lazy to keepup with the updates and the
branches and the Google stuff.
Anna Sabino (38:59):
Yeah.
Alicia Downs (39:00):
Coffee or tea?
Dr. Paula Diab (39:02):
Coffee.
Anna Sabino (39:03):
Coffee.
Alicia Downs (39:04):
Caffeine, please.
I don't even care how it gets in.
It just needs to get in.
Uh, mountains or beaches.
Dr. Paula Diab (39:11):
Oh, definitely both.
Anna Sabino (39:15):
I need, I need both, but Ocean is, yeah.
There's something about the infiniteview thoughts of what the ocean brings.
Yeah.
I live four miles from four milesfrom the ocean and 40 miles from
the mountains, so I'm spoiled.
Alicia Downs (39:34):
Why are we not, uh, company picnicking at Anna's house?
Anna Sabino (39:37):
You're welcome to come to New England.
It's pretty, pretty here.
Alicia Downs (39:41):
Summer through fall?
Ocean.
Fall through winter?
Mountain or fall through Spring Mountains.
So more mountain person than a, than a,
Anna Sabino (39:52):
yeah.
Alicia Downs (39:52):
Beach person.
Best concert you've been to?
Dr. Paula Diab (39:56):
Neil Diamond.
Madison Square Gardens.
Alicia Downs (40:01):
We got Anna.
Anna Sabino (40:02):
Probably, probably U2.
Alicia Downs (40:03):
Nice.
Uh, mine is, uh, I gotta handit to Queen with Adam Lambert.
Anna Sabino (40:12):
Oh, stop.
Alicia Downs (40:13):
Uh, yeah.
And I was like four rows off the front.
It was.
Epic.
Epic.
If you can go, go before thosemen are no longer with us.
And low carb or all the carb?
Dr. Paula Diab (40:27):
All the carb.
Anna Sabino (40:29):
Load it up baby.
Alicia Downs (40:31):
What do you, what did you have, Paula?
Dr. Paula Diab (40:34):
All the carb.
Definitely.
Anna Sabino (40:36):
Yeah.
There's, there's no loss ofsweet tooth in my, over here.
Alicia Downs (40:41):
There are no dieticians in this room, y'all.
No dieticians.
Anna Sabino (40:44):
No.
No.
There's no such thing as low carb.
No.
No.
Alicia Downs (40:48):
Thank you guys so much for coming, for sharing.
Anna Sabino (40:51):
Oh, this is so fun.
Yeah, I had a blast.
Dr. Paula Diab (40:53):
Thank you.
Alicia Downs (40:54):
Um, thank you Paula, for staying up a little, little past
normal clinical office hours with us.
Anna Sabino (40:59):
Paula, what time is it there?
Alicia Downs (41:01):
What time is it right now?
Paula?
What?
Like six?
Dr. Paula Diab (41:03):
5:00 PM
5:00 PM
Alicia Downs (41:05):
Oh, I was off by an hour.
I always think you're fartherwest than, than you are.
Dr. Paula Diab (41:11):
It's not too bad.
I was just, I was just gonna say though,the reason I can choose, um, the mountains
and the beach is because in our provincewe've actually got the mountains, the
beach, and the bush all in one province.
Alicia Downs (41:23):
Oh.
Dr. Paula Diab (41:23):
So one day when you all come and visit me,
then you'll come and see them.
Alicia Downs (41:28):
It's kinda like PA. I don't know what actually constitutes the bush.
I mean, we have, bushes,but I don't think.
Big open flat space.
Not quite prairie, but it's just flat.
But we've got, the ocean is likean hour and a half that way.
The mountains are liketwo, three hours that way.
That's why I like this area.
(41:49):
It's kind of not, not quite,not quite the four miles anna's
working with over there though.
But, but thank you guys.
We wanted to share this becausewhat we love about IDS is just
being real people who are walkingthe walk and talking the talk.
We're not gurus on the mountaintop.
Sometimes life is a red,hot, flaming dumpster fire.
Anna Sabino (42:07):
It is, yeah.
Alicia Downs (42:07):
And sometimes what makes the difference between
us and the doctor is living it.
Being just neck deep init, 24/7, 365 for years.
And what makes the difference betweenus and our patients is just the
knowledge of being able to bounce.
Anna Sabino (42:28):
Yeah.
We have what?
We have like hundreds of years ofdiabetes experience and like we get it.
And I think
Alicia Downs (42:34):
Combined?
Yeah.
Hundreds of years.
Anna Sabino (42:38):
I think that's why people, I think that's why I love this team.
I learned something our, ourlike text thread is a whole
set of dumpster fire, like.
Questions.
Who needs an extra sensor?
Um, we're, we're like real people.
Alicia Downs (42:51):
Yeah.
And, and ongoing growing because, becausewe aren't perfect, we're always sharing.
Um, and because we live it and weknow that there is no right way.
There is no one way.
We're always growing because we're alwayson the search for just that, that thing
(43:15):
that's just gonna make today a littleeasier and tomorrow a little better.
And we are not gatekeepingit, we are just sharing it.
We are getting it out there and, and welove our, we sincerely love our community.
So we hope to see you.
We hope you join us on the nextpodcast, and we hope that you
(43:35):
reach out for your diabetes needsto get education and empowerment.
And if you're interested, come join us.
Gary Scheiner (43:43):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think Like a Pancreas, the podcast, isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion and diabetes
(44:04):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech, sports,
and exercise, weight loss, type onepregnancy, and emotional wellbeing.
(44:25):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas,the podcast, I'm Gary Scheiner,
(44:47):
wishing you a fantastic week ahead.
And don't forget to think like a pancreas.
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