Children with type 1 diabetes: Deep dive with senior paediatric diabetes dietitian Lila Digkliou

Senior Paediatric Diabetes Dietitian Lila Digkliou has been helping children and families living with type 1 diabetes for more than 10 years.

She was inspired to move from general diabetes care into paediatrics to help people with not only nutrition, but the perspective and tools needed to manage type 1 diabetes as early as possible in their lives.

This value packed episode is full of tips and takeaways, as we discuss the most common concerns for parents and caregivers, how they differ from what young people are worrying about - and how to find common ground through the many complexities and pressures of type 1 diabetes. 

We also look at some interesting ways to encourage diabetes management among school, hobbies and hormones - and bust some common myths about what children with type 1 diabetes can and can't do!

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DISCLAIMER
Nothing you hear on Type 1 on 1 should be taken as medical advice. Please consult your healthcare team before making any changes to your diabetes or health management.

SPONSOR MESSAGE
This episode of Type 1 on 1 is sponsored by Dexcom. Using Dexcom CGM has given me so much confidence to make informed diabetes treatment decisions in the moment.

You can choose to wear it on your arm or your abdomen, and all Dexcom CGMs have the share and follow feature even when connected to an insulin pump, so family and friends can see your glucose levels and get alerts, giving that extra bit of support when needed.

Head to Dexcom.com to request a free Dexcom ONE+ sample.

Always read the user manual for important product aspects and limitations. Talk to your doctor for diabetes management terms and conditions and terms of use. 

Episode Transcript

Speaker 1 (00:00):
This episode of Type one on one is sponsored by Dexcom.
More on that later. Just to say, as with every
episode of Type one on one, nothing you hear within
this podcast episode is intended to be nor should be
taken as medical advice, and you should absolutely seek the
advice and guidance of a healthcare professional before making any
changes to your diabetes management. If you want to come

(00:21):
and say hi, you can do so at Studio type
one on one on Instagram and I I'd love to see
you there. Hi, everyone, and welcome to Type one on one,
a podcast that delves into the obscure, complex and challenging
world of life with type one diabetes. I'm Jen Grieves,
and each week, with the help of some brilliant guests,

(00:44):
I'll be showing that there is no normal when it
comes to handlingk this whopper of a chronic condition, because
we're all pretty much figuring out the messiness of day
to day life with diabetes as we go, and most
of all, even though it doesn't always feel like it,
we are absolutely not alone. My guest today is senior

(01:04):
pediatric diabetes dietician Leela Diglil, originally from Greece but now
living and working in London. She's been helping children and
families living with type one diabetes for more than ten years.
Leela started in general diabetes care, but over time felt
that she could make the most difference to people's lives
by helping them as soon as possible on their diabetes journey,
making the move to pediatrics eight years ago. And I

(01:26):
know from being diagnosed as a child myself, how formative
those early interactions were as me and my family were
trying to understand our new reality. And I'm looking forward
to discussing the challenges and complexities as well as what
I'm sure are the many rewards of this work. So
welcome Leela, Welcome to Type one on one.

Speaker 2 (01:45):
Hi Jen, and Hi everyone, and thank you very much
for the invite with today. I'm looking forward to discussing
some of the questions that you've got and hopefully we'll
be able to answer some questions that other people may have.

Speaker 1 (01:58):
No thanks to you for joining me. I know you're
super busy and you know super in this work, and
as I said, I think to have someone with expertise
like yours at the heart of what is a very
complex condition. To say, there are some complexities growing up
with this condition would be an understatement.

Speaker 2 (02:17):
I'm sure you would agree with that, right, I absolutely agree.
It's very, very complex and sometimes you feel that you
can never get it right.

Speaker 1 (02:25):
Yeah. Absolutely, But I know from the little bit that
we've chatted back and forth that well, my aim and
my hope and I'm sure if I'm doing my job right,
it absolutely will be helpful and practical as well for
parents and cares of young type ones listening. So, thank
you so much for being here today. Yeah, this is super,
super valuable. So I'd love to start by summing up

(02:47):
a little bit for me the work that you do
if we really start from the basics there and you
know what's the role of a pediatric diabetes dietitian, but
also how you generally day to day help families and
children with type one diabetes.

Speaker 2 (03:03):
So I work at a hospital and at hospitals in
the UK, we see patients with type one diabetes, every
kind of diabetes really, both in MDT clinics, which means
you have the dietician, the nurse and the doctor in
the same room, usually in the same room, and then
you see them as one to one appointments as well.

(03:24):
Mostly you see them face to face, but you might
see them by vidhicles or telephone appointments as well, and
we have to see them at least once a year
on one to one appointment at least we have to
offer them and then as many times as I needed
as well within the year, and we discuss anything that

(03:46):
has to do with their diabetes, diabetes and exercise management,
carbohydrate accounting. We view their weight, their heights and whether
they need to put on weight, whether they eat enough
for their age. Sometimes we'll see that many children may not.
It's much of a food group and we are trying
to balance things out and then everything that the parents

(04:10):
or or the child has to have to ask us.
So it's a really nice role. I really enjoy it
because in the pediatric diabetes you see the same families
over and over again, and you develop a relationship with them.
You know their complexity, so it's easier to help them,
whereas an adult here you might see them once or

(04:31):
twice and then it's a little different.

Speaker 1 (04:35):
And is that something that you and you particularly enjoy
in terms of being able to work in this world
in many different guises. But that connection, that ongoing relationship
development with the families. Tell me what that is for
you in terms of personal job satisfaction.

Speaker 2 (04:50):
I do enjoy it very much because it's very difficult
for someone who is easy for the first time to
open up for their complexities. And it's very difficult I
should have for a child to know that it's okay
and you're not their teacher, that you're not going to
tell them off if they are doing something that they
think is wrong. So by seeing them more time, you

(05:13):
develop this relationship that they open up. They say, well,
I haven't done this, I don't like this, or things
that go well, and they know that you're not there
to judge them, but you're there to help them and
provide them with some information that you know and you
just want to share it with them and to just
help them. So it's very warding.

Speaker 1 (05:33):
I love that I noticed that in your content list,
like you have an amazing presence and the information that
you're offering on Instagram and I will direct people to
it later on. But what I noticed from it was
one the clarity with which you're giving these kinds of
tips and just taking bite by bite the challenges that
you might encounter on a day to day because there

(05:55):
are just so many like living with this.

Speaker 2 (05:56):
I just feel like they're still endless.

Speaker 1 (05:58):
You know, I'm always surprised, but be the lack of judgment,
and that really stood out to me, and it's something
that I have had conversations with with other parents or
other people as adults entering clinics, that fear of judgment.
And where did your awareness of that come from? Is
that something you've developed over time or is that something
that's actually taught through your training. I'm just kind of

(06:21):
curious around that I developed.

Speaker 2 (06:24):
Over time, and I think it came because some of
their parents have gave us, have given us a Facebook
over time. And then you get to realize how difficult
it is for a child or their parents to come
to clinics. Some of the parents were coming and saying,
we had some weddings, we had some we were on holidays,

(06:44):
so black sugars were a bit high, so about that
and without you don't need to apologize, We're not your teachers.
So one was many parents apologizing at some point, which
made me realize how they feel about having high blood
sugar not being able to manage it so closely at
some point. And then the other thing was a mom

(07:06):
we have very good relationship with her and the dad
and the child as well. And the mom shared at
some point in clinic that when he was firstly, when
he was newly diagnosed, he was crying in the car
on the way to the hospital, and this made me
feel very badly. Why did he cry? And I realized

(07:30):
that sometimes seeing clinics, and especially in MDT clinics, the
time that we have to review things is very tight.
So we have to crack on. We have to review
the readings, and what we are trying to do is
improve things, make changes to the incident. But that can
feel a bit too tight for the parents that might

(07:51):
need more time, or the child might feel that I'm
being judged here, whereas we're not judging anyone. We're just
seeing if there is any problem many eat you how
can we can make improvements, change their insulin doses and
just help them. But maybe we don't do it in
the right way sometimes, or maybe the perception is different.

(08:14):
So this is definitely something that help us a lot.
See it from their side, being on their shoes and
how they might feel coming to clinics every three months.

Speaker 1 (08:26):
I can kind of hear the parents just breathing a
sigh of relief and exhaling at the words that you're
saying and probably wanting to sign up with you immediately
adding to your workload there. I'm interested as to how
you personally balance that need for tangible and actionable outcomes
in these very short sessions and limited time versus that

(08:50):
supportive and more holistic side of things, because you know,
you are a dietitian, but you can kind of speak
to me a bit of about how much this is
food glucose carbs, but how much of this is more
about other things in terms of the emotional side and
the emotional aspects of type one. So how do you

(09:10):
kind of balance that given the timeframes and like is
their extra communication? Like how does that look today in
twenty twenty five.

Speaker 2 (09:20):
So it's important for them to know how much time
they've got available. So it's it's nice if they know,
for example, we have thirty minutes or forty five minutes,
and this is the agenda that I'm thinking to follow,
this is what we need to do. Do you have
any questions in the meantime? Do you have any issues?
So their expectations are more manageable and they know that

(09:42):
I've got thirty minutes. We can run a bit out
of time, but that's very important also to know that
they can ask us anything they need to ask. And
then I always think of even if you give the
best that you know that's going to have a result

(10:03):
one hundred percent, if the person feels that this is
too much for them and they are not going to
follow them, then it's a useless advice. So every time
I'm trying to check whether that's something that they can do,
and it depends whether the parent can do that or
the child can do that themselves. So it's very important

(10:24):
to check. And sometimes I see the child nodding and
then mom says, well, you don't like that, do you.
You're saying yes now, but you're not going to follow
this advice in the end. So I think that we
have in twenty twenty five, we have more awareness about
how people feel about their diabetes, about the fact that

(10:47):
it's not very easy to follow our advice sometimes because
life gets in the way because they have very little time,
for example, at school to have lunch. So but this
is what it would encourage them to bring all these
problems to clinic because they might have some some things

(11:09):
at school in place that they can help them. For example,
they may be able to get out of the class
a bit earlier. So there are ways to manage it,
but we have to be open and honest about what
the problem really is. And it definitely makes me feel
that I'm doing a better job when the person worth

(11:31):
of diabetes tells me what the complexities are and how
my advice is going to impact them as well. You know,
we think that we are going to and give you
a better quality of life if you do carb counting
or if you have better blood sugar levels, but quality
of time, a quality of life for someone who has

(11:53):
to carp count several times a day might be very
different to what we think it is. So from one
point is having blacturable levels in target and not to
more hat B one C and lower risk of complications.
But it comes definitely with paying something for that, doing

(12:15):
a lot of work.

Speaker 1 (12:16):
Yeah, yeah, And I think being aware of that sometimes
is a big piece of the puzzle because I think
for me, speaking personally, it was a long time before
I sort of understood that this was a bigger deal
than I was maybe admitting to myself. Do you know
what I mean? And I can imagine it's quite interesting
the dynamic between where the child is at in their

(12:39):
head and what they perceive the condition to be, and
then maybe what the parent is occupied with or worried about,
or you know, how they're perceiving the condition and you
know understandably their fears. So what are some of those
main if we take the parents first or the care is,
what are some of the kind of main challenges that

(13:00):
parents or cares are worried about when they come to
see you.

Speaker 2 (13:06):
So I see people see diabetes in a different way.
So we have some parents who are really worried about
high blood sugars, even if they have the children have
a spike for a little while, they are chasing the
blood sugar levels that might reduce the carbohydrates because they're

(13:26):
so scared of this high reading. And then what we
want to say is, actually it's normal. So unless you
leave it for a long time and you don't do
anything about it and the doses are wrong, So it's
normal to have some spikes and there are some ways

(13:46):
to work around it. On the other hand, we might
see some parents who don't really understand the complications risk.
So as clinicians we have we have to talk about
that as well, but in a way that it doesn't
fill you with fear about the future, but you are

(14:07):
aware of it because you have to be aware of it.
It's a duty to let you know about the risks.
But also the good news is that there are ways
to manage it and to prevent these highs for example,
or to work in a way that will reduce the
risk of complications. So it's very important. I see in

(14:31):
parents when they are on top of diabetes from a
young age and they support their children. It's very important
because they continue to do it throughout when there are
teens as well. And what I see a lot is
teens coming to clinic and they give their parents this

(14:53):
look that this is my diabetes. Now you can't talk
about it. If a parent is more involved when the
child is younger, it's easier for them to check on
with a child when they are a bit older, so
you have a bit more. You can do a bit

(15:14):
more on yourself. But then if your parent asks, if
your parent asks you if you gave your insulin, you
get you don't get so upset as you would get
if the parent wasn't very much involved in your care.
When you were younger.

Speaker 1 (15:29):
Yeah, I'd love to come back to that transition period
in terms of letting go for the parents, but also yeah,
just teen hormones and everything in general. So we'll come
back to that. But children or young young people, what
are some of the main kind of concerns that they

(15:50):
come to clinic with or maybe that they you feel
that they are concerned with that they potentially aren't expressing.
I imagine that happens a lot of the time as well.

Speaker 2 (16:01):
It's diabetes itself. They don't want to have diabetes, so
many of them tell me I want to feel normal.
That's why I don't have my insulin because my my
friends just eat, so I do the same thing. I
just eat. So what I say to them is that
you are normal. You are a normal person with diabetes.

(16:25):
And if you don't give your insulin, it doesn't make
your diabetes go away and can make it worse in
so many ways because then you're chasing high blood sugar
is because then you have risk of complications. So how
can we make it a bit easier? Very important thing
is I ask them, do your friends know that you

(16:47):
have diabetes? If they say yes, then we discuss how
their friends can support them when their friends can say, well,
wait a minute, why are you eating? Have you had
your insulin yet? So we involve the friends as well
if possible. But they do come with the same thing
that I don't have much time. I forget to give

(17:09):
my insulin, I forget to do the carb counting, I
want to do other things. I'm very busy. So it's
very very common in actually, even when they're children or
a bit older, it's very common to say the same thing.
I'm very busy, I've got to do other things to do.
I want to feel normal.

Speaker 1 (17:31):
Okay, And we'll definitely come back to that in terms
of offering some practical advice around particular challenges. But I
what do you think or what you generally advise in
terms of parents who are worried about these particular issues
or not being engaged or not taking insulin because they
want to be normal. In terms of approaching those conversations

(17:53):
with the child, because obviously they're in much more regular
contact than the care team, do you have any kind
of top level tips in terms of approaching those conversations
with your children who aren't maybe as engaged as you
as a parent or care would like them to be.

Speaker 2 (18:13):
First of all, it's very important to have the talk
with the child, not so much with a parent, because
it's the child who is going to have the incident
or not, and ask them what is the problem? The
problem in their daily lives that they can't have their
insulin not sometimes for example at school, gets at the

(18:35):
top of this problem and see how you can you
can make adjustments. What I see a lot is that
they want to feel validated. Once you tell them, I
know diabetes is annoying, I know that you have other
things to do. I know that this makes you feel different.

(19:00):
I don't know that you would prefer to not have
diabetes and that you would prefer to do other things.
So I see a lot of relief. And that's actually
very common. That you don't expect me to do things
that you don't understand me. They want to have understandment,
and once you validate those feelings, they're more open to

(19:21):
make adjustments, even if they begin with something small. So
it's very important to tell them that I hear you.
What you say is valid. That don't think it's uncommon,
I don't think it's something abnormal. It's valid. So that's
very very important. I think that's number one. And then

(19:42):
you can negotiate things and you can find what's better
to put in place for them so that they do
what we ask them to do. But understanding them and
letting them know that we hear you, that's very important.
I'd say number one. Okay, great.

Speaker 1 (20:01):
And in terms of a parent in a situation with
their child in the house, approaching a meal or after
a day at school where that hasn't happened, would you
say that approach would be similar to come at it
from a place of understanding and be the child being
seen and heard and validated.

Speaker 2 (20:20):
Yes. And it's also important to let the parents know
that this is actually common in other families as well.
And I see their relief as well when they hear
that this is common, this is what this age brings,
this is what the child with diabetes has to go
through on daily life. And we hear that from other
parents as well. And let's see now how we can

(20:44):
improve things, how you can make your relationship a bit
better in terms of you don't have to know so
many times and then the child doesn't get upset with you.
So it's very important for parents to hear that it's
actually something that a lot of parents are going through.
It's very similar.

Speaker 1 (21:03):
Okay, great again, we're breathing size of relief across the
nation here. So I do want to kind of drill
into that a little bit because understandably, I think for
everyone involved, there is a lot of pressure because the
targets are so clear, they're so defined. You know, you
get your you know, in this world of data that
we now live in. You know, I had a bit
of a different story as a child, because it was

(21:24):
a bit more like ignorance is bliss, but maybe not
to a helpful extent, you know, beyond a helpful extent.
So maybe it's it's the opposite problem now in terms
of this very clear data that's in front of us.
So can I kind of just clarify that that time
out of range is inevitable?

Speaker 2 (21:45):
It is, it is. But also you mentioned time in range,
not hbe C, and that's actually where we are heading
hiding towards now. So we used to see the HP
and C over a period of two to three months,
and we're saying very good HP and seeing target so great, amazing,

(22:07):
And then we were looking at the blood sugars in
more detail and we're seeing lots of hypos. But now
we're looking at the time in range, and when you
see a time in range that is very low, I
always like to see it as a problem. And every
problem has a solution, So what can we do to
improve that. You can take your insuin for example a

(22:28):
bit earlier, or what is the issue that's causing this problem.
But then, like I said before, many parents may get
very worried if they see one high blood sugar level
here or there, But that's that's going to happen. Even
if you do everything perfectly. You count the carbohydrates to
the gram, and then it's very hot, the blod sugars

(22:52):
may go low, or you do exercise and the blo
may go low, or there is some stress and your
bloo sugars go hi. So you are going to have
some highs and lows that you don't expect, and that's
that's normal. But it's different to just say, oh, it's okay,
I'll just let it go. And it's different to review

(23:14):
reading the readings ever now and then and then think, okay,
I review the readings, I think that I can't be
in point what was the issue. So that's just diabetes
and the like you said, inevitably will have some high bloochists. Yeah.

Speaker 1 (23:33):
What I'm hearing though, as you've just expressed, there is
that there are solutions too. There are Do you feel
like there's always solutions because we often do say, well,
you know, this thing is only you can only control
it to a point, or there are only so many
variables that you can predict. Like what would you say
to someone who's like, I'm doing everything i can child

(23:55):
or adult and this just isn't this just doesn't happen, Like,
what's the response to that if someone's just you know,
really at the frustrated end of all of this, Well.

Speaker 2 (24:08):
If I want to be honest, you can't have it
one hundred percent. There are some some parents and children
that they have really amazing glucose management and very high
time and range percentage percentage, but it's very difficult. So
you can't really have one hundred percent. It's very tough

(24:30):
and we're not expecting that. This is why also they
recommend a time and range above seventy percent and not
above ninety percent, because you can't. You can't do it.
There are solutions, and it doesn't mean that you make
something wrong. It just means that we have bigger experience
perhaps in that or we might find some solutions from

(24:54):
other parents, or from research or from generally because we
work on this field for a long time and we
might know some tips that will help you. Doesn't mean
that you know you're not doing what you're supposed to
do in the right way. So there are some solutions,

(25:14):
but we're not expecting a hundred percent either.

Speaker 1 (25:18):
So to come into an appointment, if you do have
thirty minutes, say together, what can families, parents, children, anyone
involved in the care do to come into that appointment
in order to get kind of the best out of
it in terms of being able to understand what is

(25:38):
happening and having the most productive use of time in
terms of putting solutions in place. Are there things that
the families can do to come into the appointment to
get the most out of it.

Speaker 2 (25:51):
If you like, Yeah, definitely. They can review the readings
beforehand and have some ideas of what happened and not
try to remember that at the time. Or for clinic,
I have an idea for example, if the child every
Monday has low blood sugar levels, then they can give
us some information for example, he's playing football every Monday,

(26:12):
and this is why he has low blood sugar levels.
Or I've tried to make some changes and then these
changes didn't work. So it's having a look at the
blood sugar levels. If you have any pump to upload
the pump depending on whether it needs to be uploaded
or not, have a look at the readings, have a
look at the trends, and then say, discuss what you

(26:36):
tried and didn't work, or your ideas about what could
mean that you have very high blood sugars or very
low blood sugars, so they can make the most use
of the time when they are a little prepared.

Speaker 1 (26:53):
Okay, and what about in terms of retaining the information
do you have? I mean, it can be one oh
one in terms of literally bring up a pen and paper.
But I've often come away thinking like, wow, okay, that
was a lot, and I want to retain as much
as possible. But you know, how how do you advise
people approach that?

Speaker 2 (27:12):
Usually the nurse is when we're donm to takin give
them an hand out and with some notes of what
was discussed. It's a really good piece of favor that
you can take with you afterwards. We just we write
down what we where we changed in the clinicque or
if we suggest the website, we write the website so
you can go back and look at it. So that's

(27:34):
quite important. It's otherwise you will forget half of what
was discast.

Speaker 1 (27:41):
Yeah, and I mentioned at the beginning how formative those
early interactions are or can be around time of diagnosis
when this is all very new, it's new words, new jargon.
It feels quite overwhelming and scary as well. And you know,
I would absolutely vouch for that. What in your mind

(28:03):
does good diabetes support and care look like in terms
of these these early interactions. And if parents maybe suspect
or feel that they're not receiving the level of care
that they need or want, is there anything that they

(28:23):
can do about that?

Speaker 2 (28:27):
A good level of care initially is to provide a
structor training and also let them take notes or provide
some different resources for different learning cells, because some people
learn more by writing things, budding more practical examples sam
with looking at reading something or just hearing what you

(28:52):
have to say, So it's different learning cells. And then
if you use different approach and resources, that's that's really
helpful for them one thing that takes a lot of
stress is if you let them know that there's a
lot of information that we are going to discuss about,
but we are going to do to have more sessions,
and it's okay if you just forget about everything the

(29:15):
minute that I leave, and then we can come back
to it and make more more example. So if they
know that it's something difficult and it's a lot of
information and it's okay to forget about what we discussed,
but we are going to come back to it, then
it takes a lot of stress and you're more open

(29:35):
to receive information. If they feel that they don't understand
it's very important that they are open and say I
don't understand it, and then the clinician needs to find
a different way to have the discussion. So it's a
message that needs to come across a teaching and you
need to find different ways. Not everyone has the same

(29:59):
level understanding or they have a different way that they
understand things, and it's our job to find these ways
so that it's easier for them. Because it's a matter
of life, so it's very very important. It's not something
that will not make a difference. If I you don't
understand how you manage insulin. That can be very risky

(30:20):
for your child. So for us, it is number one
priority to make sure that you understand what we teach you.
And you can be open if you don't understand, so
you can ask them to repeat or to find different
ways to make the teaching.

Speaker 1 (30:38):
And I'm just gonna ask you some quick fire myth
busting questions just to put it out there in the
world so we can all be clear. So children, and
I'm sure you get these questions a fair bit online
as well. So children with type one diabetes can't eat sweets.

Speaker 2 (31:04):
Yes, so that's one number one myth. They can eat sweets,
but as I wouldn't recommend to any child without diabetes
to have lots of sweets every day, I wouldn't even
recommend it to a child with diabetes. So they can
nit anything that the child without diabetes can eat. You
might see some higher blood sugar levels that they're a

(31:27):
bit more difficult to manage if you have lots of sweets,
but again there are some solutions and then it's not
the end of the day. If you have one day
a little more a little higher blod sugar levels, But
you can. You definitely can eat sweets if you have
type one diabetes and if you have type two. But
in moderation, we.

Speaker 1 (31:48):
Love to hear it. Do you know I was told
when I was diagnosed at eight years old?

Speaker 2 (31:51):
Oh do I want to hear that?

Speaker 1 (31:54):
I've probably not.

Speaker 2 (31:57):
What did they tell you?

Speaker 1 (31:59):
They told me that, yeah, I could never eat sweets Again.

Speaker 2 (32:03):
When did you find out about the truth.

Speaker 1 (32:05):
Well, I think my stomach led me to the truth.
But yeah, thankfully, I think the thinking has changed. So
we're doing We're doing just fine. Me and sweets are
well acquainted mostly through those though chocolate. Okay. Children with

(32:25):
type one diabetes can't do the things that other children do,
like play sports or go to sleepovers.

Speaker 2 (32:32):
Were recommend playing sports unless there is a specific reason
for a specific child that they can't play in sports.
We're a commend sports. It's actually in the nice guidelines
that every child can unless, as I said, there is
a specific reason they can take part in all forms
of exercise. But it's again it's good to have a

(32:56):
discussion because different types of exercise play a different role
on the impact the blood sugar levels differently, and we
have to manage them differently. As well, but they can
do anything they want. And then as far as concerns
the sleepovers, it's good that the other parent or family
knows how to manage some situations. For example, if you

(33:17):
have a hypo, how to help you. But also if
the child is quite young, maybe the parent can sent
a picture to the other parent or discuss with them
what they're going to eat. So definitely they can. They
can do sleepovers, they go on residential trips. We provide
training to the people at school, so you can definitely

(33:41):
do things that people children with diabetes without diabetes can do.

Speaker 1 (33:47):
Amazing, and children with type one diabetes can't live a
normal life quote unquote normal life. As an adult, they
can definitely live a normal life.

Speaker 2 (33:58):
You can do all the things that you did or
you would do if you didn't have diabetes. Of course,
there is a lot more work. So someone may challenge
that and say, how is this normal because I have
to check my black sugar levels several times a day,
I have to take insulin. Yes, that's true, but you're

(34:18):
still normal and you can still do anything that a
person without diabetes would do.

Speaker 1 (34:23):
Okay, And children with type one diabetes have to follow
a specific diet.

Speaker 2 (34:29):
Oh, that's another one. No, you don't have to follow
a specific diet. You can eat anything you want. And
if you hear any term diabetes diet is usually a
marketing term just to charge you with whatever they are
selling you. So no, you can eat anything you want.

(34:51):
You don't. You don't have to buy any diabetic products
or anything that is so called diabetic or healthy, or
you're going to do any.

Speaker 1 (35:03):
This episode of Type one on one is sponsored by Dexcom.
Using DEXCOMCGM has given me so much confidence to make
informed diabetes treatment decisions in the moment. You can choose
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all dex commcgms have the share and Follow feature even
when connected to an insulin pump, so family and friends

(35:25):
can see your glucose levels and get alerts, giving that
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com to request a free Dexcom one plus sample. Always
read the user manual for important product aspects and limitations.
Talk to your doctor for diabetes management terms and conditions
and terms of use, And with that in mind, then

(35:48):
if we're speaking about a child with type one diabetes
and the parents trying to make meal times go as
smoothly as possible, both in terms of the family structure, routine, rhythm,
and then the blood sugars and the type one diabetes.
What are some some pointers or tips that you can

(36:09):
offer in terms of helping the two align as much
as possible and where to begin with that?

Speaker 2 (36:17):
And it's a bit of planning. So if you use
the same recipes or you cook the same similar foods
every now and then you can just keep some notes
of for example, you cook something complex like shepherd spy.
If you use the same recipe, then you know the

(36:38):
carbohydrates for the whole tray. You can divide, for example,
by pieces and then you can do the same thing.
Or if you make some pancakes, how much flour did
you use? Do you use the same recipe? So if
you weigh the ingredients and you do a little planning,
it gets easier. Also, do you have in mind to

(36:59):
allow some time from the time that you are going
to eat as a family for the child to have
the ten to fifteen minutes prior to eating that we
usually recommend to have their injection. So if you plan ahead,
then it doesn't get very very stressful for the family.
We forgot the incident, we have to do the carb counting.

(37:20):
Planning is good in many ways. Sometimes it's not an
available auction, is not what can happen because you don't
have much time, But most of the times I think
it's manageable. You can do it.

Speaker 1 (37:36):
And in terms of bringing siblings into the picture, whether
that be around mile times or with the diabetes in general,
either because there is an impression that the other children
aren't getting as much attention, or it's kind of you know,
just difficult to balance all of the extra demands of

(37:57):
diabetes on top of childcare and general. Is there anything
you can offer in terms of involving the whole family
within the rhythm and the demands of type one diabetes.

Speaker 2 (38:10):
We're very open if they want to bring the other
children at the appointments, and it's actually quite helpful, especially
if they discuss about all these complexities that the child
might feel a bit left behind. And then if the
other the sibling is involved in the care, for example,

(38:32):
they can help parents or their sibling car count, they
can weigh the foods, they can keep them, they can
play with them for the fifteen minutes they can they
have to wait between injection and eating, and I think
they feel important when they do that. They don't feel

(38:53):
left out, they feel like I'm part of that as well.
So that's that's I think quite helpful for the families.

Speaker 1 (39:01):
Yeah, really nice. And in terms of family may or
times and all the demands of life, how do you
encourage families given the extra considerations and planning required, how
do you encourage families to build a healthy relationship with food?

Speaker 2 (39:26):
Healthy relationship with food comes firstly from not feeling that
you're doing something wrong, that any food is wrong, and
that you do something wrong in general. So discussing with
them why it is important, to plan why it is important.
For example, if the child has to take these ten

(39:46):
to fifteen minutes of to explain why it's important, then
ask them whether that's something that is possible to happen,
and then help them plan. It doesn't work for everyone
and it doesn't work every time, but if they feel
that it's it's not something that it's a problem, but
something that you have to plan. Even when you cook

(40:08):
a food, you have to plan. For example, when you
make pasta, you have to let the water boil for
fifteen minutes. But you do this without feeling that this
is a problem. Although sometimes if you really want to
see it boiling because you're hungry, you want to prepare
your pasta earlier, but you kind of take it for granted.

(40:28):
So if you do the same thing for planning about diabetes,
maybe it doesn't feel so hard. Maybe it doesn't feel
that it's a big problem. And also for children with diabetes,
if what they can do, for example, if they start
with the vegetables, or if they eat some nuts or
food that they don't contain carbs for the peer that

(40:49):
they have to wait, then this makes it a bit
easier for them, and they don't see food something that
I really want it, I feel so hungry and I
can't have it. So you can have other foods in
the meantime. Is that with the vegetables or is that
sat with some other foods without carbs, and then it

(41:12):
makes it a little easier.

Speaker 1 (41:15):
Yeah, So I've heard like building in the diabetes steps
as part of the recipe almost as part of the
cooking of the meal time right, and then secondly specifically
to pre bowl less so they don't have to hold
off eating completely. There are maybe some things like vegetables
or nuts that they can have so that they start eating.

(41:38):
I guess with everybody else is kind of one of
the main concerns or could be one of the main
concerns there. Does that go as well? Like just going
back to your point about children wanting to feel normal.
If we stick with pre bowlisting for a minute, what
do you see in terms of children at school, maybe

(42:00):
forgetting to pre bowlist until that food is in front
of them, or just being busy chatting to their friends,
et cetera. Is there anything you can offer around that
or what.

Speaker 2 (42:12):
What do you what?

Speaker 1 (42:13):
What discussions do you have with the young people in
terms of trying to get the pre bowlers to happen.

Speaker 2 (42:22):
We can talk with first school and see if the
child can leave the class a bit earlier to have
their meal, see what they're going to eat, and then
count the carbohydrates, maybe have their bowlers before we see
whether that's possible. Then there are some types of incident
that work quicker than others. This can be discussed with

(42:44):
the consultants at the hospital appointment at the empty clinic.
We can we can see whether that's possible. In general.
So it's like I said, it's not one hundred percent
something that can happen, but in most cases there are
some things that they can do at school to have

(43:06):
the pre bowlers. So again it's having this conversation and
see individually what work can put in place to help you.

Speaker 1 (43:15):
And in terms of speaking to the young person, because
as you mentioned before, it's their diabetes and it's it's
for them to kind of make these start to make
these choices as they become more independent. I've seen on
your Instagram some interesting approaches to getting young people boys, girls,
interested in remembering to even take their insulin or you know,

(43:40):
all these little intricacies around it. So do you want
to just kind of go through those because I found
them really fascinating.

Speaker 2 (43:48):
Thank you. So I say that in clinics sometimes when
I feel that whatever I'm discussing doesn't have an impact
on them, and you see this blank gaze and you think,
I need to find something else. I need to find
something else. And then usually with boys, I talk about

(44:09):
exercise and suddenly they're listening, Suddenly they are interesting, interested
to hear what I have to say. And this is true,
So I'm not saying something that it's not true. But
if you don't take your insulin, for example, then it's
not going to help you with your sports. So we
have to talk about things that they are interested about.

(44:31):
So boys usually are interested about sports. Girls are interested
more about nutrition and nice hair or strong nails. So
it doesn't matter really what your motivation is. That if
you follow some nutritional advice or card counting advice, or

(44:52):
take your insulin advice, then that's good for us as
long as you take your insulin. So yeah, and I
see that you have to talk to them. Of course
we talk about the risk of complications as well, but
I don't like to focus too much on that. I
prefer to you talk about the positive things and where

(45:16):
incilin helps, not that if you don't take your insulin,
these is what's going to happen to you, but what
you're going to gain if you take your insulin. And
I talk about how the insulin as a key that
opens the set of the door or the doors of
the cells, and then you can use glucose as energy,
so you can talk about things that they are a

(45:38):
bit more positive and interesting.

Speaker 1 (45:42):
That's a really interesting point about focusing on what this
can give you and can offer you rather than what
it's taking away from you. So I saw on that
particular example that in this case, taking the insulin is
going to help you excel better at your sport, form
better in your sport. It's going to help you have

(46:03):
more energy to play that sport and be better at
that sport. Is that is that an approach that you've
seen be quite effective?

Speaker 2 (46:12):
Yeah, in many of them, because for example, I've had
some boys that they wanted to put on weight, they
had very high blood sugar levels, and then we're talking
about the importance of taking your insulin for that because
you're losing You can't put on muscles if you if
you're not taking your incident properly. So if you don't

(46:35):
have enough energy because you don't take your incidlin for
your food, how are you going to perform? And we
talk about all the benefits that you've got by taking
your insulin properly, but also if you do if you
play sports, then we have to talk about the hyperglycemia
risk and how you need to manage your incident because
you're not going to take the same amount of insulin

(46:56):
if you go for a run, for example. So it's
a combination of how the incident can be beneficial and
how to manage it as well when we would play sports.

Speaker 1 (47:10):
Okay, interesting, thank you for that. And in terms of
that part that you kind of touched on earlier around
the moving through the kind of teenage years and the
child or the young person kind of giving that look
of this is my diabetes now, and the parents trying
to adapt to allow that child more independence as they

(47:34):
get older. Can you speak to that a little bit
in terms of your experiences and then maybe like any
practical advice you can offer parents just to feel a
bit more comfortable about steadily letting go and letting their
child kind of try more and experience more independently.

Speaker 2 (47:55):
So it's a very difficult period for them because they
are going through a lot of change juice, changes in
their body, changes in their mindset, there might change several
things in their lives. And then comes to their transition
period as well when they meet the adult team, and
this is the time that we we're letting them know

(48:18):
that this is the time that you get more, you
get to do more about your diabetes. It's mostly you
rather than your parents, but we are letting them know
as well, that it's okay for your parent to chip
in when they need to because it's for your benefits.
Because we understand that it's you have other things to

(48:40):
do and you don't want to do diabetes things, but
it's not okay on the other hand to not take
your insulin and this will have an impact later on
in life. So this is where we have the discussion
also about the complications risk as well. It's important for

(49:01):
them to know that both for parents and for children
or young people, that this is something that most of
the families go through or many families go through, so
it's not something that other children don't have with their families.
And you have the most annoying parents. No you don't.
I'm sorry to bring you the news, but you don't

(49:22):
have the most annoying parent here. And also for parents
to know that there are many children at this age
that they may be resistant to help. Again, like I
said before, it's very important to let the young person
know that we understand you. That is, you want to

(49:47):
do the other things, different things to diabetes, but you
can't really make it go away if you ignore it,
So how can we help you? And also if you
want to be more independent. Then you need to be
able to do a bit more so that your parent
doesn't have to discuss that so much with you. It's

(50:13):
again having open and honest conversations with the children and
young people.

Speaker 1 (50:19):
It's really coming back to that time and time again,
isn't it that trust in communicating the issues and the
challenges with a view to finding solutions. But they've got
to offer up that in the first place, right sore
building an environment where that feels like it's safe, it's okay, safe, yeah, yeah, yeah, okay.

Speaker 2 (50:40):
And also it's okay to let them know that I
know that you might not be able to follow the advice,
but what would be difficult for you to follow? Or
if I give you ten tips, what do you think
will be realistic for you to follow? So having putting
some smart goals, perhaps that they are specific, measurable, you

(51:02):
can fall through, you can review, you can see the
outcomes and then say, okay, what do you think you're
going to gain if you do what I suggest that
you do? So I really like smart goals because you
can measure them, you can discuss what's possible it's not possible,
and you are kind of realistic to your expectations and

(51:24):
their expectations as well.

Speaker 1 (51:27):
Okay, great, and have you seen like obviously, without naming anyone,
I'd just love to kind of offer some sort of
success reassurance to people listening in terms of all these
practical tips that you're offering and all this valuable information

(51:47):
that you're offering. This reframing, it feels like a reframing
in terms of the giving versus what diabetes is taking
away and what is this going to enable you to do?
Just if you can give me any example of success
that you've had in a specific challenge with someone.

Speaker 2 (52:07):
Hmmm, We've had lots of successes. But I think I
can now think of a girl who has been struggling
taking her insulin for a very long time and has
been avoiding to take doses. Blasts is really high, and

(52:29):
the good thing is that she was coming to clinic
even if she wasn't taking her insulin. The blushes were
really high, but there wasn't any judgment. We're having the
same talks again and again, and then she started she
started taking more and more and more insulin and that's
for us. The success comes from even little steps that

(52:54):
will have improvement. So we're not expecting to see someone perfect.
But if you managed to do this one step, that
for you feels really a very big one. It's a
marathon for you. We may think that that's very very little,
but actually for you, it's a marathon. So if you
manage to do that, for me, that's the greatest success.

(53:15):
It's not only about having a HBO one c of
seventy percent in range or more sorry at the time
in range seventy percent more or a HB on seeing
target is where you wear or where you manage to do.
That's that's the greatest success. And we've had we've had
lots of those stories.

Speaker 1 (53:37):
Amazing. What's the one thing you wish every parent of
a child with type one diabetes?

Speaker 2 (53:45):
And you, I wish they knew that you're doing an
amazing job and a really, really, really difficult job. You
have to wake up seven old times every night, you
have to do maths NASA maths several times a day,

(54:07):
and you are really doing better than you think. And
it's a very difficult job. And well done to all
of those moms and dads and cares who who do this. Yeah.

Speaker 1 (54:18):
Absolutely, And what's the one thing that you wish every
child or young person living with type one diabetes and new.

Speaker 2 (54:27):
So they are they have a difficult maybe this is
a difficult disease to have and it doesn't go away,
type one diabetes. But you can absolutely live a normal
life despite the fact that you have to do more work.
And technology gets better and better and better, so hopefully

(54:50):
you will have to do less work and live your
life more. But you are absolutely a normal person, as
everyone knows, and you can live life as anyone else.

Speaker 1 (55:03):
Amazing. In terms of those dreaded post meal spikes, just
keeping it on the practical side of things here, I
mean they happen, well, they certainly still happened to me
twenty nine years. But as you just mentioned, like the
tools and the technology and the knowledge and just life

(55:24):
experience has kind of help helped along the way in
various ways. What in terms of like the basics that
I think sometimes we can easily forget or just maybe
forget to remember consciously, what are your sort of top
three tips for avoiding those those postmeal spikes that get

(55:48):
you on that roller coaster that is just awful when
you know you're on it and like it's happening. Yeah,
top three tips.

Speaker 2 (55:56):
When I would check first this carb counting, whether you've
count the carbs correctly. The second is if you PrePost
on time, and the third is carb racious, So if
your car coming is accurate, then you're prepolised on time
as well. And I would review the carb racious and

(56:17):
what's happening on the second hour and between two to
five hours after the meals. I would start with these
three and then how many times within the you have
high blood sugars? Is it on specific days and in
other days you're more active, for example, and you don't
see these bikes or is it because of something that

(56:37):
you ate before? How many times in the week is happening?
But these are the main three. Did you count the
carbs correctly? Did you give your insulent on time? And
are your carb racious correct? Okay? Great?

Speaker 1 (56:51):
And in terms of people who are maybe in the
thick of the hormones and figuring life out alongside type
one dive in your experience, is this something that children
and young people do move through and do come out
of the other side of Just to kind of offer
that out to people, what's your experience of being in

(57:15):
it and then moving through.

Speaker 2 (57:17):
It when they're growing it is a period when hormones
definitely play a role, and they do get out of that,
so you see that there is more insulin resistance for
some years. It doesn't happen to everyone, and sometimes people
who are more active may not have that so apparent,

(57:39):
or they might have it on specific hours of the day,
So we can look at those hours individually and see
how we can make changes. But it's not always going
to be like that. It's for some years during adolescents
that you have all these hormones that mess up your
black sugar levels, but it definitely can get better afterwards.

(58:03):
But it also depends how you manage those times. So
if you see high blood sugartion and you just ignore
them and you feel that this difficult, it might be
more difficult to get to get them right later on.
So again, discuss with your team, see how you can
make changes, see whether there is a problem, for example,

(58:26):
early hours of the day or later on, how these
hormones affect your black sugar levels individually, and then get
from there.

Speaker 1 (58:37):
And personally for you, is there anything in your approach
As you've moved through this career and over the years,
obviously the technology has changed so much. A lot of
the thinking, you know, me being told I could never
eat sweets again, that kind of thing. It feels like
it moves so slowly but then very quickly at the
same time, I'm curious as to whether anything in your

(58:58):
professional approach had changed or evolved quite significantly from when
you started working, particularly in pediatrics.

Speaker 2 (59:06):
The technology has helped a lot, definitely, and I'm really
happy that, for example, you don't have to break your
fingers eight times a day and you have the sensors,
which is amazing. But what change they would say for
me was to have a better understanding of what a
person with diabetes has to go through in the day
and just be more aware and mindful that I might

(59:30):
propose that, I might suggest the perfect advice, but if
it's not realistic for the person who is listening to it,
then it's useless. So I think that changed a lot
for me, to be more understanding, to ask more questions,
to be more open to the answers as well, and

(59:52):
find ways to connect with people, to have a more
open conversation and be able to make more realistic plans
for them. I think that's that's what's changed.

Speaker 1 (01:00:07):
Yeah, nice, And where can people find you because as
I've mentioned your Instagram content, I think that's how I
found you, because yeah, it's got these practical tips broken
down into steps and covering everything from quote unquote diabetes,
diet which we've absolutely negated even exists an alcohol and

(01:00:29):
all these different things. So please let people know where
they can find you.

Speaker 2 (01:00:34):
They can find me on my Instagram account and message
me there to find out how we can work together.
It's pediatric dot diabetes dot dietitian, and then we can
discuss how we can work together. And thank you very
much for their lovely feedback about my posts. It really
makes a difference and makes me want to create more.

(01:00:57):
This is not only for children and young people. It
can apply to anyone. Really, some of them can apply
to anyone with type one diabetes.

Speaker 1 (01:01:06):
Yeah, I mean it was helpful personally as an adult
who's been living with it for a very long time.
I think the kind of bite sized, snackable way that
the huge, big like I just think of diabetes equals life.
It's just all part of this big jumble of things
and just zone in on specific things for a minute
and be like, oh, yeah, actually I can do that.

(01:01:28):
It was actually very reassuring for me. So thank you
very much.

Speaker 2 (01:01:32):
That's great to hear.

Speaker 1 (01:01:33):
Well inspired you to start posting online.

Speaker 2 (01:01:35):
I'm just curious. I had people who were coming to
clinics and then I thought they waited for a few
weeks or man's to come and see me. What if
they could find this information online? And what about people
who are in patients at the hospital? Worked about other

(01:01:56):
people out there who go through the same things, and
I didn't find the information that I wanted to give
them anywhere else online. So I thought I'll do that.
I'd break it down for them. And sometimes I use
things that people bring to clinic ask questions, and I say,
this is what I'm going to post today, this is

(01:02:17):
what I'm going to discuss where other people who may
have the same question.

Speaker 1 (01:02:23):
Yeah, it's such a service because I think as well,
like there's so much information out there now, which is incredible,
but it can be hard to know which parts to
take and where the information is coming from. So I
think when that extra layer of reassurance that it is
coming from healthcare professional, but again, it's so accessible, so relatable,

(01:02:43):
so understandable. Yeah, it was reassuring to me and I
know my Mum definitely would have appreciated it way back
when when we were trying to figure this out for
the first few weeks and months.

Speaker 2 (01:02:53):
So yeah, that's lovely to hear. Thank you.

Speaker 1 (01:02:56):
Yeah, absolutely. Is there anything else you want to offer people?
Just before we wrap up? Is there anything we haven't
covered that you'd like to touch on?

Speaker 2 (01:03:05):
I think the most important thing is to not ignore diabetes,
be open with your healthcare professionals, and just remember that
you are doing a lot already, that you're doing great.
That's my message for everyone.

Speaker 1 (01:03:24):
Beautiful message. And just to quickly clarify, you mentioned there
about people messaging in terms of how you might be
able to work together. Is that something that you offer
outside of your.

Speaker 2 (01:03:33):
I do some yes, one too once as well? Or
do you all through one to one appointments? Okay? Perfect?

Speaker 1 (01:03:40):
Glad we cleared that. I will absolutely add that information
into the episode description so that people can come and
find you. But this has been such a viable and
lovely conversation. Thank you so much for talking to me today.
Thank you very much for inviting me. It was lovely
to talk to you. Absolutely, thank you. I hope you
enjoyed this episode of Type one on one. Please remember

(01:04:01):
that nothing you hear on this podcast should be taken
as medical advice. I'm definitely not a healthcare professional. If
you like what you hear, hit subscribe and do leave
a little review on iTunes if you have time. It
really helps to spread the word about type one diabetes,
and thank you so much for listening.