Destigmatizing Diabetes

0:01 so good afternoon and good morning everyone my name is Brooks roach I'm manager of patient knowledge and 0:06 connection with diabetes Canada and I'd like to welcome you all uh to this this really exciting webinar presentation 0:13 I'd like to begin by acknowledging that I am joining this webinar from the traditional and unseated territory of 0:19 the migma people so wherever you are joining or watching from I'll just invite you to take a moment to express 0:25 recognition and gratitude for the land on which we live and to acknowledge the history of the indigenous lands that we 0:31 now call Canada we are here today to talk about something that will be familiar to 0:38 almost anyone living with or affected by diabetes this is an issue present in clinics in 0:44 classrooms workplaces Social Circles and in all these tiny interactions scattered 0:50 throughout our lives and what we're going to be talking about is stigma so we're going to do a few things we're 0:57 going to introduce some definitions around stigma talk about the differences that may 1:02 exist across types of diabetes and life stages and then we'll explore some steps 1:08 that both individuals groups organizations can take to help in destigmatizing diabetes 1:15 and to do this we're joined by three incredible guests that I have the pleasure of welcoming so first I'd like 1:20 to introduce Austin McDonald who is currently an airline pilot with jazz Aviation or Air Canada Express flying 1:27 the dash 8 Q 400. Austin was the first person in the world to earn a commercial pilot's license 1:34 with pre-existing type 1 diabetes he holds a BSC in mechanical engineering 1:39 from the University of Alberta and uh welcome Austin thanks for having me I'm happy to be 1:45 here Brooks uh we're also joined by Dr Michael vallis so Dr vallis is a 1:51 registered health psychologist and lead of the behavior change Institute at the QE2 Health Sciences Center in Halifax 1:56 and an associate professor in Family Medicine at Dalhousie University Welcome Michael 2:02 thank you very much great to be here and finally we're joined by Quentin Bellon former professional writer and 2:10 current ambassador for the all type 1 professional cycling team team Novo Nordisk welcome Quentin 2:16 thank you very much so in addition to just having some 2:21 incredible backgrounds and CVS of what they've they've been able to do our experts today will be answering some key 2:27 questions that they've heard from patients colleagues and seen in their work and research 2:32 we will also be taking questions from you our viewers so you can ask your questions by replying in the comments 2:38 Below on Facebook live and we'll do our best to uh to fit those in in the Q a 2:43 session toward the end of this this talk so feel free to to ask those at any point throughout the session and we'll 2:50 uh we'll pass those along to our panelists so with that uh I'd like to Dive Right 2:56 In and start with a question to Dr Ballas so some foundations first uh Michael what 3:04 do we mean by stigma and How might people with diabetes recognize it from their past experiences 3:10 yeah I think it's actually really important to address this issue because it's kind of subtle it's sort of like 3:15 you know under the surface so it's not immediately obvious but if we think about it we start with the individual so 3:22 bias refers to individual attitudes or beliefs about the disease and the 3:27 individuals living with diabetes and then those biased beliefs about diabetes 3:33 and individuals actually can result in unfair treatment of the person living 3:38 with diabetes but then it spreads and then we have stigma which is really the the societal 3:46 social stereotypes that exist that our individuals are exposed to in the normal 3:52 day-to-day course of their lives so it's not sort of just at an individual level 3:58 We Believe very strongly that that individual bias has actually crept into 4:03 the sort of social stereotypes and that impacts the experience that people have 4:09 with diabetes great thank you thank you Michael 4:15 um to take that into a lived experience or these sort of real-time experiences we 4:21 might have had um I'd like to ask both Austin and Clinton uh to share any stories or 4:27 Reflections on when you might have encountered stigma and how you responded or wish you responded and advice that 4:33 you might gather from these experiences so I'll ask that to Austin first I've typically found that stigma in 4:40 diabetes the diabetes usually goes hand in hand with a lack of understanding or a misconception about the the disease 4:46 for example my attempts at getting my commercial pilot medical certificate was pretty much all about trying to dispel 4:53 myths and stigmas such as all diabetics are very brittle the treatment 4:59 technology hasn't changed since the 1970s another really important kind of 5:04 stigma and and kind of myth I tried to dispel as well is that you know my life is controlled by insulin and blood 5:11 glucose rather than I control my life or my blood group glucose and my insulin 5:16 requirements around my lifestyle um when it comes to dealing with with dispelling this or dealing with this 5:22 stigma The Motto I use is patience and consistency for example when I was 5:28 working with our governing body Transport Canada which issue which issues flight crew licensing I did wish 5:34 I practiced a little bit more patience with them and there's a few times where I quite nearly lost my cool but once 5:42 once I I broke through the barrier and got my license I found for the most part everyone in my industry is very happy 5:48 for me and and very curious about what it is like living with diabetes 5:53 um and uh to to be frank with you they're they're they're really open and 5:59 and wanting to learn more about it which hopefully helps in dispelling uh some of the myths and the stigma around the 6:05 disease yeah thank you Austin 6:10 um you know Quentin I'm curious to get your perspective having have the chance to to 6:16 you know work as a professional athlete and travel the world and how you've encountered stigma in in your own your 6:23 own experience yeah thank you for the chance to speak there um I I was thinking 6:31 um I have been diagnosticated with type 1 when I was six years old I'm 26 right now and even before being professional 6:39 right there and things start um it's quite hard for me to to remember 6:45 because I have to tell I have to say all my family we are perfect with me they 6:51 introduced me to to the school the school were perfect all the Cycling Club the claiming Club all the sport I did 6:57 before being professional they were all nice with uh with my type 1 diabetes the 7:04 thing it's quite funny I remember it's when I was like 13 years old I was 7:09 already a cyclist I am a sprinter so at the end of the race you know we we find we with other people and one one day I 7:17 crashed so this this finger broke and I have a teacher I had a teacher who 7:23 planned to make a travel to Italy and when she saw that I have been I had an 7:30 injuries she was she was like okay Quentin you have an injury so we cannot bring you to Italy with us the reality 7:37 is she didn't know what was diabetes and she was afraid about it and it's fine 7:42 because it's not your fault we I think as at least as people living with type 7:48 one it's also our mission you know to to educate to explain what is what is 7:54 diabetes so that that's the my story and I would add just something I have also a 8:00 cat who has type one and he got a lot of stigma because all the time that people 8:06 come in my home and they they see me giving him insulin they asked me okay oh that that's why he's little bit 8:13 overweight because this type one so that kind of things I know he is upset we speak after between us but that's this 8:19 kind of things foreign yeah I appreciate that example because 8:25 it's uh you know it's so small and specific but at the same time that illustrates a lot of what people experience on the day-to-day this sense 8:32 of like oh that explains that or they're looking for the what uh what Behavior brought this on what uh what can I link 8:38 to the cause here when in reality it's far more complicated than that 8:43 um [Music] so Michael another question for you and it's that we'll have some you know and 8:50 Quentin you alluded this that uh you know you're speaking really with a type one focus and that's the you know team 8:56 Nova Nordisk is a team of individuals with type 1 diabetes who are who are cycling and Michael I'm curious because 9:03 we will have viewers living with both you know with with either type 1 and type 2 diabetes as well as some who are 9:09 our caregivers and maybe experiencing it from a different perspective so our viewership will be diverse from 9:15 perspectives of age or location ethnic background and I'm wondering if you can speak a bit 9:21 on how all of these factors in in a viewer's identity could lead to people 9:26 experiencing stigma differently absolutely yeah it's actually really important for us to um kind of elaborate 9:34 on that point Brooks because you know we're sort of trying to understand stigma trying to figure out okay what 9:40 can we do about it so we're sort of looking for answers and what I'd encourage us all to think about is let's 9:45 find out what the questions are because each individual has to answer these questions for themselves so bottom line 9:52 is is one size doesn't fit all so it's important for us not to try to paint everybody with the same brush so if we 9:58 kind of flip the question around we could ask everyone who is listening in be it someone with diabetes or a 10:06 caregiver and they can locate themselves on the dimensions of type of Diabetes 10:11 age location ethnicity income Etc and then I would encourage everyone to to 10:16 really ask themselves about their experiences with others have you ever encountered these biased attitudes or 10:23 behaviors from others and listening to quinton's example of this cat is really really interesting isn't it because it 10:30 kind of shows you it's a very straightforward one but it's so illustrative this cat did not contribute 10:36 to this bias in any way shape or form this little kid he's just doing what it's doing and yet people are imposing 10:43 these attitudes on them so if we could ask your cat your cat would probably say hey this isn't fair and that's the key 10:49 and then we try to really build from that are you treated in a manner that makes you feel uncomfortable because of 10:56 your diabetes I think that would be the question for everybody to reflect on because if you're in the presence of 11:02 others and you're starting to feel uncomfortable because of your disease that's when we see the flag for bias and 11:09 stigma and then you need to ask if that is shared by others if the person is aware of their attitude 11:15 and so one of the things that is really important and I love being on a panel like this because we've got some some 11:21 real citizen representations so we've got Austin and Quentin who live with this disease and have really determined 11:29 that they're not going to be suppressed by the stigma in the bias so these are spokespeople who are are really willing 11:36 to take a stand and that's actually really really important because we're trying to support the diabetes community 11:41 in really claiming their voice so you might ask the person if they're aware of 11:49 the impact that their attitude has on them and so if we could ask Quentin's cat we 11:56 could ask the kitty you know does that make you feel good about yourself or does that make you feel bad and if it 12:01 does then perhaps we could think about how could we potentially raise the issue 12:06 with the person or how do we protect ourselves from potentially uneducated 12:13 and judgmental individuals who aren't interested in a conversation so the key 12:20 to my response here is If you experience it try to link it to where the source is and then make your decision is this an 12:26 important person to me and if this person is maybe I could raise the issue with the person and that might be as 12:32 simple as just take a a diabetes Canada leaflet and put it on the kitchen table so 12:39 everybody could see it bring it with you when you're at a coffee shop and put it out there something that might cue a 12:44 discussion and then you kind of decide to be honest who's willing to listen and communicate and who do I have to protect 12:51 myself against I I really appreciate that um that 12:57 framing Michael and and if I may I I I'm curious to pick up on something you mentioned which I I love the acid test 13:04 of does this make me uncomfortable does does this provide me with this sense of 13:10 have I done something wrong does make me question my role in all this um and then taking that forward into can 13:17 I educate this person and if I encounter that resistance can I walk away you know knowing when to when to find protection 13:24 um I'm curious if I can ask Austin you know I I know Austin you had a a pretty 13:30 long Trek through your advocacy journey in going from you know to become a 13:36 licensed pilot like it was it was an uphill climate times and I I imagine without naming names that you would have 13:43 encountered a lot of folks who who wouldn't have understood or who would have been would have been tempting to 13:49 walk away and I'm curious if you can speak a little bit to how you protected your own well-being 13:55 when you were in those situations that's a that's a really really good question and absolutely I did encounter 14:01 a lot of people that would just say it's not possible or it can't be done uh not to go into too much detail but 14:09 um several uh officials at the government level basically said this is not achievable and they were medical 14:15 experts however their Viewpoint at diabetes hadn't changed from what I thought since 1980s or 1970s 14:23 um the best advice I could give again was the the patience and consistency and having a excuse me a fantastic support 14:30 team I leaned heavily on my family and specifically my dad he was the the 14:35 champion for my for my fight with all this so I'd say the key to all this is having an excellent support team to kind 14:41 of help you vent and help you um come to terms with the the biases and 14:47 the stigmas you're facing a little story I guess I have is my mom uh once I was 14:52 on the phone with with Transport Canada kind of arguing my point about specific kinds of insulins it's a it was a very 14:59 very specific conversation but it got to the point where I was you know vibrating Madoff after the phone call and she just 15:06 after I hung up she she took me aside and said listen you know you're doing good this is going to be a long uphill 15:11 battle but you got this and it's it's a fight worth fighting so like I said having a a great support team is is 15:18 massive massive for this yeah thanks Austin I appreciate you sharing that 15:24 um I I think a major component to this whole issue as we've touched on is is a 15:30 misunderstanding of diabetes or its causes its severity a lot of a lot of people try to dial down how severe it 15:37 can be um it's complications you know whether it's they're not aware or they don't really grasp the interconnection with 15:43 that this this can be a really severe really dangerous condition to live with 15:50 and I'm wondering you know what have you found to be the keys to shifting how people understand 15:55 we've talked about that that importance or that that Duty in some cases to educate others to help people 16:02 clear that hurdle of understanding what have you found helpful to to help change 16:07 how others understand or think about or speak about diabetes so it could be could be family friends Healthcare 16:13 Providers Transport Canada or you know it takes a lot of forms um Quentin I'm wondering if you can can 16:19 share yeah um I think first of all we need to 16:25 to see to sing also about oh we are thinking about how our diabetes 16:31 ourselves a small story when I have been diagnosticated I was like why me why 16:37 when my diabetes is not well controlled people are upset about me my parents the 16:43 the doctors another of them what I mean not my my friend my brother my sister I did not 16:49 understand what happens so I started I started to fight against my diabetes at this point then when I was 14 when I met 16:56 for the first time team novel artist who is only um athletes with type 1 diabetes 17:02 I was like wow they are like me they are as as I want to be and then they invite 17:08 me to a training camp in Atlanta Georgia and I was there and the CEO and the 17:14 co-founder of the team Phil stood around spoke to us and asked us questions what do you think about diabetes how do you 17:20 see so I explained my English was perfectly bad at this moment but I understood this sentence and I was like 17:27 okay I fight against my diabetes I'm sure to say one thing that changed my life he said okay Quentin if this works 17:34 for you perfect but don't forget diabetes only choose Champions so okay it's it's marketing it's what whatever 17:40 you want but for young a young kid with a lot of dreams that changed my life 17:46 from this I learned to use level difference to make the difference 17:53 but I I think that's worth repeating to to use the difference to make a difference it's interesting because it 17:59 can be can be a lot on on our shoulders to to feel you know responsibility to 18:04 take everything on on top of the demands of living with diabetes and 18:09 um yeah using the difference is is an interesting really great perspective 18:16 um Austin can you uh speak to this a little bit I can and I like to say I really like the uh the analogy diabetes 18:22 only chooses Champions that that's that's a really really good one and it shows how we have to be resilient and 18:28 have to have to be tough so to speak but um uh talking about you know misunderstanding and 18:35 um and having to kind of educate one of my favorite favorite kind of Segways into doing this to educating is you know 18:43 are you sure you can have that cake or ice cream or how many needles do you give yourself a day 18:48 um and the analogy I use nowadays with the kind of the way Car Technology is going is uh diabetes control is just 18:55 like an autopilot for those fancy new Tesla cars or even for the airplanes I fly where 19:01 um everyone without diabetes has this perfectly good autopilot that manages everything for them they almost don't 19:06 have to think about it whereas us we have to think as if we're driving a 19:11 1960s Mustang with three gears let alone even cruise control and so that's a 19:17 that's kind of one of the analogies I use to provide um education and kind of show the 19:23 misunderstanding that a lot of people have with diabetes and I think that's really the my in my opinion analogies 19:29 are a great way to educate people um a little side story about understanding is that actually uh one of 19:36 my best friends is a as a medical student right now and during his first year they made him do uh have diabetes 19:42 for a week exercise where he had to test his blood sugar four to six times a day he had to give himself saline shots to 19:49 stimulate insulin carb counted did all what we do on a daily basis in day in and day out and during that week we had 19:57 a little get-together with him and he actually with him and a few other friends and he pulled me aside and said 20:02 I never really understood what this was like and this is only a fraction of what you go through every day and so having 20:10 somebody recognize that it was massive and I hope more and more people today get to learn learn from this from these 20:18 webinars as well as from diabetes kind of information pamphlets about what this disease is and what we're capable of 20:25 doing yeah yeah thanks Austin uh Michael I'd 20:30 like to turn the same question your way and I just wanted to add something that came to mind and it's 20:36 I can imagine some folks may be watching this and and might struggle to view 20:41 themselves as a champion might struggle to to Really grasp that uh it can feel 20:47 sometimes like a burden to to have to go out and keep doing your best and Performing it's at a high level just to 20:53 do what what seems like what everyone else can do so easily um and whether that's educating others 20:59 or just going about your day can it can at times feel really tough I'm wondering if you can speak to the role of yeah you 21:06 know burnout and this this sense of consistent motivation when it comes to 21:11 tackling this yeah absolutely so if people are sort of listening notice how this conversation has been going we 21:17 start with stigma which is this subtle societal level assumptions that people 21:23 make and it's true it's there we cannot deny it and so it's really important for individuals like Quentin and Austin to 21:31 call it out in the experience of their lives critically important for diabetes Canada to to Really champion this to 21:37 take this forward but stigma then is really based on on misunderstanding 21:42 which really is about being uneducated and so ignorant in in the descriptive 21:48 way people just don't know better most of the individuals who people encounter 21:53 actually are not bad people wanting to do you harm 21:58 they're simply following the sort of General beliefs that we have like you know if you're 22:06 really really sick if you've got a life-threatening disease shouldn't you have an IV pole hanging on you and 22:11 you're walking around in a Johnny shirt or how long are you going to live look at look look at Austin's wearing a a a 22:18 an Air Canada suit and and Quentin is wearing an athlete's Jersey they can't 22:24 be sick if they were sick I would know they were sick so it can't be that serious so these are just very kind of 22:29 natural sorts of beliefs we need to look to the media there was a paper just published in we have a journal in Canada 22:35 called the Canadian Journal of diabetes and a group in Montreal Just published a paper in which they looked at some of 22:42 the misbeliefs presented by Stu by TV and movies in which there's what you and citizens 22:49 see on the screen promotes misunderstanding oh you know 22:54 the person is in a coma oh they're diabetic give them insulin and you know or in you know 23:01 the great big needles you know get brought out when people are uh so so there's a lot of reasons that we 23:06 understand that so it's really important that we you know look for these opportunities to re-educate and that's 23:13 what can happen at a broad level and right now in our society we sort of need 23:19 diabetes Canada and we need people like Quentin and Austin to sort of call it out but let's be honest most of us are 23:27 just ordinary people with ordinary lives but those are where the extraordinary accomplishments really happen and so 23:34 everybody talks about you know particularly type 1 diabetes you know is like all those poor people let me share 23:40 something with you as a psychologist people living with type 1 diabetes especially if they've been diagnosed as 23:46 children end up being as adults less neurotic than the average person 23:53 and better friends and let me show you what I mean most of us are privileged we grow up in a 24:00 society in which we're safe and so we kind of get neurotic you know I wanted a blue one and they sent me a red one oh 24:07 my goodness let me complain because I really wanted the blue one and they sent me a red one well if you're living with 24:12 diabetes and you're having you know worrying about nocturnal hypoglycemia you don't care about blue and red so 24:17 you're actually less neurotic you're actually more able to focus in on what's important in life and also you know 24:23 friendships most people are fair where they're friends it's like oh let's go out to a party oh I'm not doing so well 24:29 I think I'm just going to sort of go for a walk and sit and stare at the stars oh oh well we'll be at the pub if you need 24:35 us whereas someone living with diabetes who every day recognizes the burdens is 24:40 likely to say oh okay I'll sit with you so I think it's really important for us to understand that there are definitely 24:47 burdens but it's really the opportunity to to act on those burdens and what we 24:52 really need to do is establish and call this conversation out so that we can 24:58 begin to promote more correct types of models and we should call out the the 25:03 industry around how people are presented so 25:08 there's a movie um called the whale that's just been released uh and and uh by with Brendan 25:16 Fraser playing a a super obese man with type 2 diabetes and and people from 25:23 obesity Canada actually were involved in the script so we're beginning to see some of this 25:29 openness so it's very much true that that diabetes can be a burden but in 25:34 fact that life isn't about happiness life is about meaning and people living with diabetes often have the opportunity 25:42 if they have support to actually bring meaning to their own lives so we're 25:47 starting with the talk on stigma but what we're really trying to do is promote well-being or what we call empowerment 25:55 so people actually are able to actualize and by the way people living with diabetes who are 26:02 doing the least amount to take care of their diabetes are healthier in their behavior than the 26:10 average Canadian so before people start thinking about what they're not doing they need to recognize the average 26:16 Canadian's diet is a mess their activity is a mess their Stress Management is a 26:21 mess and the average person living with diabetes is way more advanced in terms 26:26 of knowledge of nutrition and knowledge of how to manage their lives so it's interesting isn't it in a way and that 26:34 strength really develop through hardships so there's the burden element but we believe I'm a health professional 26:41 in diabetes and we really do believe that there's an opportunity for empowerment and people like Clinton and 26:47 Austin are really necessary right now because they are kind of Trailblazers and they show us the way 26:54 and I hope I didn't talk too long not uh not a worry Michael because that 26:59 was a really beautiful answer I I think [Music] it's really resonant that uh sort of the 27:08 power in the everyday and the recognition that a lot of you know to to go through or at this the 27:14 old language of suffering from diabetes yes well there's a lot of uh a lot of strength that can be built through the 27:21 problems that are inherent to it the challenges that have to be solved by definition living with this they build 27:26 things up yeah just I won't elaborate just want to let the audience know if 27:31 you're interested in this language issue recently diabetes Canada published in the in the Canadian journal and it could 27:39 be accessed through the website a very important paper called language matters 27:44 and it's very accessible it's not an academic paper and it will just give you 27:49 an explanation of the Damage Done by these judgmental types of words and it 27:54 calls out some of the words and some of the strategies so it might be informative to the audience and it would 28:00 certainly be something that you might want to code if you had a friend who was trying to help like maybe I'm trying to 28:06 help Austin and I say Austin should you really be eating that because I don't know and maybe Austin if he feels 28:12 comfortable might give me this paper to read which by the way is quite informative 28:18 yeah yeah it's an excellent example I've just um I think we'll be posting that in the chat if anyone's interested uh on on 28:24 Facebook and comments um this is this is a great conversation and 28:30 before we get dive into a couple of questions that folks are submitting um I just want to ask 28:36 you know what and we've touched on it a little bit but the the actions that we can really take you know we've talked 28:42 about the and a lot yeah this this call is a real privilege because we're dealing with people that have taken a 28:49 lot of action to change the conversation um what advice or what uh what action 28:55 would you would you suggest would you share with people affected by diabetes with 29:01 organizations or Media or viewers who want to once this this webinar is over go out 29:06 and be able to make some changes and I'll ask that to to Quentin first 29:12 thank you um I would say I will come back our mission there is to inspire educate 29:20 people living with diabetes around the world and I think it's the mission of everyone living with diabetes we have to 29:27 to inspire to be proud of our diabetism to to live with it I won't repeat what 29:32 just Michael said that I I definitely agree so I think the the best way is to be proud 29:39 of ourselves thank you Austin 29:46 diabetes um isn't what it used to be uh compared to when I was diagnosed around 10 15 years ago let alone back in the 29:52 1980s the 50s or even the 30s um pardon the airplane pun but the sky's 29:58 the limit for those living with diabetes I try to demonstrate as as many people as I can that this is possible 30:05 um when I was first diagnosed at 14 years old I was told by the social worker at the The stallery Children's 30:11 Clinic that in terms of careers anything is possible you can do anything you want except serve in the military or be a 30:17 professional airline pilot and I managed to myself take away one of those answers like that that is now off the table you 30:24 can become a professional airline pilot and that's something I'm proud of doing and I'm very proud to say that I have 30:31 removed a barrier from those living with diabetes um to say the least we have come so far 30:37 we have such great treatments and Technologies um and we're this close to a cure but my 30:44 advice until then is that we should shouldn't stop we shouldn't say we're doing good enough 30:49 and we shouldn't Pat ourselves on the back and call it a day we need to continue to keep pushing forward but the 30:55 very least take care of ourselves and make sure we we manage our treatment of diabetes appropriately from that from 31:02 that basis from you know managing your diabetes and taking care of yourself anything is possible it's the starting 31:07 Foundation I believe for for for anything no thank you Austin's good it's a great 31:14 point to you have to you know as they say filled with the watering can before you can water the plants so taking care of yourself first 31:21 is uh is a great Foundation um so folks we're going to open the the 31:26 Florida questions we have a few that have rolled in and the first is one that I'll ask to to Quentin and uh this 31:32 person is wondering as an athlete with with type one um what steps do you take to manage 31:39 blood glucose while you're in on a race or preparing um 31:45 and what advice do you have for young athletes and what I would add is how do you 31:51 add to this the the you know the the time that it takes to prepare those around you to know what you might need 31:57 in as a as an athlete to know how to support you thank you for the question I would say 32:05 um when you are when you are living with diabetes what we we ask you is to have a good way of life at the end of the day 32:12 what we ask to uh to an athlete it's to have a good way of life so here we have 32:18 an advantage I would say when uh I I go to the pro level I was roommate with 32:24 another Pro provider in another team without diabetes and we compare what we 32:30 add and all these kind of things you know and now I don't there is some company making some CGM from 32:37 non-diabetic people for sports and performance and he is using this this 32:42 kind of things and at the end of the day I am making a less viability I would say 32:48 less less I manage better my diabetes than him even if he's not diabetic so 32:54 that's exactly what you said before Michael but yeah that that's that's an advantage after what I would say it's we 33:03 are all different every diabetes is different and what works for me won't 33:08 work won't work for for someone else so the the thing is to find your way the 33:15 way to find different Zone the zone for the a long physical exercise a short 33:22 physical exercise and when you go down of this Zone then you you can eat differently if you go down very fast if 33:28 you go down very slow uh the same if you if you go higher very fast or very very 33:34 slow I think the the thing is to find your way 33:40 that's a great point Thank You Clinton um I have someone that that's that's 33:45 shared that they've faced some criticism of their diabetes self-management uh 33:52 even in the context of healthcare provider when they've been referred to another Specialist or someone that's in 33:58 passing getting access to their their records and and you know may not be Trey may not be a specific uh may not be 34:05 their endocrinologist or their care team but going in for example for pre-surgery admission 34:11 um and I'm curious I'll pose this to Michael if you have any any thoughts on addressing this or navigating that 34:17 absolutely yeah it's a it's a really important question and just to sort of normalize the context so you may 34:25 mentioned about burden and one of the things that we've really focused on in the last number of years is what we're 34:31 calling diabetes distress and so we really very strongly believe that everyone living with diabetes in a 34:37 medical context should be screened for diabetes distress and when we talk about diabetes distress it's really 34:43 interesting if we think about it in four components the emotional burden of 34:49 living with diabetes that sort of emotional weight that can get heavy at times 34:54 the regimen to stress the distress associated with all of the tasks and the work 35:00 but importantly two other aspects of distress what we call social support distress which is that kind of stuff 35:07 that we're talking about with other people and then my favorite aspect of diabetes 35:13 distress we call provider-based distress where individuals living without with 35:19 diabetes gets systematically sort of judged by Healthcare Providers and what's really interesting is that and 35:25 this represents a lot of the work that we're doing in Canada is that sometimes the medical profession can can sort of 35:31 look at things in just in terms of what's the diagnosis what's the treatment and let's implement the 35:37 treatment and then see the outcome and they do that in a way that's really simplified almost as if it was surgery 35:43 where the surgeon is in charge they do their thing and it works that's 35:49 not how chronic disease or diabetes is managed it's really about the complexity 35:54 of that and so a lot of clinicians will sort of be trained in here's the problem here's the solution why aren't you doing 36:01 it and there's a really strong strong initiative in amongst the sort of chronic disease 36:08 management to really flip that around and do what we call patient-centered care 36:13 and so the next time anyone experiences this with their medical provider depending on how comfortable you are you 36:21 might actually sort of respond to that treatment by sort of saying are you aware of the Canadian clinical practice 36:28 guidelines for diabetes management um do you believe that chronic disease 36:33 has to involve the patient and these are questions what's interesting I spend most of my time training doctors how to 36:41 really communicate and support people living with diabetes and other chronic diseases and one of the things that I've 36:46 learned and I really hope that this comes across is that if the doctor knows that they're missing The Mark with you 36:52 they will not be happy with themselves so if you sit there passively taking 36:57 that treatment they won't know that's the problem with that because these doctors in fact are uneducated they 37:05 would say diabetes is a glucose regulatory disorder and here are some 37:10 therapies that will correct that so the evidence says they work so do it what 37:16 could be simpler and in fact that's completely wrong and if we can start to communicate this back and so we did 37:23 something a number of years ago we called it the it was a part of a study called diabetes attitudes wishes and 37:28 needs and it was called Dawn d-a-w-n and we called it the dawn experiment 37:34 which is we just encourage people living with diabetes to say to their health care provider can I ask you Doctor why 37:42 haven't you ever asked me how diabetes affects my life 37:47 that one question was a bit of a groundbreaker because all of a sudden the doctor goes oh okay well how does it 37:54 affect your life and this you see if we start with stigma and it's subtle and it's at a societal level 38:00 what do we do with that but if we start at the at the micro level between you and the person who you're who's making 38:07 you feel uncomfortable then you can see change happening so it's actually a 38:12 super important issue to identify that and and really is that this word notice 38:18 that that Clinton's sort of raise on Tetra in his team is empowerment that's 38:24 part of their their initiative and and I would like to you know link us back to 38:29 to small changes uh to empowerment happens in Little Bits right now we need 38:34 these iconic features the figures like Quentin and and Austin to sort of show 38:40 us the path but then we don't expect everybody to turn into these groundbreaking uh accomplishments what 38:47 we are trying to do is use as an example for people to find that they're victories that they can because remember 38:52 the Journey of a thousand miles begins with a single footstep 39:00 Michael thank you thank you again for just a wonderful answer and and we've uh 39:05 We've shared the clinical practice guidelines in the in the Facebook comments as a reference point if 39:13 with a healthcare provider because um can be really helpful to to come into an engagement like that armed with some 39:20 knowledge you know armed with something that can can help the that person learn I don't want to interrupt you but let's 39:26 be honest if you're not talking to a diabetes specialist you know so much more about your disease 39:33 than that family doctor that surgeon that physiotherapist that I don't think 39:38 that just because they've got a diploma on the degree on a degree on the wall that that gives them more knowledge than 39:45 you you live this disease you know this disease and and if we start to bring that voice forward we really believe 39:53 that will change the conversation and again I'll just end by saying if the doctor knows that they're not hitting 39:58 the mark that they will not be comfortable with that and that can shift that Dynamic where they can do more 40:04 listening than speaking yeah fantastic 40:10 um one more question that we we have is um and I'll actually I might pose this to the three of you because you'd have a 40:17 I'm sure an interesting but a but a slightly different perspective on it and the question is 40:22 what advice would you give to kids in building their confidence around diabetes stigma to someone who's young 40:28 who's encountering a lot of this maybe for the first time still learning sort of social rules of engagement how do 40:35 they uh advice to approach this whether for the the child themself or for a caregiver or a friend to support them 40:42 um I might pose that to uh to Austin first any thoughts you have I would say don't be ashamed of it wear 40:49 it as a badge of honestly honors the wrong word but embrace it you know it 40:55 embrace it as a unique part of who you are and and and What Makes You Different to others 41:02 um Dad don't don't be ashamed of it it's uh it's it's something that can be cool as well you can kind of show all you 41:08 know the cool toys you have extra or you know diabetes Christmas when you get a new pump or a new CGM or something like 41:14 that that's a unique experience for for people and it's something that you can Embrace as being unique 41:20 yeah um Quentin any thoughts yeah um I agree 41:26 with your team thank you for this and I I would I would say it's it's normal uh 41:32 to have this different step before the resilience to be upset to to try to 41:37 negotiate with the diabetes and then to to be to depress the decrement to the 41:43 price uh and then to have the resilience that's normal and even when you are the 41:48 resilience then you come back to the fight result because your daily is because it's not perfect for the time 41:54 even when you don't have that it is it's not perfect all the time so that's normal that's what I would say 42:01 uh Michael any advice yeah uh so um I would say 42:07 um don't try to fix what's not broken um I I love kids I think kids are a great example we should learn from the 42:14 children uh in two ways because children don't don't get stuck in Old ideas I've been doing this for years and so you 42:21 know kids are are in a developmental stage they're innocent they're they're learning about the world and so they 42:27 they incorporate so they they absorb diabetes much much easier than adults do 42:33 and the second thing about children that's really lovely is children without diabetes 42:39 they just get it right so like you know let's imagine that Quentin is eight years old and I say Quinn what are you 42:46 doing you're sticking yourself with a needle and and he says yeah I've got this diabetes I have to take this three times 42:51 oh cool can you get can you give it to me and then all of a sudden it's like oh look at that this is they don't start 42:57 doing all this judgmental stuff a lot of the challenges with children are excuse my language the parents and the system 43:03 like you know we heard about oh you can't go to Italy because you've got a broken finger what that's ridiculous 43:10 right but it's because you're living with type 1 diabetes and a broken finger that we don't think you should go to Italy which is not fair so I think it's 43:17 really interesting I I would make the note that with adolescence it's a little delicate because you know what we need 43:23 to do is try to protect adolescents from their diabetes so that they can do what they're meant to do which is to be as 43:30 different from their parents as they possibly can be and as most like their friends as they can possibly be that's a 43:36 normal stage of development and so it makes it important to get good care in adolescence but generally I would leave 43:42 the children alone by the way most psychological interventions with 43:47 children are directed towards the parents and managing the parents anxiety and we 43:53 kind of try to leave the kids alone because they are actually I love the to see how kids adapt because like you know 44:01 we heard from Austin like it just becomes cool um so so I think it's a great great 44:06 point and uh and I find as a psychologist you don't really work to help people 44:14 with type 1 diabetes diagnosed as children with the self-management tasks that's 44:20 like drinking water for them it's the adults who have been stuck in patterns for years that struggle to to change so 44:28 I think it's a great a great comment yeah 44:34 um folks that's that's all for uh audience submitted questions but um what I'd just like to to close off with is to 44:42 our audience I'd like to thank those that have submitted your questions and and um I I'd like to say that to learn more and 44:49 stay up to date on what we're doing at diabetes Canada on this topic and Beyond you can visit diabetes.ca uh you can 44:56 visit our social media at diabetescanada and if you want specific Direction you can call 1-800 Banting or email info 45:04 diabetes.ca if you have any questions and uh finally I'd just like to one more 45:09 time turn the floor to our guests uh if you have anything final that you'd like to share or anything that you're struck 45:15 by after this conversation or that you'd want to leave our audience with um some final remarks so I'll I'll pass 45:21 it um maybe we'll go back through that that order in reverse and I'll hand the Florida to Michael 45:27 yeah my words here are way less important than listening to what and Austin have to say about this but what I 45:35 would really just want to say is is kind of you know keep your friends close and 45:41 be and protect yourself from those people who aren't willing to listen to you 45:47 um and you know we don't we need to really create an environment that that really matches us and so I think that 45:54 that would be my comment then I'm really interested in hearing what the real experts have to say about this 46:00 uh Quentin your thoughts yeah firstly it would be a comment to to 46:05 make her the when I asked my cat what do you think about it I know that's Kimberly yes the neighbor why he is 46:13 getting weight and because all my neighbor gives to him some food 46:19 that's that's the thing yeah it's it's uh once all this remainder uh are done perfectly when I 46:27 speak about reminder is having a good ovarian among good friend good family 46:32 like explaining to family explaining to friend what is diabetes once everything is done just one more time we have to 46:40 use our difference to make the difference thank you Quentin and uh Austin 46:48 um like I said earlier have patients have consistency in like Michael and Quentin have emphasized have a good 46:53 support system good friends good family know who you're surrounding yourself with who can support you when you need 46:58 them um that I think is the the the big takeaway I think in this is when it comes to stigma uh with diabetes 47:07 yeah well listen um Austin Quentin Michael I'd like to just sincerely thank the three of you 47:13 for a really fantastic conversation and for being willing to to share your own experiences and your expertise and uh I 47:21 know it's you know personally living with diabetes this has been a really wonderful session to to be part of and 47:27 and I hope that it's been helpful for our audience as well so a sincere thank you to the three of you and uh and to 47:33 our audience uh feel free to get in touch with further questions and uh we'll be happy to assist wherever 47:38 possible so thank you and take care and uh use your difference to make a difference as they say 47:44 thank you Brooks thank you diabetes Canada thank you thank you