0:10

Music .

0:19

Coming from you know , 25

0:21

years ago , starting with NPH and regular

0:24

and such a strict diet

0:26

, Music . It

0:33

was a set amount of carbs . It was 60

0:35

carbs at each meal , 30

0:37

carbs , 25 , 30 carbs for

0:39

a snack and you had to have a bedtime

0:41

snack . Whether I was hungry or not

0:44

had to have it . I still can't

0:46

eat graham crackers and peanut butter to this day

0:48

because that was my snack

0:50

every night . I still can't eat it . Music

0:54

.

0:58

Welcome back to the Healthy Diabetic Podcast

1:02

. As always , before we get started , please remember that nothing

1:04

that you hear on this podcast should be considered

1:06

medical advice or otherwise . Please

1:08

always consult your medical team before making

1:10

any changes to your diabetes management

1:13

. If you haven't done so yet

1:15

, please make sure to like subscribe

1:17

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1:19

on a platform that allows

1:21

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1:24

or five star review , please

1:26

do so . It really helps the show grow . Again

1:28

, thank you to all of you who are showing up

1:30

every single week and listening to these conversations

1:33

, listening to these episodes , and

1:35

I also thank you to those of

1:37

you who are sharing these conversations , sharing

1:39

these episodes with someone

1:42

that you know is going to get some really good value out of this . We're

1:44

all in this journey together , and

1:47

that's what this podcast is here for to help

1:49

you by supporting you with good

1:51

quality conversations and

1:53

with really good information that

1:56

you can implement into your diabetes management

1:58

style . Now , alright

2:01

, let's get with today's guest . Today

2:03

, I got to sit down with Elizabeth Pisha . She's

2:05

a type one diabetic , has been a type one diabetic

2:07

for 25 years , she's a registered

2:10

dietitian and she's the

2:12

mother of four boys . Yes , you heard

2:14

me right . Four boys , and I'll

2:16

tell you what . Two is

2:18

hard enough , and I got two girls Same

2:21

gender . It's hard enough . I can't

2:23

imagine three , four , five

2:25

, six , my goodness , those

2:27

of you who have multiple

2:30

kids . Not that two or one is

2:32

any walk in the park , but

2:34

those of you who have multiple

2:36

kids , same gender , different genders , I

2:38

don't care , you guys are troopers . God bless

2:41

all of you . Elizabeth

2:43

is very passionate about helping

2:45

people with and without diabetes to

2:47

understand the foods that we eat and

2:50

empower us to live

2:52

a healthy lifestyle

2:54

that's ultimately going to improve

2:56

our blood sugars and improve

2:58

our lives . I'm so pumped

3:01

for you guys to hear this conversation , so

3:03

, without further ado , let's get with

3:05

Elizabeth Pisha .

3:18

All right . Well , I am Elizabeth Pisha

3:20

and I'm a registered dietitian and

3:23

I have my masters in clinical nutrition

3:25

. I've had diabetes for

3:27

25 years . I was diagnosed

3:30

on December 3 1998

3:32

. So it all

3:34

kind of jumped out at me this in

3:36

December , that it's been a quarter of a century

3:39

, which just sounds crazy

3:41

. It makes me feel really old . But

3:44

yeah , it's , it's been that

3:46

long . I

3:48

don't remember a whole lot . I was 11 years

3:50

old . My mom

3:53

noticed that I was drinking

3:55

more water and more tired

3:57

and I had lost about 15 pounds

3:59

, which could either be a growth

4:02

spurt during puberty or

4:04

something serious . And

4:06

a neighbor made a comment and my

4:08

mom knew that something was off , went to the doctor

4:11

, checked my blood sugar

4:13

and basically went straight to the

4:15

hospital for three days . And

4:19

I do remember that a little bit clearer than

4:21

before . No

4:24

one else in my family has type one diabetes

4:26

, which I think is much

4:28

more common to hear that now than what

4:30

people expect , but

4:34

I did have like a flu

4:36

, a virus , pretty , pretty

4:39

soon before my diagnosis , which

4:41

that's really the only thing

4:43

that makes sense to me , that

4:45

that triggered that . So

4:49

, yeah , spent three , three days in the hospital

4:51

and went home with

4:53

NPH and

4:56

regular and started

5:01

counting carbohydrates and everything

5:03

that goes along with that and

5:06

then about a maybe a year later I

5:08

started hemalogue and then about a year later

5:10

went on to a pump . So this was around

5:13

, you know , around the year 2000

5:15

. And my doctor was

5:17

really good about getting me right on whatever

5:19

was coming out , whatever was new

5:21

and the thing to do . I've

5:27

been on the

5:31

pump since then and , yeah , I when CGMs

5:33

came out and I don't remember

5:35

when they first came out , but I got mine in 2007

5:39

or 2008 . Which

5:41

one started on Medtronics

5:43

because I was using their pump , hated

5:45

it . Yeah , totally honest

5:48

.

5:50

So how many people ? I mean I ? That's the first one

5:52

I started on , like , my first was Medtronic

5:54

.

5:55

Yeah , I mean , there wasn't at that point , there wasn't

5:57

another option . Then

6:00

, pretty soon after , there was then Dexcom

6:02

. But yeah , hated it

6:04

and really what I hear people kind of saying

6:06

now isn't too different from

6:09

my experience . You

6:11

know what was that ? 15 , almost 15

6:13

years ?

6:13

ago .

6:14

So , um , yeah , now

6:16

I'm using Dexcom . Switch to

6:18

Omnipod and Dexcom about

6:20

maybe 12 years ago .

6:22

Okay .

6:24

And I've never turned back . It

6:26

was just night and day . Love

6:28

my Dexcom , never , never

6:30

turned back . And

6:34

yeah , I mean here

6:36

. Here we are now with

6:39

all the other

6:41

pump options and I

6:44

love all the tech . All the new tech is

6:46

just very cool , coming

6:48

from you know , 25 years

6:50

ago , starting with NPH and regular

6:52

and such a strict diet

6:55

. You know you hear about strict diabetic

6:58

diets . Yeah , and it kind

7:00

of come from that time period

7:02

, which isn't so much the case anymore

7:04

.

7:04

So yeah , I can't wait to dive

7:06

into that with you , being a dietitian , and what your

7:08

thoughts are , because I have my own personal thoughts

7:11

about the restrictive part

7:13

of that , that concept and that

7:15

foundational thing and I think

7:17

that we're even hearing that from doctors

7:20

today like a diabetes

7:22

diet , especially for type twos , and

7:26

it's just . It's a sad thing

7:28

and world that we're living in

7:30

right now with that is

7:33

having to be in that space

7:35

, and it's one of

7:37

those things that I just I think that

7:39

we're

7:42

in this space where technology

7:45

is incredible and it's

7:47

just getting better and better every single year

7:49

, and thinking about

7:52

like being able to be in this space

7:54

where technology is so

7:56

good , why are we holding

7:58

on to old things that we thought

8:00

that work ?

8:02

Yeah .

8:03

You know we're not proactive enough to

8:05

being able to change with the times .

8:07

Yeah , a lot of times that education

8:10

of how to eat and

8:12

give insulin is not

8:14

caught up to where tech is .

8:17

Yeah , yeah , so

8:19

it's a . That's a very interesting piece , and

8:22

even thinking about what you're talking about when you

8:24

were first diagnosed , when you're

8:26

on NPH and like doing .

8:28

I mean I can't imagine that .

8:30

I can't imagine that .

8:32

You had to . It was it

8:34

was a set amount of carbs . It was 60

8:36

carbs at each meal , 30

8:38

carbs , 25 , 30 carbs for a snack

8:41

, and you had to have a bedtime snack

8:43

. Whether I was hungry or not

8:45

, had to have it . I still can't

8:47

eat graham crackers and peanut butter to this day

8:49

because that was my snack

8:51

every night . I still can't eat it . And

8:55

but you had to because that

8:57

was your set dose and it

8:59

was . It would kick in half an hour

9:01

later and you had to eat . So

9:04

yeah , thank goodness it's

9:07

not like that anymore . We're

9:09

so much more free to skip that .

9:15

I'm curious too this this comes from the

9:17

, the coach and trainer and the fitness person

9:19

in me it were

9:22

were were you using fitness or

9:24

were using exercise to help manage

9:27

blood sugars , or is it

9:29

more like hey , we have this regimented

9:31

eating schedule and this regimented

9:33

insulin schedule .

9:36

Yeah , that's a good question . I I

9:39

played soccer , I played sports

9:41

, but at that time I was on

9:43

the pump once . I so

9:47

that did change , change that

9:49

change that , change the game a lot

9:51

, yeah , plan , yeah . So

9:54

you know , when I was 11 , 12 , just

9:57

doing shots and I

9:59

was just playing outside doing kids stuff

10:01

. So I don't remember

10:04

any specific Exercise

10:07

Protocol

10:09

or anything that I was yeah , specifically

10:12

with that .

10:13

Yeah , it's just an interesting

10:15

thing for me all the time when I think about , you

10:17

know , the I

10:19

hate to say the ancient times Of

10:22

diabetes , right where there wasn't

10:24

all this technology . We didn't have cgms . We , you

10:26

know , we had in pH or we had , you

10:28

know , you know , long-acting . When

10:31

that's what I started on as long acting into

10:33

that in 2007 , at

10:35

the age of 25 , that's what I had to start on

10:37

and he started me on long acting , you

10:40

know , and it wasn't even actually long acting , it

10:42

was more of a 70 30 split and

10:44

oh , wow . Yeah , so that's

10:46

what .

10:46

I started on a 70 30 . Oh , interesting

10:50

. Yeah , cuz that's . I mean that's hard

10:52

. There's kind of more rules

10:54

with that too , because you've got it

10:56

. Yeah , that's , yeah it

10:59

was . It was pretty challenging and yeah it was

11:01

like .

11:02

I've talked about it in lengths on this

11:05

show . I've talked about it in lengths on on

11:07

speaking , in speaking engagements

11:09

and on social media . It's like it

11:13

is one of these like missions

11:15

and passions for me , because I Didn't

11:18

have that support . I talked to so

11:20

many people that go to the hospital for three days

11:22

. I've talked to people that were

11:24

diagnosed at the age of eight or ten

11:26

or younger and they were in the hospital for five days , getting

11:29

educated , going through all this amazing stuff

11:31

and and it's like part

11:33

of me is like man I wish I would have

11:35

had that because maybe I wouldn't have been denial

11:37

in denial about the condition for

11:39

three straight years .

11:41

Yeah .

11:41

I literally had no one . Yeah , I had my parents

11:44

. Like my dad was like very

11:46

, very into it . He's a researcher

11:48

at Ohio State , he was

11:50

on the JTF board , but

11:52

it just wasn't the same .

11:54

No , one to compare stories to , and yeah

11:56

, yeah yeah

11:58

yeah , yeah , I think , also being

12:00

diagnosed as an adult

12:02

, even a young adult . Back

12:05

and to that was it 2005

12:07

there

12:09

wasn't as much we . They didn't know back

12:12

then that Adults can

12:14

get it as often as as they are in

12:16

this diagnosis and I could go down

12:18

that that rabbit hole Podcast

12:21

to .

12:21

But I love that .

12:24

Um that's a fun rabbit hole though

12:26

I know um , yeah

12:30

, so that 70 , 30 kind

12:32

of probably was . Oh , it's

12:34

not juvenile diabetes , so yeah

12:39

, yeah education . I don't know , yeah , I don't . There's

12:42

a big gap there . I think , one

12:44

thing , but there's like there was

12:46

a gap .

12:46

Yeah , there's a . There's a big gap there and and

12:49

I hope I hope that

12:51

it has caught up because it

12:53

was . I was diagnosed with my

12:55

family practitioner Amazing

12:57

, amazing doctor he's . He

12:59

was incredible , the best you

13:02

know GP I ever had but

13:04

they just wasn't knowledgeable . They weren't knowledgeable

13:06

about the condition , of what was going on , and

13:08

it was . I went in with Almost

13:11

no symptoms your excessive

13:13

urination in thirst is my only symptoms and

13:16

I only recognized it because I was . I

13:18

went to our summer house in New

13:20

York on a 12-hour trip and had to stop

13:22

every 45 minutes to use the restroom on

13:24

the way up there and the way back 12-hour trip

13:27

. So something was going on

13:29

. So it's the only reason I went to go see him . And

13:31

they tested my blood sugar

13:33

three or four times . It was over 450

13:35

. I felt like a million bucks and

13:38

they just they were so Baffled . Yeah

13:40

they gave me a 70 30 split , gave me a glucose

13:42

monitor , said here , take 12 units at

13:44

night , 12 units in the morning . We'll see you

13:47

back in a couple weeks . And that was it . It

13:49

wasn't all . Your over 450 . You probably

13:51

need to go to the emergency room . It

13:53

was how . Just take this so

13:57

it , and I've heard multiple stories like

13:59

that . Yeah , yeah , yeah , no , there's too

14:01

many yeah so but

14:03

I , just I , I , I hope that the

14:05

in at least in the GP world , we're

14:08

getting better . I

14:11

believe we are , and and

14:14

I think the other interesting piece when

14:16

I hear people that were diagnosed

14:18

2000 and you

14:21

know before it's the

14:23

thought process of being able to have multiple

14:25

days in the hospital

14:28

, not just they , not just

14:30

24 , 48 hours to get you to

14:32

your blood sugars regulator , to get them back to where they're

14:34

supposed to be .

14:35

But it's it's constant feedback

14:38

, it's constant education , it's constant like

14:40

this is what this is , is what this is and

14:43

my my under chronologist

14:46

and his One

14:48

of his nurses came in multiple

14:50

times over those days With the

14:53

education . My first shot that I

14:55

ever gave was actually in my under

14:57

chronologist arm . It was a some

14:59

. He filled a shot with saline , yeah

15:01

. So there's stories of , oh , I'm gonna

15:04

give a shot in an orange , like nope , I gave my

15:06

first shot in my doctor's arm . That's

15:08

awesome . They made it so . They

15:11

were wonderful . I Credit

15:13

them with so much of who

15:15

I am today . They

15:18

won't take the credit for it , but I give it to them

15:20

. All the time yeah and

15:23

because of that , like that memory sticks out

15:25

and okay , this isn't scary if

15:27

I can jab this Doctors

15:29

arm .

15:30

Yeah .

15:31

I can , I can do it , so that

15:33

made a huge difference .

15:35

What was you know growing up and Going

15:40

through all that ? What ? What do you think

15:42

was the biggest Impactful

15:44

thing that you learned , or you

15:46

have learned from diabetes ? No

15:48

matter whatever that is , whether it's support

15:51

, whether it's some type of educational

15:53

thing , whether it's a management style , you've learned . Whatever

15:55

it might be , what is the biggest impactful thing

15:57

that you've learned ?

15:58

Well , my kind of going

16:00

back to what I was just saying about that , my under

16:02

chronologist and the team that he

16:04

has , um I , they

16:06

were phenomenal from

16:08

in the hospital I remember

16:11

and my mom clearly remembers

16:13

them telling us that Having

16:17

type 1 diabetes was not gonna

16:19

stop me from doing anything . It's just

16:21

gonna take a little bit more planning than

16:23

someone who doesn't have diabetes . And

16:26

that really stuck with my mom and

16:28

it has stuck with me . I mean , that's

16:30

the the attitude

16:33

that they had at every single Appointment

16:36

that I had . Oh , you want to go to two-week

16:39

summer camp , let's figure it out , let's

16:41

do it . Oh , you're gonna Go

16:44

camping for five days , we

16:46

can figure that out and do that , we

16:49

are gonna . You know , whatever it is , whatever came

16:51

up , it was okay . You

16:54

know how much insulin do you need to take you it with

16:56

you ? What snacks should you

16:58

bring ? Here's some strategies

17:00

to try . You can do it . And

17:02

Just that belief from

17:06

day one , I think

17:08

, their belief in me

17:10

, like they believed that . I

17:12

could do it and I

17:15

believed them . So

17:18

I think that

17:20

also helps because I was going right into

17:22

my teenage years too and I mean it

17:24

was hard in school being the

17:26

I went to a small school and

17:28

I was the one who was like checking her

17:30

blood sugar and eating snacks and it

17:32

felt , you know , I felt weird , but

17:36

I never went through like a

17:38

rebellious time

17:40

with my diabetes , where I , you

17:43

know , was making up numbers and not giving

17:45

myself insulin . I was motivated

17:47

to do that because

17:50

I knew my parents and

17:52

my healthcare team believed

17:54

in me , and not

17:56

that I didn't want to let them down , but

17:58

I was like , okay , like I can

18:00

do this , why wouldn't I do it ?

18:03

You know , a feeling . Yeah

18:05

, that's awesome .

18:06

You know , back even

18:09

when I was a teenager , talking to people . I

18:11

was told then that I was really

18:13

good at helping

18:15

others and explaining to other people

18:17

with diabetes and

18:19

helping them through some of just what

18:21

you have to do and giving tips and that kind of thing

18:24

, and that was really the first spark

18:26

in my mind that I wanted

18:28

to be a

18:30

diabetes educator . I'm not one

18:32

yet Got the first step . I'm

18:35

a registered dietitian . Who

18:37

knows what'll happen next ? But ultimately

18:40

this is what I have been wanting to do since

18:43

I was a teenager and

18:45

that spark has always been

18:47

there . So

18:49

, and I don't think I could have done that without having

18:52

a healthcare team that supported me and

18:55

believed in me .

18:56

Yeah , that's awesome . I

18:58

love that because it's

19:01

one of those things it's like when

19:03

you figure out at

19:05

a young age what you want to do

19:07

and you hold on to that and you

19:10

ride that all the way through . You

19:12

know a lot of young kids . They'll

19:14

have multiple things that they're like oh I want to do this , I want

19:17

to do this , I want to do this . This sounds really cool , but

19:20

when you hold on to something like that , it's super powerful

19:22

and you're doing it .

19:26

I'm 36 and it finally happened , so

19:31

I mean lots of things had to happen before

19:33

that . I've

19:35

got four kids and got

19:38

married right after I graduated

19:40

with my nutrition degree

19:43

, and it just took another

19:45

eight , nine years to

19:48

finally get here . So

19:51

it's been quite

19:53

the long road , but it

19:55

was what it was supposed to be .

19:58

Exactly , exactly . So

20:02

let's go into this . Then your

20:06

philosophy with

20:09

food right , I think this is super

20:11

powerful . I want to go into this part and

20:13

then we'll circle back , because I do want to ask

20:15

you about your pregnancies and

20:17

how that went , because I know a lot

20:19

of young women , a lot of women

20:21

that are thinking about it or have gone through it

20:24

really like those types of conversations

20:27

because they're sort of powerful . So we'll come

20:29

back to that . But I'd love just to dive

20:31

into your coaching

20:33

philosophy with food . What

20:35

are the things that really jazzes you

20:37

up when you think about food and coaching

20:39

people ?

20:41

Yeah . So I'm all

20:43

about meeting people where they are at

20:46

. I don't like

20:48

whole diet overhauls . It

20:51

just doesn't work , it's not fun , nobody

20:53

really wants to do that and

20:55

we all know that it doesn't work . So

20:58

I like to meet people

21:01

. What is their situation

21:04

in life , what

21:06

is going on in their life , and meeting

21:08

them there and figuring

21:12

out it's not just about food

21:14

figuring out what

21:16

is going on

21:18

in their life that's causing trouble

21:22

with getting this food in

21:24

their diet . Or

21:26

I mean pre-bolusing

21:29

is like that's like my number

21:32

one .

21:33

Yeah , with diabetics yeah .

21:35

I struggle with it . I feel like every time

21:37

I go to the doctor I know I gotta be

21:39

better about pre-bolusing , but

21:43

what are the things that are

21:45

making that hard to do and going

21:49

that route and

21:52

just connecting on an emotional level ? Nobody likes to

21:54

be told what to eat , so what do you

21:56

want to eat ? Let's

22:00

make that work for you . I don't like taking

22:03

out foods or insisting that

22:06

someone eat a food . What

22:08

are the foods that you eat ? What

22:11

is your favorite breakfast ? Let's

22:13

make that work for you , and whatever .

22:14

yeah , I love that , because

22:17

it's one of those things that we think about what

22:19

are you eating , and

22:23

we're not here to restrict that type of food . I think

22:26

about pizza for people . Pizza is one

22:28

thing that people love to eat . So I always think about

22:30

two different things when

22:33

I think of food . It's one what does the person actually want

22:36

, which

22:38

is what you're saying , it's perfect . And then I

22:40

also think what is the quality of that food , and

22:43

can we improve that in whatever way we need

22:45

to , and

22:48

is this a situation where we need to improve it ? So

22:51

I think about pizza . People

22:53

just love pizza . I love pizza . I

22:56

eat it probably once a week , but

22:58

I'm not going to constantly go eat cauliflower

23:00

crust pizza . I'm

23:03

going to sometimes indulge myself into some pizza , real pizza

23:05

yeah , Real pizza right . I

23:07

like cauliflower crust pizza but

23:10

it doesn't fill me up for the 10 sizes

23:12

that they have and the carbs really

23:14

aren't that different . There you go

23:17

, right . Yeah , yeah , I'm figuring

23:19

it out .

23:19

There's so many different strategies for

23:22

dosage .

23:22

Yeah .

23:23

Like , let's figure it out . It's

23:25

empowering to figure that out and be like hey

23:28

, I had a bunch of pizza last night and

23:31

I wasn't sky high all night , Cool . I

23:33

couldn't do it . But

23:37

figuring things out from that perspective and bringing diabetes

23:39

into it specifically like

23:44

diabetes is unique and you can really

23:47

, when you try to describe it , even

23:50

do another diabetic . It's the constantness

23:52

of it and the 24-stage . It's

23:56

the constantness of it and

23:58

the 24-7 . And

24:01

it's more than just living with it 24-7

24:03

. It's the constant . It's always in the

24:05

background , decision making , and

24:08

it's hard to put into words that feeling

24:10

. But whenever you talk to another diabetic

24:12

they nod and say , yep , I know exactly

24:14

what you're talking about and

24:16

that emotional . It

24:19

doesn't have anything to do with your blood sugars , it's

24:22

just that emotional toll of living

24:24

with that every

24:26

single day , every single hour , minute , second

24:29

. It's so it's

24:32

hard to work through that and

24:34

it can really hold

24:36

you back from

24:39

pre-bolusing or from

24:41

trying to figure out dosing

24:43

for pizza or it

24:46

can really be one of the big roadblocks

24:49

in

24:51

getting better

24:53

blood sugars and

24:55

I think Specifically

24:58

us having diabetes ourselves

25:00

. It's just really

25:02

special to be able to completely

25:04

have that empathy with the patient , with

25:06

the person that you're working with , and they

25:09

know that , you know

25:11

that they know exactly

25:14

what that feels like and

25:16

then you can really get through to

25:19

even just

25:21

talking it out , having someone to talk to can

25:23

kind of start to break down that barrier and

25:26

make it feel a little

25:28

bit more motivated to have

25:31

a little bit more balanced breakfast . Or

25:33

try

25:36

pizza and try figuring

25:38

out pizza , because that can be really overwhelming

25:41

, or

25:43

whatever . The thing is that . The change

25:45

is that you want to make .

25:46

Yeah , I'm interested too because

25:49

, as we're having this conversation , I

25:52

think back to my values with

25:56

coaching and my own personal values and food values

25:58

, and

26:01

I'm curious what is your thoughts on

26:03

this concept of

26:06

understanding what your relationship with

26:08

food is ? Because I know for

26:10

me , when I talk to people about food

26:12

and about nutrition and about eating and

26:15

their habits , that's like the very first

26:17

place I go to , even

26:19

when I'm talking to a diabetic , and

26:21

we're not even talking about food . We're

26:23

talking about two specific things what is your

26:25

relationship with yourself and your diabetes , and then

26:27

what is your relationship with food . So I'm interested

26:30

to know what are your

26:32

thoughts about that .

26:36

Yeah , that's a deep one . I

26:41

think you can , at

26:43

least for me , and

26:45

I've seen it with some of the people that I've worked with , whether

26:48

they have diabetes or not understanding

26:52

your food and

26:54

if you're shocked that some

26:58

food that you eat every day has this many

27:01

carbs and this much fat and

27:03

that's shocking to you , you need

27:05

to learn what that portion

27:07

size is Then

27:10

. What is in your food

27:12

and it's just

27:14

a neutral thing , but just the

27:17

knowledge of learning

27:19

the carbs and fruits

27:21

and the carbs and fat

27:23

and protein , that

27:28

can almost make

27:31

it even more neutral . Instead

27:33

of this more

27:36

negative relationship to

27:38

food . Get it more

27:40

as data , as

27:42

just science or

27:44

trying to separate it . Learn

27:47

about it . Read labels , know

27:50

what the makeup of your

27:52

meals are , even if it's just your

27:54

typical meals . That's obviously

27:57

where I would suggest starting and

28:00

I think that that can really start

28:02

to change the tune in your head if you're struggling

28:04

. Knowledge

28:07

is power . It's a cliche , but it's

28:10

true .

28:10

It's true , yeah , 100% , if you want to understand

28:12

about your food .

28:14

You're going to have more control

28:18

over it and

28:20

be able to make more intentional

28:24

decisions surrounding that meal and

28:26

your insulin dose . I

28:31

think food needs to be a little bit more neutral than

28:33

we make it , because

28:37

we're supposed to enjoy it , and it

28:40

also is fuel .

28:42

They're not just things , they're combined .

28:46

So , yeah , it's complicated and each person has

28:48

their own experience . But

28:53

that's typically where I tend

28:55

to start looking at all of this

28:57

is data . You're bombarded

29:00

with numbers constantly , especially

29:02

with CGMs . Every

29:05

five minutes you have a new number and

29:08

trying to separate that from who

29:12

you are and what you're doing

29:14

and look at it as data . Looking

29:16

at it , if you're going to try pizza , it's

29:19

an experiment . You're gathering

29:21

data for an experiment .

29:23

Yeah , I love that the experimentation

29:26

is so powerful to understand

29:28

that , because I know I

29:30

get in front of a bunch of tons of people

29:32

that are just like I can't figure this out . I can't

29:34

figure this out and like , well , what have you tried ? And

29:37

like , well , I've only tried this . I'm like , well , did that

29:39

work ? No , then

29:41

why you keep doing it ? Try something

29:43

different , come up with a different strategy . Maybe

29:45

it's because you ate

29:47

something two hours earlier , maybe

29:50

it could be like the list goes on of

29:52

how many things it could possibly be , even

29:55

as someone that's not diabetic . So

29:57

I think that is an important

30:00

piece and I love that you brought that up the experimentation

30:02

, because it's all about especially

30:04

with diabetes too , it's

30:07

like experiment fail , figure it out Experiment

30:09

fail , figure it out , and you might even figure it out , and

30:11

then the next time that same thing fails . That

30:14

happens to me all the time . With pizza , that

30:17

happens to me all the time .

30:19

Yeah , and because of all the other things

30:21

that we don't have control over , like , maybe

30:23

you had a stressful afternoon and your

30:25

adrenaline still pumping

30:27

. Maybe

30:31

for women , where are you in your cycle

30:33

? Maybe you tried pizza in

30:35

the first half of your cycle and now you're trying it

30:37

, that's a good point . You're insulin resistant

30:39

, so there's just so many other

30:41

factors that go into it that

30:44

maybe next time it's not going to work . But

30:46

it's not always your fault . There's

30:49

a lot going on .

30:50

I love that . It's not always your fault

30:52

. That is , that's great . It is because it's

30:54

not . It's not always your fault .

30:57

Really all we can do is count carbs and

30:59

do our best to give the right amount of insulin

31:02

and

31:04

really that's it . I mean

31:07

that's like the basis of it .

31:09

I mean there's a lot of things . You guys heard it here first . That's

31:12

all it takes .

31:14

Perfect blood sugars . But

31:16

like we don't , we can't control

31:19

what happened earlier in the day that made

31:21

it , you know , made us

31:23

feel stressed for the rest of the day , or

31:25

something that we're worried about that's going to happen tomorrow

31:28

, or if we're coming

31:30

down with a cold , or we

31:32

don't have control over those things . So

31:35

you have to do your best with what you

31:37

know and what you can control and experiment

31:41

.

31:42

Yeah , I love that Awesome

31:45

. So okay

31:47

, let's , let's shift back , because

31:49

I want to go into this next part . You

31:53

know you have four little ones or four kids . How

31:55

old are your kids ?

31:57

I have four boys . They are nine .

32:00

Good for you .

32:03

Nine , seven , four and

32:05

almost three . He turns three in a couple of weeks

32:07

Nice .

32:09

Four boys , good for you , good for

32:11

you .

32:11

It's wild and Whatever

32:13

you're picturing in your head .

32:14

That's probably what's happening .

32:16

I love it .

32:18

So , yeah , talk me through these pregnancies

32:21

, because a lot

32:23

of people , a lot of women , I feel

32:27

it's like all

32:30

over the spectrum of the

32:32

of how

32:34

they get through these pregnancies in terms of

32:36

bad to good , good

32:39

, bad experience to good experience . And

32:42

I would , I would love to hear your thought

32:44

processes , maybe even from

32:46

the first one to even the last

32:49

one , different things that you learned

32:51

, different things that you did differently

32:53

, that type of stuff .

32:55

Okay , yeah . So

32:57

when I was first diagnosed

32:59

and even I

33:02

still feel like some of that fear is still there

33:04

but that was like post

33:06

steel magnolias Julia Roberts

33:08

, you know dying from her

33:10

pregnancy with type one diabetes

33:12

era , and I feel like a

33:15

lot of that fear is still still

33:18

there . When you talk about pregnancy with diabetes

33:20

, um , it's

33:22

gotten tons better . Um

33:24

, yeah , I don't get as many

33:26

comments like , oh , aren't you scared

33:28

? Or you know whatever ? Um

33:31

, so that's definitely gotten better

33:33

. I'm very glad because a

33:36

lot of that has to do with technology and

33:38

everything improving

33:40

with our care . Um , so

33:43

by the time my husband

33:45

and I got married and we were , um

33:48

talking

33:50

about starting a family , I first

33:52

met with a maternal

33:56

fetal medicine doctor and

33:59

met with him just

34:01

to go over expectations

34:03

. What was my

34:05

care going to be like and

34:08

that made me feel really good . He was really happy

34:10

with where my A1C was already

34:13

. My endocrinologists were

34:15

happy with my pre-pregnancy

34:18

blood sugars and

34:20

A1C and everything . That

34:23

really gave me a good amount of confidence

34:25

. Going into that first pregnancy was

34:28

just kind of going over the basics

34:31

of what was going to be expected . I

34:34

did have to tell them no , I'm not going to fill

34:36

out a meal and blood

34:39

sugar log because I have my DEXCOM and

34:41

my endocrinologist

34:43

looks over it . So I'm sorry I'm not going to

34:46

do that . I think , as

34:48

women going into pregnancy and

34:50

all the decisions we have to make , you do

34:52

have to know yourself and be

34:55

able to advocate for yourself and

34:57

say no , this is going to be taken

34:59

care of this way . Sometimes

35:02

you don't have a choice , but most of the times you do . My

35:07

first pregnancy was pretty

35:11

standard . All

35:13

of them really were just

35:15

kind of your usual feeling

35:18

gross at the beginning and

35:21

all of that . You

35:25

just kind of double down on counting

35:28

carbs and pre-policing . I

35:33

really don't change too much about

35:35

my diet when I'm pregnant for

35:38

all four of them . Some people are really

35:40

surprised by that . They'll

35:43

say , oh , you're not following a diabetic

35:46

pregnancy diet . I'm like well

35:48

no , no , why . I'm

35:51

just going to eat what I feel like eating

35:53

and be careful about

35:55

my insulin doses

35:57

. And as soon as I see you

36:00

just keep cranking up the insulin as

36:02

the trimesters go by , it

36:04

really is incredible to see . Usually

36:07

my insulin will triple by

36:09

the end of pregnancy . Which

36:13

is just wild . I

36:16

think people also forget that that

36:18

happens . Whether you have diabetes

36:20

or not , your body is making . Every

36:25

pregnant woman's pancreas

36:29

is making more insulin . The

36:32

entire pregnancy it goes

36:34

up because the baby and the placenta

36:37

are using all that up too . You're

36:39

growing a human . I

36:43

think it's annoying sometimes , but it

36:45

is just crazy to see what our bodies

36:47

are doing and to see that

36:51

insulin usage is just wild . I

36:56

did go

36:58

into labor with him before

37:01

they would have gone for an induction . I

37:03

avoided an induction with him , which is what I was

37:05

trying for . I didn't

37:07

like the idea of going in and being

37:09

induced . Thankfully

37:12

, for the next three , I went in

37:14

to labor before they would have wanted

37:17

to induce me , which

37:19

I'm very thankful for . I know that's not always the case

37:21

. I know my pregnancies

37:23

are not . It's not what

37:25

everyone is going to have , but

37:28

I want women to know

37:30

that it is possible . It's not

37:32

something to be scared of

37:34

. Again

37:36

, we can do everything . It just takes a little

37:39

bit more planning . My

37:41

second was pretty similar Just

37:45

watching the insulin go up and staying

37:47

on top of my carbohydrates and

37:49

insulin doses and

37:51

didn't have any

37:54

big issues with him . My

37:58

third , kind

38:00

of a similar story . He

38:04

was the only one who had a low blood sugar after

38:06

he was born . It

38:09

was pretty uneventful

38:11

labor , but his blood sugar was

38:13

, I believe , 16 when

38:15

he was born . Breastfeeding

38:18

didn't bring it up , the glucose gel

38:20

didn't bring it up . He was in the

38:22

NICU for a couple of days on a

38:24

glucose drip Then

38:27

did fine . His blood sugars came up and held

38:29

themselves steady . That

38:33

was definitely a different from the

38:36

first two having to do the trips to

38:38

the NICU back and forth . He

38:41

was great . He responded great

38:43

to that . My

38:45

fourth , I did

38:47

have to be induced . I

38:49

think this one is more of an interesting

38:52

story diabetes-wise . I

38:57

knew that if anything weird

38:59

happens , especially at the end of pregnancy

39:01

, with your blood sugars or with your insulin

39:03

needs , you got to talk to your

39:06

doctor . It was over Martin

39:12

Luther King Day weekend and my

39:15

, so almost the three years

39:17

ago , because he's almost three , so he , my

39:22

blood sugars were . I could not keep them up . I

39:24

kept going low and over about a

39:26

period of a week my insulin needs dropped

39:29

pretty dramatically , almost maybe

39:31

like six To

39:34

like 60% of what it was .

39:36

I was like I don't remember this happening

39:38

before and then one .

39:40

So it was . So

39:42

Martin Luther King Day , the doctor's office

39:45

was closed and I was like this is still

39:47

happening , like I just can't keep my blood

39:49

sugar up . I keep having to treat these lows

39:51

and decrease my insulin . Something

39:53

is off . So

39:55

that Tuesday morning I

39:57

had about a . In the

39:59

about a four-hour period I had

40:02

about a at least a hundred

40:04

grams of carbs and Maybe

40:07

like five units of insulin , which

40:10

, wow , when you're which I

40:12

mean even if you aren't pregnant

40:14

that's crazy .

40:15

Yeah .

40:16

And it just kept like I would . My blood sugar

40:19

would go up a little bit and then it would just start to come

40:21

down . Yeah

40:24

, and I'm like this is not ever happened before

40:26

. So I , you know , called my OB , called

40:29

my endocrinologist , and so

40:32

what , most what ? What they

40:34

think was happening was my placenta was

40:36

not working well and

40:38

the baby wasn't getting what he , what

40:41

he needed . So it

40:43

didn't , it wasn't using the insulin like

40:45

it was before and my

40:47

blood sugar just kept crashing . So

40:50

it was actually the first day of the

40:52

semester and I was in the middle of a zoom

40:55

like going over the class schedule

40:57

and everything , and I had to exit

41:00

out and you mail my professor

41:02

and tell her that I was going

41:04

to the hospital to be induced , so

41:07

that that was my first experience with

41:09

an induction and

41:12

it went . It went smoothly , it went well

41:14

and , yeah

41:17

, now he's gonna be three and so

41:21

, yeah , that was definitely

41:24

the most unique diabetes

41:26

related pregnant

41:28

in late . You know . But

41:32

again , everything you know if you're , if

41:34

you're paying attention and you know

41:36

your body and you know what's expected

41:39

With your blood sugars through

41:41

each trimester . You know , in the first trimester

41:44

, a lot of times insulin needs go down , which

41:46

is kind you wouldn't expect in

41:49

the first trimester . A lot of times you'll have more lows

41:52

and then your insulin needs

41:54

start to go up , up , up , and

41:56

Towards the very end of pregnancy your

41:59

insulin needs kind of

42:01

it stops going up , it kind of just tapers

42:03

a little bit and I

42:07

knew that it wasn't normal to

42:09

have a drop in my

42:11

total daily insulin . So

42:13

if you know what to expect and you know your

42:15

, how you , how

42:18

your body responds to things , you

42:20

can catch those things . And I caught it , you

42:23

know . I mean , yeah

42:25

, I caught it and talked to my

42:27

doctors right away and we

42:29

did what we had to do . So

42:32

, being prepared , going into pregnancy , probably

42:36

, especially with your first , and

42:38

I really feel for women

42:41

who are Scared to

42:44

get pregnant , you know , when

42:46

you look at the , the goals of

42:48

Pregnancy blood sugars

42:50

, it can feel completely undoable

42:52

. They're very that

42:54

you're the goal ranges for

42:57

pregnancy . Fasting

42:59

and after meals is

43:01

much lower than Then

43:04

when you're not pregnant , and it can

43:06

feel very Just that , well , that's gonna

43:08

be impossible . How will I ever

43:11

be able to have blood sugars like

43:13

that and a lot of mine weren't

43:15

, you know it , especially

43:17

with type 1 diabetes it's you

43:20

really have to look at . You

43:23

know more than just each individual

43:25

number and you have to look . I

43:28

think it's really important to look at that time

43:30

in range during these times , to and

43:34

just stay in touch with your doctor

43:36

and They'll

43:38

tell you if something looks

43:40

a little off . Yeah

43:43

, you really have to have that trust there and

43:45

If you don't trust

43:47

, even if you're OB , if you don't trust your

43:49

OB , find

43:51

another OB . That that relationship

43:54

is so crucial . Yeah during this

43:56

time to get through

43:58

all of pregnancy and the

44:01

birth .

44:03

Yeah , it's , yeah , that that's . That's

44:05

crazy about your , your

44:07

your fourth , yeah

44:09

, and the insulin needs and like

44:11

that , like how it all turned

44:14

out , and yeah , and I think it

44:16

is . I think is a really another really cool

44:18

thing , because I think I think pregnancy

44:20

and women's hormones

44:22

and in Diabetes and women

44:24

is just so fascinating because it's it's

44:27

hands down different than

44:29

the males . It's just hands down way

44:31

different . And I remember

44:35

like the , the crazy

44:37

mood swings , the craziness of

44:40

my wife going through our art

44:42

with our two girls and Then

44:45

having really good conversations with

44:47

women that are type one and

44:49

. Everything that they have to go through

44:51

and just like , oh my gosh , you guys

44:53

are freaking troopers . Freaking

44:55

troopers for what ? What

44:58

? Not just having

45:00

to think about , okay , I'm doing

45:02

this for myself , I Am

45:05

managing my diabetes on a

45:07

very high level for myself , so I can

45:09

be healthy , but now you have this other person

45:11

, that every single decision

45:13

affects them as well .

45:15

Yeah , it's like it's no , that it's

45:17

very . It could be very overwhelming . I

45:20

think you get an ultrasound

45:22

typically every four weeks

45:24

and they're really looking at

45:27

the , the

45:29

size of the baby , the size of the baby

45:31

, the size of the baby , and

45:33

I can't tell you how guilty

45:36

I felt sometimes seeing

45:38

that percentage Jump

45:40

up a little bit and

45:42

it's like I could have just been a little if my

45:45

a1c was just lower or if I

45:47

didn't have that one

45:49

meal or whatever it was . That

45:53

to me was was probably the hardest

45:55

part was

45:58

Trying to let go

46:00

of that Guilt that

46:02

oh type of like diabetics just have

46:04

bigger babies because they

46:06

have high blood sugars . It's like I work

46:08

so hard to have not high blood sugar

46:11

yeah it's still happening and we

46:14

forget that people who don't , women

46:17

who don't have diabetes , they have big babies too . It

46:20

happens to . We

46:22

have babies of all different sizes . Um

46:25

, so yeah

46:27

, that was really hard Trying

46:30

to let go of that guilt

46:32

. I don't know if I , if I do have

46:34

another one I don't I probably will feel the same

46:36

. It's really hard

46:38

to let go of that and not have that be

46:40

like a personal attack on yourself

46:42

, seeing that Measurement of the baby

46:45

, which probably is not it , might not be accurate

46:47

either .

46:48

Yeah , that it's

46:50

. It's also interesting . I Want

46:53

to ask you what this follow-up

46:55

question , because we're

46:58

talking a lot about fears and you brought

47:00

up fear quite , quite a lot in that

47:02

, in that span of talking about pregnancy

47:04

and like Think emotions that you're going through

47:06

, do

47:09

you , do you have

47:11

emotions towards your

47:13

kids possibly becoming being

47:16

diagnosed with type one ?

47:20

Mostly no , some

47:23

I do if they're , if

47:26

they're just off and Sick

47:29

or they have a fever , but it's , you

47:31

know , like if something's weird it's not

47:33

like a normal sickness , or if

47:35

one of them goes to the bathroom a couple

47:38

more times , then Then

47:40

normal , it does cross my mind

47:43

like , oh , like , if this keeps going

47:45

I'm going to check their blood sugar , or you

47:49

know . But overall

47:51

I don't worry about it too much

47:53

. The , the percentage

47:55

, the percent chance of your

47:59

, the child , of someone , with diabetes Getting

48:02

diagnosed themselves is

48:04

, I believe , only like a half percent

48:07

higher than the normal population

48:09

. So I Just keep

48:11

that in mind . It's really not that

48:14

much higher of a chance . So

48:17

I I try not to worry about it

48:20

and mostly I don't . My

48:22

four-year-old was I don't know if you just drank

48:25

a little bit more than usual last

48:27

week and he like ran to the bathroom

48:29

like three times in like an hour and a half

48:31

and I was like , okay , if he does this again , I'm gonna

48:33

check his blood sugar .

48:36

Have you checked their blood sugar before ?

48:37

I have , yeah , yeah , just some

48:39

weird illness , things that didn't make

48:42

sense . I have yeah and I

48:44

, I just tell myself , you know what ? Who

48:46

like I can know , like right

48:48

now , yeah , like I could just poke

48:50

their finger and know right now

48:52

whether or not I don't have to , I

48:55

don't have to wait to know . Yeah

48:57

usually it's like 80 , you

48:59

know no , yeah

49:01

.

49:01

I have done it .

49:06

And you know . I mean , I know what to do

49:08

If it did happen , I

49:12

know what to do . I mean it's really stink

49:14

, it'll be awful , and awful

49:16

horrible but we know what to do and

49:19

I could know right now . I could check all

49:21

my kids' blood sugars right now and catch

49:24

it before any symptoms .

49:26

Yeah , I love that because

49:28

it's , I know , for me

49:30

. I've struggled with those emotions .

49:32

Yeah .

49:33

And like it used to when

49:36

my first was born . It

49:38

used to keep me up of

49:40

like thinking about it and every time she

49:42

would have a cough , every time she would have to go

49:44

to the . You know just , it would keep me

49:46

up . And it took my wife

49:49

to say saying to me that

49:51

you know it's not

49:53

gonna happen , but here's

49:56

the bright side . If it does , who

49:58

better to be in a position to

50:01

support them than someone that lives with

50:03

it themselves ?

50:04

Yeah .

50:05

And that , just that really aligned and

50:07

stuck with me and it's , and

50:09

even just that one phrase has allowed

50:12

me to take a step back and like , totally

50:14

right , if it happens , it happens .

50:17

It's not gonna happen and they won't be put on and they won't be

50:19

just slept on 70 , 30

50:21

and sent on their way .

50:22

There you go .

50:23

But all what we have now to .

50:25

Yeah . To immediately

50:27

just get kids rockin' and

50:29

rollin' and Yep , and

50:31

then I even think about the testing now too . So

50:33

it's you know cause ? I always get those questions too

50:35

when I tell people that story of

50:37

the fear that I've had and they won't

50:39

just get tested . I'm like because , regardless

50:42

, if that test says is positive or not

50:44

, it doesn't mean they're gonna get it , and this doesn't mean they're not gonna

50:47

get it , right ? I ?

50:48

personally do not at all want

50:50

to know or know that there's

50:52

a chance , because why ? What

50:54

would that change other than me

50:57

just waiting ? I

50:59

would just spend a state of like , anxious

51:02

, waiting for that somebody and

51:04

maybe it won't even come , and

51:06

if I can catch it right away , which we can , so

51:09

I know some people are really excited

51:12

about that being able to know and

51:14

get their kids tested . You

51:16

know it's a personal .

51:18

Absolutely .

51:19

What we can each handle , and I know

51:21

that I couldn't handle , so I'm good with

51:23

if they're sick or something weird's going

51:25

on , I'll poke their finger and know .

51:27

Yeah , what position in

51:29

life are you in and what do you

51:31

ultimately want ? If you want to

51:34

, you know , test your kids and take

51:36

them for the treatment to

51:38

you know , not

51:41

allow them to have it for three , four years . Okay

51:43

, cool , that's , you know . All power

51:46

to that individual , yeah

51:48

. But yeah , I'm more on

51:50

the side of like I

51:52

know myself and I know

51:54

, like I know these symptoms

51:57

. I know how to treat them . I

52:00

know how to coach someone through them , so

52:02

I'm not going to make myself go crazy by

52:05

a yes or no or maybe and

52:08

maybe not , and just

52:10

go with life . Roll with life .

52:12

Yeah , no , we need to . I struggle enough

52:14

with being present and I

52:16

don't need anything else to distract

52:18

me from living right

52:20

now with my kids . So

52:23

yeah , 100% 100%

52:26

.

52:27

Well , this was just a fabulous conversation

52:29

. Thank you so much for jumping

52:32

on here talking and you

52:35

know , giving us your expertise

52:37

and nutrition , giving us your

52:39

expertise , and you know , being

52:42

a mother with type one , going through

52:44

that process I know this

52:46

episode is really going to touch a lot of people , so

52:48

I really appreciate that .

52:50

Yeah , this has been great . It was a

52:52

fun first podcast to do .

52:54

I'm really excited , so thank , you Many

52:56

more to come , many more to come .

52:58

Yeah , for sure .

53:00

So yeah , for

53:02

everyone that's listening , if

53:05

you want to get

53:07

in touch with Elizabeth , please

53:09

reach out to her . Elizabeth

53:11

, people want to connect with you , work

53:13

with you . How do they get in contact

53:16

with you ?

53:17

The best way is right now is following

53:19

me on Instagram . My

53:22

handle is Elizabeth underscore

53:24

dietitian and

53:26

it has links to all the ways to contact

53:28

me and

53:31

I'm working on getting more active

53:33

on there , but I'm there , so please

53:35

reach out if you want to say hi or

53:37

have any questions and

53:41

yeah , all the links are there to get

53:43

in touch with me .

53:44

Awesome , awesome . Yeah , please reach

53:47

out to Elizabeth , follow her page

53:49

. I've you know . Since

53:51

we connected , I've been following

53:53

what she's doing and what she's putting out . She's putting out

53:55

some really cool content , really good

53:58

information that

54:00

is very impactful and valuable

54:02

. So please make sure you guys go on to her

54:04

page , follow her , send her a message

54:06

and connect with her . Elizabeth , thank you

54:08

so much for jumping on , thank

54:10

you everyone for listening and I

54:13

will see you guys next

54:15

time . As

54:17

always

54:21

, thanks for taking your time .