This webinar presentation discusses sexual health, tips, and considerations for people living with diabetes, along with the risks and realities of using drugs like alcohol and cannabis.
Speakers: Dr. Alice Cheng and Dr. Celine Huot
Helpful resources:
Cannabis use in adults and adolescents with diabetes: https://www.diabetes.ca/advocacy---po...
Brief Screener for Tobacco, Alcohol, and other Drugs: https://nida.nih.gov/bstad/ OR Screening to Brief Intervention (S2BI): https://nida.nih.gov/s2bi/
Brief counselling for marihuana dependence: A manual for treating adults: https://store.samhsa.gov/product/Brie...
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okay welcome everyone and thank you for being here my name is brooks roach i am manager of patient knowledge and
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connection with diabetes canada and i'd like to begin by acknowledging that i am joining this webinar from the
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traditional and unseated territory of migma people and wherever you're joining or watching from today i invite you to
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just take a moment to express some gratitude and recognition for the indigenous lands that we now
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call canada we are here today to talk about a pair of topics that often do not receive
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enough attention in the diabetes community or certainly traditionally haven't so
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lo and behold people living with diabetes do have sex and do use drugs and we wanted to come together to share
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some knowledge and tools to keep in mind when navigating these pieces of our personal lives
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so i'm very very pleased to welcome our two guests today dr alice chang who is an endocrinologist at trillium health
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partners and unity health toronto and an associate professor at the university of toronto welcome dr chang thank you
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thanks for having me it's a great topic it is yeah and uh happy to have a couple experts and our other expert is dr
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celine huo who is a full clinical professor pediatric endocrinologist and head of the endocrinology division at
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chu saint justin in montreal as well as president-elect of the canadian society
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of endocrinology and metabolism full bio and welcome celine happy to have you hello everyone for the purpose
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of our talk i won't be talking about children but adolescents and adults
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okay excellent so again thank you both for being here and i personally as someone who lives
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with type one i'm just really interested to hear about this some of these topics that have been taboo and to dive right
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in so the format today is that our two experts will be answering some key questions that they've heard from
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patients and seen in their work and research i'd also like to take a moment to remind
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viewers that while this session is relevant to people of almost any age the recommendations you'll hear are intended
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for an adult audience so as celine mentioned adolescents or their caregivers are strongly encouraged to
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ask further questions specifically to their diabetes care team we will be taking questions from viewers
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so you can ask your questions by replying in the comments below and if you would prefer to keep your questions anonymous recognizing this may be a
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sensitive topic or one you would rather keep private you can send a direct message to diabetes canada on facebook
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so with that we will dive right into the discussion and i would like to pass it
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to dr chang and ask let's start at the beginning so if someone with living with
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diabetes was considering starting to have sex either for the first time or with a new partner what are some of the
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key considerations they should keep in mind so i i think a very important message to
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take away from today is to remind everyone that someone living with diabetes can absolutely have a
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satisfying and enjoyable sex life just like anyone else who may not live with
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diabetes so i think that's a very important starting point to come from and just like everyone else in order to
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try to achieve that satisfying and enjoyable sex life it is very much about communication it's about strong direct
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communication with your potential partner so that everybody is on the same
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page and specific to diabetes there are some practical considerations that one needs
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to discuss with their potential partner so let's start off with uh how can sex
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impact one's blood sugars or vice versa so remember uh sexual activity is is
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exercise uh so it it is considered physical activity it is considered exercise and therefore the potential for
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a low blood sugar is certainly there uh depending on on how vigorous the sex may be or the
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duration etc but all of that does in fact uh is exercise and therefore could make
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the blood sugars lower so ensure that your partner is aware of that possibility ensure that you have
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candies or dex tabs or juice or somewhere within arm's reach then that of course is important to consider
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the other thing that one needs to think about is uh potential wearable technology that you may be using
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so for some of you who are listening you may be wearing a sensor you may be wearing an insulin pump there may be a
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tubed pump a tubeless pump so there are certain technologies that you may wear may be wearing on your body
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and i think it's important to have a conversation with your partner about that piece
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and this is always one of the fun debates that one could have at a session is are you a pump on or pump off kind of
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person some people choose to leave their pump on when engaging in sexual activity and some people choose to take their
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pump off and i think that's very much a personal decision and it may change from session
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to session but it is important that again you've thought about it and that you've discussed it with your partner
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because it's just sort of you know what happens if my leg gets tangled in the tubing and you know those kind of things
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do need to be uh discussed ahead of time and and sort of go with the flow and so everybody's
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not um anxious or surprised or or unsure about what to do in those situations so
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i think those are kind of important conversations to uh to have uh with a potential partner and those
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are some of the ones that are sort of specific to diabetes and one other thing that i will mention about blood sugar as
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i said how sexual activity can impact the blood sugars but the blood sugars can impact sexual activity
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so if someone is in fact experiencing hypoglycemia um during sex then that is going to
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impact uh performance so i think that is also relevant to be aware of is how
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blood sugars can also impact sexual activity
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thank you dr chang all very useful things to think about and it's the the debate of pump on pump off does
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rage on um wondering if you could speak a little bit about sexual function and diabetes
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sure excellent excellent question so those living with diabetes particularly
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of longer duration may in fact experience sexual dysfunction or abnormal function from a sexual
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perspective now let's start with in men so in men i think we've all seen the commercials
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it's no longer a taboo topic which is great men may experience erectile dysfunction
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now as we know from the tv commercials etc it's not just men living with diabetes who can experience erectile
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dysfunction but in fact any man can experience erectile dysfunction
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and particularly those with diabetes though they may have some more risk factors for it
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such as some circulation issues or neuropathy nerve related issues from
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long-standing diabetes that may impact erectile function so i i think the key there is again to
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communicate but to communicate with your health care team because if you are experiencing any
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erectile dysfunction uh please mention it and what your team will do is uh perhaps
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do some blood work to check for things like low testosterone which again any man may experience but those living with
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diabetes may experience it a little more often and then that can be treated and as well of course we've got excellent
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medications to address the erectile dysfunction which can be very effective
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but if it's not discussed then of course your healthcare team is not able to help
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you now it is our role to ask the question but sometimes the question does not come
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up in which case we would very much hope that our patients would be able to share the information
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with us and then being able to maintain glucose levels close to target is ultimately going to
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help with that situation and sometimes can be an additional motivating factor for people uh to work on their on their
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blood sugars so that's on the the male side of things now let's talk about female
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now female sexual dysfunction is definitely not discussed publicly you don't see tv ads about it it's not
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discussed uh in movies and and tv shows etc and it's also not something that we're very good about asking
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however we we should be and we do realize that female sexual dysfunction is
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common in general uh but also in those living with diabetes and it may come in
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the form of impacting either desire or impacting arousal or impacting orgasm
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which are sort of phases of the sexual response and depending on where the issue is there may be different treatments that
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could be offered so again number one is to mention it is to mention it is to discuss it with your
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health care team and then based on what the situation is there may be blood tests that need to be
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done to rule out other contributing causes there may be simple therapies like vaginal creams that could deal with
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vaginal dryness or it may involve a referral to a sex therapist who could help with some of
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the sexual desire pieces but it it can happen and it's not something to sort of just brush
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under the rug it is something to discuss with your team because there may very well be things that could be done to to
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help you yeah thank you thank you also i think
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that point of communication is really resounding like across all of what you shared and i'm wondering
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just thinking about if someone as you say you know it's it's great if they do get this targeted question from a healthcare provider you
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know specifically asking about this and i was just thinking i wonder if you have any advice from folks who may not have
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that question coming in from a healthcare provider how could they feel comfortable about
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reaching this topic well one thing that i think all of us do uh even if we forget to ask the pointed
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question all of us will do it towards the end of the visit would say do you have any other questions right i would hope that all of us tend to end our
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appointments with that and then that is a great opportunity to actually say
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uh this is what i have experienced over the last you know whatever period of time
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one thing i would say is that all of us as healthcare providers want to know if you're having an issue
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we may forget to ask but we appreciate when you share that
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information is everyone going to know how to help you maybe not but is everyone going to want to know and then
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direct you to someone who may be able to help you the answer is yes so
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people are going to be open to it people are going to appreciate the fact that you've shared it
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however um we sometimes forget to ask and and that is very much our issue i think in men we tend to remember but i
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got to say when i went through medical school and residency asking women about sexual function just was not
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we weren't taught to do it so therefore we don't ask um but but please bring it up because we we want to help and like i
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said even if the person you're mentioning it to doesn't know what to do they can send you to someone who
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who uh who can help i think that's really helpful keeping in mind that it's not a deliberate um
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blocking out of the the topic it's just people are busy people are healthcare providers may just have a lot on their
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plate and not explicitly ask but that they want to help is a really important lens to keep in mind um
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okay we're going to press pause on topic one uh of sex and move on to drugs so
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with that uh abrupt shift i'm gonna ask you dr huo
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if i am an individual who lives with diabetes and uses drugs which is many of us
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whether that's alcohol cannabis or illicit substances what do i need to know
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that's a great question as well um if we uh take the different substances
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differently alcohol and cannabis are now legal in canada cannabis has been now
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legalized in canada since uh 2018 so people are
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more willing to give information legally and report their use of cannabis so what
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we've known since it's been legalized it's um that for instance if in most of the
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provinces reported use is between 15 to 25
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according to the different provinces uh people living with diabetes will report officially less use and what's uh
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commonly reported for other people not living with diabetes and the people
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living with type 1 diabetes report it more often of course the type of use the type of
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product the mode of administration differs so that's not necessarily asked
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once people contribute the information what has stemmed out uh our potential
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risks though so the risks that people should be aware of
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and then again we don't know what the chicken and the egg is is it just an association is it really related to
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diabetes is it related to other factors we have to keep that in mind but for type 1 diabetes the use of cannabis has
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been related to a slight deterioration in uh the uh glucose control
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namely the hba1c uh the famous blood test that everybody gets once they see their physician and
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but that again when you analyze more according to a level of education
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socioeconomic level this may not be as much of an impact and a risk what has been mostly
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reported in people living with type 1 diabetes is an increased risk
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let's say two to three times of having diabetic ketoacidosis and that's a
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severe complication of type 1 diabetes so what is
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more um more so what's also reported is the fact that if you have a tendency to have a
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diabetic ketoacidosis which will bring you to the hospital you have more of a
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risk of being readmitted within the next year if you have um use
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of cannabis and more so if you use cannabis and other substances so these
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are risks that people living with type 1 should be aware of as for type 2 the use is less reported
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but numbers seem to indicate that there is an increased risk of having vascular
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problems of having cardiovascular problems as well and um these things have to be taken
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into account there are also um there's also information coming in that
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maybe the function of the kidneys may be compromised at some point
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so these are potential risks um then again there's
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up till now we don't know is it a matter of long-term use is it a matter of
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amounts that are being used is it a a matter of the mode of administration of the cannabis is it the type of cannabis
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we don't know so this at least for cannabis is known and the use of cannabis not only may
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impact on glycemic control and also on potential complications of diabetes but
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it's also uh being written also that it may impact on the way we self-care for
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our diabetes so for instance um the way we eat can be perturbed uh while using
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cannabis the way we check our blood glucose and the level of vigilance may
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be um perturbed as well so for those reasons there may be
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risks associated with the glycemic control and also are the way we
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self-care for ourselves if we live with diabetes so that's for cannabis
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um i will go along what what dr chang has said
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before if you don't engage in the discussion with your patients i deal with adolescents as well and young
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adults as nora roberts the famous novelist said
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if you don't ask a question the answer will always be no so ask the question
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engage in it if you don't feel comfortable well at least you'll know the information and as dr chang said
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please bring it to the people who would at least give some advice but officially the recommendations
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overall from physicians would be to uh try to minimally uh use cannabis
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recreationally i'm not talking here about medicinal use of cannabis this is a different topic completely
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but if it is going um to be a part of
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your i would say extracurricular activities uh then the best thing to uh do is to
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make sure that somebody will help you to ensure that at least your self-care is
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not perturbed because of your recreational use of cannabis these are
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the main lines um for other substances there isn't much
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uh published both for type 1 and type 2 diabetes more so in canada because it's illegal so if you report it
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you're not supposed to use it so we doubt very much that the numbers are
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reliable there as for alcohol alcohol
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for anybody should be a topic of discussion in any
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follow-up in healthcare situation that's for sure and alcohol more so when its
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use is not considered moderate can have impact on health there are additional
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risks for people living with diabetes and
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then again it's hard to generalize the information because yes there's the type
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of diabetes that can influence your reaction to the alcohol intake more so if it's more
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than moderate or just socially once in a while but there's individual predispositions
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as to how you metabolize the alcohol and whatever so the recommendations are
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general there are for safety but it's it's a matter of controlling the risks
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risks and can also with the use of alcohol include um worsening of other health
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problems uh more so if you have them to start with so for instance high blood pressure
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very common people living with type 2 diabetes an increase in some of the fats in the
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blood which are called triglycerides so more so if you have them those people who already have inflammation to their
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pancreas can have uh serious bouts of inflammation which are very painful and
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can lead to very serious medical um imbalances as well um and also it's it's
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it's known that alcohol use can impact on the function of the liver and as we
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know the liver is very important not only in releasing the sugar we need in
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between meals and when we sleep but it's also very important to metabolize or to help the way some of
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our medications work when we treat diabetes so for those
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reasons there are moderate
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i would say uh risks in the in the moderate long term but in the short term
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the use of uh using alcohol i would say within um
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[Music] more than uh less than less than minimal amounts uh can impact in some
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individuals um in the short term and uh there are potential two risks if
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your blood sugar is already very very high more so if you have type 2 diabetes and
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you take certain medications your blood sugar is very high and you take alcohol this can lead to dehydration alcohol
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makes you go pee and then again your blood sugar may spike right up and you
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may feel very dehydrated and end up very very sick
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while most people will agree that many types of
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drinks include carbohydrates uh sugars
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the initial thought would be oh yeah the alcohol would lead to an increase in
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blood sugar not necessarily wrong but don't forget not all alcohol types uh include a lot
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of carbohydrates sugars but uh what actually happens is once
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your body starts getting rid of the alcohol then it's so busy that
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the liver can't provide sufficient sugar uh in between meals or more so if
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you've drunk um alcohol without having uh a meal or food
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in the meantime so the risk of having uh
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alcohol of taking alcohol is actually to having a low blood sugar
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low blood sugar can also more so in time people with type 1 diabetes but in type 2 diabetes if you
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take even something with a lot of sugar in the drink your pancreas is still secreting insulin
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it can go really high up in terms of secreting insulin and then you will end up having hypoglycemia anyway
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so let's not forget there is sugar in alcohol but the immediate
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danger is more the low blood sugars and this can be a problem until you wake
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up the next morning whether you have a headache for having drunk too much or not but you can also have a very severe
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headache if you're in a hypoglycemia or have treated hypoglycemia during the the night
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so there are some measures that we recommend we discuss this uh openly with
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all our patients pretending that people will never drink alcohol for many will prove to be difficult and so there are
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many ways in which you can prevent for sure there's the types of alcohol
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i.e concentration here what is included in terms of sugars
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in the alcohol that you drink monitoring
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checking for your blood sugar having a partner somebody who helps you uh to actually make sure that
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the blood sugar is still normal and these are additional
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uh this is an additional help that you may need simply because alcohol may perturb your cell your sense of
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feeling well or unwell and let's not forget also that alcohol may lead to symptoms which may be
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difficult to distinguish from hypoglycemia or oh i'm just i'm
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just having a little bit of a headache because i've done too much there
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so overall these are the messages for substance and alcohol use
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uh yes engage with patients but i would say also
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um let's discuss it openly prevention here is much better than having to deal i
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speak for myself speaking um uh dealing with adolescents uh you have this 17 year old in the
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emergency who doesn't feel well and then they have to explain to their parents
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what actually happened whereas you know if they just they they discuss it before beforehand this would never have shown
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up on the radar okay thanks very much that's a very
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in-depth rundown like i feel like that's a great uh sort of starting kit if someone's
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looking into whether it's beginning to use alcohol or cannabis or looking to
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revisit the way that they engage with those substances that's really helpful
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lay of the land so thank you um on the note of opening that dialogue and
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similar kind of point around the importance of just communication and you know you can you know i love that that
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quote about the only way to get a definite no is not to ask so just go first um
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on the note of an open dialogue i would now like to open the floor questions so we have a couple that have already come
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in and i would just encourage folks to engage you know as mentioned in the
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comments section or via direct message and you know potentially treat this as a
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chance to test out the way that you might ask about your own health situation um because we want this to be
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you know this is a very uh open and understanding setting so i want to welcome any type of question so a couple
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that have come in already which i'll share with you folks and the first is probably the most direct uh and easy to
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answer is um franklin asks is there a link to studies on cannabis and diabetes so what
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i'll say is certainly and i can connect with you dr huo and we can share those
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uh in the comments section on this video after the fact um so just stay tuned and we'll follow up but great question and
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happy to help you explore a bit further the next question is regarding um the
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use of cbd to help sleep issues so wondering perhaps um celine if you could touch on
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the distinction between perhaps thc and cbd if relevant and then as you
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mentioned these sort of medicinal uses if it's been prescribed
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um the literature
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on thc which is known to have effects on quotes unquote's well-being
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either stimulating or relaxing properties are i would say
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more preponderant in the literature the information is more preponderant than it is for a cbd
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the quality of the literature for cbd because it has various uses
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is is is is more difficult to um to get
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thc doesn't act on the body on the same
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receptors as cbd thc acts throughout the body and there
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are um this is why we can explain this is how we explain actually why it has some
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central nervous system positive and sometimes not so positive effects
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whereas cbd acts elsewhere in the body and it acts on
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let's translate it this way pain receptors so um
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those pain receptors have not been as well characterized as the receptors for
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thc so the effect of cbd on sleep
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more so in people with diabetes where whether it would have a positive impact
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i'm not in a position to tell you how necessarily it would
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work whether it would enhance or improve the situation
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don't take from this message that i don't believe in the medicinal
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use of cbd all i'm saying is that we don't know as much yet
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and we can't focus and target those specific people who could potentially benefit from it as
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of today okay very helpful thank you
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the next comment we've received is in and around menopause so i'll field this one to alice and it's
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this individual has lived with type 1 diabetes for 46 years and is having trouble with blood glucose
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levels since starting menopause they say they've gone to the gym and sugar is going up and since menopause
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it's quote unquote never normal so menopause is a
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pain in the butt for everyone when diabetes or not because it is a change in your
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hormonal profile and and what's happening is that your ovaries have
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packed up they're quit the eggs are done and you no longer get the cycling of uh
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of hormones which in some ways is good but then you're now missing estrogen
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which can then wreak havoc on things like sleep mood energy levels for some people
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memory and and then when you're not sleeping that then worsens the memory and it can also wreak havoc on um blood
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sugars but in a different way when you were having your periods it the the havoc that the hormone was causing
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was the fluctuation but if your periods were predictable you could somewhat predict what was going to happen and
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adjust your insulin accordingly with menopause you you lose that um fluctuation which is great but then your
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your body needs to readjust itself and that perimenopausal period is uh very
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difficult because sometimes your hormones go up and then sometimes they go down and then it's
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it's unpredictable so then it makes it very hard to be able to adjust your insulin accordingly
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for some women their insulin requirements go down in menopause but then for others it goes up because there
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may be an associated weight gain that may occur in menopause and then with increased weight in increased
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insulin resistance and then therefore um higher insulin requirements so it's very hard to say
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you know there's a rule of thumb that it's definitely going to go up or definitely going to go down all that i can say is that it is all
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about frequent monitoring and then tweaking of your therapy accordingly
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your body's response to exercise should be no different really in menopause versus not in
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menopause however because your body has changed and likely body weight has changed
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then it is different from before and and the perimenopause like i said is just it's just a big old roller coaster
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so i wish i had a simple answer for you i wish i had a magic bullet for you but it really is about frequent monitoring
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and then frequent adjustments if you're not sleeping if you're having terrible hot flashes then please speak to your
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healthcare team because there are things that can be done to help hot flashes are very difficult because
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they feel like hypoglycemia and sometimes it feels like hyperglycemia and then you don't know what's going on
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so again it's about frequent monitoring so i i wish i had a magic bullet for you
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uh if it is terrible certainly hormone replacement therapy is something that can be offered can be offered safely in
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people living with diabetes as well so if you're miserable please go see your team because there are ways to
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uh to try to lessen the symptoms of perimenopause and and menopause
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thank you and and i hope this is uh helpful to our audience and thank you for for asking and uh hope that that can
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steer you in in the right direction recognizing it sometimes as you say tough to have the magic bullet but sometimes just
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heading you know heading down the right street at least can be a good first step um
32:56
another question and it's it's somewhat related although at a very different uh potentially life stage and it's about
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uh planning for pregnancy so alice i'll feel that back back your way
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so first message just like i had with sex i think the first message is to say that uh women living with diabetes can
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absolutely have a healthy pregnancy healthy successful pregnancy and and that is the expectation in 2022 that
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that would be the case it does require some extra thinking and that extra thinking is planning
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which technically other pregnancies should have as well right so it is just about planning ahead
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and avoiding surprises so specific to diabetes there actually is a checklist that you can find on the
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diabetes canada website which sort of like a preconception checklist so we want to make sure that certain things
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have been achieved prior to conception so these include things like having the the blood sugars at target so an a1c
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less than seven percent preferably even less than 6.5 making sure if they're on any other
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medications that can impact a pregnancy that we stop those things like statins
34:04
ace inhibitors just getting rid of those medications ensuring that you've screened for complications so having had your eyes
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checked within the past year making sure your kidneys have been checked the urine has been checked um
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and then folic acid ensuring you've been taking folic acid at least one milligram per day for a
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good three months prior to conception so that your body's chopped full of folic acid and then that way the um the
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developing embryo will have the nutrients that it in fact requires
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and those would be the components of the of the preconception checklist so blood
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sugars other medications folic acid eyes checked screening for complications
34:46
so always plan your pregnancy obviously with your partner but plan it with your with your doctor and your diabetes team
34:53
and i often joke with my patients that as soon as you discover you're pregnant the first phone call you make should
34:58
probably be to me and then to your partner in that order because it's critical that
35:04
the team be aware and that once you are pregnant that we put you in the right kind of clinics where you're going to
35:10
get um very specialized care and we're going to stay on top of things because in pregnancy
35:16
it's critical to then maintain the glucose control to ensure successful pregnancy and as well maintaining
35:22
vitamins through the first um part of the pregnancy aspirin may be needed in in the
35:28
beginning part as well so there are great things that we can do and it's all about preparation
35:35
planning ahead communication and then once you are pregnant let us know asap and we put you in with the team and the
35:42
expectation is for a successful pregnancy
35:49
thank you and also very uh helpful and prescriptive you know get your tests get your folic acid so and call alice first
35:56
call your your team first um okay um another question and this is in
36:02
recognition um silly and you had mentioned you know that it's it's much easier to
36:08
report on and have a bit more of a direct answer on substances that are legal and
36:13
this person's wondering if you have any specific guidance or you know just how to how to approach something if they
36:20
are interested in trying or have been a user of uh illicit substances
36:27
one very very easy uh way of getting the information is i'll take the example for adolescents i
36:34
don't ask an adolescent do you have you used cannabis
36:40
or pot or whatever their terminology uh in the past year i
36:45
usually ask them how many times have you actually used pot in the last year i usually get frank answers when i ask it
36:53
that way rather than do you use it generally um
36:58
so this is one way um and if somebody even if somebody answers oh
37:05
just once or whatever i'll i'll probably take this opportunity as well when i ask about cannabis to ask about
37:12
alcohol at the same time and other substance use as well during those things and
37:19
i must say that um the ease with which you bring up the the
37:26
question will probably help in the answer so if you don't feel very comfortable with it you may even
37:33
rehearse if you have adolescents at home or with your your partner or even rehearse at home so that at least
37:40
when you ask the question you don't feel it at ease yourself so that's one thing and um usually when
37:48
we address substance use whether it be alcohol cannabis or something else
37:55
i usually try to approach it by substance if it's a real problem in terms of use
38:02
then i would ask the help of my colleagues in adolescent
38:08
medicine because usually there are other issues at stakes than just the diabetes
38:14
then but when i deal with a particular use of a
38:20
substance first goal is to try to cut down if it's at all possible and there
38:25
are many ways and we can also send you the link as to how you can stream screen for that and
38:31
also how you can help people to at least start cutting on the use recreational use or
38:37
non-recreational use or abuse let's call things the way they should be called for some people we would be pleased to
38:44
send you those uh links okay great well um we'll share those as
38:50
well in the comments uh so we'll have a little bundle of resources for viewers after the fact
38:56
um and and thanks for the question because again can be difficult to ask when something is taboo or in this case
39:01
you know even illegal uh it can be hard to to own up to something and try to get help so
39:07
um i i if i may add also one of my personal fears is that somebody will come up with
39:13
a name i don't know and i have no idea what the substance is about well then i just ask okay tell me about it and i'll
39:20
you know i'll read about sometimes it's just a different name for something that already exists or a mixture of things
39:26
that already exist but i'm very humble uh when it comes to that
39:31
i all you know i would say every two weeks i hear a new name i haven't heard and well that's part of education i guess
39:42
we have uh we have a question that's not doesn't cleanly necessarily fit into
39:47
the two categories we've discussed but i think it may be relevant just to ask you folks given your your expertise and it's
39:53
a question can you help me with pain sciatica and arthritis for diabetes as i am taking
39:59
too many meds and nothing is helping do you have any guidance for this person so i i constantly know i'll jump in here
40:06
um pain pain management is is uh difficult obviously as this person who's asking is
40:13
already alluded to and and in in the diabetes space we often think about diabetic neuropathy or nerve damage uh
40:20
that can manifest as painful diabetic neuropathy and in the case of painful diabetic neuropathy we sort of go
40:26
through a cocktail of medications that we may choose to try right so we may choose to
40:31
try things like tricyclic medications we could then try things like uh pregabalin
40:37
we might try things like gabapentin duloxetine uh sort of in that antidepressant group that may help
40:44
um and sometimes things like non-steroidal anti-inflammatories um nsaids can can be helpful and then
40:52
i personally do not tend to prescribe the narcotics or the opioids simply because i don't
40:58
know enough about them nor do i follow people closely enough to be able to
41:03
prescribe that safely but in those individuals where we sort of try those basic things and it's not cutting it
41:09
i always will involve a neurologist because the neurologist can then do the proper test to see is this actually
41:16
painful diabetic neuropathy or is this some other form of neuropathy and then if necessary they will also
41:22
involve the pain clinic so for the person who's asking the question who clearly sounds frustrated which is completely understandable um if
41:30
you're not already engaged with the pain clinic i would ask for that referral to a pain clinic because at the pain clinic
41:37
they see all types of pain not just diabetic neuropathy pain but all types of pain and will have access to
41:42
different modalities and treatments and blocks and things that that certainly your endocrinologist would not have
41:49
access to uh and even most neurologists would not uh or your primary care physician so i i would strongly
41:55
recommend that you visit or ask for a referral to a pain clinic to have assessment there and and
42:02
cannabis may very well be part of the armamentarium for treatment of the pain but not something for you to experiment
42:08
with on your own because it is about the dosing and the type and then the cbd versus the thc and
42:15
and it gets uh fancy but in a good way and not something that you would just
42:20
sort of buy at the store and then try out right so i i would encourage again a referral to a pain clinic uh who often
42:27
will have expertise in in cannabis as well as a potential pain treatment
42:36
thank you and um just to add noting that um been tested to see if it's if it is in
42:42
fact neuropathy it's a disc herniation um so again maybe uh
42:48
an added layer of complexity um we we also have a question and i'll just
42:53
direct this person that sonia is asking a question about the odsp specifically
42:58
if fiasco will be covered in insulin pumps for those who are on odsp um and i would just advise i think we
43:05
have some print resources but i would i would advise reaching out to uh via email info
43:11
dot ca or 1 800 banting as they have all the the most updated resources and can
43:17
dive in a bit more in a bit more depth with your specific situation to help you so i just hear you that way and thanks
43:23
for asking um so i want to
43:28
just say a big thank you to those who who ask questions and and uh you know
43:33
express their curiosity and and thanks for some really thoughtful answers as well to our our panelists
43:39
um and before we wrap up i want to also give another chance for uh for the two of you doctors chang huo to
43:46
to touch on anything else that you might want to share or anything that you feel is important to highlight from this session
43:53
um so celine maybe i'll i'll go first i i think a big theme out of everything that i talked about is uh is
43:59
communication it's uh communicating between you and your potential partner or partners um communicating between you
44:06
and your health care team and talking about
44:11
talking about whatever is bothering you planning ahead and even if we as healthcare providers
44:18
are not asking the right questions and and that will happen and i apologize on behalf of all of my colleagues including
44:24
myself ahead of time because that for sure that will happen we we do want to know
44:29
uh so share it with us and if we don't know how to help you then
44:34
we'll find you somebody who can't or we will try to direct you to the right resources so it is all about
44:39
communication but you absolutely living with diabetes should and can uh have a satisfying enjoyable sex life
44:47
a successful pregnancy uh and navigates through stages like menopause with as
44:53
much difficulty as everyone else so so the the expectation is that you should
44:58
be able to experience all of those phases in the same way as everyone else with just a few extra details that we
45:04
need to think about but that's what the team is there for is to help you with that
45:11
well said now i will quote gandhi now andy said
45:17
if you don't ask you won't know so if you don't ask you won't know it's pretty much the same
45:23
if you don't engage in the conversation with your health care provider then nobody will know about the information
45:30
there's no there's no problem in admitting that there is recreation or even abuse of the
45:37
substances it's it's part of you know health discussions um and um
45:43
okay if the health care professional is not comfortable at least a it will be
45:49
on the map and needs to be discussed further if the person you've just confided in is not the person who
45:56
actually should be taking over this situation hopefully that will guide you to the proper
46:01
person and uh let's not pretend that people don't drink let's not
46:08
pretend that people never use uh recreational cannabis or other
46:14
substances and if we start from there i think it's a very good start
46:20
well said indeed to both of you and i think that theme of communicating openly and
46:26
you know recognizing it it can be really tough to share but it can can also open up a lot of doors to better understand
46:32
yourself and to you know i think alice what you've described is to have it be just as
46:37
difficult as for someone without diabetes is a really really interesting way to think about it because a lot of the time yeah this is
46:44
these are challenging spaces to navigate but um to be able to handle the hurdles of
46:50
diabetes well they can feel the right amount of challenging um
46:56
i want to say thanks again to you both um again to those who have asked comments
47:01
that we weren't necessarily able to resolve or may take a bit more time again feel free to follow along at
47:07
diabetes.ca or at diabetes canada on social media and if you want specific
47:13
information or direction to your situation call 1-800 banting or email info
47:18
diabetes.ca i really hope this webinar has been helpful for anyone who was curious about
47:26
sex drugs and life with diabetes uh our next conversation will be in november uh
47:32
on november 3rd for a conversation about destigmatizing diabetes so it's a very similar notion of what the the power of
47:39
having an open conversation can can do so keep an eye out and tune in if you're interested and you're also encouraged to
47:46
attend our conferences if you want to take our uh take your education a step further so we have no limits with type 1
47:53
diabetes on october 15 and let's end diabetes type 2 diabetes on the 22nd
47:59
both are free events and take place virtually so we would love to see folks there to come learn from
48:06
experts hear from diabetes champions and uh gain steps from their experiences and to connect
48:11
with each other so hope to see you there and hope to uh again hope that this was helpful for you i know it was helpful
48:17
for me and i really appreciate your time to our guests so so thanks again and be well
48:23
thank you thank you brooks great job thank you yes goodbye everyone have a great day
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Category Tags: General Tips, Just the Basics, Management, Healthy Living;