In this special webinar presentation, Drs. Alice Cheng and Celine Huot discuss sexual health, tips, and considerations for people living with diabetes, along with the risks and realities of using drugs like alcohol and cannabis.
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
30:54
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
31:06
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
31:51
and then frequent adjustments if you're not sleeping if you're having terrible hot flashes then please speak to your
31:58
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
32:44
steer you in in the right direction recognizing it sometimes as you say tough to have the magic bullet but sometimes just
32:51
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
33:03
uh planning for pregnancy so alice i'll feel that back back your way
33:09
so first message just like i had with sex i think the first message is to say that uh women living with diabetes can
33:15
absolutely have a healthy pregnancy healthy successful pregnancy and and that is the expectation in 2022 that
33:23
that would be the case it does require some extra thinking and that extra thinking is planning
33:29
which technically other pregnancies should have as well right so it is just about planning ahead
33:35
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
33:54
less than seven percent preferably even less than 6.5 making sure if they're on any other
33:59
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
34:11
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
34:23
good three months prior to conception so that your body's chopped full of folic acid and then that way the um the
34:30
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;