This Is Your Brain on Diabetes (ADA 2021)

The brain affects diabetes, and diabetes affects the brain, a complex relationship that goes in both directions.

For many patients, the brain-metabolism connection means challenges and health declines. Most people that have experienced hypo- and hyperglycemia are well aware of the way that blood sugar troubles can inflict brain fog and other minor short-term malfunctions. Unfortunately, that’s just the start of it. The cognitive dysfunctions associated with diabetes can become permanent.

The first days of the recent American Diabetes Association Scientific Sessions featured several sessions on the intersections between brain health and diabetes. Some presenters sketched out the scope of the problem; others suggested potential solutions. Patients with both type 1 and type 2 have a lot to think about.

The Vicious Cycle

At the heart of the brain-diabetes relationship is a negative feedback loop that pushes people towards bad decision-making and bad health outcomes. Hyperglycemia leads to both short- and long-term cognitive impairment, which leads to increasingly poor glucose management decisions, which leads to more cognitive impairment, a vicious cycle if there ever was one.

Australia’s Dr. Fergus Cameron sketched out this dynamic:

Source: ADA 2021 Presentation

This feedback loop helps define how and why brain issues tend to snowball as the years go by.

The Developing Brain

Diabetes can impact brain function at every age, but perhaps most important is its immense effect on the developing brain. Acute and chronic hyperglycemia during those early, critical years of development can easily cause lasting damage.

Many of the most important negative cognitive effects of type 1 diabetes seem to occur in the first days and weeks leading up to diagnosis. Just days after diagnosis, children already perform more poorly than expected on intelligence tests. “We’re seeing impacts right from the get-go,” said Dr. Ferguson.

The severity of hyperglycemia at diagnosis is also significant: children that are diagnosed during diabetic ketoacidosis (DKA) see much more cognitive impairment than children that never experience that critical state. That difference alone might mean as much as 6 points of IQ, on average.

We don’t like to dwell on immutable factors—today, you cannot change the circumstances around your diagnosis or that of a loved one. It is more important to people with diabetes to learn what they can do now to help improve their health and quality of life. The answer to that is clear: avoid chronic hyperglycemia.

Mental Issues Accumulate

The effect of chronic hyperglycemia is cumulative and comprehensive. As people with type 1 diabetes age, they perform worse on tests of executive functioning, IQ, information processing speed, and memory. The differences are bigger in high school than in elementary school, and the gap just continues to widen throughout adulthood. A 2019 study found that an incredible (and terrifying) 48% of older adults with longstanding diabetes displayed “clinically significant cognitive impairment.”

Dementia and Diabetes

Dr. Anna Marseglia, a neuropsychologist with Sweden’s Karolinska Institutet, took the baton to discuss cognitive impairment and dementia in old age. Most of her talk referred to patients with type 2 diabetes, although it’s possible that patients with other forms of diabetes could still benefit from her conclusions.

Diabetes is a major risk factor for dementia—in fact, the link between metabolic dysfunction and late age mental decline is so clear that Alzheimer’s disease has sometimes been called type 3 diabetes.

But diabetes is not destiny—the risk of dementia is significantly amplified by lifestyle.

The Power of Activity

Dr. Marseglia presented the results from her own study, a look at thousands of older Swedish adults with diabetes, to see if an active lifestyle might prevent progression to dementia. Researchers tried to track both the number of leisure activities that participants enjoyed and the strength and extent of their social connections. Would an active social life reduce the risk of dementia?

The answer was yes, and the correlation was enormous, as you can see in the graph below. “Inactive” adults with diabetes were vastly more likely to develop dementia than “active” adults, whose risk was barely higher than that of people without diabetes. Dr. Marseglia suggested that if all of the adults in the study had led “active” lives, as many as 48% of dementia cases could have been avoided.

Source: ADA 2021 Presentation

The study suggests that while both diabetes and social inactivity are hazards in and of themselves, the real danger is when those two conditions coexist.

Accordingly, Dr. Marseglia highlighted two broad strategies to improve one’s risk of late age cognitive decline. The first is to employ strategies that reduce physical cardio-metabolic burden: improved glucose control, healthier diet, exercise, weight loss, quitting smoking, and so on. The second is to create a kind of resilience within the brain through education, challenging work, and vibrant social activities.

The protective effect of an active life is physically verifiable. Adults labeled “inactive” actually have significantly smaller brains than active adults. Activity, by preserving brain volume, somehow overrides the vascular damage associated with diabetes.

An active life to fight dementia doesn’t just start in old age—good health, mental stimulation, and social activity early in life will also protect the brain from decline decades later.

Executive Functioning in Teens

Teens have a particularly tough go of it; typically, they are the age bracket with the highest A1c.

Anxiety, depression, and diabetes burnout are distressingly common in the teenage years. Such mental health issues can easily throw diabetes decision-making out of whack. As Oregon’s Dr. Danny Duke stated, “When we’re emotionally dysregulated, it affects all of our other executive functions.”

Executive functioning, explained Oregon’s Dr. Danny Duke, is the part of the brain that’s “in charge of making sure things happen when and how they’re supposed to happen.” It’s like “the conductor of the orchestra of our thinking.”

Good executive functioning is of paramount importance to all humans, but especially to those with diabetes, who must almost continually balance short- and long-term costs and benefits. And because executive functioning usually does not fully mature until age 25, it’s no surprise that teens can have so much difficulty managing their conditions.

Some teens have better executive functioning than others, and those that struggle to make good diabetes management decisions need as much help as they can get. Otherwise, the vicious cycle will rear its ugly head once again: poor executive functioning leads to reduced glycemic control, and reduced glycemic control leads to poor executive functioning.

While Dr. Duke focused mostly on the ways that executive functioning failures could lead to dangerous blood sugar swings, he had little doubt that the converse was equally true:

I’ve worked with a lot of these kids that are hanging up there in the mid-300s [mg/dL], doing the bare minimum necessary to stay out of DKA. When we get them back down into range, they’ll often say ‘Wow, I had no idea how bad I felt and how foggy I was thinking.’

A Family Affair

For kids and teens, good diabetes decision-making is a family affair. Dr. Maartje de Wit, of Amsterdam University Medical Center, pointed to several studies assessing the role that parental executive functioning plays in diabetes management success.

Naturally, in younger children, parents will make all significant treatment decisions, but even as children age, parents continue to play a surprisingly big role in treatment success (or lack thereof). Studies show that, for example, maternal executive functioning skills have a significant influence on a child’s A1c levels, and that both the father’s and mother’s involvement played a big role in delivering better glucose control, especially when the children had executive functioning issues themselves. This did not change as children aged, even as they presumably took on more of their own management decisions.

This sounds obvious—less disciplined kids need more help—but it’s not necessarily so easy to determine who needs help, and how to help them.

Identifying and Improving Executive Function Issues

Children and teens with subpar executive function, when asked why they can’t adhere to their diabetes treatment regimen, may say things like “I forget” or “I’m lazy,” or “I don’t know why.”

Whether by nature or nurture, executive function problems are often shared between parents and children. In a presentation aimed at medical professionals, Dr. Rachel Wasserman encouraged practitioners to consider disorganized or scatterbrained parents a real warning sign of potential executive function issues in children.

If you recognize these sorts of behaviors in your child (or in yourself!), it might be worth trying to work with your child to improve his or her executive functioning skills.

Dr. Wasserman recommended activities that require repeated practice and offer progressive challenges. That could describe schoolwork and related academic pursuits; it could also describe athletics like martial arts and yoga.

Today there are also a dizzying number of scheduling apps that people with diabetes can use to help enforce good habits. More old-fashioned techniques, like alarm clocks and post-it notes, can be equally effective. Dr. Wasserman cautioned that advanced diabetes technology, such as insulin pumps and continuous glucose monitors, as helpful as they can otherwise be, do not necessarily lessen the cognitive load on the executive functioning system.


Diabetes has a significant negative effect on cognitive abilities. In type 1 diabetes, this effect can begin very early in life, with the first bouts of acute hyperglycemia leading up to diagnosis. In both type 1 and type 2 diabetes, the damage wrought by high blood sugars is cumulative, and symptoms are likely to get worse over the years.

Hyperglycemia can also set a vicious cycle in motion, whereby high blood sugars cause bad decisions, which just cause more high blood sugars.

The best way for a person with diabetes to avoid cognitive decline, probably, is to avoid chronic and acute hyperglycemia—the more time you spend with your blood sugar in a healthy range, the more likely that you will avoid accumulated damage to your brain.

It also may be possible to strengthen executive functioning skills and make the brain more resilient to age-related decline by enjoying a robust social and intellectual life. Hobbies, education, challenging work, and community involvement—in short, an active and stimulating mental life, at every age—may protect against eventual decline.


Remember, Your Time in Range Isn’t a Grade Either

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

Time in Range (TIR) is another number for people with diabetes to pay attention to and use to improve their daily diabetes management. We talked with three women in the diabetes community about how they use TIR as a helpful number to keep them on track and inform their care.

Time in Range (TIR) is a helpful tool that captures the highs, lows, and in-range glucose values that characterize life with diabetes. TIR can help people understand how their daily habits and behaviors affect glucose levels, so they can use this information to feel better and reduce glucose swings. But it’s also another measurement to keep track of – and the goal is to look at it as a number and not have it loaded with emotion or negativity if it falls short of your goal.

For many people, it can be challenging to get past seeing glucose levels as “tests” and A1C checks as “grades.” But as Adam Brown explains, blood sugars are just numbers – they are neither good nor bad, but rather they are information that will help you make a decision about your diabetes. Click here to read about how Adam transformed how he views diabetes data. Seeing your A1C level as a grade can actually cause harm – some people are demotivated to take care of their diabetes when they feel they are frequently failing. Renza Scibilia and Chris Aldred write more about this in “What’s Your Grade?

Enter Time in Range (TIR), the percentage of time that a person spends with their glucose levels in their target range. TIR is a powerful tool to assess patterns in glucose levels throughout the day and over time, and this can help inform lifestyle changes and treatment decisions in a way that A1C cannot. People with diabetes should aim to spend as much time in their target range as possible.

With the TIR number comes the risk that people may see it as yet another test of their diabetes management. It might be another mark that tells them they are not measuring up.

“When I read about Time in Range, it was a bit scary at first, simply because it seemed like it was a ‘grade,’ like you would get in school, so I didn’t want to think of it too much because my own fear of failure is high,” said Sarah Knotts who has lived with type 1 diabetes for 32 years. She has two young children and works with mySugr as the US Head of Customer Support.


Image source: diaTribe

Stacey Simms agreed. Simms is the host of Diabetes Connections and author of The World’s Worst Diabetes Mom: Real Life Stories of Parenting a Child with Type 1 Diabetes. Her son Benny was diagnosed with type 1 diabetes in 2006, right before he turned two.

“It’s easy to look at TIR and other diabetes markers as a judgment on your value as a person. I think there’s a bit of a danger in looking at these markers as anything but math and management tools” she told us. “Less TIR doesn’t mean you’re a bad person or worth less than a person with more TIR. I don’t know how we can keep these tools from weighing on the mental burden of diabetes, but I do think being aware they can have this effect is a good first step.”


Image source: diaTribe

Knotts now uses TIR regularly. “My biggest hurdle to get past was that I equated TIR to being a grade – as if I was turning in a term paper or project and those percentages related to a letter grade,” she said. “Just as your A1C is not an accurate picture of your control, a TIR is also not a complete picture either. Yes, I have a range that I want my TIR to be, but I’m not focusing on one average number, or one A1C target. I’ve been able to learn that if I can keep my numbers close to the target range, everything else (A1C, standard deviation) tends to also be better, and I feel better overall.”

Christel Oerum, who was diagnosed with type 1 diabetes at the age of 19 and created Diabetes Strong with her husband in 2015, thinks about TIR both every day and in a long-term sense.


Image source: diaTribe

“I use TIR daily in the sense that I aim for glucose levels in my target range (70-160 mg/dL, but I don’t focus on always meeting a daily TIR goal, as I think that’s too stressful and not realistic,” she said. “There are going to be days where I’m in range most of the day and days where I’m not, and for me, that’s okay. I do have a monthly TIR goal that I’d like to see myself hit, but that’s more of a retrospective analysis.”

Oerum acknowledged how easy it is to get obsessed with making TIR goals. “For me, that’s not healthy, which is why I try to not use TIR as a daily goal but rather as an overall indicator of whether I should make changes to my care,” she said. “TIR is not a grade or score. It’s a tool to help you manage your diabetes to the best of your ability.”

Simms’ family focuses less on the actual numbers (like TIR and A1C) and more on helping Benny thrive with diabetes: “I spend a lot less time working on TIR than on things like fostering independence, teaching Benny to trouble shoot and helping him advocate for himself. TIR is a great tool to check on for trends and adjustments, but we don’t use it very often. I wouldn’t want Benny checking TIR every day or even more than once a week unless he was really tweaking settings or trying something new.”

We don’t want TIR to be scary or intimidating. At diaTribe, our hope is that more and more people will be able to use TIR in a non-judgmental and informative way, helping themselves and their families lead healthier lives. Oerum summed it up well. “TIR for me means more details on how my management is going and can help me hone in on what to change and what to leave alone. Diabetes can’t be about perfection, and just as my A1C isn’t a grade of my effort, neither is my TIR.”

This article is part of a series on time in range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients’ health. Learn more about the Time in Range Coalition here.


How to Find a Good Mental Health Provider

If you live with any form of diabetes, you’re far more likely to suffer from depression and anxiety. An estimated 40% of people with type 1 diabetes and 35% of people with type 2 diabetes experience significant levels of “diabetes distress,” which can result in negative mental health repercussions, including diabetes burnout.

A mental health provider can be a crucial part of your medical team. Dr. Mark Heyman, the Founder and Director of the Center for Diabetes and Mental Health (CDMH), explains why:

Diabetes is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances.

In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management every day. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However, doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.

There are things you can do to help manage the mental distress of diabetes, including finding a good mental health provider that is especially positioned to help people with diabetes. This article will outline how to find the perfect fit!

Consider What You Want in a Mental Health Provider

Think of your mental health provider (or therapist) as someone you’re trying to develop a long-term relationship with. You want to be comfortable sharing all of your thoughts and feelings with this person, and be vulnerable with them as well.

Mental health providers become very close with their clients, so knowing what will make you uncomfortable is very important and crucial to knowing who you want to look for when searching for a provider. Some things you may want to keep in mind:

  • Gender (do you have a preference to work with only men or only women?)
  • Age (you may feel more comfortable working with someone much older or younger than you, or maybe you’d prefer someone closer to your age)
  • Religion (are you looking to connect spiritually with someone? Perhaps your religion is very important to you, or perhaps you’re looking to keep the interactions completely secular)

When you contact a provider’s office or complete an initial questionnaire for therapy, you’ll usually be asked some questions about basic preferences, such as those described above, to help match you with the best therapist.

You may also be able to research a mental health provider’s bio online to learn more about their areas of expertise before scheduling a visit.

Consider the Issues You Want to Address

There are many different types of mental health providers out there, and knowing that specific issues you want to address can help steer you in the right direction. Perhaps you’re suffering from substance abuse, or maybe you have developed anxiety around food. Maybe you and your spouse are struggling with your child’s new diabetes diagnosis, or you’ve noticed depressive symptoms that you want to tackle early. Different providers can help you manage different issues, so be cognizant of that. Some of the different types of specialists include:

  • LCSW – Licensed Clinical Social Worker
  • LMFT – Licensed Marriage and Family Therapist
  • NCC – National Certified Counselor
  • LCDC – Licensed Chemical Dependency Counselor
  • LPC – Licensed Professional Counselor
  • LMHC – Licensed Mental Health Counselor
  • PsyD – Doctor of Psychology
  • Ph.D. – Doctor of Philosophy
  • MD – Doctor of Medicine

But no matter what a provider’s background credentials entail, what matters most is their area of expertise. Reading up on a provider’s background information and bio can help you familiarize yourself with the areas of mental health they deal with, and can help you decide if they would ultimately make the best fit for you and your needs.

Consider Asking for a Consultation

Consider this an interview for the mental health provider you’re considering “hiring.” Some practices will offer a free, 30-minute consultation, so that you can get to know the provider before deciding to come on as a client. Some important questions to ask if you’re able to, are:

  • Are you a licensed provider? (while every state varies, a licensed provider has passed the minimum competency standards for training within your state)
  • What’s your educational background?
  • What is your treatment orientation? (this refers to the school of thought that the therapist draws from in understanding and treating mental health issues)
  • What is your area of expertise? (and if they say “chronic disease” or “diabetes,” that would be excellent!)
  • Do you accept my insurance?
  • What is the cost per session?
  • Are you a prescribing physician? (some providers may be able to prescribe medication for things like obsessive-compulsive disorder, anxiety, and depression)
  • What is your communication style?
  • Do you prefer short or longer-term therapy? (some providers are very short-term goal-oriented, while others prefer developing a relationship over a long period of time)

These questions are not a complete list, but it’s a good start to finding the perfect fit for you and your care.

Seek out Diabetes Experts

It can be very difficult to find the right mental health provider for you and your needs, and that’s especially true when living with a chronic disease like diabetes.

The American Diabetes Association (ADA) recently teamed up with the American Psychological Association (APA) and created a directory of mental health providers specifically equipped to meet the needs of people with diabetes. All providers in this directory are:

  • Currently licensed as a mental health provider
  • A professional member of the ADA (Associate, Medicine & Science, Health Care & Education)
  • Have demonstrated competence in treating the mental health needs of people with diabetes

Currently, the directory has about 60 providers, 40 of which provide pediatric services, and the list is rapidly growing. The tool is simple to use: enter your zip code and whether you’re looking for adult or pediatric services. The directory will then pull up diabetes-trained mental health providers near you. The directory also lets you access what types of insurance a chosen provider accepts, their office location, phone number, and more.

Finding an appropriate mental health provider can be a difficult but worthwhile challenge. Investing your time, money, and energy to improving your mental health as someone living with diabetes is absolutely worth it, and it is crucial that you find a mental health provider that is going to work best for you in getting your needs and goals met. Hopefully these tools will make it a little easier to get there!


Mental Health Check In: Identifying and Processing Trauma

This content originally appeared on Beyond Type 1. Republished with permission.

By Beyond Type 1 Editorial Team

Over the past year, we’ve collectively faced an intense and stress-inducing time due to COVID-19. Even with some light at the end of the tunnel approaching due to vaccines, we will each be dealing with and processing the ramifications of this past year for some time, and nowhere is that more true than the year’s impact on our mental health. So we spoke with diabetes psychologist Dr. Mark Heyman about how to identify stress versus trauma, when and how to get help, and how often similar issues come up when we’re dealing with diabetes, from diagnosis to low blood sugars and more.

For more mental health + diabetes content, check out Dr. Heyman’s podcast at

Watch the Entire Roundtable Discussion in Full:

The following transcript has been edited for content and clarity.

Lala: Today, we’re going to be talking about trauma – how to identify it, some of the tools and resources to help us through it. Dr. Heyman, can you start to give us a little bit of an overview of what trauma is?

Dr. Heyman: The definition of trauma is real or perceived danger and threat of death or serious injury. So if you are in a car accident, if you experience a sexual assault, if you have been diagnosed with diabetes, that is the definition of a trauma. Also, if you have a close friend or family member who has experienced that and you have a belief or an actuality that you’re going to lose them and they’re going to be seriously injured or die in a situation, that’s considered a trauma.

I think that often times trauma is thrown around as a buzzword and as a substitute for stressful situations. And not that stressful situations are not challenging for all of us to deal with, and also I think that there’s a lot of similarities in ongoing stress like COVID, and in quarantine and being in this situation for a long time. But that is not the definition of trauma. The definition of trauma is having an event or sometimes a series of events where you are in danger of dying, or you perceive that you are in danger of serious injury or death.

Lala: What are some of the ways that someone might be able to recognize that they did in fact go through something that their minds and body are processing as a trauma?

When somebody experiences trauma, and I’ll use the example of a car accident as an example here, generally speaking, what happens is your anxiety level increases and that’s a natural thing. We would hope that would happen because it’s your body’s way and your mind’s way of keeping you safe. And what happens is you have a couple of symptoms, oftentimes you have what we call re-experiencing, and so you have either intrusive thoughts, or you have nightmares around that event.

You also have what’s called hypervigilance, which means that for example, the car accident, you may be nervous to see a car or nervous that’s the first time you drive after a car after your car accident. So you’re going to be vigilant and kind of be on guard.

And then the third symptom that we see is what’s called avoidance. And that’s exactly what it sounds like – you avoid situations, people, things that remind you of that trauma. But when those happen, those aren’t problematic in and of themselves, those are actually a really natural response.

What the challenge with trauma is, is when those symptoms of re-experiencing, avoidance, and hypervigilance stay with you and they don’t resolve—because naturally they should resolve—but when you get stuck in those symptoms and you stay there in that hypervigilance, avoiding, re-experiencing state, that’s where it becomes really problematic for us, because the context is different in your life, because you’re not in danger anymore, but your body and your mind is telling you that you are still in danger. And that can cause all kinds of challenges in our functioning and our ability to live in the world in a really effective way.

Lala: I want to go through some of the things that I’ve heard on the internet to debunk and maybe verify some things. One of the phrases that I’ve heard is that you can’t process trauma while you’re in it. Can you clarify that statement?

I think that’s probably a fairly accurate way of putting it, because when you’re in a traumatic event or you’re experiencing a traumatic event, or you’re experiencing ongoing stress, your goal is to keep yourself safe.

And so if you’re on guard because there is a danger coming at you, either perceived or real, and you want to stay alive and your mind is telling you to stay alive, your mind doesn’t have the capacity to process that. Your goal is to stay alive.

It’s kind of like having a low blood sugar – when you’re low, all you want to do is eat and get your blood sugar up, because your body knows that if you don’t do that, you can get yourself into some really big danger and really big trouble there.

And so, not that trauma and low blood sugar are in any way equated, but it’s the same concept your body is telling you, “I need food.” Your body’s telling you, or your mind’s telling you, “I need to get out of this situation.”

And you cannot process something while you are in it, because those symptoms that we just talked about are actually really helpful for you. They’re keeping you safe in that place.

When you’re outside of that situation and those symptoms continue in the long-term, that’s where things get challenging, that’s where the processing really needs to happen.

Lala: If I think I may have been through something, what are some tools I can use to just kind of assess where I’m at? I think in this day and age, we’re often taught to just kind of push through it, and if you just keep going, the bad stuff will go away. But how can someone really look at themselves and figure out if this is something that they might need some help processing?

The simple answer is looking at your behavior and how you are right now and how that’s impacting your ability to live in the world.

Is it impacting your work? Is it impacting your relationships? Is it impacting your sleep? And if you’re having trouble in your relationships because of a diagnosis with diabetes, or because of some other trauma, that’s really making you stay away from relationships or be overdependent on relationships, if you’re having trouble sleeping and you’re having nightmares on a regular basis, and that’s impacting your ability to work, because you’re so tired, if you’re not able to focus on your work, those are some really good signs that you might need help because the trauma is not resolving on its own.

Again, I look back to using the example of a car accident. So imagine that you get in a car accident today, God forbid. And so you get your car towed, you get it fixed, and it comes back to you, and so you go and you get in your car and you drive it for the first time, maybe next week after it’s all fixed up. You’re probably going to be a little bit nervous and that’s normal. You’ve just experienced something pretty traumatic and now you are trying to kind of process that and move through it and show yourself that driving is generally a safe thing, although the thing that happened to you that one time is a one-off, but you’re going to be nervous.

And so you do it, but the more you’re able to drive and see that you’re a safe driving, then the easier it gets. But if the same situation happens and you go to get in the car and you cannot get yourself to open the door, or you can’t get in the car without taking three Xanax. And so you’re avoiding that anxiety in that way, that shows you that you’re not able to function at a high level like you want to. And the trauma is the reason why, and that’s a good sign that you may need some help.

T’ara: While you were talking, I was thinking, this is probably the best example of collective trauma that we’ve been through in our lifetimes with COVID. And I feel like we’re still in that state of hypervigilance and sensing danger, and I think as people with diabetes, we know that our risks of severe complications or even death from COVID are very real. But we are starting to see that sort of light at the end of the tunnel, people are getting vaccinated, but I don’t think that means that the trauma is going to just go away. So what are some ways that we can start to process our traumatic experiences, especially as people with diabetes going forward? What are some tools that we can use?

I think, community is really number one, both using the resource of the community that we have, but also talking about it and just being open about how this experience has impacted all of us, and it impacted us individually and impacted us as a society. I think that’s number one.

I think that the number two thing is really using the data to drive our behavior. I’ve talked to a lot of my patients recently about this, many people who have been very, very isolated because of COVID, both because there’s nothing to do, but also because they have fears about it. And talking about what’s going to happen next, once they get vaccinated or once the world opens up, and there’s a lot of people who are really saying, “I’m not sure I’m going to be going out until 2023.”

And that’s a really kind of scary and a really kind of a hopeless place to be. And my response to that is, up until now and even right now, not going to restaurants, wearing a mask, all of those things, those are really important things. Those are really functional. And those things are keeping us safe.

But there’s going to be a time in the future, hopefully sooner rather than later, when those things are not going to be necessary anymore. And they’re not going to be helpful anymore. And not socializing is not going to be helpful anymore. But if we continue in the belief that we are in danger there, and that goes against what the evidence is showing us, the case rates are down, you’re vaccinated, then you get stuck in this traumatic cycle of not being able to process, not being able to move forward.

And so what I would suggest that people do is of course follow the public health guidelines, do not disregard them. But when the public health guidelines say, “It’s okay to go to the grocery store and not wear a mask,” or, “It’s okay to go to a restaurant and eat inside.” And you may feel a little bit uncomfortable doing that, I would really encourage you to push yourself to do that, because that continued avoidance is going to keep you stuck.

Trauma and traumatic events are very contextual. And when you’re experiencing the trauma, or when you’re in danger, those types of behaviors are keeping you alive. But when the context is different those types of behaviors are keeping you stuck, and it’s important to recognize that context.

And if you’re having trouble recognizing that or having trouble taking those steps when it’s safe, and when it’s objectively safe, that may be a time where you need some professional help, because trauma and PTSD—post traumatic stress, which is that stuck place after a trauma—those things generally don’t resolve on their own. Those are things that really require some help in getting you to a place where you can be more flexible in the world.

T’ara: I’ll even say there is no shame in getting extra help or professional help. I know for me, I started therapy in COVID just because of how scary it is… But even then, we know that this isolation that we’ve been in for a year can definitely take a toll, especially how we interact with one another. How do we make sure that our personal traumas are not impacting others? How do we make sure that we’re not lashing out and taking out our anger and fear on other people?

Each one of us has to do some introspection in, and really make sure that that’s not happening. I think that the first piece of advice is to do that introspection and say, “I’m angry right now, or I’m feeling stressed right now. And I’m lashing out at my friends and family, what’s causing that? Is it them or is it me?”

And maybe it’s them, but most likely, or more likely than not, it may be you, especially kind of given the stress you’ve gone through. And so if you’re able to see that and you’re able to use that introspection and be able to look at yourself from the outside and make change, then that’s really helpful. Also, it can be really helpful when you notice yourself getting that anger or that lashing out, that impulse to lash out is to take a deep breath and just give yourself a beat and see if you can make a choice not to.

If you’re having trouble making that choice, if you’re having trouble being able to choose whether or not you lash out or not, you may need some professional help. But if you’re able to do that on your own, and you’re able to calm yourself down and be intentional about how you respond, you have the ability to do this on your own.

But again as you said, there’s no shame in getting help, because staying in that stuck place, it generally becomes even more stuck and more stuck the longer it happens.

T’ara: Someone close to me went on vacation. They got on a plane travel because they were like, “I am tired. I need a break.” And instead of asking them, “Well, what’s going on? How can I help?” I went straight to, “you shouldn’t be doing this. You shouldn’t be doing that. You’re going to kill yourself. You’re going to kill someone else.” Like just completely lashing out and not recognizing that I was projecting my fear onto that person. 

I think that COVID – I think that in some instances it’s this trauma, but in some instances it’s ongoing stress. And in some ways that can be actually even more challenging to deal with because it’s day-to-day, every day is Groundhog day, same thing over and over again.

And that’s stressful for all of us. And so we feel very boxed in and have a difficulty just being in the world because it’s hard to right now. And so, that sort of stress builds up and then we take it out on other people. I certainly been guilty of that as well.

T’ara: I think what you said about introspection is right. I think, especially as the world kind of starts to open up more people are getting vaccinated. So more people are itching just to get out there. If you’re feeling super strong feelings I would probably say to journal it out, write it down and really analyze where those deep feelings are coming from.

I want to say, when we’re talking about trauma, and if you are looking for professional help around trauma, I would really encourage you to make sure that you find a therapist who knows what they’re doing with trauma. And there’s a couple of reasons I say this.

One is that trauma therapy is hard. It’s hard for the therapist. It’s hard for the person getting the therapy, but it’s also hard for the therapist because the therapist’s job here is really to push the person out of their comfort zone. It’s certainly with compassion. But if someone comes to me who’s experienced trauma and they say, “I’m really worried about leaving my house, because I’m worried that I’m going to have a low blood sugar when I leave my house.” Okay. Fair enough.

If I said, “Well, then, I think what you should do is just stay home. I think we should, in order to keep you calm in order to keep you not stressed, I want you to stay home. And that’s probably a good thing for you.” That’s actually doing the exact opposite of what needs to happen.

What needs to happen is for us to assess the risk. And then if the risk is at an acceptable level, objectively push the person to become uncomfortable. And that’s hard to do. And if you’re not trained to do that well, it’s easy to get trapped in this way of like, “Oh, it’s going to be okay, stay home.” And so finding a therapist who is trained in trauma therapy is important.

T’ara: Can you give some tips on how people can find or at least interview with therapists and make sure that that therapist is actually trained in that? Or if that therapist will be for them? What are some common things that you should ask a potential therapist?

There are a couple of evidence-based treatments for PTSD and for people who’ve experienced trauma. I would say that there are three big ones. One is called prolonged exposure. It’s a therapy where the person is asked to recount the trauma out loud, as a way of processing it, as a way of kind of making sense of it. So making the list of things that are scaring you that you’re not doing, and going and doing them on a greater level.

The other one’s called cognitive processing therapy, which is a cognitive therapy, which really focuses on a couple of different areas, including safety, trust, intimacy, and seeing how the trauma has impacted those areas and really finding ways to reframe your thoughts and then moving your behavior forward in those areas.

And the other one is called EMDR, which is a therapy where it includes bilateral stimulation. So, you know, tapping – it’s evidence-based because it helps the brain to process it, as well as to have those exposures.

So asking a therapist how they treat trauma, and what evidence is in place to support the treatments that they use. If they’re unable to answer that question, they’re not the right therapist for the person who’s experienced trauma. Because therapists who are going to help you dealing with stress with your relationships may not be the right therapist to help you if you’ve experienced a traumatic event like a diabetes diagnosis, like a car accident, a sexual assault or having COVID or having a family member who’s had COVID.

Just like you wouldn’t go see your dermatologist for your diabetes, you don’t want to go see a relationship therapist for a trauma-related issue.

T’ara: Thank you for answering, Dr. Heyman. Those are really good tips. 

Lala: I think my last question, Dr. Heyman – if you have a loved one, that you can see has clearly gone through, or is going through a trauma, but is maybe reticent to recognize that or reticent to get help, what’s the best way that we can lend support to those loved ones who are going through something?

I think the best way is really being transparent about what your observations are about what’s happened to that person, how it has impacted them, and also how that’s impacting you. For example, let’s say that your mom is this person that you’re seeing is having a lot of trouble because of a trauma because of COVID. And that’s impacting her ability to come over to your house for dinner, or to talk to you on the phone for that matter.

So saying, “Mom, I’m really concerned about you because it used to be, we talked on the phone every three days, and now I talk to you on the phone once a month – you seem like you’re having a really hard time. And I really want to regain that relationship. And I want to do whatever I can to do that as well, but I want to let you know that what’s happening for you, seems to be impacting you a lot, but it’s also impacting me. And so what can I do to support you in helping us to get back what we had before?”

And so I think that kind of, that sort of transparency – letting somebody see how what’s happening is impacting them, which they may not be aware of, but also how it’s impacting you. You can give them both sides and hopefully give them the courage and motivation they need to get help if they do need that.

Thank you so much, Dr. Heyman, any closing thoughts on trauma and what we’re all going through?

We’ve all experienced stress over the past year, and it’s been significant. And I think it’s going to be a little bit of a road getting out of this situation. When things get back to ‘normal’ I think it’s going to be hard for all of us to do that, because we’re just so used to being in this place of not doing things and it’s going to be really weird to have people in your house again, or go to a restaurant again.

Be patient with yourself and just give yourself some grace, but also when it’s safe and when the public health officials are letting us know that it’s safe, push yourself to be uncomfortable in those situations. Because the last thing we want to do is continue to get stuck and kind of have this collective trauma impacting our lives in the future.

The more we can push ourselves to get back into a routine that may not feel comfortable right away, just like things didn’t feel comfortable when we started this whole process, we didn’t know what was going on, the same thing is going to be the process for getting out of it.

Because now we’re so used to it. And we’re used to, even though it’s not comfortable at all, we’re used to the discomfort. And so we’re going to have to kind of get back into that. And it’s clearly a process.

So patience and grace, a willingness to seek out support, if you need it, whether it’s friends and family, the diabetes community, or a professional.


5 Ways to Talk Gentler to Yourself with Diabetes

Living with diabetes is hard. The 24/7/365 management, constant conscientiousness, precise measurements and tracking, and near perfection that the condition requires can be exhausting, and sometimes we’re our own worst critic.

We can become siloed in the “shoulds” and “should nots”, working ourselves into a corner of unrealistic expectations, not letting ourselves be fully human.

If you find that your language around diabetes is especially harsh, try flipping these 5 phrases to change your entire perspective on things, improve your mood, and live a fuller, free life with diabetes.

Instead of, “I can’t have that”, try “I choose not to have that”

The truth is, people with diabetes can eat anything they want. Sometimes, we may choose lower carbohydrate meals, or opt for seltzer water instead of an alcoholic mixed drink due to high blood sugar, rough diabetes day, or just because we want to take a little less insulin on that occasion.

But saying that you “can’t” have a food item puts you in a position of weakness. It shows that the food has power over you, putting on it a pedestal, and then you’ll begin to crave that food more and perhaps overeat it at a later date. It limits your thinking and creates a limiting mentality.

Instead, saying that you simply choose not to eat something puts you in a position of power, lets everyone else around you know that you’re in control of what you want and do not want to eat, and educates people that you really can have something if you choose to do so. You’ll also feel better about your food choices as a result.

Instead of, “My A1c is so bad”, try “I’m working to improve my A1c”

There are no “good” or “bad” blood sugars. Your blood sugar level is just a piece of data informing you what to do next. Low? You’ll need to eat something. High? You’ll need to dose some insulin. It helps educate you to learn how you respond to food, stress, exercise, new medications, or lack of sleep, and since the A1c test is just a cumulation of 3 months’ of blood sugars, the test result should just inform you on how you need to proceed to feel the best that you possibly can.

The great thing about an A1c test is that once you get your results, you can start working on your goals for the next one, and each quarter that you get the test is a clean slate. Maybe you tried a raw vegan (high carbohydrate) diet for a few months and your A1c came back a little higher. Getting a higher result might steer you in a lower carbohydrate direction for the next time. Perhaps you picked up strength training, and your A1c dropped 1% point. This might inspire you to continue the habit or even increase it. An A1c test is a tool in your toolbelt to help you along on your diabetes journey, but it should never be something that you use to negatively judge yourself.

Instead of, “I have to work out”, try “I get to work out”

Exercise is a cornerstone of any good diabetes management routine, but sometimes keeping that exercise routine is extremely hard. We’ve all had those moments where it’s early, we’re cold, the sky is still dark, and we really do not want to go to the gym, but we say we “have to work out” for better blood sugars.

Instead of feeling like you “have to”, why not flip it and express how thankful you are that you “get” to work out? That you have a body that can move, that your heart and lungs can pump, that you have a bicycle to ride, good running shoes for a jog, or a welcoming gym to go to?

Being thankful for having the time, mental bandwidth, energy, and money for exercise can help motivate you to get it done when it can sometimes be easier to complain.

Instead of, “I always have to go to the doctor”, try “I get to regularly check-in on my overall health”

If diabetes does one thing well, it makes people more cognizant of their overall health and wellbeing more than they ever would be without the disease. It makes you run a fine-tooth comb through your eating and exercise habits, how you manage stress and relationships, even how well you hydrate and sleep. And while going to the doctor often for checkups can sometimes seem like a drag, try and think of it as a great thing that professionals are frequently drawing blood, checking for vitamin and mineral deficiencies, checking in on your mental health, and making sure you’re healthy all around.

A lot of people do not see a doctor regularly, only seeking help when something is really wrong, and unfortunately, sometimes that help comes too late. The positive aspect of seeing a physician frequently is that you can check in on little things that may be bothering you before they turn into big problems.

This can be helpful not only for diabetes-related issues but for your vision, cardiovascular health, foot health, diet, mental health, and more. It’s a great thing and will ultimately make you healthier in the long run.

Instead of, “Diabetes always holds me back”, try “Diabetes lets me slow down and assess what I really need”

There will be times when diabetes slows you down. Perhaps you go low during a game of soccer or basketball and need to sit on the sidelines until your blood sugar comes up. Perhaps your insulin pump malfunctioned and your blood sugar has been high all day, and you’re dealing with a bad headache.

It can be easy to get down on yourself and start believing that diabetes is really holding you back, but in my experience, diabetes has only really had me slow down and tune myself into what was really going on. For instance, if I’m on a hike and keep going low, it’s usually because I didn’t have an adequate enough breakfast and I actually need to eat something with a little more protein, fat, and carbohydrates. If I have a terrible headache, and my blood sugar is stubbornly high, I can zero in that I haven’t had enough water or fresh air that day.

Blood sugars are usually an indicator that something else is going on; the instant feedback that they give people with diabetes is something that other people don’t get. We know if some food has tons of sugar because our levels will skyrocket; we can then portion things appropriately, while others may overeat and feel crumby the next day. We know that regular exercise makes our blood sugars more stable; someone without diabetes may forget or not have enough motivation to exercise because they don’t feel the instant results, and thus won’t feel as energized or refreshed regularly.

Taking the time to really assess what your blood sugars are telling you, and appreciating the time to slow down and address the issue is the key not only to better health but to better diabetes management as well.

What are ways that you’ve learned to talk kinder to yourself with diabetes? Share this post and comment on your ideas below; we love hearing from our readers!


How to Deal with Uncomfortable Situations

We’ve all been there. Whether it’s a coworker telling you that you shouldn’t join in on the company cake or a friend who makes an ignorant joke, there are many times where we are put into social situations where diabetes is a brunt of a joke or just blatantly misunderstood.

How does this make a person living with diabetes feel? Well, that depends on the person, their relationship with their condition, their sense of humor, and their ability to let things go. I bet many of us fall somewhere in the middle, which means at times we say nothing but other times, we feel compelled to put some myths to bed and/or educate our friends and family on a disorder that most know so little about.

About a year into my diagnosis, I went to a party and a friend came over, proudly carrying a dessert tray shouting, “Who wants diabetes?” Now in this instance, I was shocked. At that point, I was newly diagnosed and hadn’t been the brunt of a joke yet. I decided to let this one go. It wasn’t directed at one person, and it wasn’t said maliciously. It was just a distasteful joke, considering I hadn’t slept for days, was just coming out of my honeymoon and each day was a new diabetes adventure.

Fast forward to six years later. My son was only six when I was diagnosed but now he is 13 and always has friends over at the house. This summer, the boys were making different mug cakes concoctions and one joked, “We are totally getting diabetes after this.” I wanted to say nothing. I knew my son would be embarrassed if I chimed in. But then, I thought about their friend who lives around the block from us who was diagnosed two years after I was. I thought about him hearing that joke and I decided to educate. I explained that neither I nor the boy around the block did anything to deserve this disease. I told him that it is an autoimmune condition and we just got unlucky. Next, I went on to explain that people living with type 2 diabetes have it for different reasons, including their genetics. Luckily, this kid is an intellectual one who took interest in what I was saying. Maybe I made a difference.

Here are some main ways that I usually like to handle these types of uncomfortable situations:

Cut People Some Slack

I bring this one up first because I feel it’s very important to take a step back and remember — most if us knew nothing about diabetes until we had to. I have a very good friend who lives with Mulitple Sclerosis; she fights her own battle and I can honestly say it’s one I am not familiar with. While I wouldn’t go around making jokes, I also wouldn’t be aware of the impact that they may make.

Lighten Up

It’s okay to get bothered by insensitive jokes, but it can sometimes be better to just laugh and let it go! It’s better for your mental and emotional state and if you have children, you set a good example about not sweating the small stuff!

Keep Your Cool

This doesn’t only apply to uncomfortable situations involving diabetes, but any circumstance that may trigger you to react suddenly. I often have to remind myself to take a step back, wait a few minutes, and then think about how I should approach the situation. The last thing you want to do is unleash on Betty from down the hall because she asked if you should be eating that cookie. There is always a better way to handle these types of scenarios!

Take the Opportunity to Educate

There is a time and a place to educate; it just may not be worth it when it comes to your 96-year-old aunt who still thinks if you would just start exercising, your blood sugars will normalize. But, there are opportunities, and when appropriate, we should all do our part to shed some light on a disease that is in fact, quite time-consuming and quite demanding. You may be pleasantly surprised by the interest and responses you receive.

Choose Kindness

Let’s remember that everyone is fighting a battle we know nothing about. Chances are, if someone is saying insensitive things or making you feel uncomfortable, it is likely more about them than it is you. So remember that, have grace and choose kindness.

Getting upset with uncomfortable situations is understandable and we can all relate. But focusing on the more important things in life is sure to leave you feeling happier and healthier!

Have you dealt with uncomfortable situations surrounding diabetes? How did you handle it? Share and comment below!


How to Not Let Stress Come in the Way of Your Diabetes Care

With the current state of the world, we are all struggling in some way. Whether you are homeschooling your children, trying to manage a full-time job from the confinements of your makeshift home office, or grieving a recent loss; it is a difficult time for all. We are all adapting to the changes and roll with the punches, but with all the chaos ensuing, our diabetes oftentimes falls to the back burner.

I am trying hard to not let my emotions consume me. I am trying to get through the day and stick to my routine, but being busy and stressed makes me distracted, lack motivation, and not prioritize my diabetes or myself.

Here are five ways to not let stress come in way of your diabetes management:

Start the Day Off Right

I know for me, my emotions change by the day, but a wise diabuddy once told me, “If you put negative thoughts in your head, you’ll have negative emotions.”  Try waking up and being grateful for another day. Start the day right by testing your blood sugar, taking any necessary insulin or oral medications, and any vitamins and/or supplements you may take. Eat a protein-rich breakfast that will give you the energy you need to face the day ahead.

Set Alarms

This is one I need to start doing myself. When we are busy, or anxious, or both, we are likely to delay our eating or even skip a meal. By setting an alarm for a meal or sneak break, you are also allowing yourself a mental break from whatever it is you are dealing with at the moment. It’s a good time to check in with yourself, plan your meal, and dose insulin accordingly, if necessary.

Stay Active

Stress and worry can consume us, so it is in our best interest to keep ourselves busy and distracted. There is perhaps no better way to distract yourself than doing something good for your mind, body and soul. Exercise will not only make you feel physically better but you will release endorphins that will automatically put you in a better mood. “There’s good epidemiological data to suggest that active people are less depressed than inactive people. And people who were active and stopped tend to be more depressed than those who maintain or initiate an exercise program,” says James Blumenthal, Ph.D., a clinical psychologist at Duke University.

Find a Support System

Whether it be a local mom’s group, a diabetes Facebook group or your family members, it is good to have someone to lean on. Finding people that are also struggling but trying to keep positive will help motivate you and also keep you accountable. The diabetes online community is an amazing resource and can change your outlook for the better. You can also find countless blogs of people dealing with difficult times who discuss coping mechanisms that you may find useful. You may walk away with a few new recipes, a new mindset and a new best friend!

Have Grace with Yourself

We are going through unprecedented times and that compounded with the already existing daily life stressors, it’s a lot for anyone to bear. Add in the around the clock job of playing pancreas and it is a lot to juggle. Remember to breathe and be kind to yourself, you are doing the best you can.

Having some systems in place can help you not only manage your diabetes better but live a more relaxing life during these very stressful times. Have you put any measures in place to help you focus more on your diabetes management during times of stress? Comment and share below!


The Mental Impact of COVID-19 on Children with Diabetes

The negative mental impact of a pandemic like COVID-19 is well-known and documented. According to the U.S. Census Bureau, now 1 in 3 Americans is showing signs of clinical depression and anxiety. Coping with this (hopefully) once-in-a-lifetime event is something that a human brain has a hard time assimilating to: extreme and extended social distancing can make one feel anxious and isolated, constant vigilance to adhere to hand washing and mask wearing protocols and the 24/7 news media can increase one’s stress and anxiety levels, financial insecurity from the widespread economic fallout from the pandemic, fear of getting sick, and the unprecedented levels of community spread of the disease are just some of the reasons why people may feel anxious and depressed. Americans have been hard hit: with just 4% of the world’s population, we have 25% of the world’s COVID-19 cases, and researchers, doctors, and scientists alike are fearful of a “twindemic” where flu season and a second wave of COVID-19 cases will coincide over winter, once most outdoor activities become infeasible when the temperature drops across the country.

Children, and especially children with chronic conditions like diabetes that put them at higher risk for more severe reactions to the virus, are especially susceptible to the mental health impacts of the pandemic. A recent study from the American Journal of Pediatrics of over 1,000 U.S. parents in early June showed that 27% said their mental health had worsened since March, and 14% said their children’s behavior problems had gotten worse. Families with younger children reported worse mental outcomes than those with older children. About 10% of all families said their children’s mental and behavioral health worsened.

Vanderbilt University researchers said that disrupted routines are hard on young children, and in the study, 48% of families reported losing their normal childcare. Abnormal school routines can also be hard on children.

“In some communities, school will be remote, and schools should consider working with pediatricians and mental health professionals on how they may address the mental health of children, parents and staff even when school is remote,” the researchers wrote. “To implement these strategies effectively, Congress could consider enhanced funding to schools to address schools’ budgetary challenges related to implementing these recommendations.”

In another study out of China, published in JAMA Pediatrics, researchers in Hubei province,  examined a sample group of 2,330 school-aged children for signs of emotional disturbances. The children had been on lockdown for an average of 33.7 days. Even after one month, 22.6% of children reported depressive symptoms and 18.9% were experiencing anxiety.

These problems are exacerbated in children with diabetes for a few reasons. First, since most children are spared the brunt of the disease, many children without chronic conditions are starting to socialize again, with many schools across the country going back to in-person classes, sometimes with the option for remote learning for students who don’t feel safe. This leaves those affected by chronic disease feeling more isolated than ever before. It’s not just young children that are feeling the negative mental health repercussions of the pandemic. Teenagers and young adults are affected, too.

Ian Fleming, a freshman at CU Boulder, says, “Starting college as a freshman this year has been very difficult. I was looking forward to football games and parties. However, because of the COVID-19 pandemic, I will have to wait for the traditional college experience. I have been overwhelmed and scared because I have type 1 diabetes; I could still have serious complications if I contracted the virus. Being a college student has not helped with this stress as I am in a place where kids are still partying and being irresponsible when we need to unite and protect each other.”

Another college student in Colorado, Faith Riddell-Harding, says, “There are still students (on campus) who are going out and partying, which as someone who is high risk, is somewhat infuriating. I could not justify having a dorm roommate this year, with my compromised immune system, so I worked with the University Disability Center to request a single, until a vaccine is available.”

Second, children and young adults with diabetes are already at heightened risk for depression and anxiety, with rates estimated between 13-17%. Those with diabetes are twice as likely to receive a psychiatric diagnosis by age 18 as kids without the condition. Adding the fear, stress, and anxiety of an uncontrolled pandemic on top of that can mean a recipe for disaster.

Izzy Myszak from Indiana says, “Having type 1 diabetes already brought my mental health down. Coronavirus and T1D has skyrocketed my anxiety.”

Lynda Jimenez, of Arizona, adds, “It’s hard to watch your friends and family not taking this seriously when you have to be extra cautious as someone with a chronic illness. On top of the worry that comes from a pandemic, we have to deal with this dichotomy too.”

Finally, it can be really devastating on one’s mental health with on-going lockdowns and no end in sight to the pandemic. But there is hope. The Centers for Disease Control and Prevention has developed several tools to help you care for your child’s mental health during this time. The COVID-19 Parental Resource Kit offers help for understanding your child’s mental health needs according to their age group. The Essentials for Parenting Toddlers and Preschoolers page helps with common parenting challenges and provides information on building a positive, healthy relationship with your child.

Exercise helps improve mental health

Exercise helps improve mental health. Photo credit: Adobe Stock

Additionally, it’s important to keep children on a regular routine, make sure they’re exercising and getting plenty of fresh air every day, limiting screen time, and that families aim for regular dinners together to ensure that your child is getting both socialization and healthy nutrition. Many families have also created a “social pod” with another family or two to both mitigate COVID-19 risk and maintain mental sanity, while also achieving healthy socialization for their children.

If your child or teenager is exhibiting suicidal ideations or extreme depressive symptoms, call their pediatrician or primary care physician immediately or contact the National Suicide Prevention Hotline: 800-273-8255 to get help immediately.

Maintaining an optimistic outlook and having hope is paramount. Ian adds, “I have been safe and diligent about where I go, who I hang out with, and making sure that I always wash my hands and don’t touch my face, but my hope is that a vaccine comes out soon and we can all have the college experience we were hoping for.”

And sometimes, hope is all we can do.

How has your child with diabetes coped during the pandemic? What strategies have helped you? Share this post and comment below; we love hearing from our readers!


How to Increase Your Life Expectancy

If 2020 has taught us anything, it’s that health is everything. There are simple steps everyone can take to increase their life expectancy, and to give individuals the best chance at living a long, healthy life. Incorporate these simple habits into your daily and weekly routines to increase your life expectancy and improve your health now and into the future.

1. Keep Your HbA1c Low, TiR High

If you live with diabetes, one of the healthiest life-extending habits you can adopt is keeping your HbA1c low and time in range (TiR) high. Tightly managing blood sugar levels can help prevent devastating complications such as blindness, amputation, heart disease, kidney failure and premature death.

In addition, since the HbA1c test is simply an average of one’s high blood sugars and low blood sugars, it’s important to keep your blood sugar consistent and stable, with your time in your target range as high as you can get it. Studies have linked more stable blood sugars (and not gigantic swings between highs and lows) to longer life for those with diabetes. Most people aim for an HbA1c lower than 7%, but check with your doctor for your ideal target.

2. Wear Sunscreen

Wearing sunscreen daily is crucial for preventing the deadliest form of skin cancer, melanoma. Even on cloudy days, your skin will absorb 80% of the sun’s rays, and with it, harmful UV radiation. The American Academy of Dermatology recommends using a broad-spectrum sunscreen of at least 30 SPF every time you go outside. Ample use is crucial: On average, people only use about 20-25% of the amount of sunscreen needed for sufficient protection, so make sure to lather up!

3. Move Your Body

It’s no surprise that exercise is healthy for people, especially people living with chronic conditions like diabetes. Exercise is crucial for heart health, to manage blood sugars, increase lung capacity, and build and tone muscles to prevent future injury. All of the short term benefits of exercise add up to a longer, healthier life. Aim for 30 minutes of moderate exercise most days of the week, more if able! A study showed that people who exercise vigorously for only 3 hours a week had cells that were 9 years younger than nonexercisers.

Photo credit: Adobe Stock

4. Spend Time Outside

Nearly 50% of adults have low vitamin D levels, due to our sedentary lifestyle and the fact that most Americans live and work inside most hours of the day. Vitamin D (which can be absorbed right into the skin when people go outside) is important for proper immune system functioning, healthy teeth and bones, managing depression, and may even help prevent both type 1 and type 2 diabetes! Getting outside for just 15 minutes a day is usually enough to maintain adequate vitamin D levels for most people.

5. Spend More Time with Family & Friends

Blue Zone countries, places around the world that have notoriously long, healthy life expectancies, place a lot of emphasis on socializing with family and friends. Having a social circle can help people get through hard times, reduce daily stress, boost resilience and immune response, and act as a literal shoulder to cry on. This is especially important for people with diabetes who can oftentimes feel isolated and alone with their condition. Connecting with others in our struggle can help extend life expectancy: studies show that maintaining a social circle can help people live up to 50% longer, and having just 3 close social ties can decrease your risk of an early death by 200%. 

6. Eat Whole Foods, Mostly Plants

Consuming a diet rich in fruits and vegetables will be full of vitamins, minerals, and antioxidants that can extend life. Even if you don’t go completely vegetarian or vegan, eating more whole, unprocessed foods is beneficial for a healthy life, and to prevent diabetes complications. Many studies over the years have correlated a plant-forward diet to a lower risk of premature death, as well as protective factors against cancer, heart disease, depression, and dementia. People who eat mostly plants tend to have lower body weight, healthier blood pressure levels, and have significantly lower mortality risk. Bon Appetit!

7. Meditate to Manage Stress

Stress has been correlated with shorter life expectancies, and learning to manage it through meditation and yoga can improve and lengthen your life. Successfully managing stress through meditation can improve the quantity and quality of your sleep, boost your immune response, and improve your relationships, all of which add up to a healthier, longer life. Check out some free meditation apps to get you going!

Photo credit: Adobe Stock

8. See Your Doctor Regularly

Regularly seeing your doctor for screens and tests can catch diseases early (such as cancer), and can ensure an appropriate and timely treatment plan if something is detected. Mammograms, colonoscopies, and pap smears are some of the routine tests and screens scientifically proven to decrease mortality from the diseases they screen for. It may not be fun, but it’s proven, effective, and worth it!

9. Reduce Your Sugar Intake

Sugar is the new tobacco. Dr. Aseem Malhotra, a cardiologist from England, shares, “…added sugar is completely unnecessary. Contrary to what the food industry wants you to believe, the body doesn’t require any carbohydrate energy from added sugar.”

There is evidence linking sugar not only to obesity and higher incidence rates of type 2 diabetes, but also to liver disease, heart disease and tooth decay (which can lead to dementia). If you cut out added sugar from your diet, you are also more likely to gravitate to unpackaged, whole foods, which are chock full of vitamins, minerals, antioxidants, and life-extending properties.

10. Get More Sleep

One in three Americans don’t get enough sleep. Lack of sleep has been linked with a plethora of negative outcomes on many body systems, including cardiovascular, endocrine, immune, and nervous systems. Side effects of not getting enough Zs include obesity, heart disease, hypertension, anxiety, depression, alcohol abuse, stroke and increased risk of developing cancer that can all shorten one’s life. Sleep is when the body replenishes cells, is crucial to proper brain functioning, regulates one’s metabolism, and repairs damage done to the body during the day. Adequate sleep promotes healing of all body systems, and getting enough of it can extend your life. Aim for 7-9 hours per night.

These small, easy changes can add up to many more healthy years. Try to incorporate a few of these strategies into your routine today to increase your life expectancy!


Incorporating a Latinx Lens for Mental Health

This content originally appeared on Beyond Type 1. Republished with permission.

By Mariana Gomez

As I prepared to write this piece, I had to do my own personal research. My family and I moved from México to the United States in July 2019. We have spent a lot of time trying to learn as much as we can to better understand systemic racism in this new home of ours and learn how to work towards a difference. It is our duty not only to learn as parents, but to teach a thirteen-year-old who is watching, learning and is ready to join in any possible way to help his peers.

What I’ve learned? There is major work to be done in health policies, programs and campaigns that address social determinants of health, health disparities, risk factors, and to build health services for the Hispanic/ Latinx population alongside other ethnicities and races.

Because of a lack of easily accessible or fair health services, the Hispanic and Latinx population in the US will pay a high mental health and emotional well-being price during the COVID-19 pandemic. According to Minority Health, poverty levels among these groups will also have an important impact on emotional health.

“Poor access to care due to low rates of insurance, immigration status, language and cultural barriers in healthcare which can include differences between provider-patient in explanatory models of illness and families as the gatekeepers can limit entry into treatment.” (Cortes et al, 2008) as read in the Handbook of Multicultural Mental Health Assessment and Treatment of Diverse Populations.

Talking about Latinx population includes different sub-groups. Us Latinx are a diverse community. Most of us come from different countries and speak different languages. Yes, Spanish is the official language but some will speak native tongues as well.

I am a Mexican Diabetes Educator who believes that talking about Latinx culture in the diabetes space requires us to work on more topics besides food and language barriers in our practice. Diabetes Education must include programs that recognize our many cultural differences as well.

We need more Latinx researchers, professors and conference speakers guiding these efforts in order to build better, stronger but also culturally appropriate strategies and programs. The work we’ve been able to see so far is indeed amazing, but how about incorporating a “Latinx lens” when talking about us Latinx populations and our health needs? Addressing our emotional health is even more complex as these cultural differences should be included in the different programs designed to help.

I found Salud Latina some years ago in a twitter conversation and felt immediately drawn to their mission “to lead the creation of culturally relevant multimedia research, tools, and stories to fuel people to start and support policy, system, and environmental changes in schools and communities to improve Latino child health, reduce disparities, and promote health equity and a culture of health.”

To explore and learn more about these disparities and the way our mental health is being addressed nowadays, I spoke with Rosalie Aguilar, project coordinator for the Salud America! program at University of Texas Health San Antonio.

During the COVID-19 pandemic, is there a need for culturally and linguistically-oriented mental health care for the Hispanic/Latinx population?

Rosalie: Yes! For Latinos and other people of color, COVID-19 has caused disproportionately higher rates of cases and death, job loss, and other inequitable impacts.

Many are also experiencing more mental health issues than in previous eras, according to Dr. Madeline Aviles-Hernandez, the Outpatient Services Director at the Gándara Center.

“This crisis is making life much more difficult for those [Latinos, African-Americans and other culturally diverse populations] we serve, including those in recovery and people who have yet to be treated for such problems as anxiety and depression,” Áviles-Hernández said in a statement. “Minorities have been—and continue to be—less likely to receive mental health treatment.”

The COVID-19 outbreak has resulted in forced isolation, school and business closure, massive job loss, food insecurity, and a litany of other impacts outside of the illness itself.

These ramifications impact more than just physical health, but mental wellness, too, according to Cathi Tillman, the executive director and founder of La Puerta Abierta — a Philadelphia nonprofit providing mental health support to immigrant and refugee communities.

“People who were supporting themselves on some level now can’t,” Tillman told the Philadelphia Inquirer. “They’ve lost their jobs. They can’t congregate socially, or go to church, which is a big part of the community for many people. They can’t come into the office for therapy. For recent immigrants and refugees, the things that were already difficult are 100% more difficult now.”

How are these needs being addressed so far? What kind of help are these groups receiving and how is your organization and team working to provide support? 

Rosalie: Various nonprofits are stepping in to help fill the gap, but there’s still a huge need for mental health care services and additional social support services. There’s also a need to help address the stigma involved with accessing these services.

Our organization is not involved with providing direct mental health care services. But at the Institute for Health Promotion (IHPR) at UT Health San Antonio, the headquarters of Salud America!, we do have a team of community health workers, promotoras, who provide patient navigation and reach out to patients in the Bexar County area to check up on them, provide social support and to help them connect with their health care providers. These services have been associated with less anxiety and depression among patients and fewer hospital readmissions.

There are other groups out there at the national level like NAMI that can also help connect people to services. We really also appreciate that Informed Immigrant, Immigrants Rising, and produced a 10-step guide to help mental health care providers respond to the distress of immigrants whose status is in flux due to ongoing changes to the Deferred Action for Childhood Arrivals (DACA) program, amid coronavirus. We wrote about it here.

Folks can also use or call 211 find support services in their areas. We actually got a chance to speak with the creator of, and tell the story of how he and his team were able to take on the herculean task of digitizing all the social services available in the United States, thus making it easy for people to find and apply for those resources.

How can us Latinx people in the non-profit and health space work and help you? 

I think the important thing right now is to continue to do all we can to prevent the spread of COVID-19 with culturally appropriate messaging and also to continue to push for health equity in Latino communities. If you offer a support service that can be helpful to Latinos let us know, because the word needs to get out.

Also, share our materials on the Impacts of COVID-19 on Latinos and solutions. We have a bilingual infographic, a landing page on “Coronavirus and Latino Health Equity” and a list of actions that could help Latino communities.

What is the biggest campaign you are working on and how can people and our readers join and help?

We are working on several things right now, including culturally aligned messaging to help stop the spread of COVID and also a campaign to help communities get their cities to declare racism a public health issue and commit to action. We know that racism coupled with the impacts of COVID-19 are detrimental to our population. Therefore, we need to do all we can to promote a culture of equity and to reduce bias.


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