Episode 015 - An Open Conversation on Playing Both Roles.. A Health Care Provider with T1D Taking a Functional Approach to Diabetes

Episode 015 - An Open Conversation on Playing Both Roles.. A Health Care Provider with T1D Taking a Functional Approach to Diabetes

January 11, 2022

Of all of the endocrinologists that you've met with, how many of them have actually had type one diabetes like you? Throughout my 8 years of living with T1D, I can't name a single physician that has truly been able to identify with my diagnosis. Well, that's where people like Paige come in.

Meet Paige Proctor, a Certified Endocrinology PA and Health/Fitness Coach who has type 1 diabetes herself. She helps her patients and clients understand the root causes of their blood sugar trends so that they can live their lives without diabetes holding them back.

In today's conversation, Paige and I talk about what it's like playing the role of a patient and provider - the good, the bad and the ugly. We also discuss the flaws in traditional western medicine and why she's decided to take a functional approach to diabetes care and how she is training her patients to do the same.

Here's what we discuss in today's episode:

- The experience of playing the role of patient and provider in the health care setting

- How a background in nutrition and exercise has changed the experience for her patients

- What is a functional approach to diabetes and how it can help patients self-sustain success


 Thank you to Skin Grip for sponsoring this episode! Check out my absolute favorite patches and save 10% at check out by using the code "LISSIE"!


Hit the play button and let's get started!



- Apply for the Skin Grip Diabetes Scholarship

- Hangout with Paige on Instagram


Show notes:

  •  (0:00): INTRO
  •  (0:25): Skin Grip Scholarship - Apply or contribute at https://bold.org/scholarships/skin-grip-diabetes-scholarship/
  •  (2:57): Introducing today’s guest
  •  (3:45): Do you mind talking a little bit about your journey? Your diagnosis? Just kind of sharing a bit of your story with us?
  •  (3:27): Kudos to your dad for catching that. What made him even, if it doesn't run in your family, what made him think of that?
  •  (8:02): So is that how you kind of got into the health care field because of your dad, I'm assuming?
  •  (10:53): Did you originally think you never would’ve wanted to work with diabetics because of how your relationship with diabetes was? Or like the management aspect? Like where, what, what makes you say that?
  •  (11:55): I mean, growing up, how many of your endocrinologist were actually diabetic
  •  (13:55): Can you speak on how you’re in the unique position of being able to sit in both seats - you’re both a patient and a provider. Can you tell us how each role kind of influences the other?
  •  (19:29): Difference in insulins
  •  (23:06): How do you feel that having a more holistic lens, and more all encompassing focus, has helped you in both your personal management and you know, you seeing patients?
  •  (35:20): What led you to want to learn more about that approach? And like, what do you hope to do with more of that education?
  •  (48:01): So if somebody let's say, anybody listening, or your patients or whoever, whoever you're talking to, if they want to, like investigate more of that functional or holistic approach, like, where do you send them to start learning about that stuff? Like, what resources do you give them? What do you encourage them to educate themselves on?
  •  (53:09): So where where can everybody find you? What will they learn from you? 
    IG: @Paige_t1d_fitness
  •  (54:01):  Thank you so much for joining us and talking about your unique perspective of seeing both sides as a type one!



Elisabeth Poyner  0:00  

Welcome to Keeping it 100 Radio. I'm your host, Lissie Poyner. Type one diabetic, certified health coach, personal trainer and founder of Needles and Spoons Health and Wellness. Inside this podcast, you'll find the real and raw conversations around diabetes management, including the lessons that we don't learn in our endo's office, my best tips and trainings and conversations from the experts that I trust inside the community so that you can create more predictability in your diabetes management and feel empowered while doing so. Let's dive in. 


Elisabeth Poyner  0:25  

Alright, guys, before we get into this episode, I have to let you know about an incredible opportunity for the diabetes community. So if you've been here a while then you know that our sponsor behind the podcast is Skin Grip. And that's simply because I love their product, I love their mission, and everything that they do for the community. Now, if you've also been listening for a while, then you also know that I was diagnosed with diabetes when I was 19. So I was a freshman in college. And that whole time was very, very difficult. There was a lot of costs associated with diabetes, there is a lot of mental stress, emotional stress of that diagnosis. And this is something that Skin Grip recognizes in our community. So what they're doing is awarding 20 students living with diabetes $1,000 scholarships to go towards their education. So I know that you might have some questions. So what makes me eligible? To be eligible for the scholarship, you must either be a high school senior or any undergraduate in a two or four year degree program who has diabetes. Now, I know you might also be wondering, do I have to have type one diabetes? And no, you can be any person living with diabetes who simply can answer the question, how do you live fearlessly with diabetes? All you have to do is go to the link in the show notes, fill out the application and answer that one question in a one or two minute video. The applications are due on March 1st, and the winners will be announced at the end of March. Now I know you also might be wondering, okay, I'm not a college student anymore, I'm an alumni or I've just been living with diabetes for so many years, how can I also give back? And I have an opportunity for you too! So not only is Skin Grip donating $20,000 towards this scholarship, but they are allowing contributions on top of that amount. So that means those $1,000 scholarships can easily turn into $2,000, $3,000, all with donations. This money is going directly to the students. So if you're somebody who wants to give back to the diabetes community, but you're not sure which organization to give to, or which organization to trust with your hard earned money. This is a perfect opportunity because again, this is going directly to the students. If you are interested in being a contributor, again, all you have to do is go to the link in my show notes and hit the contribute button. I'm so excited for this opportunity. This is something that no other brands are doing and it's just an incredible way to give back to a community that I know that they love so much. So go ahead hit the apply button, hit the contribute button. If you haven't tried Skin Grip before it was SkinGrip.com and use my code LISSIE, L-I-S-S-I-E at checkout to save some money. Alright, let's get into the episode. 


Elisabeth Poyner  2:57  

Hello everyone. Welcome back to Keeping it 100 Radio I'm here today with Paige Proctor. She is a certified endocrinology PA and health and fitness coach who has type one diabetes herself. Paige earned her Bachelor's in Science and Human Nutrition foods and exercise at Virginia Tech and went on to pursue her Master's of medical science and Physician Assistant Studies at Wake Forest School of Medicine. Paige is passionate about all things health, fitness and type one diabetes management. She helps her patients and clients understand the root causes of their blood sugar trends so that they can live their lives without diabetes holding them back. Thank you so much for joining us, Paige. I'm so excited to talk today.


Paige 3:34  

Of course. I'm so excited to be here! Thank you for having me. I'm I love your page. And I love everything you're doing with keeping it 100 And with your Instagram and I'm just really excited to be talking to you today.


Elisabeth Poyner  3:45  

Oh, thank you so much. Do you mind sharing a little bit of that because you're type one diabetic yourself. So do you mind talking a little bit about your journey? Your diagnosis? Just kind of yeah, sharing a bit of your story with us?


Paige 3:57  

Yeah, so I was eight when I was diagnosed. And it was one of those, the classic like your go to the bathroom a lot  and you're really hungry all the time and you're losing weight. And I wouldn't point I was just like, I was just really hungry. My parents thought I was just growing and that was you know, just typical kid. But then my dad he fortunately, he was like, Oh, what about type one diabetes? And he called my granddaddy who was a pediatrician and he was like, oh, yeah, you should probably you should probably take her in. And when we were in the car on the way to the hospital, I was eating a Fruit by the Foot and my dad was like Paige. Not the time. Now right now. We don't know what your blood sugar is. And I didn't have one of those crazy stories where my sugar was like over 1000 or anything but I think maybe if I had continued eating the Fruit by the Foot without any insulin. But yeah, it was a huge shock to my family. Because nobody else in the family has diabetes, so um a big thing to, you know, take on as a kid or as, you know, as an adult, as a teen, but um it definitely shapes the way you grow up. And I was really, really shy about my diabetes when I was in middle school and high school. And then it wasn't really until college that I feel like I kind of, I feel like in college, you kind of you're off on your own, you kind of come into your own and you're confident about the things that make you who you are. And I started getting really into fitness, exercise, and I taught through exercise classes in college. So that was where I was really interested in exercise and diabetes management and how the two of them kind of intertwine.


Elisabeth Poyner  5:50  

Oh, that's so cool. That, kudos to your dad for catching that. What made him even, if it doesn't run in your family, what made him think of that?


Paige 5:57  

So my dad, again, like very, very fortunate in this situation. He's a family medicine doctor. But I think as a parent, sometimes, like, I don't know, I feel this way as a health care provider now, like, as a parent, you're probably just thinking like, Oh, my kid, probably just like, because she's like, drinking water all time and going to the bathroom like, maybe she just has a UTI or something. And it's gonna, like work itself out. And but um, it, it might have been something, and back then it was more rare. I feel like that it's just been a little bit a little bit more popular. It's still pretty rare. But yeah, it was one of those things where I was lucky that he like had that, that thought about type one, because it must have just been. I don't know, I just I feel lucky that he thought he thought that because nobody in the family had it or anything or any autoimmune. So.


Elisabeth Poyner  6:01  

Yeah, that's I mean, that you're definitely at the age that you were, I feel like it's so easy to pass off those symptoms. So, I mean, you being eight years old, you weren't really, really able to advocate for yourself in that way, I'm assuming as a normal kid. Whereas like, my experience is a little bit different. I was 19. So I was like, okay, like, I know, my body at this point, something feels weird. And I was able to, like, make that appointment on my own. But yeah, definitely kudos to him.


Paige 7:25  

Oh, I know, thanks dad. But that's gotta be hard too, as a 19 year old, because you live, you grow up a certain way. And then it's like the rug is ripped out from under you.


Elisabeth Poyner  7:35  

It's definitely an adjustment. But I feel like each one has their each kind of perks. Like there's no appropriate time to be diagnosed with type one. But, you know, there's kind of some benefit to when you're younger, where you grow up with it, you're kind of used to it, and then and then there's benefits to when you're an adult, because you can kind of take it on by yourself and, you know, be your own advocate. So I guess either way, it's a bit different.


Paige 7:59  

Either way there's a lot a lot to learn.


Elisabeth Poyner  8:02  

Yeah. So is that how you kind of got into the health care field because of your dad, I'm assuming? 


Paige 8:09  

Mm hmm. Yeah. Well, it was more so. I kind of at one point, I think in high school, I went through a lot of things I wanted to be I think I wanted I randomly for like a day that I wanted to be an accountant because I got like an A on a math test or something. But I then I wanted to be like in women's health, like OBGYN and, and then I wanted to be a dietitian, and I got my undergraduate in HNFe, the human nutrition, foods and exercise. And a lot of people at Virginia Tech that was kind of the health sciences, pre-health professions major too. So I thought I just had some options with it, but I wasn't really sure. Going into it that I wanted to do like Endo, you know, PA, um, it wasn't until I kind of, you know, I didn't really want a lot, a lot to do with my diabetes at one point because I like I didn't want to go to the camps. I didn't want to like talk to other diabetics, like I was just very, it was, at that time in high school, when I was kind of not wanting to really associate with the disease. I wanted to, like, do everything like a normal, quote, unquote, you know, like, I just wanted to not have to be anything different. But then in college, I think it changed when I started getting really into fitness and I was having a little bit of trouble managing my sugars and I was like, starting to take ownership of it. And I was like, Okay, well, why are certain exercises causing high blood sugars? Why are certain ones causing low blood sugars? And I started, I actually joined a couple of Facebook groups and I noticed, I was just seeing these people were sharing different experiences that they had and I felt like oh my gosh, they get it. And it was like the first like clicked. I was like, whoa, like, I think I do want to work with other people with diabetes because they actually get it. And then that was when I was kind of taking the prerequisites for PA school and ended up um going to PA school. And when I was there, I had pretty much already decided, like, from the beginning of PA school, that endocrinology was what I wanted to do. So I was we went through our other units, and they were interesting. Like, we would go through ortho and GI and everything, but I think I definitely people knew like, okay, she wants to go into endo. Like Paige wants to work with diabetics. So by that time, after undergraduate, it was pretty set that that was what I wanted to do. But it definitely wasn't, like a, like a pretty journey with diabetes in the teen years. I was, I didn't, I would have never thought that I would have a profession working with diabetics. Not to [...]


Elisabeth Poyner  10:55  

No, it is that just because of like how your relationship with diabetes was? Or like the management aspect? Like where, what, what makes you say that?


Paige 11:02  

I used to hate going to endo appointments. Like I would cry. And it wasn't, it wasn't my endo itself, it was just the fact of like, I just felt like it was like my progress report and I'm just gonna be told something I was doing wrong and something I needed to be better at. And it was just really, as someone who was very driven by like, achievement and words of like, affirmation, like, sometimes it was just like a lot. And I don't think I really wanted to do that. Unless some at some point, there was kind of a shift where I was like, you know, I could, I could do this differently. And I could relate with people and like, they could have that. Okay, you get it. Like, [...] kind of thing. So.


Elisabeth Poyner  11:56  

Yeah, I think that's such a cool, like empowering feeling. When you're like, wait, I get to change how things are done. Because I mean, how many growing up, how many of your endocrinologist were actually diabetic? 


Paige 12:07  



Elisabeth Poyner  12:08  

None, exactly.


Paige 12:10  

I don't think that it's, it's very common at all.


Elisabeth Poyner  12:13  

Yeah, I don't think I've ever. Nope, never had one. I mean, I've only been diagnosed since I was 19. But still, like it would have made such a difference to have somebody to be like, hey, yeah, I get that. Like, you're not gonna remember why your blood sugar was 300 3 weeks ago, like at 3am. You know?


Paige 12:30  

Yeah, absolutely. And it's, it's um, that's one thing that I have that was that exact thing is something I used to get so frustrated about growing up, I was like, I don't know, like, I was just living my life. I'm not sure why my blood sugar's doing a certain thing. But that's one thing that I've kind of taken into practice now is like, I that's one question I don't think I ever asked is like, what were you doing on September 17? At literally, yeah.


Elisabeth Poyner  13:03  

Yeah, the most frustrating question.


Paige 13:05  

Yeah, it's and it's not black and white. It's not. There's, if you're looking at someone's blood sugars and even if you see a trend on that download of the past two weeks, it, there are hidden things happening, too, that you only know if you're, you only think to ask I think if you're living with it, like if you see a bunch of numbers that are in range, when someone is waking up, a lot of people wouldn't think to ask like, but sometimes I'll be like, okay, like, are these actually in range? Or are you eating a snack before bed to prevent, you know, or having to put more work on yourself to make these readings in range? And um I think there's there's a lot that that has been really helpful just living with the disease and having it.


Elisabeth Poyner  13:55  

Yeah, can you kind of speak on so I mean, obviously, you're in a unique, it, you're in a unique position being that you are a patient, and you're also a provider, so you got to kind of sit in both seats. And I'm sure that, in both ways, they allow you do each job better. So I'm sure that being a provider allows you to be a better patient, being a patient allows you to be a better provider. Can you kind of speak on like how those, how each role kind of influences each other, you know, aside from just being diabetic, but for being in the in the field?


Paige 14:28  

Mhm yeah. I know, that's I really like that question. Thank you for asking it. I was like, Oh, yeah. I think the first thing I was thinking was, it has made me being a provider in that seat has made me a lot more grateful for the uh technology and just the access that that I happen to have with the health insurance that I happen to have. I think that being in the provider seat has really opened my eyes to a lot of unfairness and um just, it's just frustrating, you know? That the health insurance can dictate what technology you have access, a patient has access to, or what insulin the patient has access to. And a lot of that is, we, like I've tried as a provider to write letters to insurances. And sometimes, it's just or if insurance doesn't want to pay for the Dexcom, we'll try the Libre instead. And sometimes that works, sometimes it doesn't. And we, we go through all these things and try different things. But it definitely, I think, looking back at myself as a patient before I was a provider, it's something that I think I took for granted a little bit, and I just kind of, you know, I didn't really want to, like I wasn't necessarily as thankful for like insulin as I am, or, you know, if I have a high blood sugar, sometimes it reminds me of like, wow, like, this, this would happen to me, if I didn't have insulin, like, it would just be like this all the time. And I would feel like this. So yeah, it definitely opened my eyes to that, um, um, a couple other things. Like, I think that being a person with diabetes, I can better relate to my patients kind of, like we were talking about. And I think that has strengthened the relationships there. Just because we know like, we the little thing, like just the little relatable things like the feeling like you're going to just you want to eat like, an entire refrigerator of food when you have a low blood sugar or, you know, just like the things that they're like, yeah, like, I do feel like that, like, or I get really hangry you know, anxious. Yeah. So, um, that I think, is like, it just, it's like, it's just like, when you meet someone else with diabetes, it's just that connection that other people don't understand. Yeah. Yeah, that has been really rewarding to build those relationships. I think, I think from a, from a provider, I've learned that there's, there's a lot that goes on, like, with the insurance, like the paperwork and stuff that um like, sometimes if me as a patient, I'm like, waiting on my Dexcom, or, you know, if you're waiting on a prescription, and the pharmacy is like, well, we're waiting on your doctor. Or they're like, we're waiting on you know. And I'm like


Elisabeth Poyner  17:28  

That's the worst thing to hear. 


Paige 17:29  

Yeah, yeah. And like, I used to be like, well, what's taking her so long? So but but on the other end of it, there's so like, broken I think communication somewhat with like, the fax world, I think that sometimes faxes like get lost and then I don't know that edgepark is waiting on me to sign. But nobody knows that I didn't get it until something goes wrong. And somebody calls right. I think you're waiting on it. Yeah. So I think it's made me more more like, I don't get it. I don't get like angry at my endo or anything. Just because I know that like, there's probably so much going on that just behind the desk, you know, or behind. Yeah, and all the all the fax stuff that happens. But yeah, there's a lot of there's a lot like when we get a especially like for the CGMs and the pumps, there's a paper and it has to you have to check all these little things about like, like their last visit and their last A1C. I'm like why do they need to know their A1C? Like, you know, I mean, it's, I guess they're trying to see, make sure you're up to date on getting your labs and having your visits in order to get the supplies, but just all of those little things, but then it's like, sometimes they won't ship out the pump supplies if the patient had like, say they had COVID and we had to do their visit over telehealth. And they didn't get A1C yet because but we looked at their continuous glucose monitor remotely, but then on that piece of paper, maybe they don't accept it because there's not an A1C. An actual report. Yeah, yeah. So then, um, then we're like calling because we're like this patient is a type one they need, they need something they either need their pump supplies or they need we need to prescribe them some some backup insulin or something. 


Elisabeth Poyner  19:29  

Yeah and it is really I think it's awesome that you have both perspectives because even on the side of like, meditation and and devices and technology, I think from a provider perspective, if you're not diabetic, it can be really easy to just say like to inter interchange them and not really give the the patient choice. You know what I'm saying? So, when insurance does make that call of oh, hey, you're, you're insured for Humalog over Novolog. This happened to me personally a few years ago. Humalog just doesn't work for me. And from a provider standpoint it like, you know, it's logistically like, well, they should work the same but me knowing my body and trying it, I'm like it doesn't work the same.


Paige 20:12  

I feel like that too. Sometimes I feel like Humalog makes it mine. It takes longer or something.


Elisabeth Poyner  20:17  

Yeah, I was constantly spiking to 300 and my, like, my endo was like, well, they should do the same thing but like, no, but I know my body and I know what it's doing. And you can see it in my my Dexcom reports, but you like so you having having type one and being on both sides of the of the desk, let's just say like, you can advocate in that way too of saying like, no, like the pump choice does matter. Medication choice does matter. And you can kind of make more of a judgment in in respect to the patient, which I think is really cool.


Paige 20:51  

Yeah, thank you. I know I think it is crazy how they're not, they're not all the same like with with the insulins. And have you ever tried those really fast Ultra rapid ones like fiasp and 


Elisabeth Poyner  21:05  

Yeah, I didn't like it. 


Paige 21:07  

A lot of people talk about it burning. The citrate in it is kind of acidic. So in this study, 3% of the patients had some burning at the infusion site. And I think the citrate is supposed to make it absorb faster to reduce the spikes but um I have not tried that one. I tried fiasp and I really liked it but insurance was having a hard time trying to because they were like well you didn't fail novolog and I was like [...]


Elisabeth Poyner  21:37  

Yeah, like well, I've mastered novolog. I know how it works. So I can work with it. Yeah, I didn't really like I don't know I tried Fiasp in my pump a little bit and it almost worked too fast. Where it messed up my basals s a bit so my endo is like we can try and fight for this. But I'm like, honestly, like, I'm just so used to Novolog that I'll, I'll work with it. It's fine.


Paige 21:58  

Yeah, that's what I said. They're both, they both work just fine. You just have to manipulate, like, maybe your behaviors with them, I guess, you know,


Elisabeth Poyner  22:06  

Mhm, right. And at some point, like you kind of know your behaviors and you've kind of mastered them. So it's like, why change? Why, why change what ain't broken? Yeah, why fix what ain't broke. That one.


Paige 22:18  

Exactly, exactly. So, yeah, I don't I a lot of people like those ultra rapid acting ones. Especially I feel like if they're people who, like I have a patient who's in OR nurse and she's always on her feet, so she doesn't always have time to like, give her bolus 15 Like sometimes she's just scarfing down like a really quick lunch. So those, those ones sometimes that works well for her because she can just like give her insulin and then eat right away.


Elisabeth Poyner  22:44  

Oh, yeah, for sure. So you had mentioned that you had also so you taught group fitness classes, you um you either got your personal training certification, or you're studying? I can't remember which one. Sorry.


Paige 22:45  

Yeah, no, for personal training, there was actually a course in college that was like my PE elective. So we did a course, and then we took the ACE exam at the end.


Elisabeth Poyner  23:06  

Yeah. Awesome. Okay, I got mine through ACE too. Um and you had, you know, studying nutrition. So what I have found from my personal experience with my health care providers is that usually they don't have too much of a nutritional background, they don't really take too many classes on it. They don't really they know the basics of exercise, but they don't really understand the, you know, the differences between anaerobic and aerobic, and the different impacts. So how do you feel that these kind of extra holistic, like, basically a more holistic lens, and more all encompassing focus has helped you in your, both your personal management and you know, you seeing patients?


Paige 23:46  

Mhm. Yeah, no, that's, that's huge. I think that like, like you I think you posted on like your V02 Max, I loved all those posts with like, the different heart rate zones and how it's affecting your blood sugar. And if you have delayed hyperglycemia, after you work out, it depends on where you ate in relation to your workout. And a lot of this stuff is because diabetes, when you think about it, it's it's a disease about metabolism and glucose, and the glucose rises, once we digest our food and exercise is also with metabolism. So you would think that I think that would be something that at least and I don't know what in med school, they study as far as Nutrition and Metabolism, but I know that in my schooling in PA school, it wasn't it definitely was kind of not as in depth is I think that if you want to really take like a root cause approach and kind of get to the nitty gritty of some of these diabetes behaviors. You do need to kind of um do a little bit more research as as a provider on your own about some of that stuff because it is, or do like if you're interested in that kind of stuff, do continuing education about exercise science and metabolism and stuff. But it has really changed the way that I manage my diabetes, because a lot of times when we see a high blood sugar, it's not just the carbs or the carb ratio. And I think that when, if you're, if you were to just look at a Dexcom download, and sometimes I'll do that. I'll ask people to download their Dexcom in two weeks after we make a change. But sometimes when you're just looking at the download, and you see these spikes, if I'm not looking at like the Omnipod download next to it, and you can't see like, oh, well the lows are from the stacking, like or if you know that one is stacking on top of on top of itself. So if you were to just look at a graph and see that someone's having lows, you might think like, oh, let me just soften their carb ratios. So they're not having lows after meals. And that's what I think a lot of a lot of people do. But if you really, really look, it's because we actually need to strengthen the carb ratio, because they're having to give so many corrections over top of each other, and that's stacking and causing the lows. So and I think that the exercise component too, the different types of exercise, there's just, there's no way that we can program someone's pump settings to just be like, perfect, because our lives are going to be different every day. Like if you're going to be doing a lot of moving around one day, you as the patient or me as the patient need to know how to kind of manipulate our own stuff. And I think that you're not if if a provider is only never wanting you to manipulate your stuff, in any certain circumstance, that that's kind of I think that you really you should because circumstances change like yeah, not every day is gonna be like, that day four days ago on your Dexcom, where everything is in range. And you have to just repeat that day over and over again. 


Elisabeth Poyner  27:21  

Right? Yeah.


Paige 27:22  

Yeah. But it's, um, I and I think with the foods too, with the with the knowledge of carbs and fiber and just how the different foods are metabolized from from my undergrad I think that has helped with teaching about bolus timing, because I mean you know, they're like, if we bolus for 15 grams of like, avocado toast versus 15 grams of cereal is going to be way different.


Elisabeth Poyner  27:50  

No different. Yeah. Yeah. 


Paige 27:53  

Or even 15. I mean, even if both of them are quick carbs. Like Sour Patch Kids and grapes. They're both 15 grams. But there I think that our body just processes like the processed foods a little bit differently is [...]


Elisabeth Poyner  28:07  

Oh, yeah, same like I can have. It's so interesting. Even just the difference between like, if I treat a low with soda, versus if I treat it with like a whole juice I'm like, Oh my gosh, I spike so much faster from the sode. I call i i find their high fructose corn syrup. It's like sugar on steroids. And like, Yeah, I'll go up to 300


Paige 28:26  

Yeah, I know it is. It's crazy. And, and reflecting on that kind of stuff is is huge. Because those are the patients I think that are successful are the ones that know like their body because I I don't like I know my body. But I don't know how one person responds to Sour Patch Kids or something. Or I had some people who were like I ate one bite of bread and my sugar. I just feel like I just can't eat bread. And I'm like, like, I can. I think you can eat bread, you might just need to,


Elisabeth Poyner  28:59  

You might need to adjust some things. Yeah,


Paige 29:01  

Yeah Yeah. Adjust the way you're doing your insulin or something. But yeah, so. And that's, that's another thing that I still see today is when I have a new patient, they will think that like when I go over a dietary record or initial visit, they're like, Oh, well, I know. I know. I should be staying away from x like and I was like, don't like there. A lot of people still think that they can't have carbs and they can't have potatoes. They can't have rice and it's it's very heartbreaking to me. [...]


Elisabeth Poyner  29:37  

Oh my gosh, I know I'm like, I will eat like 200 carbs a day. I told my my endo that last time and she was like, What?? I'm like yup. I'm like I I  aim for.. Oh, it was so funny in my recap, or like my summary for my appointment. I told her during the appointment that you know, I aim for 1800 calories a day just kind of based on my diet, what I've been working on with my my own personal fitness goals, and in this session notes she's like, continue on your 1800 Calorie low carb diet like No, no, no, I never said low carb. You didn't hear me there.


Paige 30:13  

Yeah, yeah, I know, I really think that because it's not, it's, I've had times where, because I've tried really high carb, like I've tried high carb. And I've tried low carb. And the interesting thing for me is, whenever I've like switched it, and just kind of kind of made my body adapt to something new, my insulin sensitivity was like, you know, I just kind of, I don't know if my body was getting used to being a certain way. But I do feel like having tried the different things. For me, my insulin sensitivity is better with more like moderate to higher carb. And um when I do low carb, I feel like my carb ratios, I have to strengthen them a lot when I'm eating higher fat, lower carb.


Elisabeth Poyner  30:58  

Yeah, I agree. I've tried a lot of different ones. And, I mean, obviously, it's about personal preference. And I'm sure you advocate for your patients in the same way. But no, I love that you have that background information, you have the additional like those additional resources to pull from because, you know, our physicians can just pull from like the ADA website or whatever other resources that you have, like the different studies, but there it's not enough just to have the different numbers and the the roundabouts to pull from and like, Oh, if you're going to work out just reduce your basal by X percent. Like there are different intensities or different impacts, like there's so many different things that determine the blood sugar outcome that you cannot just simplify it and, you know, generalize it to one number, you know, at least I find it really hard to.


Paige 31:46  

Yeah, I always always was under the impression growing up the exercise caused low blood sugar. And I thought I was like I thought there's something wrong with me when I was having high blood sugars when I was doing weight training, or HIIT exercise and it's just it's like you said, the more you educate yourself or just learn through conversation or learning for from what's effective for other people about all these different nuanced things that affect our blood sugar's the more, you're going to start to be like a student to kind of have your own body and see kind of what things are causing you to go high or go low. And, yeah, people don't need 20% Like some people need like 50% less for exercising, some people need more, and it's just there's so many different things that go into it.


Elisabeth Poyner  32:39  

Yeah, that's why I feel like it's so important to have that education not only from you, but then giving it to your to your patients because like you said, you get to be the student and if you can encourage your patients to be the, you know, have to have more ownership over their bodies, I just think it gives them so much more of an empowering relationship with diabetes. And it takes less of that reliance on on you. I think um I was doing some, I need to remember the exact resource and I'll put it in the show notes but there was a a piece of data that had said about I believe is about 43% of patients rely on their p on their physicians for like adjustments to be made you know, just for interventions, like they won't make any interventions or adjustments unless they see their endo first and I'm looking at like my management and I'm like I'll make a change every other week if I have to. 


Paige 33:31  

I love when my patients make changes, I mean not just not like whoa like like a change that they have noticed a trend and they I've you know they're educated on how to kind of what to adjust there, um I think it because either either I recommend they either yeah make the changes in between the visits or if they need some help with making the changes then call me or message me that says I'm noticing this is always happening, can I do this or what do you think I should do? But definitely don't wait until your quarterly visit and then we have this thing happening all the time that um the the you know, but sometimes I don't think we are and I know this from personal experience too I don't if I'm not reflecting on things that I'm that are happening in my blood sugars, it's easy to we were busy and we all you know we have busy lives so if we have a high blood sugar most of the time we just kind of correct it and keep on rolling and but if we are either like if if some people like to look at their their downloads each week, you know at their home computer or even simpler or like all like write a note on my phone if I notice that I'm having a high blood sugar like I'll put like, Okay, sweet potato. You put 33 carbs and that didn't work. And because like there there are some, I don't know if you noticed that too, like, there are foods that like when you look up how many carbs it is like, yeah, like Starbucks one time said that this vanilla bean powder was 25 carbs. And I got one scoop of it in my like, coffee, and um the shaken espresso thing, and I was like, I'm entering like 10. Yeah. And then [...]


Elisabeth Poyner  35:20  

like a stretch, yeah, yeah, yeah. So alright, so just the the conversation of kind of identifying different trends, looking at different factors, that kind of brings us more into that like, holistic, functional approach. And, in speaking, we had kind of mentioned that you're looking into studying more of the functional medicine approach through, you know, additional courses. So what led you to want to learn more about that approach? And like, what do you hope to do with more of that education?


Paige 35:52  

Yeah, so I think that, um, initially, what led me to wanting to take this kind of root cause approach was the fact that the endo visits, this is something that we're talking about that I learned on the provider side, is that check in I almost the way that I think the healthcare system has it with the the amount of patients that need to be seen. Those visits are pretty short for a lot of practices. So they really are like, check ins. And I think that the endo is looking at everything as a whole as far as preventing complications, managing existing complications, and kind of giving, like some tips, but a lot of it is like, we're making sure have they had the annual labs? Is everything okay? If something's abnormal, can we address it? Do we refer out? Is, you know, yeah, are they are they getting all their prescriptions, all their supplies? Is everything pretty much good to go for them? But it's not. And this is kind of what I had, I thought that it would be a little bit more like, into like, the day to day management, but it's definitely a more I'm checking in, like, just looking at the picture as a whole, like, how is their, like, their control? I guess? And like, what questions do they have? But I think that a quick check in once a quarter, you know, for for 15 or 20 minutes, is not like, going to get to a lot of the root causes of these things. And that was what was has really been like, like, like the like, I just feel like I want to help with with those things. And I think with functional medicine, when we think about functional medicine, we think about like root cause of a lot of things. And I have even like, I have a couple patients, thyroid patients, and they will ask me, what's the best diet for people with thyroid disease? And I'm kind of like, you know, honestly, we didn't really learn about that in my school. So it's kind of out of my my scope, but I can refer you to registered dietitian or, but what I really would like to learn more about is, yeah, like, what are the best diets for people with certain diseases that need need medication? It's not to say that we can replace, yeah, like we can't replace insulin with you know, anything like we need it. But what are some, I think, I think diabetes is in a different category a little bit than a lot of diseases that we can like, like with certain GI diseases we can improve with like, like sometimes like like licorice tea, or like help if I have like a stomachache or something, you know, like things like that. But with diabetes, because we're on insulin, well how can we look at other lifestyle factors? And if you are like, like I noticed, like, I've had, after a week of getting nine hours of sleep, versus a week of getting six hours of sleep, my sugars are so much like I'm way more insulin sensitive and I don't have spikes or anything. And I think that if we're getting patients to be able to reflect on all of these other lifestyle factors, knowing their body and their trends, like in females, like your menstrual cycle, like what's going on with your blood sugars before and during and if people are seeing how these different things affect their blood sugars, they're going to be the ones that are self managing their diabetes and it can truly be what the system has set it up to be with the endos as a check in once every couple months for a quick tip, but it's it's tough because that was something that was like really like tugging at my heartstrings, because I really want to be able to, like, go into all these different things. But on that two week or four week download at the visit, I kind of I want to be like, well, how was your sleep? You know, those days. Because they were so good. You're so and they're like, I don't really remember like.


Elisabeth Poyner  40:19  

RIght. Yeah. Yeah.


Paige 40:20  

And so, yeah, it's, I think that there is just this gap for sure with um with all the things that are affecting our sugars between the visits, our digestion, our sleep, our, our hormones, our um stress, our exercising, and um if I was able to check in with my patients on a weekly, you know, like, we do the check ins and like their check in days, Tuesday, by Tuesday at noon, submit, you know, your little check in document. And if they're just getting tips, you know, every week, I think that a system like that might be make for better outcomes.


Elisabeth Poyner  41:04  

Absolutely. Yeah, I love that so much. And like, I mean, to your point, you know, no, we can't get off of insulin, but there's ways that we can utilize it more to our advantage, like we can, you know, increase our insulin sensitivity or just understand insulin timing with like you were saying your metabolism and digestion. Or even one thing that I didn't acknowledge until I started taking more of a holistic route was I also have Crohn's disease. So how does the inflammation in my body affect my my blood sugars? And how has it affected my A1C and my day-to-day? I am so much more resistant when I am going through a flare or when my inflammation is higher. And that's something I never would have even addressed if I didn't get curious about it. So yeah, I love that you're kind of bringing these points to your to your patients, because I've never had a doctor that asked those questions. So if you're kind of like, encouraging them to get curious, it can only help them in between those three months.


Paige 42:04  

Yeah, I think a lot of people think that it's gonna put more work on them, it's going to make it harder if I'm asking them to analyze, like, just take note of their trends and count carbs a little bit more meticulously for two weeks just to see if you're noticing any patterns. Or because because it seems like it's more work, but it ends up in the long run being less work if you know your body and you're not chasing a roller coaster of blood sugars when you're, you're when you're at, you know, the beach or the waterpark, and if you know how to approach those situations, that actually makes it less work on you, but it's just more kind of it's just more becoming more aware, you know, I think of it as like we, we, we look at our checking account, like we if we if we don't keep an eye on our checking account, then it can kind of get a little crazy, like, I think you check in with ourselves in our diabetes.


Elisabeth Poyner  43:07  

Yeah. Yeah, I love that, like check, check your blood sugars like you check your bank account. I love it. Yeah, and that's kind of what we do. So like inside of our program personally Keeping it 100, that's exactly what we do to like, we have a 10 week time period where yeah you're putting a little bit of extra attention to your blood sugars, but that's there to help you in the long run. Because if you can, like establish your baseline behaviors, establish your baseline blood sugars, and like that management part of it, when things change, you know what to do, like, you know, like, it's so much, it doesn't have that snowball effect of like, okay, my basals are off, and then my meals are off. And then now the seasons are changing, and my sleep habits are changing, you know, everything's a mess. It's like you kind of iron out each thing. So that it, you can get down to it later. Like when things change, you can iron it out then and make it a lot less messy.


Paige 44:01  

Right. It's like you're not having to be reliant on your Endo. It's, I mean, it's even it's like with with parents, so when they're raising kids like they, they want their kid to become self sufficient on their own, they want to guide them and teach them. It's kind of like that's really how it should be with endos too, is kind of they should be guiding and teaching them how to change if you change your if your job changes and we can we can provide, you know, guidance, but um like you're the one that has to live with it every day and I live with mine every day and it's different than how that person with diabetes lives with theirs every day. So yeah, yeah, but no, I think that's that's awesome that what you guys are doing and that's what I'm really trying to do is incorporate into like if my ultimate goal with with a practice is going to be incoroporating this kind of functional like coaching and the normal maybe two days a week doing the normal visits with the A1C and the foot exam and but then the other three days of the week, maybe I'm doing check ins and checking in with those same group of patients. And if they don't have a lot to check in about that week, they don't have to, but I just like I had this like vision in my mind of this like, HIPAA compliant app that they can just upload, you know, their, their screenshot of their sugar logs that week. And their. If I had a thing that's asking them, you know, all the check in questions like, how was your digestion? Your water intake? Your sleep? All this stuff. And if they're noticing, like, Oh, my sleep was crap, and I reached for a lot of processed foods and my shoulders were like, crazy, then this is my one goal for the week, more sleep, more natural foods, and then they see the change, I think that their brain is gonna like, I think that we just make more of those connections that way. Yeah, change rather than a doctor a couple times a year being like, eat better and sleep more. 


Elisabeth Poyner  46:09  

Literally, like eat more whole foods like okay, that's so that's so vague. [both speaking] Yeah, I love that though. Because I feel like that's removing a lot of the communication barrier, because like one of the things that like, at least stood in my way of like, okay, like, my doctor wants me to run a basal test. Alright, well, first of all, there's no accountability there, because who's gonna check in with me? three, like before the three month visit? And then two like, what do I do with that information? Like, now I have to reach back out to my endo, I have to make the phone call, hope that they're there, hope that like I can get in touch with them. And like, that whole communication barrier just made it so much less appealing to actually go through the process. So I love that idea.


Paige 46:50  

Yeah, so that's, I think that is how I would imagine functional medicine integrated with type one, coz it's not, you know, it's not really like, like you said, like, we should be able to eat the foods in the diet, that that are best for us and that we enjoy. And but I think it's more of when it comes to like the management of how we cover those foods or how we you know, we react or prevent lows and highs for certain situations. um I think that just taking I think holistic is holistic, in a sense, with type one is, is taken into account, like the lifestyle factors that we don't often do in a traditional healthcare setting, because we're, we're so doing a lot about what the pharmacology in the setting.


Elisabeth Poyner  47:43  

Right. Oh I love that. Like, I love that insight so much. And it's just so important that it start like it's, it's has to start from somewhere. And like, yes, we can do it from a patient perspective. But the fact that you're, you are bringing the snowball effect from the healthcare side of things, I just think it's so important. So if somebody let's say, anybody listening, or your patients or whoever, whoever you're talking to, if they want to, like investigate more of that functional or holistic approach, like, where do you send them to start learning about that stuff? Like, what resources do you give them? What do you encourage them to educate themselves on?


Paige 48:21  

Yeah, yeah. So I think the first thing if somebody does want to take that root cause approach with their diabetes, the first thing would be kinda like we talked about being a student of your diabetes. So if you are noticing a trend, put a note in your phone. Like if I'm having a low blood sugar, if it happens in the moment, while I'm treating it, I will write down on my phone like okay, 11am on Monday, I had a low and this is the kind of exercise I did that morning. And then if it happens again on Wednesday, okay, writing in my foot 11:15 had a low this is the kind of workout I did. And to me, it is a trend quote unquote, if it's happening more than half the time So majority of the time it's happening three days a week, four days a week, it's it's pretty significant. So there's something that needs to change, whether it's the settings or how we're handling that particular exercise that morning and um I think that's the first thing is noticing those trends. Noticing how are your sugar's when you're the week before your cycle versus the week of your cycle. And seeing how things, different things work for your body. So trying out different kinds of exercise you know, try do an experiment, you know, take a yoga class or do some yoga in your house and check your sugar before and check your sugar after and see how that affects you know, reducing the stress affects your blood sugars and just trial and error with with everything. And um if you need um more help with learning more about how all these other factors are influencing your blood sugar's I think that online like if you're following like, you know credible sources in the diabetes community and and just seeing kind of what anecdotally is working for some people because I mean you start to see trends that way people are posting like oh I, I was in the car all day on a road trip and I was really sedentary and my sugars were running high all day and the next time you're in the car, you're like, Oh, my sugars are running high all day when I'm in the car. And I just think that there's something to be said about that community. I don't think that I ever would have the diabetes management for myself that I have now if I hadn't, like joined those those groups on Facebook, you know, a couple years ago and just kind of started trying to follow credible accounts. And I think that just seeking out more like and there they have articles like if you go if you do like a Google Scholar or like PubMed search and you search like exercise and hyperglycemia because you know, you can find some some studies too that way. And if you want to learn a little bit more yourself about like the why behind things like my patient, one time she was having, she was having this delayed high blood sugar after her exercising her exercise was walking. So if you're a surface level, you would think like, oh, like walking, that'll cause a low but like, maybe not, like what if she so she found out that whenever she walks her cat, her blood sugars are fine after dinner, but she always does her walk after dinner. But whenever she's not walking her cat, she's going she's booking it and her she gets this delayed spike and who is I mean, yeah, and then you you know, I do this search on, on, I think Google Scholar, I think anyone you know, I think those things anyone can can search. And, you know, I found out about, oh, well, your body is at these intense heart rate levels, your body is shunting all the energy to the working muscles. And it's not really focusing on digestion. So when you're done your workout, your body starts digesting your dinner that you just ate. So those things are Yeah, I mean, that's not something that I learned in school, that was just something that just be be curious, I think would be a good thing for people. If you if you're noticing, like why something happening, just make sure that your your sources are okay, and just do some research and


Elisabeth Poyner  52:52  

I love it. yeah, yeah, yeah. Like, the more questions you can ask, the more answers that you're going to get. And it really just comes down to asking the right questions. And the only way to know if they're the right questions is to get curious and, and, you know, just kind of sort through the thought process. So, oh, I love that so much. So you are on Instagram yourself. And you give a lot of, you give a lot of really great advice for the community and, and post a lot. So where where can everybody find you? What will they learn from you? Um yeah.


Paige  53:23  

Thank you. I am on Instagram, it's paige_t1d_fitness. And I definitely started it off as uh lot of because I get so enthusiastic about fitness and diabetes, because that was what initially got me into endocrinology. And because I love how the two intertwine. But it's kind of morphed a lot into more so diabetes and more this holistic that we're talking about, like how these other factors are affecting our diabetes, and just diabetes management as a whole thing. 


Elisabeth Poyner  54:01  

I will put all that information in the show notes. But thank you so much for joining us and talking about your unique perspective of seeing both sides as a type one, so we really appreciate you coming on.


Paige  54:11  

Yeah, thank you so much for having me. I really enjoyed this conversation and just sharing my experience and hearing your experiences. And um I think that that is how change happens, you know, for the systems is just by talking about our experiences as patients.


Elisabeth Poyner  54:30  

Yeah. Absolutely. 100%


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