Podcast 173: Busting Myths about Blood Sugars and Diabetes

Rebecca Scritchfield, RDN: 0:02

This episode is brought to you by self care for diabetes, a virtual online program that's doing diabetes care differently.

Glenys Oyston, RDN: 0:09

We don't tell you to lose weight. Instead, we help you create positive and meaningful changes that make your life with diabetes better than before. Visit self-care for diabetes.com to learn more,

Rebecca Scritchfield, RDN: 0:21

Hey, Glenys, what's going on?

Glenys Oyston, RDN: 0:23

Hey, Rebecca, I am so excited to be here with you again.

Rebecca Scritchfield, RDN: 0:27

Yes. And I'm excited to talk about blood sugars.

Glenys Oyston, RDN: 0:30

Yes. Yes, we want to talk about blood sugars and diabetes today, because it's just such a big place of confusion for people. And I'm excited to help but I know you are too.

Rebecca Scritchfield, RDN: 0:42

Yeah. Yeah. I mean, anytime we could, like, bring back freedom to ice cream and desserts, and the dreaded sugar, and yes, you know, we want to be aware of eating patterns, etc. But it's this idea. It's almost like if you look at a dessert, and you have diabetes, that you're just toast, and it's it causes a lot of stress and anxiety for people, the more live chats we do with our group members, for self care for diabetes, it's really clear, especially early on in diabetes diagnosis that understanding blood sugars and checking them what to do when or even, you know, deciding not to check them cutting back making a different plan. It's just such a significant source of anxiety. And it really does not have to be.

Glenys Oyston, RDN: 1:29

Right, it's checking blood sugar's we want it to be a tool for people to help them help them manage their diabetes. And I think what's happening is people are just getting super stressed out, it's leading to that shame spiral, and then they just become paralyzed. And then it's sort of like, I can't do anything, and it's not helpful. So I thought we could share some of the most common myths and facts about blood sugars. But first, let's start with clearing up the connection between blood sugars and diabetes. And, and like why we're checking and, and what's going on. So so I think would be helpful. Maybe if we talk about what happens to your blood sugar's with diabetes, where people are sort of new to this. Sure. And, and why, why we want to know what's going on with them. So so in somebody without diabetes, your cells just take in the sugar that comes in through food, primarily carbohydrate. And it, you know, goes through that, I'm thinking back to our dietetic education days to learn the terrible, like

Rebecca Scritchfield, RDN: 2:33

way back!

Glenys Oyston, RDN: 2:35

Now, I've all forgotten how to draw reactions, but basically that glucose goes through a little pathway, and it eventually produces energy for your body. So basically, what happens is somebody without diabetes, your your blood sugars go through that, that glycolysis cycle that, you know, we had to learn about and memorize and have since forgotten, but basically, in our dietetic days, school days, and it basically goes through and produces energy for your body to use and for your muscles to use. And for you know, everything to happen in your body, you need energy, and it comes primarily from the carbohydrates and the, the glucose that your body extracts from those carbohydrates. And normally, there's no problem somebody without diabetes, to just use the sugar that they need, whatever it is not used, get stored for later use. And then in somebody with diabetes, what happens is the cells become a little bit resistant to the insulin that takes the glucose in or helps the glucose to get in sort of a lock and key analysis that people like to use look don't know that it's perfectly analogy. In somebody with diabetes, what happens is the glucose has a hard time getting into the cells. So the cells become a little bit resistant to the insulin that helps the glucose get into the cells. And then that sugar just starts wandering around in your bloodstream. And that's where it starts to cause some problems. And so that's what taking your blood sugar helps you determine how much blood sugar is wandering around in your bloodstream. And what happens is, if too much is there over a long term, that sugar can start to do damage to those little tiny vessels, you know, at the sort of in fingers and toes and feet and kidneys and that kind of thing. So that's why those things become a little bit at risk with with constantly high blood sugar, and so that's what happens over time. And so check your blood sugars after that very complicated sort of description of what I you know what I've just said, here is that I'm taking your blood sugar is going to help you determine if you've got just a little too much blood sugar wandering around. And that's what's going to help you manage your care and make decisions about self care and eating and exercise and what needs to happen in your life. Or medications come in and help take care of that blood sugar and help it get it into the cells.

Rebecca Scritchfield, RDN: 5:24

That's a really great explanation, it brings me to the first myth that I would like you to help, you know, to boss and, you know, I think it's this idea that there's even without taking the blood sugar reading, there's that fear of what's it going to be I know, it's going to be high, you know, so somebody wakes up and has breakfast, and it's a egg and cheese bagel with some fruit or something like that, you know, maybe it's a yogurt parfait with granola or something, you know, but just like, gets up, has breakfast, you need morning energy, right? But it's like, oh, my gosh, what should I eat? to not have a high reading? What can I eat? It's almost in this fear anxiety of what's safe or not safe and say no matter what, you know, they go ahead and they do the the reading, you know, the postprandial reading or, you know, I guess we could come up with really any scenario where they finally work it up to do the reading, and it looks high. You know, I was like, Oh, my gosh, it's high. This is a high blood sugar reading and having this is bad. Right. So it's really this context of they decided to check they got a high reading and that next, it's almost like my fear came true. And this is bad, almost like it's a catastrophizing. And, yeah, I just think blanketly there's this belief that, oh, if I get a high reading, it's bad. And I wondered if you could sort of help address that, that for us? I mean, is this true that having a high blood sugar reading is bad?

Glenys Oyston, RDN: 6:58

Right. I think the problem is we're looking at one data point. And, you know, it's not enough information to say whether your diabetes is being well controlled, or if it needs more help with control, being your blood sugar's need more help with being controlled. And I just don't think one reading one bad reading is enough to give you a lot of good information. It's really just a data point. And I think the thing is, people look at that. And they, they think, well, now for the rest of the day, I have to do something different. And I think it's more useful to take that data point and look back and say, Okay, well, what was going on? How was that meal? For me? What was the meal mix? Like, um, you know, readings are going to vary based on the time of the meal, what's going on with your stress, sleep, movement, all of that. And so it's just one reading. And people really go into a shame spiral over one bad reading, and then it makes them not want to check again. And I think the way we want to look at that is we really need a bunch of data points before we can see what's going on. We really need to see trends in blood sugar's to know what's going on, rather than that one focusing on that, oh, what's it going to be? What's it going to be so much anxiety before checking, and then so much shame after if it wasn't like what you had hoped or the perfect reading? And instead, I think what's more useful is thinking about it in terms of I'm going to collect some data points. And maybe at this time, I'm not ready to make changes, or maybe I am, but I really need to see more information. And so just one data point is not the place where you want to stop and go into the shame spiral.

Rebecca Scritchfield, RDN: 8:58

Mm hmm. Yeah. Yeah. You know, it's, I think, you know, I mean, even thinking about the idea of the word bad, right? I got a bad reading. It's not that hard to jump from that the reading is bad, too. I am bad. I mean, and now you're in shame. Right. And, you know, we that's why there's a whole module and we had our earlier podcast on that. So we'll make sure that you get that in the notes for today's episode. So if you haven't heard us talk about shame and its role, but you make sure you get that information too. And yeah, I really like what you're talking about. It's almost like a curiosity. Is this helpful to get some trends and patterns? So in, in my example, where I talked about just different breakfasts, right, like, you might see that no matter what you eat in the mornings, that you tend to get this blood sugar reading and it's higher than you would like or you wish it were lower. But in the end, you're eating breakfast, you're eating things you like it's giving you energy, you're enjoying it. And it's almost like even, you know, like, you're just not noticing enough of a difference in your readings, you know that it's not really about the food or food or meal mix changes, like, we've seen that we've seen folks in our group who, who were noticing that like, there was just a difference in having bagels in the morning versus a bagel sandwich at lunch. And it's just a different time of day. And there was nothing else that we could decipher, it really wasn't the bagel was like, what was going on, like with the body and different blood sugars for different times of day. And I remember that person too, also wasn't really getting enough protein. And so when we talked about making adjustments to the meal mix, this idea of adding in which a lot of our participants are like, wait, aren't we always supposed to be cutting back, but the adding in actually also made a difference?

Glenys Oyston, RDN: 10:57

Yeah. And I think the piece that people really forget about is stress level. So I'm thinking of one client who told me, I eat this meal when I'm not working, and it's my sugars are within range, I eat it when I'm working, and they're way above range.

Rebecca Scritchfield, RDN: 11:14

It's your job.

Glenys Oyston, RDN: 11:16

It is, and this person had a very high stress job. And, you know, the truth is, stress is going to make a big difference in your blood sugars. So all of those things are going to come together. And I think people just focus on like, it's just the food, I've done something wrong with the food. And, you know, we want to draw out and have a bigger sort of picture.

Rebecca Scritchfield, RDN: 11:37

Yeah, yeah. Yeah. And we have a lot of modules in our program on food. And I know, we're going to do a podcast chat on it. So we'll be able to get into a lot more detail. And, but generally speaking, if you're thinking about food, you know, food ideas, it's like, if you see it as an experiment and say, Oh, you know, I think I could like it like this. It reminds me of a client who they had family, you know, like Taco Tuesday, right? They always went out and just she was tracking and getting these high readings. And, you know, you know, doing intuitive eating, but also having diabetes concerns, and just came up on her own about what she enjoyed the most, and just had this idea of, I really want to have, you know, chips and salsa as part of the meal. But when we do fajitas, and stuff, I really feel like I could enjoy a lot of the stuff that's on the inside. And like, I just I want to see what it's like if I don't do the tortillas, and again, I was not advising that that was an idea of an experiment. And she just said, yeah, it was it was a difference in the reading. And but the thing is, I enjoyed the food just as much. And so what the person decided was just let me decide what I want to do, you know, on on the taco Tuesdays, like, so it ended up being a flexible approach, like it wasn't never have those tortillas again, right? It was more like I could use this as information. And if I wanted fajitas with tortillas, it's like, I could choose not to check because I can assume that it might be a little bit higher. And that's okay, because of trends. Or I could do it and check. And if it's higher, it's not surprising, I don't need to do anything, you know, out of year, you know, that really isn't in line with self care. So I just think that's another really good example of sort of trying to let yourself know numbers and trends and things but without kind of spilling into sort of a chaotic response, because all that stress alone, and as you said, right, all that stress is going to spike them anyway. Right?

Glenys Oyston, RDN: 13:33

Yeah, absolutely. So what's our second big myth?

Rebecca Scritchfield, RDN: 13:37

Yeah, um, well, I would love for us to address this idea that it's kind of like what do I do first, and it has to do with meds, right? This idea that you have to do diet and exercise right before meds, right? Or even that more flexible term, we're here now, right? lifestyle changes. I mean, whether it's the prescription ads that I catch, or when we hear people who just come from their doctor and their diagnosis, it like it seems to be that this approach or a chat with, a family member, Oh, you've got to make your changes or you know, diet and exercise first. And it's this specific myth that it must come before meds so what would you say to that?

Glenys Oyston, RDN: 14:21

Yeah, this I think that really leans on this idea that you brought diabetes on yourself, and now you alone have to fix it and forget about meds first, right? And really, you need to see if you can fix it, and that is absolutely fine. If somebody wants to go that route, if they think well, you know, I'd like to try the I really hate the word lifestyle changes diet culture, right, but, you know, true lifestyle changes. It may be looking at the meal mix, maybe looking at your overall patterns of eating and not talking about restriction or deprivation. I'm just talking about oh, what's, you know, could I add foods in that could be helpful. And looking at exercise, and I think that's fine if somebody really wants to go that route. And I think sometimes people choose that route out of shame, when you know, if somebody is really grappling with disordered eating, because they were immersed in diet culture for a long time, and that that lifestyle change route isn't going to be that easy initially, because there's still diet mindset going on, there's still, maybe there's overeating as a result of long term restriction, you know, maybe medication is going to give you a little breathing space, to do that work to heal your relationship with eating, and with food. And that's okay, too, to go the medication route. And I think that what I would love to see is that people feel don't feel shame about either, whatever choice is involved, but it really comes out of a sort of a positive spiral up kind of situation where it's like, oh, you know, this is maybe my opportunity to look at, you know, are there ways to take care of myself differently? Or, even while I think I need some help with medication right now, and that's okay. It's just it's that stigma piece around getting diabetes, that really throws a monkey wrench in that decision making, I think, you know, we're just so socialized to believe that, like, our bad habits cause diabetes, and that's just not that's not false. There's, that's a complicated diagnosis and condition to get and it's, it's way beyond, you know, bad habits. eat too much sugar.

Rebecca Scritchfield, RDN: 16:41

Yeah, absolutely. I mean, I'll just speak from my perspective. Like, as a daughter, I've been helping my mom with her diabetes concerns for for well over a decade, and she had an eating disorder history that went undiagnosed for most of her life. And, you know, but when, when, you know, when she first got her diabetes diagnosis, she was on a certain amount of meds that like a certain you know, types of meds and a certain pattern. And we went with that right away. And then we were able to work on stress as anxieties and her mental health and take workable, flexible changes that she could build. And she'd go back in, and they would look at, you know, we think we can experiment with getting rid of this med, and then we keep the habit changes going. And she was able to stop one med because she was getting different highs and lows. And it was like it was it worked for a while, but then it didn't work because things can change. And, and, and we've also seen in our groups with people would talk about that they were experiencing changes to their medications. And you know, they felt good about it. And, and I think that that is a, it's a good and a reasonable thing to so it's, maybe as you're starting out, and you're opening your mind to meds. And again, there's fear about, you know, is this something I'll be taking forever or whatnot, it's, the truth is in the beginning, you don't really know. And so it's remembering that meds work, and they can help you feel better. And meds do also have side effects. And you might not like those side effects. And so I think if you remember that it's your choice what to do first, second, or both at the same time, right? It's about non judgement and stepping outside of shame. And knowing that you always get to choose next steps and that if with time and good mental health support and other really positive things, there becomes really positive medical related reasons to make a change to the med plan. That's a medical adjustment that just went along with where you're at in your diabetes journey. And I would say the other aspect goes with overtime, if there does become a reason to increase a med that also is not a personal failing. But at the end of the day, this idea that there's a there's a set strategy for what is success for diabetes concerns the way meds go, I just think that's total BS.

Glenys Oyston, RDN: 19:13

Right? Yeah, I mean, diabetes is a progressive condition, and more meds may be needed over time or different meds, and there's, there's no shame in that. And then that is just the nature of diabetes. And, you know, the medications can just be a part of your self care plan. Yeah,

Rebecca Scritchfield, RDN: 19:32

Yeah. And even I love the idea of like different meds because with time new meds are created, and certainly it's we know that there is sort of the business of it, and I'm not trying to open you know, because we want affordable and accessible medications too. But also it's like, people need to be working on the best meds for diabetes concerns because as we said, it's not individuals don't cause diabetes, we it's a complicated we know there's genetic factors and with time, med should get better and better and better. And that's not Your that's not your burden to hold you do what you can you make, you know, as smart as you can self care choices. And, you know, you feel validated and in your decisions and that you have a good support system in place, too. All right, one more myth to go. And I would love to discuss with you this idea that you should check your blood sugar's often to have the best control of your blood sugar's

Glenys Oyston, RDN: 20:29

Right. And I think neither one of us are here to say how often you should check your blood sugar's just to be clear on that, that this is a plan that you want to make with your healthcare provider. First of all, but what you need is a, you know, above all a reasonable and realistic plan to check. And that can be flexible. And, you know, we show you how to sort of create that flexible program for yourself. We're not again, we're not telling you do it this time, in this time, in this time, this is about you sort of deciding what is realistic for you, and what's helpful for you. And then again, working with your healthcare provider on what data they need to. And, um, you know, we're looking again, at a plan that can give you some data on trends, and help you follow the trends that you see. And, you know, things like making decisions on things like CGM, continuous glucose monitor that I have, I have clients that do that we have many people in our groups that, you know, use those, instead of, you know, having to do the individual checks. And that's taken the stress out of checking for a lot of people and giving them some really good information. And that is, you know, whether to check or not also depends on, you know, the medication you're on, you know, in the place that I worked. A few years ago, when somebody was newly diagnosed with diabetes, this was just their particular protocol, they didn't have people checking blood sugars, other places will have people checking morning blood sugars to give an idea of is the medication working. So it really just depends on, you know, again, what information your healthcare provider wants, what information you need, and find helpful. And I think it doesn't have to be this all the time situation that is creating stress. And I, I see that people who have sort of not had any input on how they do it, are the most stressed about it. So really just having that agency of choosing.

Rebecca Scritchfield, RDN: 22:46

Yeah, yeah. And and, you know, I think the key word is helpful, right, and the way you figure out what is a helpful plan is by, you know, coming up with a realistic one for you and trying it out, like a little experiment. And question, you know, hey, how is this helpful? How is this helping me? You know, maybe you approach you're checking with curiosity and compassion. If ever you feel lost and confused on that, I always say, hey, imagine you're advising a friend act like that. No, oh, yeah. You know, I know you'd like so we all have that wisdom of how we should be approaching, you know, the readings and things like that, but it's just it is harder when it's when it's for yourself. So you can hold compassion that it's a difficult You know, you're having a difficult experience with your blood sugar's but actually, by acknowledging that focusing on helpfulness of a plan, and experimenting, and giving yourself, kind of reducing the urgency and giving yourself some time to collaborate and connect with others, you'll actually have so much less stress and anxiety about it, you will find that workable plan and you know, that's a workable plan for now, and things things could could change, you know, we've certainly helped people who had the anxiety, they felt like it, you know, it seemed to be over checking, and they weren't even, you know, we'd ask, oh, you know, what was the doctor recommendation? It's like, not even collaborating with their, their doctor, their, you know, outpatient dietitian, specifically on a plan yet, it's like, well, let's, let's focus on that first, you know, come up with a plan and make it a lot less random. And then sure enough, like a lot of people just their checking went down, they found that they were actually able to use it as a neutral piece of data. And we've even had people that have decided to stop for periods of time for a lot of different reasons. Just they needed their focus attention elsewhere. You know, people take in trips, and just like yeah, you know, maybe I don't need to check for several days. So, you know, yeah, I think that that's, I just think if you're hearing or feeling like okay, you know, you don't have your CGM or you're not considering that or whatnot and It's like, you're in that this mode of like you, you urgently have to know what the reading is in order to make the next decision. That is checking anxiety and you got to deal with the anxiety first before you can actually trust what's going to come out of your readings plan.

Glenys Oyston, RDN: 25:20

Yeah, I agree with all of that.

Rebecca Scritchfield, RDN: 25:22

Like any closing tips or anything for us any any recent news around checking any other strategies that we missed? Um,

Glenys Oyston, RDN: 25:32

I think the one thing I get, I get various diabetes journals. And the one thing I was sort of excited to see for my, for people with who are using a CGM. I have clients and we have people in group who will say things like, Oh, I'm looking at my CGM, and it's freaking me out. And every time I see vibra, I'm like, well, that's taking your blood sugar constantly. So if you're looking at it constantly, that it's going to be pretty stressful. And then what happens is they get there, they're sort of analysis of what's going on. And they go, Oh, wasn't that bad, because what we're looking at is time and range. And that's what healthcare practitioners might be looking at. And so the sort of time and range to help determine if you're controlling your blood sugar is being used now more than just that number that A1C number, so people get really focused on the A1C, but now especially for people with the CGM. They are also looking at time and range. And so they're very specific sort of times in range that kind of tell people or tell your healthcare practitioners, if you're doing pretty well. And instead of sort of looking constantly at bat and freaking out, my advice is to say, like, you know, maybe pick some time to days, you know, to say, Okay, why do I want to look at this, oh, I want to evaluate that meal mix. And look at it, then. But otherwise, you might want to look away a little bit. Because that time and range is going to surprise you. I think when it comes in. I had clients go I saw my sugar's go up and then oh, but my time in range actually was pretty good. Oh, so one, going back to that one bad blood sugar reading it, it's not telling you everything. And just, you know, focusing back on the shame piece, and and, you know, go back to that podcast that we did. And that's why we just have such a huge focus on our in our in our program on that. Go back to reducing the shame around this, because it's not your fault.

Rebecca Scritchfield, RDN: 27:41

Yeah, definitely. And it's interesting, you know, that, that we're finishing up around this, but having talked about CGM, I, I wanted to bring up just really quickly if you do not have diabetes, okay, you have no diabetes diagnosis. Should you be buying and using a CGM?

Glenys Oyston, RDN: 28:07

My advice is No.

Rebecca Scritchfield, RDN: 28:11

You know why I am asking, right.

Glenys Oyston, RDN: 28:12

Because we have people that have done that. Well, I know people that have like, I need to check my blood sugars. It's like you but you don't have diabetes.

Rebecca Scritchfield, RDN: 28:20

Yeah, well, they're they're advertising it now on Facebook. It's like a 20 year old then person, you know, it's like a diet culture thing. Now. Look, it's a two step insertion. And but you know, and it's, of course, it's going to be out of pocket. It is. But yeah, they're advertising CGM. Not for diabetes care, but just, oh, because you need to watch this, you need to track that it's like, you know, I don't know that. People thought they need suddenly needed a Fitbit. And every step needed to be monitored, right? Well, that makes however, billions of dollars. And so now let's try to sell people this. But, you know, it's CGMs are wonderful tools, and might be a good fit for people who have diabetes, to get that data. But just because, you know, you know, the supply casts, and folks are listening. And I just thought people might ask, oh, I've seen this. Is this a good idea? Whether it's prevention or help aware it a good awareness help? I mean, would you say that, that people who don't have diabetes, get one

Glenys Oyston, RDN: 29:23

And that's 100% diet culture, right? The idea that the body in all its functions have to be tracked constantly, by you know, your Fitbit or your Apple watch or your now it's blood sugar. I mean, I can't think of anything more stressful than somebody who doesn't have diabetes and is checking this and wondering, with every reading, or with every with every data point that shows up, Oh, do I have diabetes now, where it's like, well, what does that run in your family? Is there any indicator for you that you might have you know, and, and it just that, to me sounds like another piece of diet culture coming in. So No, and I would not even recommend a CGM for somebody with pre diabetes. But that's, you know, that's me. I'm not a doctor. So but I'm not seeing doctors recommend that for people with pre diabetes. And often they don't recommend it for people who are newly diagnosed with diabetes. Depending, you know, I say absolutely not for people with no diabetes like that, save your money, save your money, right. And yeah,

Rebecca Scritchfield, RDN: 30:28

Right. I know, because I, I'm just even thinking about that sort of too much misinformation, right? Like, I actually want my blood sugar's to be higher after I've eaten a full meal, because that tells me, that tells me that my body is about to get energy that it needs to function. So I want them to go up, and I want them to go back down. And I could just see oh, you know, I had some carrots. And I heard there was sugar in here all of a sudden, you know, I mean, it could get really extreme. So yeah, just in case you hear anyone saying, Oh, you know, this that or the other thing. It's, I think that back to that question of helpfulness. So CGM, unfortunately, if it's a Facebook ad, and it's saying you need this, and it's not specific for diabetes care, that is diet, culture, cgms, you're talking to your doctor about it data, and that this is a way to sort of get trends and like you said, that can be helpful without having to have that solid plan in place and change it up and everything like that. But just because you have data doesn't mean you should always look at the data. Again, there's a workable plan for interpreting that data.

Glenys Oyston, RDN: 31:38

Yeah, well, that's, that's frustrating, because what I really want the focus to be on is having more insurance coverage for different kinds of CGM, because there we go. Not every insurance company covers the newest one or ones with alarms that give you so that to me, that's the concern. Let's not buy into this "Everybody needs a CGM". It's like no, but all these insurance companies need to cover all the good CGMs you know, so

Rebecca Scritchfield, RDN: 32:03

You need you need to get them in the hands of people who need it, and we should not have... We have so much inequity in health care. So you know, yeah, Medicare, Medicaid insurance programs, we should be giving people these tools that will help them better care for themselves. Yeah.

Glenys Oyston, RDN: 32:22

Well, thank you so much for having me.

Rebecca Scritchfield, RDN: 32:23

On that note. I guess we're done chatting about that and welcome folks into the program. If you'd like our next live call, we'll be starting soon. And we love meeting our folks and chatting and answering questions. And it will be like listening to us in the podcast except you get to talk to us directly. How fun is that?

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