Session 385: Diabetes Digital with Wendy & Jess

Published Nov 13, 2024, 8:00 AM

Many of you in our community are familiar with Wendy and Jess of the Food Heaven podcast, who joined us in 2022 for a conversation about developing a healthy relationship with food. Well, the dynamic duo of BFFs and registered dietician nutritionists are back — this time in honor of National Diabetes Month — to discuss their new platform, Diabetes Digital. Diabetes Digital is an insurance-covered telehealth platform designed to empower individuals to manage and prevent diabetes through 1:1 virtual nutrition counseling. During my conversation with Wendy and Jess, we discuss not just how you might benefit from getting involved with their new platform, but also how to generally manage stress, diet, and lifestyle concerns that may come up after a diabetes or prediabetes diagnosis. 

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The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

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Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, doctor Joy Hard and Bradford, a licensed psychologist in Atlanta, Georgia. For more information or to find a therapist in your area, visit our website at Therapy for Blackgirls dot com. While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey, y'all, thanks so much for joining me for session three eighty five of the Therapy for Black Girls Podcast. We'll get right into our conversation after word from our sponsors.

Hi.

I'm Jess and I'm Wendy, and we're on the Therapy for Black Girls Podcast.

We are in session today unpacking our new platform, Diabetes Digital.

Masis. We're seeking an experienced and passionate ad sales strategists to join our team here at Therapy for Black Girls. Were looking for somebody who can help us to strengthen and maintain our existing brand partnerships and who can help us identify and cultivate new brand partnerships that align with our mission. If you are someone who has five to seven years in AD sales or media buying or similar position with a proven track record of success, we love to chat with you. Go to Therapy for Blackgirls dot com slash ad Sales to learn more about the position or to apply. Many of you in our community are familiar with Wendy and Jess of the Food Heaven podcast, who joined us in twenty twenty two for a conversation about developing a health the relationship with food Will the dynamic duo of BFFs and registered dietitian nutritionists are back, this time in honor of National Diabetes Month to discuss their new platform, Diabetes Digital. A little bit about Diabetes Digital is that it's an insurance covered telehealth platform designed to empower individuals to manage and prevent diabetes through one on one virtual nutrition counseling. And in my conversation today with Wendy and Jess, we discuss not just how you might benefit from getting involved with their new platform, but also how to generally manage stress, diet and lifestyle concerns that may come up after diabetes or pre diabetes diagnosis. If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag tpg in session or join us over in the Sister Circle. To talk more about the episode. You can join us at community dot therapy for Blackgirls dot Com. Here's our conversation. Well, I am very excited to have the dynamic duo that we know in love behind Food Heaven Podcasts joining me again today. So welcome back Wendy and jizz Hi.

Thank you. We're so excited to be back.

So we both of course know you most for the Food Heaven podcast, which you are here today to talk to me more about your newest venture, which is Diabetes Digital. So can you tell me a little bit about how food haveven then pivoted into your new offering.

Yes, that is the question.

Basically, we have been doing Food Heaven had past tense for over ten years, and I think that there just became a point where we still loved the idea of Food Heaven, but the actual doing the same thing for so long. I think it was actually twelve years. We were ready for a change, and to be honest, a lot of the work became around social media, and as people who are not the biggest fans of social media, that can be tough, you know, just the whole landscape change, especially with the pandemic, and it felt, I don't know, just felt a little more gross. I even recently deactivated in my Instagram. So we decided that we wanted to get back to our roots of why we became dietitians in the first place.

And that was to help people.

And also early on we knew that we wanted to work with diabetes. So back in I think for me it was like twenty sixteen I became a certified diabetes educator. Wendy also did shortly after, and we were just thinking, like, what can we do that kind of fills a gap that doesn't exist around diabetes, cultural inclusivity, all of those things. And that's where we came up with the idea of Diabetes Digital, which is essentially accessible virtual nutrition counseling for people with diabetes and pre diabetes that accepts an insurance and works in twenty nine states.

Beautiful. So I feel like this is a whole separate conversation. You may need to have a part three. Yeah, to talk about how much social media and like the changing landscape then impacted your business, right, because I feel like you all were on the very cutting edge, Like you were some of the pioneers in terms of podcasting, and I think particularly podcasting from experts who wanted to use podcasts as a way to solve issues for a community and to give to people in a way that was accessible. And then so much changes and you feel like, wait a minute, this isn't what I set out to do, right. Can you say a little bit more about like how that all then happened?

Yeah, we became quickly burned out because I think when we initially.

Started on social media.

It was definitely our outlet for creativity for us and connection. And then I think with the monetization of social media, it was very much about output. It was just like creating, creating, creating, being able to put things out. And then also we were signed with an agency and it was very much about analytics, so like you had to meet certain numbers and it was just really stressful to have to create from that place. It sucked a lot of the creativity out and it was all about like, how is this going to perform?

Well?

Imagine initially creating something from a place of excitement and joy, and then you're like, okay, well, what's actually going to do well for people? What's going to get the clicks? And yeah, it was a complete buzzkill for us. And then just getting older and being like, okay, we don't really want to be on camera like that. And also in the wellness space especially, it became saturated with people who are not professionals, and that is really why it's important the work that we have done and being able to get it out on social media. But it just becomes draining when you're like, you have these influencers that are promoting all types of things that are just unsafe and scary, and having to keep up with these things and then have people ask us questions constantly about the latest trends and things.

So yeah, it's just a lot.

Yeah, well, I'm really happy that y'all have been able to then further show up for your community in a way that is in alignment with your values and then the way that you want to be serving your community. So tell us a little bit about what we can expect with diabetes digital. So it's a community and you're answering questions, tell us what we can expect in the community.

Yeah, so when somebody has either diabetes or pre diabetes, and that is fifty percent of the US adult population, also PCOS and metabolic syndrome, they can sign up to work one on one with one of our expert dietitians and so there's really like a four step process, so it's more than just a community. We'll be literally working one on one with their dietitian to help essentially lower their A and C. And people who have diabetes or pre diabetes, they typically know what A and C is. It's your average politic glucost over three months period of time, and the goal typically is to lower that A and C. So we work really closely with people. Step one on would be verifying their insurance benefits because we do accept all major insurance plans, so Etna, Anthem, Blue Cross, Blue Shields, SIGNA, United Medicare. I think those are the main ones, so we accept those and they would just go to our website Diabetesdigital dot com slash quiz. They can fill out our form and within a day we'll get back to them and let them know if they're a network or not. And there's options whether you are or are not.

In network.

Then from there people will have an initial consultation. So during this session, it's really probably similar to a therapy session, where we're gathering information about them, their medical history, their lifestyle, they're current health status. Will also order labs for them they're A one C to see where they're at right now, they're fasting, glucose, their lipids.

And from there we.

Will do weekly sessions. Typically some people they want to do bi weekly, that's fine, most people do weekly.

And you know, in addition to.

The initial assessment, we'll come up with a personalized nutrition plan for them that will include things like joyful movement, hydration, how to build a nutritious breakfast, meal timing because so many people are not really sure the best timing for them to have their meals. A lot of people are skipping meals. How to reduce added sugars. That's another thing the dietitian will talk about with people increasing their fiber intake, looking at protein. Also, how to celebrate success. So there's so many different things, and the goal is over the twelve weeks to lower that A and C, and most of the time I would say it does happen. Of course, you can't guarantee all the time, and then we'll do a final check in if you're A and C. Depending upon your goal, you might still have more sessions after that, and that check in is where we'll look at the A and C again, look at your labs, see where you're at, evaluate, check in with your doctor if needed. Maybe you know it's time to bring in some medication management as well that the doctor would manage. And we can work flexibly with people. And the good thing is most people's insurance fully covers it, similar to therapy, because with the Preventative Plan under Obamacare, people are really able to have these benefits that are going to improve their overall health without them needing to pay typically no copay either.

You mentioned a stat that I want us to go back to in terms of fifty percent of the population either meeting criteria for pre diabetes or diabetes. Can you tell us more about that? What are the criteria? I know there's also type one and type two diabetes. Can you break some of those definitions down for us?

Absolutely, So, first we'll talk about the different types of diabetes, because I think a lot of folks are confused about that. So that's a good place to start now, Type one is what used to be called juvenile onset is an autoimmune condition where the body's immune system mistakenly attacks the insulin producing cells in the pancrease. And so with type one, you definitely have to take insulin every single day, multiple times a day to manage your blood glucose levels. Now, like I said, it's often diagnosed in children and young adults, but it can occur at any age. So that's type one. It's kind of more autoimmune. Type two occurs mostly I would say, in adults, but sometimes in kids too when the body doesn't use insulin properly or where it has a harder time regulating that blood glucose. And there are several risk factors for type two, and those are things like genetics, age, family history. It's also important to recognize that these factors play a role in managing diabetes. And it's really important to also like work with your body's unique needs and figure out how your body responds to exercise in different food combinations, things like that. So those are the differences between the two. And then in terms of the actual diagnostic tools that we might use, the number one is a one C. So in somebody who is quote normal, I use that in air quotes. Their A one C is going to be under five point seven. In somebody who has pre diabetes, the A one C is going to be five point seven to six point four. So that's what you might call borderline. I think a lot of people in the black community use that you're not quite in the diabetes range, but you're a little bit above quote normal, and then diabetes is six point five in higher. And for most people with diabetes, you want to still keep that A and C through diet lifestyle meds in some cases under seven percent for most people, again sometimes older people, it's a little bit more relaxed with the guidelines, and yeah, you can also look at fast and glucose and other things, but typically we're going to be looking at A one C.

Got it okay?

And people are typically I'm guessing either you're having some symptoms that cause you to go to the doctor, or is that something that you would expect to get a panel from from your regular yearly physical A doctor is typically tacking for that every year, or do you have to have symptoms for them to even check for this.

That's a good question, because sometimes you do have to advocate to get that test done, especially if you're thinner, because unfortunately providers, if you're in a larger body, they will associate things like diabetes with your weight, and so people that are thinner, they can get these conditions overlook because they're like, oh, you're in good health, you don't need an A and C. I've been told that when I go to the doctor, and I'm like, no, no, no, let's run that A and C. I recommend that anyone get it, especially if you have a family history, at least once a year, because I mean, it's really nothing for the doctor to order it if you do have symptoms, for example, like some symptoms of high blood sugar will include blurry vision, You're going to the bathroom a lot because your kidneys are trying to get rid of the excess glucose. You're dehydrated because you're going to the bathroom a lot. You might be really fatigued because it could do a number on your hormones when you have elevated blood glucose. And so those are some of the symptoms. But honestly, for most people with pre diabetes, they have no symptoms at all because it's only when your glucose becomes to such a high level that you start becoming symptomatic, and that is very advanced diabetes, and at that point you're probably going to need insulin to help bring it down, at least in the beginning. And so when you're symptomatic, that means that your numbers are probably running really, really high. And so that's why someone may have pre diabetes for years without knowing if they're not getting these tests done, and then they only come to find out when the diabetes has progressed significantly.

So primary candidates for people who would likely do well with diabetes digital or people who are pre diabetic or who are in maybe those earlier stages and maybe don't require insulin just yet.

Exactly, or if also if they're at a high risk, like if they have a family history, if they have PCOS, because insulin resistance is a very common component of PCOS. So also someone like that could be a good candidate too.

Yeah, and we see people with also type one as well on insulin. Even one of our dieticians has type one diabetes.

Who leads our groups.

But even if you're not someone who has type one, usually people with type one no a lot like I said, a lot of them have had it for a long time. Definitely get that A and C checked because they won't run it a lot of the times. Even my husband, he's dinner, he's never had an A and C. I'm like, what, So I'm trying to like advocate for him to get one. And I think a lot of people to a similar situation.

So I wonder if you all can talk a little bit more about that genetic component. So do you know like the numbers in terms of like how many people who end up being diagnosed with diabetes actually have a family history.

So in terms of inheritance, the number is very greatly because research and science is super variable, but it can be up to seventy percent that's attributed to genetic factors in terms of inheriting type two diabetes. And I feel like that's pretty consistent with what I've seen clinically in the years that I've worked as a dietitian. For someone especially someone who comes in and they have uncontrolled diabetes. Maybe they haven't tested for a few years, but it just spirals. Typically what I've seen is that they definitely have a close family member like a parent or a grandparent.

That has also had type two diabetes.

One thing that I think is important to talk about is ethnic groups are hit harder with diabetes, especially type two. So, for example, Native Americans developed type two diabetes at nearly twice the rate of Caucasians do. Also, latinx Asian Americans and African Americans are also at higher risk, which is important to know because many people don't really realize that and so then they don't get the testing that they need. And people are always asking, Okay, well, why is it that we're at higher risk? And researchers used to think that in type two the rates were because of genetic differences between different racial groups, right, But now we're realizing that's not the whole story. So I'm sure you all have talked about on this podcast social determinants of health, which are non medical factors that influence health outcomes. And these are just different conditions related to where people are born, where they live, where they work. It can include things like economic stability and chronic stress, education access and quality right, education levels influence health literacy, healthcare access and quality. We all know doctors, especially in the hood. Sometimes there's a lack of doctors or it's a long wait or maybe you can't even get your medications, and it's hard to get in touch with anybody because the doctors are so overwhelmed the neighborhood and environment as well food insecurity. So I think it's important to talk about social determinants of health because now that's what we're more thinking that it has to do with that versus there being like inherent differences genetically within different ethnic groups. Also racism, of course that's going to play a role, and stress and all of those things. And we know that stress is a huge factor for diabetes and also just your blood glucose levels go high when your body is under stress. So just things to think about.

You know, as y'all were talking, I was definitely thinking, Okay, what is the connection between like racism and stress and how that maybe impacts how glucose breaks down. Now, this is beyond my pay grade. That feels like very sciencey, and I don't know the answers.

Maybe you do, but it feels.

Like there must be some connection, right for the numbers to be so much higher in communities of color exactly.

I think there's a huge connection.

And it's also interesting because a lot of patients they're like, oh, moving to the US causes diabetes. People from other countries when they move here, they're like, oh, my aunt got diabetes when she moved here, or I only got diabetes when I moved here. And I think part of it is the food system here, right, Like a lot of times our native cultural foods are naturally organic, naturally more fruits and vegetable heavy. But also I think it's the stress of coming to the US, the racism, all the things that I mentioned, like housing, environmental food, deserts, and it plays a huge role, and I don't think that we're paying enough attention to it.

And a lot.

Of the talk about diabetes is very shame and blame, blaming people for the disease and not really looking at how all these structures in place have a real impact on the likelihood that somebody might be at more risk for developing type two diabetes in particular.

Yeah, I'm really glad that you wrote up the shame piece, because of course that is something that as therapists, we are paying a lot of attention to you, right, Like, what kind of shame narrative people have around whatever their experience is. Can you say more about how this shame shows up with a diabetes diagnosis and what kinds of things maybe you're doing in diabetes Digital To help address some of it.

Is when someone is initially diagnosed, typically they come in and they think it's something that they have done themselves, like oh, I was just drinking so much soda during the holidays, And I think a lot of that comes from the messaging that we're seeing online about these are all the things that you can do to cure your diabetes or to get your blood sugars regulated, and it's all on you. It all falls on you without accounting all of the different factors that we just spoke about, and so a lot of times when people come in and they've been recently diagnosed, they feel very defeated because they're just like, oh my god, it's been years of me not doing the right thing. It's too late. And oftentimes people associate diabetes with complications from diabetes, so it's really scary because they're just like, I'm going to get amputations, I'm going to lose all my teeth. I have to go on insulin, which there is no problem being on insulin, but just the idea of having to inject yourself every day is very scary for people, and so we really work on that during the first few sessions, just unpacking all of that because it is a form of therapy. Like you have people who may have seen family members going through a lot of hardship from having a diagnosis like diabetes, but in reality, if it's well managed and you have a supportive healthcare team like a dietician, a nurse at endocrinologist, all of those things can make them more manageable. You're not as stressed out about it, and you can live along and healthy life with diabetes. Like just making sure that you have that support in place, and also a therapist. We work a lot with therapists because for people who have diabetes, there's a lot of restrictive eating that happens where they're just like, I'm going to cut out carbohydrates because they associate that with increased glucose levels and so there's a lot of disordered eating associated with that or like they really want to lose weight, and so that's another component. There might be binge and restricting happening, and so yeah, there's just so much that we cover, and that's why the sessions are longer because simply when you go to the doctor, the visits are super sure. We your doctor, and then if they refer you to a dietician in the hospital, it's like a twenty minute visit, but we spend an hour because we know that we want to allow space to really dive into all of those different things.

Got it more from our conversation after the break, but first a quick snippet of what's coming up next week on TVG.

My heart smiles as I bask in their legacies, knowing their lives have altered many deathkins these in her eyes. I see my mother's poise and her face. I glips my Auntie's grace. In this case of deja vous, a nineteenth century question comes into view, and the time win Sojourner truth.

Asks, ain't I a woman?

Today? We pose this question to new powers making that's on artificial intelligence, Hope towers. The Amazonians peek through windows, blocking deep blues as faces increment, scars, old burns, new urns, collecting data chronicling our past, often forgetting to deal with gender, race and class.

Again, I ask ain't to eye a woman.

Casis we're seeking inexperienced and passionate and sales strategist to join our team here at Therapy for Black Girls. We're looking for somebody who can help us to strengthen and maintain our existing brand partnerships and who can help us identify and cultivate new brand partnerships that are align with our mission. If you are someone who has five to seven years in AD sales or media buying or similar position with a proven track record of success, we love to chat with you. Go to Therapy for Black Girls dot com slash ad sales to learn more about the position or to apply. Yeah, and you touched on something that I definitely want to hear more about because we know that diet and you all have said that is a part of managing your gluecose what I think a lot of people think, Okay, that just means you got to cut out sugar, and I know that there is way more involved. So can you say more about the whole idea around like healthy eating and what does this look like to actually have a nutrition plan when you are trying to manage diabetes.

I will say I think the least sustainable thing somebody can do who has diabetes is to just go and cut out all carbs. It's not sustainable, it's not necessary, it's not even healthy, And that is typically the messaging people are getting. A lot of people on the diabetes community talk about the diabetes handout. If they get diagnosed and they get this handout, that's just this list of foods not to eat, and a lot of times it might be cultural foods, right, Like I've had a lot of Mexican patients where they're just told cut out rice, cut out tortillas, and it's okay, Well, that's an important part of the diet. And we also know that even if somebody did do that, it's not going to be sustainable long term, right because they're cultural foods that have significance to them. So I think that's number one, is just setting that framework that we're not going to ask you to cut anything out. But what we like to do is figure out what foods are important to you, what foods do you love that you want to incorporate, and how can we balance those with other foods to help them not have as big of an impact on your blood glucose long term. So, for example, if you did want to have tortillas, that's totally fine. Maybe we make tacos and we include some protein in the tacos. So that could be in the form of beans which also have carbohie, it can be beans, it can be some ground turkey, so you can have that. And you can also add some vegetables which are going to provide fiber which helped us slow the release of the carbohydrate into the blood stream. So maybe for vegetables you have some lettuce and some salsa, right, and then maybe you also add fat to those tacos in the form of guacamole, and that fat is also going to help to slow the release of that glucose into the blood stream, which is going to keep your blood glucose more stable over time. For people who have diabetes, that will make it more helpful for managing it when you have that slower release of sugar into the bloodstream. So that's Number one, is just focusing on a balance, so anytime you have carbs, trying to also have protein fat in fiber. Also looking at added sugars because I think a lot of people are not really clear on how to read nutrition facts labels. They're not really sure that there's a difference between added sugars and naturally occurring sugars, and that the added sugars might raise their blood sugar a little bit more, and so we might look at that and not saying we have to cut them out completely, but maybe we have our dessert with added sugars with our meal so that there's a slower release of sugar into the blood because you have all those other food groups coming with it. There's also a lot of added sugars in the form of beverages that people are not really aware of. And even when I was a kid, I thought this, like, oh, orange juice is so great, which nothing against orange juice, but those sugars, because it's extracted from the fruit and it's not the whole fruit, they're gonna spike your blood sugar more than if you had an actual orange. So we talk a lot about that with people, or like sodas, like how can we maybe have less sodas or replace some sodas with seltzer waters or.

Do half and half things like that.

And you mentioned that there are four steps in your program too, so not only nutrition but also joyful movement. Can you talk to us about the comprehensive plan for somebody managing their diabetes?

Absolutely, So, like I said, somebody would do an initial assessment with us, and we're going to see where they're at and what they need support with. There might be some people who were like, look, I have my fitness routine going, I love it. I don't want to talk about that.

Great.

There's other people where one week we might talk about hydration and ways to like still enjoy your hydration without having so much added sugar. But there might be people who are like, I only drink water, I don't need this, but maybe they do. Maybe they need help drinking more water. Right, So those are just a couple of weeks, Like we talked about breakfast, meal timing, reducing added sugars, increasing fiber intake because there's a lot of research that supports that fiber is one of the best things to do to help lower that a one c over time. So if we can just get closer to our fiber needs, which is about twenty five grams a day for women about thirty eight for men. Powering up on protein. A lot of folks, especially earlier in the day, they're not really getting enough protein with breakfast and sometimes not even with lunch, and so that might have an impact on their blood glucose. Can we figure out what your needs are and make sure you're getting enough. We also talk about stress and sleep because if you are stress and not sleeping, it doesn't matter what you do. Your blood sugar is not going to do what you wanted to do because it's very sensitive to stress and sleep, and even like stress in the form of being sick. I'll give an example of myself, and I'm someone who doesn't even have diabetes, but I was sick with COVID and I went to the hospital. I think this was like a couple of months ago, but my blood sugger was two ninety eight, which is high, and normally my blood sugar is like one hundred. So that goes to show that stress can really have an impact.

And then, of course, how can.

We celebrate wins and success in ways that are not only about food, because often times for folks they only kind of lean on food to celebrate success, or even sometimes when they're.

Not even in a good mood, they might lean on food.

And not saying you can't lean on food, but maybe we lean on food sometimes and we have other ways to celebrate other times. So we'll talk about that. And then emotional eating too, because it's huge for so many people there's a history of disordered eating, not having a healthy relationship with food, not being in tune with their hunger and fullness cues from the initial assessment, we'll see where you're at and whether you are somebody with a disordered eating history or not, Like will tailor things just for you based on your history.

What's the role of hydration in all of this. You mentioned that as like a separate, standalone thing, so there's some connection between hydration and glucose levels.

I was like, well, I think you just want to make sure that you're hydrated so that.

You don't feel harm.

Yeah, you're just you're gonna get headaches, You're gonna be aggie. I mean just thinking about all the things that happened when you're dehydrated. I remember having a client with diabetes and already like you might be going through mood fluctuations when you have kihs and lows with your glucose, and she had these chronic headaches that would not go away, and we were just like troubleshooting, troubleshooting. At the end of it all, I'm like, how much water are you drinking during And it turns out that she was like severely dehydrated. She wasn't really drinking much water during the day, and it was such an easy fix. We were just like, Okay, well, how can you incorporate more fluids during the day that won't spike your blood sugars and the headaches went away. So I think it just helps you feel better, and it's important for your organs.

To make sure that they're hydrated. Got it.

So you've already mentioned a little bit about the care team. So y'all talked about often working with therapists. I imagine that there's like a primary care doctor involved who's on the care team for somebody who might be a client of yours.

So typically a primary provider, and it could be a doctor. It could also be a nurse. For some people, they have nurses that are their primary providers. For people that have type two diabetes and type one, sometimes they have an endocrinologist, especially if they're having a hard time getting their numbers down with medication, and the endocrinologist is a specialist that focuses on diabetes, and they get involved, especially when the medication approach is a little more advanced and they're primary doctor. Feels like they would benefit from more specialized care. And then there's of course a dietician, and we work with everyone on their care team to make sure that we're communicating the plan and that we're all on the same page, because, for example, with someone who might be restricting a lot because they think that might be beneficial to their diabetes, and maybe they have a history of disordered eating, that might be getting pushed by their primary provider because their primary provider might be like, cut this out, cut that out, lose weight, and so it doesn't really align with the work that we're doing. So many times we have to communicate with the provider like, hey, these are the guidelines and this is actually not helping our client. So let's try to get on the same page about what the goals are going to be.

Because they might not know.

Because they only have maybe fifteen minutes to see the person, they might not know like, hey, this is someone who's really struggling with restrictive eating and things like that. So we try to keep an open line of communication their therapists that are involved. For some people who for many reason, I mean, there's so many reasons why you would want to see a therapist, but it's really stressful to have a chronic condition and have to manage all of those different aspects. And so if someone is not in therapy and we think that they would find it useful, which is most people, and they have coverage for it, we recommend starting therapy with the mental health professional. And then there's also just things like an ophthalmologist that you want to see every year because diabetes can cause damage to your eyes, and so you want to make sure you're getting your eye checks. You want to go to the foot doctor because oftentimes you can also get damage to your feet because when you have high glucose levels, it affects circulation. Let's say you bump your toe on something, or you get like a little cut on your foot. You might not feel it because you have decreased sensation, and that can quickly progress into an infection. So you want to make sure that you're going to the podiatrist, that they're cutting your nails for you so that you don't accidentally cut yourself and then it turns into something that it didn't need to be. The dentist, because diabetes, when uncontrolled, can affect your teeth, your oral health. You might be losing teeth, you might get oral infections. And then there's a pharmacist. You want to make sure you have a good pharmacist where it's not stressful. Every time you go to the pharmacy, you can't get your medication. They have to send an order. We've all been there where like the pharmacy is a hot mess, and so like, how do I get my medication? They have to put in another order and they get it. So you want to make sure you have a good pharmacy. And thankfully now there's a lot of virtual pharmacies that you can sign up for where you just get it mailed to your house and you don't even have to go through the stress of getting online and spending an hour trying to get your medication.

So you have just listed like several different entities that somebody would have to be coordinated. And so I'm wondering, like, is there some kind of case manager or is it a part of your program where you are keeping track of Okay, have you had your padetor just visit this month or this year, Like are you helping to manage some of that as well?

Exactly, Yeah, we would do that.

We include that as part of our assessment and our follow ups, and we keep track of the dates so that we know, Okay, it's time to schedule your p dietary appointment. Because Justin and I are being diabetes educators, we're very familiar with what the guidelines are, and so we make sure we provide training to our dietitians so that they know, hey, these are the established guidelines. We have to make sure that every so and so time, all of these appointments are made to reduce the likelihood of complications.

So we talked a little bit about this when you introduce the idea of social determinants of health, Jess. But I want to talk a little bit about prevention because you mentioned okay, is the correct information out there, like don't we know? And so I wonder if you could share some things for people to be mindful of that might help to prevent a diabetes diagnosis.

Yeah, I mean, I think number one is knowing your numbers super important. I think if you all just take one thing from this episode, it's make sure you know what your A and C is. The longer name is hemoglobe and A and C. And it's not even an expensive tap, I mean, insurance covers it. So I don't know why doctors don't always automatically order it. So that's number one. And then I think just not being too overwhelmed if you do have a pre diabetes diagnosis, because I can't tell you the number of patients I have where they really freak out and I understand why because their mind is going to like the worst possible outcome in scenario. But just take a deep breath. It's probably going to be okay. Also, not everybody with pre diabetes develops diabetes. You do have an increased risk, but there's a lot you can do, So I would say even doing things like having walks after meals. I love toying with continuous glucose monitors. I actually have one right here. I'll show you. These are ways that you can track your blood glucose in real time, and so a lot of our patients will use it's called a CGM. And even when I have used it in the past and I'm just using one now just to play around with it. But when I take a walk, like just ten minute walk after dinner or any meal, really like it dramatically lowers your blood glucose. Even if you just did a ten minute walk after dinner, and that's all you did, that's probably going to have a positive impact on.

Your A and C.

Now, of course, incorporating strain training is going to be even more beneficial because your muscles when you do strain training, they continuously eat that glucose in your blood. I think it's up to seventy two hours, so it has a longer term effect versus the walking is more an acute effect in the actual moment. So I have so many patients where all they did was change physical activity and that really helped in terms of nutrition.

Trying to really.

Follow that MyPlate method, and the MyPlate method is essentially having a combination on your plate. Like I mentioned, half your plate is non starchy vegetables things like spinach or tomatoes, or colored greens, okra, stuff like that, even one thirty year plate is going to be great. And then making about a quarter or one to your plate lean protein fish, chicken, tofu for vegetarians, and then about a quarter or third of your plate will be your starchy carbohydrates, so things like peas, corn potatoes, potatoes, tomatoes, what are the great but no peas, corn potatoes, bread, pasta, rice, things like that. So just having that balance is really going to be helpful overall.

More from our conversation after the break. So I'm curious to hear how you are because you both have talked about the need for culturally informed and sensitive dietitians who understand Yeah, I want to keep tortillas and things in my diet. I wonder if you can talk a little bit about your vetting process for people who become dietitians as a part of diabetes Digital. But also if people are finding dietitians in their own areas, how might they bet someone for that kind of information.

Yeah, that is such a good question because how do you know? And sometimes it could be a person of color, dietitian of color who maybe isn't asking those questions or really just approaching it with curiosity. And I think that's the most important thing, like having someone who is asking you the questions and finding out like what did you grow up eating, what do you enjoy eating. It's called patients center care, but really learning because we don't know every single culture, and our staff of dietitians is very diverse and it's very intentional. Want to make sure that we have people from different backgrounds so we can learn from each other. But at the end of the day, We're not going to know everyone's background, and I'm always learning myself.

So we want to make.

Sure that the dieticians that we have on staff approach things with curiosity. It's not like I'm the provider, so I know what's best for you. It's really like, okay, well, what do you enjoy eating? What do you feel good eating? You know, like physically, how do you feel when you're pairing certain foods together, like when you're making this meal, and just respecting different cultural practices and traditions. Hopefully it's more of an outdated practice, but I remember when I was becoming a dietitian, it was super common for dietitians to be known as the food police or just making people feel bad about their food choices, where they came in and they left the office just feeling judged and looked down upon. And that's definitely not what we want. Like, there's nutritious foods from all cultures, there's plant foods from all cultures, and it's like, okay, well, how can we figure out a way to incorporate more of those foods. And also, like foods that aren't considered as healthy, they still have a place, but how can we make some modifications or maybe have them less often so that you don't feel like you're restricting everything that you love or that you grew upon.

And if I can also add with our dietitian, so that's part of the interview process too. We asked them specifically how they would deal with different scenarios like Wendy brought up. And I think one of the questions is, let's say someone talks about a culture of food. You don't know what that food is. How do you approach that, because some people can freak out or whatever. But the answer we're looking for is you ask the patient and you say, hey, I'm not familiar. Can you tell me more about that, or maybe after the visit you look it up. Things like that just so that people feel heard and seen. So that's number one. And then also the co founder of Diversified Dietetics, who's one of our good friends. She's a dietitian. Her name is Tamara Melton. She also created a training for our dietitians on cultural humility, which is something they have to do before they even see their first patient with us, which is so important. And then in terms of the patient care when you mentioned patient centered care, and we try to get a sense from our intakes as well, like we incorporate those cultural questions and the pre intake and also in the person's first visit and beyond asking them specifically what do we need to know about your culture or what do you think is important to know in terms of how you grew up and how that might impact your eating because there's a lot of things that might happen in different cultures, right like with food that might even impact your relationship with food, Like I know in some cultures that might be common to comment on people's bodies or whatever, and so being able to dissect those things out too and understand the foods that people love and reassure them we're not trying to take that away or tell them they have to eat kale and queenwa or cottage cheese to be healthy, because that's the last thing we want to do to anyone, Like we're not here to ruin your life.

I wonder if y'all could offer some advice or words of affirmation for somebody who maybe has gotten a prediabetes or early diabetes diagnosis to help with the process.

Initially, it can be really scary, And I think the most important thing is focusing on the progress that you're making instead of getting everything right, because there's definitely this perfectionist mentality that kicks in when you've been diagnosed with like pre diabetes or diabetes, and you're just like, Okay, how can I plan every meal perfectly? And the reality is that it's not sustainable. Eating is a lifelong thing. You have to do it several times a day, and it's just not realistic to plan every single meal out perfectly so that you can have these target blood sugars. You want to keep into account your sanity because you stressing out about this is also going to raise your blood sugars. So try to quiet all the noise, all the things that you're coming across about what you should be doing, and just like connecting what it is that you need and trying to plan as much as you can to set yourself up for success. But it's not about getting it right all the time. It's really about making those small changes that lead to long term results.

And Winnie, I want to go back to something that you mentioned earlier, because I had not even thought about the connection between what you need to do to manage your blood glucose as it relates to being almost a trigger for disordered eating of behavior. Right, so you get into the habit of paying attention more than you typically would have, and then that results in something maybe bigger. Can you say a little bit about what people need to be careful about or what do they want to keep an eye on so that it does not maybe become like a disordered eating situation.

Yes, definitely, I would say being aware of the thoughts that are coming up for you, Like if you're obsessively thinking about meal planning or like how you're going to put together a balanced meal, that's not a healthy approach because the goal with working with a dietician is that food becomes part of life just like anything else. It's not something you're obsessing over. It's just something that you do to get enjoyment and to survive. And it's hard because with a condition like diabetes that is very linked to food, it's hard to not fall into that because you're just like, Okay, what can I do?

What can I do?

But again, think about all the different factors that we mentioned, Like there's just so many things that can impact your blood sugar, whether it's stress, whether it's medication, whether it's life circumstances, and also family history. So with food, just like with everything else, it's good to just be patient with yourself and know that you're not going to get it right all the time. It's not worth stressing over something like this. Initially is totally understandable, but when you just find yourself constantly going down that rabbit hole just mentioned the CGM. Having a CGM can help to identify trends sometimes, and I think Abbot Freestyle they have a free trial that you can do for two weeks so you don't have to come out of pocket for because sometimes it's tricky getting it covered by insurance, but just so you see the trends for a couple weeks and you can identify like, hey, during certain parts of the day, I can see these elevations happening, like what's going on? Is it that maybe I overate or that I was really stressed out? And I will also say that that's tricky because sometimes the stress of the numbers and tracking can be another stressor So you just want to make sure that you're not becoming obsessive with any of these things, like whether it's food, monitoring your glucose, working out. It's all a balance and we don't want it consuming you.

And when we do see it consuming someone, that's where we might shift more into that relationship with food piece first before we go into gentle nutrition. Oftentimes you can't really do both. If someone is really struggling, it's like, Okay, we got to make food a little bit more neutral, loop in the therapist to care, make sure someone does have a therapist, and then once we feel like they're in a better place of food, then we can bring in the gentle nutrition.

Well, it is obvious how much care has gone into creating this program, and I'm so excited that you all have pivoted to be able to offer this. Can you tell us more about like where we can get information? How would somebody get signed up with you? You mentioned that you're available in twenty nine states. I think tell us more about like the logistical piece.

Yes, So the logistical piece is you go to our website Diabetesdigital dot co. That's dot co and we have all the information there. If you just want the direct link, it's slash quiz and you take the quiz and from there we will verify your insurance benefits within a day, and you can even get an appointment as soon as like twenty four hours our dietician. So I will say they're like getting booked up, so we will probably have to be expanding soon, which is a good thing. So you do that and from there you will start meeting with your dietitian. If you are not in network, we have a self pay version. Ninety three percent of people are in network and then seven percent aren't and they do the self pay but you can use like your FSA or HSA for that and sometimes you might get reimbursed with super bills. A lot of my patients have done that, and yeah, we would love to work with you. It's for people with type one, type two pre diabetes type one point five, which we didn't even talk about. That's a whole other type of diabetes gestational we didn't talk about. That's diabetes and pregnancy PCOS because that tends to have a higher risk of diabetes and insulin resistance. So we work with all those folks. And if you also just want to learn a little bit more about us, we have a called the Diabetes Digital Podcast, which comes out on Wednesdays, and we talk about all things related to diabetes, but also from a social justice and inclusive lens, and we have diverse guests and on Instagram we are most active at Diabetes Digital Co. So that's pretty much it. We hoped that you guys will join our community, whether as a client or just as a listener.

And I'm curious, so I know people will hear you and be like, I want to work with Wendy and Jess Are you both accepting new clients and dieticians are do they have to go with someone else?

Yes, we're doing the behind the scenes of it all, so we're not sting clients, and honestly, it's because we've been seeing clients for like ten years and we're just like, we want to oversee the operations more so so that we have longevity with this company, because we would probably just burn out if we were seeing clients ourselves. So we have an excellent team of dietitians that we have personally vetted and they are seeing the clients.

I know everyone because I'm like that too, where it's like I hear this from this person I want to work with. I promise you, Like they're all really good and they have amazing reviews from their clients and amazing like case studies, success stories.

It's like a team and we also all talk.

We do weekly meetings, we do supervision, so there's a lot of support and like one on one support from us that they get. So it's not just like some contract because I know there's a lot of like contract situations or whatever. Like they're actual employees with us and they're all amazing, beautiful.

And is there somewhere on your website for any dieticians who may be listening, who may be interested in working with you all? Can they sign up somewhere on the website.

Yes, if you go to our website and you go to the fotter, there is a section called join the team, so you can click on there and we hire on a rolling basis. We're actually gonna be hiring for the fall and the winter, so you can apply there.

We can review your application. Beautiful.

Well, thank y'all so much for joining me again. It was a real treat to chat with you all.

Thanks for having us Doctor Joy of course.

Yes, I'm so glad Wendy and just were able to join me for this conversation to learn more about them and the work they're doing. At Diabetes Digital. Be sure to visit the show notes at Therapy for Blackgirls dot com slash Session three eighty five, and don't forget to text this episode to two of your girls right now and tell them to check it out. If you're looking for a therapists in your area, visit our therapist directory at Therapy for Blackgirls dot com slash directory. And if you want to continue to dig into this topic or just be in community with other sisters, come on over and join us in the Sister Circle. It's our cozy corner of the Internet designed just for black women. You can join us at community dot Therapy for Blackgirls dot com. This episode was produced by Elise Ellis, Zaria Taylor, and Tyree Rush. Editing was done by Dennis and Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon.

Take good care.

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The Therapy for Black Girls podcast is a weekly conversation with Dr. Joy Harden Bradford, a license 
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