"There's so much focus on what people do on their day to day. But we often forget that even those choices are limited by how much money people have, how much what they have access to as far as health care. And so when we zoom out and look at the big picture for diabetes risks, it's very complicated." - Megan Muñoz, RN, MSN, CMSRN, CDCES
Shireen: Megan Muñoz is the creator and host of type two in you with Meg, the first podcast by a certified Diabetes Care and Education Specialist dedicated to people living with type two diabetes. Her passion to reduce diabetes stigmas is evident in her podcasting content contributions and live presentations. Hi, Megan.
Megan: Hi, Shireen. Thanks for having me on. Appreciate it.
Shireen: It's a pleasure having you on. So Megan, I want to dive right in. My first question is what led you to work within diabetes care.
Megan: This was something I grabbed on to even in nursing school. So I was able to do an internship at Mayo Clinic, a very prestigious hospital, and saw that interaction between a diabetes nurse educator is what they used to call them. And a person with diabetes. And it was a, it was a real partnership and a real back and forth. And that was the piece that I fell in love with this is having that partnership with a person that's coming to seek care.
Shireen: Lovely. And so I want to talk a little bit about and something that you're passionate about is the risk factors leading to diabetes. There's an understanding out there that is mostly got to do with a person's behavioral choices, you know, things, foods that they may eat, the lifestyle that they may have. What are some other risk factors that are not behavior related, that may cause diabetes?
Megan: That's a great question. Because you're right, there's so much focus on what people do on their day to day. But we often forget that even those choices are limited by how much money people have, how much what they have access to as far as health care. And so when we zoom out and look at the big picture for diabetes risks, it's very complicated. You know, lower education. So if you have a degree less than a height, if you never graduated high school, excuse me, your risk for diabetes is double a person that graduated and went to college. So something as simple as education. There's either other health conditions like thyroid disease, binge eating disorder. And then there's also this really complex piece, we call them aces, which is adverse childhood events. But that ties into a lot of the systemic racism that we're seeing on TV, is this chronic stress, ongoing trauma, those things have a tremendous impact on our body and, and how our body functions. And so type two diabetes risk is significantly higher in, in people of color, because of a lot of those structural things that happen routinely across generations, and across our society.
Shireen: And so why is it so important to talk about some of those things that are not behavior related that are in our environment that are in our, sort of in our, in our society? And the, you know, where we are, they talk about how your risk of diabetes increases based on your zip code, which is just mind boggling. So then why is it so important to talk about some of those other risk factors?
Megan: I think it's twofold. One, of course, is because we need to set up social structures and those systems, we need to create better access to health care, we need to create ways that people can get education and safety and own houses. So all of the things that we've heard, lately from, you know, great people who are trying to change some of those pieces. The other side of it on the personal side, for people with diabetes is to know it's, it's not your fault. Diabetes is really complicated. And when we focus just on, you did something wrong, it can really hinder people. I mean, I meet so many people that struggle to make changes to their diabetes health, because they just don't want to be labeled with the diagnosis, there's so much stigma around that. They don't want to be, you know, looked at by family members, or other co-workers, or even their medical provider as screwing up or doing something wrong. And that's why they have that diagnosis. So it can be very paralyzing. That could be a lot of self blame and a lot of guilt. And we need to break that down.
Shireen: And how do you address that?
Megan: You know, I think one of the things I think is really important, at least personally with me is talking to people about their personal risks for type two diabetes. So they usually come in and they say, Oh, well, you know, I have gained weight over the years and, and that's why I have diabetes. But once we start talking, they start recognizing, well, I was in the service and I was exposed to Agent Orange and I know that's a risk for diabetes. And I also have thyroid disease, and I know that's a risk for diabetes. So the, we start looking at all, all these other pieces they're able to see, okay. You know, I understand that maybe I made some lifestyle choices that were not as helpful. But it's not the only piece. And there's other things. And we, that's one way we can move past. I think the other thing is just having communication, even like for myself with other medical professionals about reducing those stigmas. For example, we know, for people that come in to get diabetes training, we only see about 10% of the people and diabetes, self management training that get diagnosed with type two diabetes, excuse me, I should say. So somebody gets newly diagnosed, only 10% of those people are going to be coming to see someone like myself in a clinic or hospital setting. That's really bad. That's horrible stats. Anything, a lot of it is because somebody comes to their medical provider, and their provider says we'll eat better, move more, and I'll see in three months. And diabetes is a chronic condition that requires lots of training and lots of support to really manage it well. And it's already got that stigma or the blame of you didn't do something, obviously, because you have diabetes, so fix it. And then you'll you'll do well, there's not the you know, diabetes, it's complicated, there's lots that you need to know, you might be doing some things great, you might be doing some things not so well go here, get some training, get some support, you can live a long, really healthy life with diabetes. So even from the get go, even across the medical world, some of the things that I do is just presenting on how we can be more Person Centered, focus on the person, making sure that we're trying to reduce the stigma even within the medical world.
Shireen: And when you are talking to someone with diabetes, what are some of those things that you talk about? And why is that so important for them to talk through in order to get quality medical care?
Megan: Well, I think like I just mentioned, the, you know, it depends on, it depends on how they can get access to care. So it's really important that we talk about the stigmas. I think it's also important for people not to not to fixate on one thing to gauge their health. And so for example, people fixate on weight as a gauge of health. And they, you know, they don't focus on other behaviors or other pieces of care to gauge health. So if they've lost weight, and they regain the weight, people throw their hands up and say, can't manage diabetes is too hard. And so if we refocused energy to how else can we gauge health by how much we're moving, what we're eating, what our blood sugars are, how often we're taking blood sugars on actual tangible actions, then people can feel more secure in Okay, maybe my weight isn't exactly where I want it to be, or whatever. But I'm doing all these things. Well, and my blood sugars are well, my blood pressure as well. And so I think we just have to refocus some of the stigmas that are out there, so that people can focus on the right things, and the right gauges of success, because people can be very, very successful. And managing diabetes, like I said before, we know, we know now, because of multiple studies, that if people have really great blood pressure, cholesterol, and blood sugars, they live very long, healthy lives, very few complications. So it's not a death sentence, like it used to be in the past.
Shireen: What are some takeaways for people to, right here listening on this podcast today? What are some takeaways for them to help them reduce those stigmas?
Megan: I think the first thing is to start with self talk. So you know where that, I feel guilty because I did this or I feel guilty because I did that. Start looking at you know, I made this decision today. And tomorrow, we'll make a different decision, or just even that self talk that self blame, restructuring that and giving yourself credit for the things you're doing well, if you're gonna give yourself credit for the things you don't do, well, you better darn well give yourself credit for the things you do well, because you deserve that too. I think the other thing is communication. Because in the medical world, we really quickly write off people when they don't do what we say. Which sounds very dominating. I know but that's how the medical world is set up. Unfortunately, it's starting to shift but, you know, people get labeled as non compliant because they're not taking medicine or they're not showing appointments. And we know that, that some of those reasons that people aren't doing those things is because they have many barriers that keep them from being able to do those things. So I think it's really important that Communication is there, so that you can talk to your provider and say, Listen, I can't take this medicine because of XYZ, I can't afford it, or I can't tolerate the side effects, or I'm worried about side effects. So I don't want to take it. Communication is really important. And finding that, that provider that's going to focus on you, they're going to focus on you what you need. They're going to connect you to social services and support. And there's even sometimes support that you don't know about unless you ask questions. I know in our clinic, one of the physicians set up a fund where people can get so much of their transportation, medications covered like $500 a year. And nobody knows about that, unless they ask or we introduce that to them, we recognize that there's a need because they talked to us about it. So, so communicate and communicate and communicate. And that goes for yourself, that self talk and for your medical team, find somebody that can support you.
Shireen: How do you address diabetes, specifically within minority communities? What do you, what kind of tools? Would you empower them in addition to the tools that you sort of mentioned? Because as we look at the numbers, it's no secret diabetes disproportionately impacts minorities, people of color? Through this, what are some other things that you would say perhaps specifically for, for these groups that are largely at risk?
Megan: That's such a loaded question. Because you know, what this is something that's, I've really wanted to expand more in our clinic, is to reach those populations. So we, we have a large population of people from Mexico here, a large probably population of people from Africa, here. We live in Cedar Rapids, Iowa. And, and we see people, but not enough people, not, you know, there's still a number of people out there that aren't getting our services. And so, I think that really starts on multiple levels on the individual level, I think it's really important. And this is something I do is asking questions about that culture. So I might ask somebody, you know, if they were from, let's say, Africa, I would say, what do people do in Africa? Like, what does your family do or friends that you know, that have diabetes? What do they do to treat diabetes there, because that's a huge indicator of where we're going to start. And the gap perhaps, between how they treat it there, or maybe they don't have as many resources or, you know, as access to certain things, as here. So if most of the time it's drinking water and taking supplements, and here we have medications, that's a big gap that we have to overcome. And helping people understand maybe the differences between here and there and meeting in the middle where, where that person needs to get the care they need, but they also get the support of what they were using, or what, what they're used to, from their culture. So I think it starts there. I also think we have to set up the social pieces. So I know, I have people that I've presented with before from the, from the our health department here in this area, that have set up systems to help the referrals come in to support the people that need those services. So there's a better referral system that's out there. But I also think that we need to create even an environment within our clinic that is more conducive to people of different ethnicities and colors. And even like gender orientation, things like that. It's pretty, we're pretty like farm kid, you know, white, everything kind of approach and not approach I wouldn't say but just the environment, it's it doesn't we don't have a bunch of different flags on the wall with people, people's countries in different languages. You know, I've been in hospitals that have those things. And it's welcoming, it's welcoming to see all those different kinds of languages. So I think even the physical environment can be adjusted to that. And that's something that I hope we will continue to work on in, our in our area.
Shireen: Now, I want to talk a little bit about your podcast, type two, and you with Meg, what inspired you to start this and what is your experience been with it?
Megan: Um, it's a lot of work. You're telling me, it's like, people think, Oh, it's just, you know, 15-20 minutes. It's not of it. Yeah, I know. It's a lot of work. But the whole, the whole goal was to kind of fill the gap between the person with diabetes and the medical world. There's so much I know being a nurse and being a diabetes educator. And same with my colleagues are so much that we know that sometimes we just wish we could get, get that information to people. And like I said before, so People that really have diabetes are coming to clinic settings to get that training and care. So I wanted to kind of bridge that gap where people could get information and support and really easy to understand way. And that was kind of my thought and way of doing it was doing the podcast.
Shireen: What has your experience been with, with the podcast in the way you run it?
Megan: You know, it's, it's good, because it's, first of all, it's a, I set it up to try to expose people with diabetes information. And I have this section called diabetes dilemma. So people can ask a question, and then I answer it. Well, sometimes they ask a question that I need to, I haven't been asked before, or it's been a long time since I've been asked, I gotta go back into the research and look at it. So I'm actually learning, again, some of the things I already knew, or I interview people and like, Oh, that's really interesting. I never thought about that. Or so I think I'm learning probably just as much. So it's been a good experience in that way. And then, of course, I love getting feedback when somebody sends a message or, or something like that, and says, Hey, I really loved this episode really spoke to me, or I'm really excited for, you know, the next season all of those different things. So that's a really cool piece, too. So overall, it's a ton of work. But I've really enjoyed the different layers of it. And you kind of feel like a rock star, when you learn all the technology, I have to say, figured out how to do all these things.
Shireen: It's I think, I think that the biggest thing is you start thinking, well, it can't be too much work. And then you go into it and you're like, this is a lot more harder than we thought it would be…. It looks real simple. People make them look so simple. Right? Exactly. Yeah, they can. Yeah. So it's, it's a challenge to put this together, people.
Megan: Exactly, shout out to everybody listening that listens to podcasts, it's a lot more than the 15-20 minutes that you hear. It's a lot behind the scenes, there's a lot of behind the scenes stuff, and even just the coordinating of like you said, interviews and editing and oh, it's a lot promoting.
Shireen: Yeah. And so with that, too, we're toward the end of the episode, Megan, I wanted to, usually what we do at the end of the episode is, we'd like to learn about how people can connect with you, learn more about your work. So how can people do that?
Megan: Yes. So I know, normally, you tried to give something away. And I'm kind of a lame duck here, because I have been working on something but it's not quite ready yet. And I didn't want to rush it and have it be a quality thing. So if somebody wanted to contact me, you can always go to type two in you.org. You can also check out type two in you with mag on your podcast app. And then there's a bunch of different ways to contact me in the descriptions of every podcast. And so those are the best ways I guess the third way would be email, which is type two, the number two, and you email@example.com. And so those are the best probably ways to get a hold of me. And, and that's how people submit. Like I said, that diabetes dilemma section. So if you run across something, you're thinking, gosh, I don't know if this is right, or I'm curious about this, it doesn't matter what the question is, you can send it to me and I will answer it on, on upcoming episodes. And I also do a series called diabetes bs are legit, where people will send me something they saw on the media. And we and I'll dive into the research and try to figure out okay, is this really legitimate? Or is this something that maybe you shouldn't take as real great information to use for your diabetes care, so, so any of that kind of stuff? Or if you just want to reach out in general, I'm, I'm open to it, for sure.
Shireen: Lovely, and so well, we'll note everything in our show notes so folks can reach out to you and connect with you and ask, ask their questions. So with that, Megan, thank you so much for your time. I truly, truly appreciate you having you on.
Megan: Thanks, Shireen. I enjoyed being here.