Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions Like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions.

Shireen: In today’s episode, we will be talking with Susan Wiener, an award-winning nutritionist, [about] incorporating a healthy lifestyle to help maintain your diabetes. Susan will be giving some suggestions on how to start and keep a good exercise routine, eat healthily, and manage mental health along the way. Stay tuned.

Shireen: Susan Wiener is an award-winning food and nutrition expert, author, speaker, and owner of Susan Wiener Nutrition. Susan was selected as a 2015 ADCES Diabetes Educator of the year and received the 2022 Distinguished Service Award for the Diabetes Dietetic Practice Group of A.N.D. Susan earned her master’s degree in applied physiology and nutrition from Columbia University. Welcome, Susan. 

Susan: I’m so grateful to be here. Thank you so much for having me today. I really appreciate being here.

Shireen: It’s such a pleasure having you on Susan. I’m really looking forward to this conversation. Tell us more, a little bit about yourself, and your journey. Why this, [and] What led you into this world of Nutrition?

Susan: Yeah, it’s a great question. I’m a registered dietician, nutritionist, and certified diabetes care and education specialist. Looking at the two and, and how they kind of came together. Ever since I was younger, I always had an interest in wellness and in health and helping people. There were many people in my family who were diagnosed with diabetes and several with heart disease, and I kind of put that together and pursued the career path. I became a registered dietician first but had so many people that came into my practice, with both, type I and type II diabetes and in more recent years with pre-diabetes and gestational diabetes. I’ve just developed such an interest in it for my master’s degree, which is in applied physiology and nutrition being sports nutrition, I also work in my practice with people who are both competitive and recreational athletes who have diabetes and don’t have diabetes. It’s just been a passion of mine to advocate, educate and support people with diabetes and those who love them. 

Shireen: Susan, have you found, and for the, you know, our podcast episode here today, we’re largely gonna be focusing on just healthy living with diabetes just trying to understand that and navigate it. Have you found that people are finding it difficult to accept change once they’re diagnosed with diabetes? I wanna get into the mental health component of it, but can you just first talk to us about what that acceptance process looks like and how difficult it is to come to terms with it?

Susan: It’s a great question. I so appreciate that we’re having this discussion, and when we think about it, a person with type I diabetes makes approximately 180 different health-related decisions every day. Think about that. It’s 8,700 hours a year spent on self-management of diabetes and only 28 minutes a year with a provider. Change is huge. Even the most organized person who’s not stressed out will become overwhelmed sometimes, and situationally disorganized with a disease, a chronic disease diagnosis, especially one of diabetes. So change is hard, especially when you’re getting information from your healthcare team, from well-meaning family and friends and coworkers, some of which is unsolicited advice.

To get to the point, of education and change, I believe that we first have to embrace the person with the lip condition of diabetes and say; please tell me about your journey with diabetes. Please tell me about your diagnosis. Embracing the person’s thoughts of where they are, has to happen before any change, any positive health outcomes are going to be embraced because it’s very overwhelming. I think that that’s the first part because change is hard. First, we have to find out where a person is before providing any information. Nothing happens in change without collaboration and the person who’s living with diabetes is in the center everything else is built around that. 

Shireen: That is so interesting that you mentioned that. Talking about that person with diabetes is at the center of making all of those different changes for themselves. Now let’s get into the mental health piece of it. How does mental health play a role? I’m assuming it’s a big part [of] someone’s motivation and this ability to make changes and make different choices for themselves. 

Susan: Yes, of course, and I think way back when, because I’ve been in practice for, many, many years. Way back when, at least when I was being educated and when I first started my practice, we talked about different ways to help manage diabetes, we spoke about food and we spoke about exercise, and we spoke about keeping up with doctor’s appointments, and we spoke about taking medications as prescribed. We didn’t address mental health and, mental and emotional health is the umbrella over all of this before anything can happen with change or education. Mental health is very important and I think we have to realize that, especially after covid 19 and the lockdown in the pandemic people with diabetes who of course can be, in denial at first of the disease, but eventually may develop diabetes burnout with a diagnosis and be tired of it, can also have general anxiety and general depression not related to diabetes.

All of those mental health aspects have to be acknowledged and respected. Acknowledge and respected. The person with diabetes may not share that at first because there’s often a power differential that exists when a person is seeking medical guidance. When a person with diabetes comes into a healthcare practice or office or telehealth, such as my practice is now. They may just answer questions. Because they don’t wanna feel shamed or blamed or guilted because they may not have done something that was educationally discussed to do and just say yes and possibly not come back for a future appointment mental health [and] emotional health must be addresses all the time with people with diabetes. I also wanna point out that there are many peer support organizations, that are helpful for people with diabetes as well. Other people with the ‘lived’ experience, who really understand what a person might be going through.

Shireen: Speaking of mental health, and there’s the other aspect of it, which is exercising. Now exercising is an important part of not just you know, diabetes for just living a healthy life in general, right: but it also helps you, regulate diabetes, the blood sugars. I would love to get your take on, some suggestions that you have to get started around exercise and what you tell your patients around that.

Susan: Oh, of course. Well, one of the things, I start off with is I sometimes don’t use the word exercise. I use physical activity sometimes people look at that e -word as like a negative word. We talk about physical activity and you’re so right. Not only does physical activity, both aerobic exercise like walking, swimming, cycling, [and] dance, help with blood sugar levels, but so does strength training exercise and anaerobic exercise as well.It also helps with weight management. Physical activity helps to lower blood pressure and also can help with lowering LDL or low-density lipoprotein bad cholesterol. There were so many benefits. I think in order to get started start small. It’s the same thing with being overwhelmed, and it goes back to mental health as well.

As you pointed out, exercise can boost your mood by boosting serotonin levels and endorphins. It has so many positive qualities. Don’t start big. I just had a patient the other day, Patty, she’s 42 years old. She lives with type II diabetes and it was the first time I met with her and she shared with me that she had not started exercising yet because she hates the treadmill and, and doesn’t wanna go to the gym. I’m like, let’s cross that off the list and start with another way, cuz she heard that in another appointment. We talked about wait a minute, let’s start this very small, and we worked out that she’s going to schedule some time to walk with a buddy. I have a dog, so I love walking with my dog. Just physical activity in general is awesome, but if you love to dance, you don’t even need to join a dance class unless you want to. You can find dance videos on YouTube or on Instagram. There are just so many different things that you can do, find what you like and schedule it in small intervals and you’ll see that that’s going to be a big accomplishment and may motivate you, really motivate you to keep going with it when you feel those benefits.

Shireen: That’s interesting. So just start small. Don’t set something, an extravagant goal that you feel like you’re feeling to meet. Just start small, something attainable. 

Susan: Start small. That’s how gyms often stay in business. Of course, many of us love going to the gym, but gyms stay in business when you join and then you pay every month, but you don’t go. But you keep that membership for fear that if you cancel it, you’ll never go. Start small, feel the accomplishment, the motivation that gives you, and then continue.

Shireen: Now let’s switch over to the foods. Now, aside from exercising, eating the right foods is also crucial to someone trying to maintain diabetes. What suggestions or tips do you have for someone who’s newly diagnosed with diabetes?

Susan: Yeah, it’s of course food is something that we speak about for people who are newly diagnosed with diabetes and for people who may have been diagnosed with diabetes for a while, but are now ready to embrace the nutritional aspects of their diabetes self-care. If it is possible and you are able to see a registered dietician nutritionist who is also a certified diabetes care education specialist or join classes that may be covered from your insurance on diabetes, self-management, education, and support which is covered under certain plans and certainly Medicare. I definitely, think that you should embrace that. I start with where a person is with what they’re eating, and we talk about learning about different foods. What foods would raise your blood sugar levels or affect your blood glucose levels and those are carbohydrate foods. We talk about different carbohydrate foods.

Again, very respectfully of a person’s background, finances, [and] cultural background, not just giving them a sheet of paper that doesn’t work, that people are not going to follow. we talk about portion management and of course other health goals that need to be incorporated in that. I would point out that there’s a lot of great information. Not all information online is great information, so I think it’s important to find the proper information online that if you’re seeking that initial guideline there is some great information through the ADCES website, which is the Association of Diabetes Care and Education Specialists fantastic tip sheets, Where to start, factual information. There’s also outstanding information on some of the peer support sites, which also have [the] support of healthcare professionals such as; Beyond Type I, Beyond Type II, Diabetes sisters, and Taking Control Of Your Diabetes, and those are just a few that I, I know are fantastic and have some great information.

Shireen: Oh, that’s great. Those are great resources. I now wanna switch and talk a little bit more about the mental slash emotional side of all of this as well. What advice would you give to someone who uses food as a perhaps safety mechanism, um, and is finding it difficult to really change their habits? Where, where does a person like that go? 

Susan: It’s an amazingly important topic primarily because one of the first topics that are discussed when a person is diagnosed with diabetes is food. And throughout the years, so many people that I’ve worked with have developed, I’m going to call them dysfunctional eating behaviors. Not necessarily fitting into a pigeonhole of emotional eating or stress eating or burnt-out eating, because every time you speak to a healthcare professional or anyone who may be well-meaning, who’s talking to you about diabetes, will say, Should you eat that?Is that right for you to eat? And that affects your mental health and affects your social life. You may even isolate because you don’t even wanna be around people who may be judging you and shaming you about what you’re going to eat. That is very understandable and please don’t be, anything other than open about that if you can with people who you are comfortable with and your healthcare professionals and a mental health professional if you need to do that, my advice would be that if that seems to be an issue, either undereating, overeating or going to foods which are making you feel less than great to seek out the help of a nutrition professional who can help guide you on that or there are certain groups also in the peer support community that may also have a good understanding to help you.

What I would suggest not doing is to, go onto online sites that may further restriction, or further the issues around food, because that can be devastating and we kind of fall down into a rabbit hole with those kinds of discussions but know that you’re not alone. If someone is constantly speaking to you about eating and what you’re eating and you feel judged by it, that’s not a great thing. I will also say this, when my practice switched in 2020, for obvious reasons, after decades being in a brick-and-mortar office to telehealth, many people were a little bit concerned because they weren’t seeing doctors, and there was telehealth about not constantly being weighed at doctor’s offices or other offices. People do often better when there’s not a medical reason to be weighed, to not be weighed, and sometimes just knowing that if there’s not a reason to be weighed. That you don’t have to be weighed every time you go for a medical visit, is very positive and I think that that’s a positive change that many healthcare professionals are embracing.

Shireen: It’s just not, not weighing the person at all. And that just helps take some of that stress off of that number.

Susan: Absolutely, and there are medical reasons why sometimes that needs to be, but certainly not every time you go into every office, there’s really no reason for it and if that becomes a reason that you’re not following up with your appointments, bring it up to your healthcare provider as to why you may not be going, because of not wanting to be weighed, and that is completely acceptable and helps you bring your voice into the conversation and maybe brings up a conversation. That you may not have been comfortable having before.

Shireen: Another alternative could be like they, absolutely need to take the weight, but they don’t have to share that information with you. 

Susan: Absolutely.

Shireen: Take all the way you want to. Just don’t gimme that number.

Susan: Absolutely. It can be you that can be discussed and with all the online portals now, you can even do that in advance of your appointments. I’m a very big believer, especially with a telehealth practice of doing as much as I can in advance of the appointment. To take a lot of that stress off so we can really get into the goals of what we want to accomplish in that appointment.

Shireen: That’s lovely. What I’m hearing from you is just sort of thinking ahead about those types of things that may be stressful. Another thing is just advocating for this is the type of care that I need and not this, one size fits all approach that, you know, a physician may have which now actually is a good segway into what I wanna talk about next is the healthcare professionals. Now the power differential that exists between a healthcare professional, and just feeling blamed or being made to feel guilty about diabetes.

Susan: Yes.

Shireen: I would love to get your take on how you’ve seen that. and what I, a healthcare professional, ideally listening to this podcast today, can do differently going forward.

Susan: Yes, I, I’m so glad that we’re having this discussion. So both on the side of the healthcare professional and for the person with chronic disease such as diabetes, who is seeking guidance from that healthcare professional. Starting with the question that we began the beginning of the podcast with; which is please tell me about your journey with diabetes? Please tell me about your healthcare journey, and as much as we want to impart education, sit back, practice active listening before we share anything, and that will hopefully start to put a person at ease, because they may have seen another healthcare provider in the past, another clinician, in the past that judged them or blamed them, or they feel blamed for whatever reason with their diabetes and that’s helps put them at ease. This goes into language as well. Rather than labeling a person as a diabetic; “Ask them how long have you had diabetes?” That does not define the person. It is a part of who you are, but it doesn’t define them. Even something simple, such as, did you check, did you test blood glucose?

Okay. The word test for some people could set them. Let’s talk about when you last checked your blood glucose level. Even a small change in language and using positive non-judgemental language and body language can help put a person at ease and really help flatten that power differential. Cause remember there [were] so few minutes per year that a healthcare professional is spending with a person and so many hours that they are spending caring for themselves. We want to really build up all of the tools in their toolbox for self-care and be available for guidance as needed.

Shireen: What does someone who has diabetes do differently? Right? We talked about the healthcare professional side, but how does one avoid that feeling of blame, [and] shame, and just have that positive relationship with that healthcare professional?

Susan: I think before we go into an appointment and that’s why I do so much in advance. I always ask people to, help set the agenda for the visit. Again, there’s such limited time that a healthcare professional who often sits in front of a computer and doesn’t even look up, they’re typing. That’s an issue in and of itself, isn’t it? But to have, if you want to speak to someone as a healthcare professional about their food, but the only thing on their mind is how to get a medication [to] improve approved by insurance as an example. There is no way that the healthcare professional could say anything about food when insurance is an issue. Asking the person who’s coming in for the guidance to please share what’s at top of your agenda to speak today, once that’s checked off. They will feel more in control, more at ease, [and] more in touch with the changes and the motivation that they want to see happen and it sets it all up for positive outcomes.

Shireen: I love that. Can you also speak to, and what we hear a lot in the news, especially during covid, is around social determinants and health of health, excuse me, and more specifically food access, right? Do you see those challenges specifically in communities of color, and how do you work with someone like that who is trying to figure out some of the basic needs you know, while also trying to balance the nutritional aspect in the implications on their disease state?

Susan: It’s certainly very challenging, and I’m not sure that all the data is out or how much it might have improved or not improved since Covid and since the lockdown things just in my small world are improving because there is, at the beginning of lockdown, people were so afraid or had so much limited access all across different communities that we may have been eating things that were not quite as nutritious. We’re able to kind of embark a little bit more on that now. I will also say one of the benefits to me of working in telehealth, and they’re not all benefits, but one of the pros of working in benefits is I can walk with people into their kitchens and their cabinets and refrigerators and freezers and have a very real discussion as a healthcare professional, as a clinician, as a registered dietician, I completely make sure and, and in my, discussions and seminars and talks to, to really, talk very deeply about making sure we get people’s not only food preferences but food accessibility and cultural backgrounds about what people are eating to get in there. So it is about speaking up because once you speak up, we will advocate for you and try to improve food access to you.

This does not solve the big issues of food deserts and non-accessible foods in different communities, and I just. I’m not solving the problem with this, but another issue that we try to address is in disaster zones and where there are weather problems, floods, hurricanes, tornadoes, where people may not have access for food for not only temporary periods of times but longer periods of times or ways to cook food or access to their medications or insulin. This is a huge problem that is trying to be addressed by many organizations, but definitely top of my priority list in a lot of different discussions. 

Shireen: Certainly a lot of work to be, to be done. 

Susan: Oh, a lot of work to be done. And at least now we’re acknowledging some of these issues. 

Shireen: Mm-hmm. 

Susan: It’s apparent that when these are acute issues, food is very important. Trying to be tight with food, what a person’s eating may not be nearly what we want it to be. People getting food and, and getting in, um, nourishment is extremely important in those situations. So we are working on it and I think another really positive thing is that people who are representing those communities are now having their voices heard more and so we are able to address many of those issues. 

Shireen: With that, Susan, we are unfortunately toward the end of the episode here is where I would love for our listeners to learn how they can connect with you and then just learn more about your work after this episode. 

Susan: Oh, absolutely. So you can check out my website and through there, connect, if you wanna send me an email, which is susanwienernutrition.com. It’s very simple. It’s my name with the word nutrition, and on my website as well, you can see a lot of the articles that I’ve written. I am the columnist for, Diabetes in Real Life, for Endocrine Today, I do many presentations and webinars and so reach out to me anytime and I’d love to connect with you and hear from your audience as well. 

Shireen: Lovely. And to our listeners, thank you so much for, joining us on this episode. Head over to our social media go over to our Facebook at Yumlish our Instagram at Yumlish_, on Instagram itself, and go on there find this podcast episode post, and in the comments, answer this one quick question. How has a healthy lifestyle changed your life? Either your life, either your life, excuse me, or a life of a loved one? Help us understand what that healthy lifestyle means for you for that loved one. Again, head over to our Facebook, Instagram, [and] answer that quick question there. We will see you there after these, this episode. Susan, thank you so much for your time. Truly appreciate having you on. 

Susan: My pleasure. Thank you so much for having me. 

Shireen: And thank you everyone for tuning in. Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, yumlish.com for more recipes, and advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. 

Stay well.

Connect with Susan:

• Instagram
• Twitter
• LinkedIn

Additional Resources:

• ADCES
• Beyond Type I
• Beyond Type II
• Taking Control of Your Diabetes