Shireen: Podcasting from Dallas, Texas, I am Shireen and this is the 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 with you each week.

In today's episode, we will be talking with SaRene Brooks, who is the director of nutrition and weight management services at integrated diabetes services, serene discusses some of the challenges people face with diabetes and how exercise and a healthy diet can help you manage it.

Brooks is a registered dietician and a certified diabetes care and education specialist whose focus is lifestyle intervention. Two of her three sons were diagnosed with type one diabetes, both at age 16. This led her to a career. She enjoys helping individuals and families work through the complexities of living with diabetes.

Welcome SaRene. 

Brooks: Hi. Thank you.

Shireen: Absolute pleasure having you on, SaRene. Starting out, tell us a little bit more about, more about your story. What led you into diabetes in the bio? It mentions the story of your two sons. We just like to learn a little bit more of what their journey was like. 

Brooks: Yeah. I would love to share my journey.  Diabetes has been part of my life, or as long as I can remember I was raised in a home with a father who was diagnosed probably in his forties with diabetes, which seems a little bit older, but I remember him getting the diagnosis. I remember him taking pills and long needles and really archaic equipment to test blood sugars.

And eventually he needed to go on insulin. And the thing I learned about this is he felt like he had failed at his diabetes care because he needed to take insulin when really insulin is just a hormone and that we, a person with diabetes doesn't produce enough of or doesn't produce at all. And so he just.

That hormone. And it's kind of sad that, that we feel that way. But so I, I was raised with that and I, I kind of always thought I would get diabetes cuz every time I was sick, we'd test my blood sugar with this horrible apparatus. So  poke your finger and not really tell you numbers. It just kind of told you a range of where you were, but I, I haven't gotten diabetes yet.

And I later went on to get married. My brother-in-law got diabetes at age 29 and the, it was new to their family. They'd never heard of much about diabetes. It was really shocking. And watching them kind of go through something. So new was a really eyeopening experience to me and his son then was diagnosed at age two with diabetes.

And this is where my involvement really started. We, my husband and I decided we wanted to, help care for him and help be able to be a respite team for when his parents needed to leave a young child with diabetes, with an adult. So we learned to dose and count carbs and check blood sugars on a little boy. And it was a really good opportunity for me to learn.

Because later I would go on to have two of my three boys be diagnosed with type one diabetes. And when they were diagnosed, it was a completely different thing for me as a parent, as opposed to someone looking onto another family with receiving that same diagnosis, even though I knew I could figure it out.

It was still a very, very challenging time for me. And it was really. Really good for me to, I guess, fill that and understand how a parent really does fill when their child is diagnosed with that. But we also had a diabetes educator that helped us. She taught us how to care for our boys, what things we needed to do.

We got a lot of really good education and she was really a big inspiration for me wanting to go on and become an educator. 

Shireen: Thank you for sharing that. Speaking of diabetes, especially with the work that you do now, what challenges do the majority of your patients face when they find out that they have diabetes?

Brooks: There's really a big mix of emotions when people. Find out they have diabetes, whether it's type one or type two, it's just a very overwhelming diagnosis. It's something that you can't walk away from. You can't take a break from it. It doesn't go away at night while you're sleeping. And so it's very overwhelming.

And like I said, from my own personal experience, it was overwhelming to me. And I had had a lot of experience. In my past with it. So imagine someone who had really not heard much about it before, or really know nothing about diabetes having this diagnosis, they might be the parent of a small child, or how does the child feel?

How does a teenager feel? So kind of be, thinking of how that would make someone feel, how do the other family members feel? I didn't mention my middle child in the middle of all my two, my oldest and youngest getting diagnosed. But how did he feel in the middle of all this and how does it impact him?

So there's just a lot of overwhelming feelings for the, the family and all those who are associated with them. And then there's also the frustration of just not knowing for sure what to do. Why you're doing it. You, you get your diagnosis, hopefully you have access to care where you can have some really good information given to you or

possibly even put in the hospital to get blood sugars under control, if it's type one diabetes, but a lot of that education given in a setting where you don't feel well, it's just hard to take an all in. So you come home kind of not knowing what to do. And so that's, that's another one of the challenges that you face right up front, but then you come home and then you try to figure out where am I gonna get care?

Do I live close to a provider who can help with teaching. Specifically diabetes or is my insurance gonna cover the supplies that I want or the particular medications that I want to take for my diabetes. So sometimes that access of care or just insurance, if you don't have insurance, how are you gonna afford it?

Diabetes is very expensive. Medication's expensive.  insulin is expensive. If you have type one and you're gonna be on a pump and a monitor just takes a lot of money. So it's big challenge can be the expense. And then there's all the misinformation out there you can read. Anything online, you can read blogs, you can learn from people's experiences, but there's just some misinformation that gets mixed in between and maybe misunderstanding of what you read.

And then you always have advice from other people. They may tell you something like you can't eat that you have diabetes. Why are, why are you eating that? And. People try to give you maybe advice and, and they're well meaning, but it can be a real challenge, especially for someone who's new to diabetes.

Shireen: And I like the fact that you touched on some of the misinformation, because it's all around us, social media, even people in your immediate circle that have all these theories on foods to eat, to avoid. So I appreciate you touching on that. Most people find it difficult to change their eating habits.

How are you able to navigate those challenges to create a healthier eating lifestyle? 

Brooks: I love working with people and helping them with making healthy lifestyle choices. And it is kind of my focus of my, of my work, but I really enjoy it. It's like a little puzzle. Everyone is so different. They come from a different background and they have different cultures and lifestyles and likes and dislikes.

And so it's really fun to meet with people and really get to know what they like and how to fit. Better eating habits for the things that they. Right. I like to teach about the macronutrients, the carbohydrates, that protein, what is their role in a healthy diet? So people can understand why it's important to have a well rounded diet, but how to make those things fit in appropriately.

And then. The next step for someone with diabetes would be, how do these things impact my blood sugar? How does it impact the insulin I'm taking or the medication that I am taking? And so really understanding what those macronutrients are doing so that they understand why they're making the changes they're making.

And then a really important part of lifestyle change is just making. Change us one at a time. It's, it's not very sustainable to think that you're going to do everything all at once. If you do that, it's probably not gonna last very long. So you have to really be patient with yourself and make one change, get it working, and then add to it.

You know, with today's technology, we have a lot of ability to. Look up nutrition information or find out how many macronutrients we've eaten today. That's something we didn't used to have, but with that information, we can use that as a tool to really fine tune our eating habits and, and understand. What is in the food that we're eating and then people can make decisions on how can I make some changes or, or swap some foods around to make 'em a little bit better, but they really just need to be tailored to that improved diabetes management.

But like I said, education, I feel like is really key to all of this understanding. It really makes a big difference. And I love to use goal setting is it's so fun to set goals and. Set. We, I call them smart goals, which is specific, measurable, attainable, realistic, and timely. So it's something, maybe they set a goal for a week.

Make this one change, but it's something they know they can do in that week. So it gives them this inspiration to really work hard on and focus on that one, that one item that they're gonna change and, and then easily change make another goal the next week. It's really fun to see what goal setting can do for someone in making these changes.

Shireen: How are diets creative for people with type one diabetes versus type two diabetes?

Brooks: There are some big differences in type one and type two diabetes of all of those who have diabetes of more than 90% of them have type two and type two diabetes is where your body becomes resistant to the insulin you're still producing.

So you just are not using it as efficiently. As you used to, and it can come from various reasons. It can be genetic or, you know, age, the older we get, the more likely we are to become more insulin resistant. And that would be type two diabetes. So type one, diabetes is an autoimmune disorder where our body no longer produces insulin.

So we rely on insulin injection, whether it's with a needle, a pump, a pen, but that insulin becomes. Life support for us. They have to have insulin. If you have type one diabetes and they didn't, you know, someone with type one does not do something to cause themselves to get type one. And the same with type two, I think there's kind of this misconception that if someone has type two diabetes, they weren't eating well.

They were not exercising enough, but that's not necessarily the case, but. Because of this, the the diets for each of them are just a little bit different in, in all of them. We consider the carbohydrates that they're eating. So carbohydrates are the body's preferred fuel source. When we eat a carbohydrate, it breaks down into glucose.

It goes into our bloodstream and then our insulin helps get it out of the bloodstream and use for energy in the body. So it impacts all of us for someone with type two diabetes. They just aren't able to utilize their is insulin as efficiently as they were before. And so medications will help that. But for someone with type two diabetes, they're usually on some type of a consistent carbohydrate diet where they're encouraged to eat about the same amount of carbohydrates with each meal, and then a little bit in between for a snack.

And this just helps keep their blood sugars more level throughout the day. And then. It helps with medication management, if those level state kind of the same throughout the day. Now someone with type one diabetes, they also will have to count their carbohydrates, but they need to learn how to dose insulin, according to how many carbohydrates they ate.

So it's a pretty complex process. So you think about sitting down to every meal, every snack and thinking how many carbohydrates are here? How large is my portion? What are my blood sugars right now? Am I about to go out and go for a walk? Or am I gonna be sitting for a while? When do I need to take my insulin?

How quickly is this food gonna absorb in my body? So these are all the things a person with type one, diabetes is thinking the entire time they're getting ready to eat. So they really do need to have a really good understanding of carbohydrate counting. And then the impact of other foods such as protein and fat would have on their blood sugar levels.

Carbohydrates aren't the bad guy here. Like I said before, they're the body's preferred energy source, but we just teach people with diabetes, how to appropriately count them and, and work their medications or insulin around them. And they're all encouraged to eat healthier carbohydrates, plenty of whole grains, plenty of fruit, things like that are all part of any person's diet who has diabetes.

Shireen: I want to switch gears and now talk about youth and just children in general, the number of children developing diabetes has grown over the years. Do you find that children have a tougher time incorporating exercise in their daily routines? And if so, how do you help guide them? And this is of course assuming a certain type of diabetes, but I'll let you speak to that.

Brooks: Yeah. And, and with the, any diabetes we are seeing more children with both type one and type two than we've ever seen before. And most kids love to be active. They love to run and play. It's usually not a problem, but there are some children for various reasons that aren't as active as they should be, could be due to their family lifestyle, maybe access of a safe place to play.

Maybe they have some sort of disability that doesn't allow them to be as active as they should be. Once again, this is where this education comes in and helping parents and children understand that physical activity helps with blood sugar management. The more you move your muscles, the more you can use your insulin efficiently.

So it's important to be active. The CDC recommends at least 60 minutes of vigorous physical activity each day for children. But once again, it's sitting down with parents and children and kind of making a personalized plan for what would work with them. If they aren't already pretty active kids. 

Shireen: What is your best advice for someone who is struggling with the changes?

Be it food, exercise, but just general changes that diabetes has created for them. 

Brooks: Yes, there's lots of changes. And my first suggestion would be to meet with a certified diabetes care and education specialist. And I'm saying that from the voice of a mom who wasn't an education specialist at the time, that's what really got me through helping my children.

That they are trained professionals who can help you learn how to manage your own diabetes, whether it's type one or type two or other types of diabetes that are out there. And then don't let all those new changes overwhelm you. You just take them one at a time. You learn something new, you implement it.

Lifestyle change takes time, but. Really, if anything you can remember is, don't let diabetes run your life. It's part of your life, but it doesn't need to take over your life. You can still go and do the things you like to do, and then learn why you're making the changes. And I think it will help you, to ma to manage your diabetes better and be willing to make them, if you understand why.

And it's also support is really important. Find a group of a network of people who are living with diabetes, or spend some time with your friends and family and explain your diabetes to them. So they understand what you're doing to manage it. It's it's really a relief to people to understand it and know more, some people hesitate to ask, but explain it and share it with your friends and family so they know, know what you're doing and know how to support you.

Shireen: SaRene. So you spoke earlier about misinformation and this is some of the things that we have seen when it comes to fad diets. That of course, you know, you see it on social media, even with friends, with all the craze around keto and paleo and other popular diets, would any of these be beneficial for someone who has diabetes?

Brooks: So my initial answer to this. That really food choices are so individualized. They can be based upon personal beliefs, religious beliefs. They can be based on the type of, I don't know, even just the access. You maybe have to certain foods, but as a general rule, the popular diets tend to be a little trendy and they kind of come and go.

A lot of things need to be considered when you make food choices. And I like to look at it. As a whole of eating a variety of all different kinds of foods, proteins, carbohydrates, fats, often the popular diets really limit one particular food group or one particular macronutrient. And our body really needs a variety of, of all of these things.

And so that is. One of the things that discourages me from recommending a particular diet, unless it is specifically something they need for their own health in general, people really just need a variety of foods that they like. It goes back to some sustainability in eating. If, if you take away food that you really like, because it's not in your diet plan, it's really difficult to stay on that for a long period of time.

There's rarely a food I find that someone can't eat, unless it. You know, something like celiac, they can't have gluten, but typically people can just learn how to fit their favorite foods into their eating habits. And so I recommend not excluding certain food groups. One other issue you have with a lot of the diets as you lose weight really quickly, which causes you to lose some lean body tissue, which is not what you want.

And so. I recommend a variety of foods, looking at moderation, figuring out how physical activity can fit into healthy eating habits. And then Work with your diabetes management team to find the best food choices for you, but be happy with who you are and be really careful with the information that's out there.

That seems to be a quick fix. A healthy way to make changes is usually not a quick fix.

Shireen: Aside from eating healthier and exercising, how important is it to take care of your mental health? 

Brooks: I'm so glad that you brought this up because people with diabetes are two to three times more likely to have depression than those who don't have diabetes.

And a lot of the times it goes unnoticed. So if you have diabetes, don't be afraid to reach out for help. Diabetes is a 24 hour a day Job and there's no breaks it, it can get frustrating. It can get tiring, but my suggestions are once again, find some support from family and friends that can understand your diabetes and support what you're doing.

There's a lot of great online groups that just like to visit about their own diabetes and ask questions with each other. And those are really great resources. I also would recommend seeing a mental health professional. If you get to the point where you just, aren't not able to cope with your diabetes, or it seems to be taking over your whole life or, or all of your thoughts, there's no shame in asking for help with your diabetes.

When it comes to your mental health. There are some great. Mental health professionals out there that I know of, that I could refer you to that specifically see people with type one diabetes or even diabetes in general, but it's really important to get help if you need it and then get education from an educate from a diabetes educator, they can help you understand your diabetes.

So maybe some of your frustration is just not knowing how to control your blood sugars. And then just do the things that you love to do. Don't stop doing the things you love. Get outside, be active. I, I find if people can find something they do that they have a little bit of control of it kind of helps 'em cope with that.

Diabetes that they don't have control of. So find some things you love to do that, that you feel you can control.

Shireen: I just love taking that energy and putting it something where, you know, it's, it's also helping you in return. So with this SaRene, we are toward the end of the episode at this point, can you tell our listeners how they can connect with you and just learn more about your work?

Brooks: Yeah. So I'm a certified diabetes educator for Integrated Diabetes Services. And I, I work with insulin users on their diabetes management, and I'm also the director of our weight management program at Integrated Diabetes. It's a really unique program design specifically for insulin users. We go over things that will help with weight loss while managing blood.

and so it's, it's a really great program that, that we've seen a lot of success with. So that's really an exciting thing as well. You can learn more about it online @ integrateddiabetesservices.com or you're welcome to reach out to me. My email is sarene @integrateddiabetes.com. And I'd love to hear from you.

Shireen:  And so with that, we are toward the end of the episode. Thank you so very much SaRene again, for your time. To our listeners out there, we have a quick question for you so that you can head over to our Facebook, our Instagram, and help answer those quick questions.  So earlier in the episode, serene talked about modifying your food.

So you don't have to cut away any of the foods that you like and you love, but you can actually modify them in a healthy way. Now, which one of these foods would you choose to modify? And then also tell us how? Would it be burgers? Chocolate, or tacos. If it's all three, then it's all three, either way. We will see you on the other side of this episode on Facebook, on Instagram, you can find us at Yumlish on Facebook at yumlish_ on Instagram. Head over there,

find this podcast episode post, comment below the post. And again, let us know which one of these foods you would modify and tell us exactly how. SaRene. Thank you so very much for your time on the episode today.

Brooks: Yes, thanks for having me.

Shireen:   Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @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 perspectives. You can also visit our website Yumlish.com for more recipes 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.

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