[0:32] Shireen: In today’s episode, we are delighted to have Emily Schilling, whose passion for nutrition advocacy and education is both inspiring and transformative. Join us as we explore her journey, innovative approaches to diabetes education, and unwavering commitment to equitable well being.  Stay tuned.  Emily Schilling is a registered dietitian and certified diabetes care and education specialist who has supported people living with diabetes across the lifespan. As a person living with type one diabetes, Emily draws on personal experiences to help others navigate real life challenges to live healthier, more empowered lives with diabetes. Welcome, Emily.

[1:16] Emily Schilling: Thank you for having me.

[1:17] Shireen: Such a pleasure having you on. As someone who has type 1 diabetes, been living with that, what really inspires you to pursue a career in nutrition? And can you tell us a little bit about your own journey?

[1:30] Emily: Yeah. So when I was 17, I was diagnosed with type 1 diabetes and really the events around the diagnosis are what inspired me to go into nutrition.  So type 1 diabetes is an autoimmune disease, and it’s characterized by the body no longer making insulin. And I grew up in a very small town. We didn’t have any diabetes specialists in the area. So, I had to wait about a month before I was able to see a diabetes educator. And in the meantime, my doctor sent me home with an insulin prescription and said to avoid carbohydrates. So, you can imagine that, you know, for that month, it was really hard and really stressful trying to eat anything. And when I eventually did get to meet with my diabetes educator, she really changed my life. She didn’t tell me to eat this or not eat that. She’s like, what do you want to eat? And how can we figure out how to do that? And you know, being 17, I was like, I really want to eat ice cream. And she taught me how to eat ice cream. And, you know, because she was such a big influence, that’s why I wanted to do the same and go on to become a diabetes educator as well.

[2:43] Shireen: Lovely. Can you also help us understand a little bit about your professional journey? How did some of your early experiences working with older adults influence your interest in nutrition advocacy, especially for those living with type two diabetes?

[2:59] Emily: Yeah, so I’ve always had this dynamic  career path. I’ve always been interested in diabetes and I’ve also been interested in working with older adults specifically. And I realized  early on as a dietitian that a lot of the older patients I had with type two diabetes were coming in with. What I’ll call very old school nutrition advice. They were diagnosed 20, 30 years ago, and at that point they were told to go on a diabetic diet. And I just want to say that there is no such thing as a diabetic diet, and that a lot of foods can be included. So that was really kind of the journey that I wanted to embark on with advocacy is debunking these myths.

[3:42] Shireen: And to that end, how do you tailor your diabetes education and from old school diabetes care, how do you really tailor your diabetes education strategies to really address the specific challenges and needs of individuals with type 2?

[3:57] Emily: So the first time I meet with a new patient, I do a really thorough interview. I want to know where they’re doing their grocery shopping, how they’re doing their grocery shopping, how they’re paying for their groceries, what their skills or cooking abilities actually are, who their support system is, what their favorite foods are. I want to know as many details as possible so I can really understand what their day to day lives actually look like and what barriers or challenges they might have in managing their diabetes before I make any kind of education or suggestions.

[4:34] Shireen: Help me understand why the payment component. Why is that important to know?

[4:39] Emily: You want to know that people have access to foods, they have access to healthy foods, and most older adults are living on fixed incomes. So they only have a certain amount of money to spend every month on food, or they might be balancing that very small budget between paying for food or medication or transportation costs. So really setting up to understand that someone has adequate food access is really the first thing before going into any type of nutrition education. And I’ll give you an example of that. If someone is doing most of their grocery shopping at a CVS, Because that’s the only  food store in their area that they’re able to get to. That’s really going to change the type of advice or education that I provide compared to someone who has access to a regular grocery store.

[5:32] Shireen: How do you ensure that the information you share really empowers individuals to make informed decisions about their nutrition? Again, just considering this dynamic nature of diabetes care.

[5:42] Emily: I like to encourage self directed learning. I think that this can be really empowering because if I meet with a client,  let’s say for 45 minutes twice a year, there’s no way we can cover every single type of food or every type of scenario that they could be presented with. So, I like to encourage people to do their own learning, and kind of run their own experiments, if you will. So, let’s say someone eats two pieces of toast every day for breakfast. What does your blood sugar look like when you’re eating those two pieces of toast? What happens to your blood sugar if you have one piece of toast?  What happens if you have a piece of toast and some eggs? And really getting people to dive into that mindset of problem solving, of trial and error, to figure out what works best for their bodies.

[6:37] Shireen: I’m also hearing a lot of like data informed decision making, like don’t only take my word for it. You look at this experiment that you can run, right? Exactly. To see the impact on blood sugar levels. I love that approach. Are there, you know, when you’re talking about even blood sugar levels, Are there specific advancements in technologies that exist today that you really believe hold particular promise for individuals living with type 2 diabetes? And then how do these innovations align with advocacy efforts?

[7:06] Emily: I am a huge fan of continuous glucose monitors. So this is a device that is attached to you and it gives you real time readings of your blood sugars. So any given point of the day, you can look and see where your blood sugar level is.  And a lot of the research on continuous glucose monitors and people with type 1 diabetes, type 2 diabetes, all across the lifespan. It shows that this helps people to make behavior changes with their eating habits. It shows that this helps people to reduce their glucose levels into their desired range. And continuous glucose monitors are also really helpful for caregivers, especially when we’re thinking about those older adults who might not be managing their diabetes entirely on their own, or if they have caregiver support, it makes it easier for those caregivers as well. So I think that continuous glucose monitors are something we’re going to be seeing a lot more of in the future. And just this year, Medicare expanded its eligibility criteria to anyone who is treated with insulin would qualify to get a continuous glucose monitor.  And I think right now that is part of my advocacy is just letting people know, Hey, you’re on insulin, talk to your doctor, you could qualify to get this. And it can be a really big game changer for your diabetes management.

[8:32] Shireen: And really the key word there being the continuous part of the continuous glucose monitoring, right? Really being able to get a lot more data points about your health all throughout the day rather than having to. prick your finger several times a day sometimes and only getting that data point for that period in time versus again the picture for the entire day. Exactly. Okay, that is helpful. I want to shift gears and talk a little bit about cooking. How does therapeutic cooking specifically benefit individuals with type 2 diabetes and are there any favorite recipes? I’m sure as a dietitian you get that question a lot, but are there any favorite recipes or cooking techniques that you find particularly helpful?

[9:13] Emily: Yeah, so therapeutic cooking is something that I do through my work and it’s usually a small group, maybe 8 to 10 people. And the point of therapeutic cooking is to bring people together to prepare and enjoy a meal together. And even though I’m a dietician who’s leading this group. It’s not heavily nutrition focused. I find that those nutrition conversations come up naturally as you’re going through the cooking process. And sometimes people learn better by actually doing things than just by what you’re telling them. So the therapeutic cooking is really modeling very small changes. You’re using familiar foods or foods that are familiar to the group that you’re working with and making very small tweaks. So, for example, we made empanadas, but we baked them instead of frying them. We made lasagna, but we added chopped spinach to it.  We make pizzas. But then we make a really nice salad or vegetable side dish to go with it. So then you can also model portion sizes as you’re dishing up the food and passing it around the table. And this has been a really positive experience and just getting people to try something new.

[10:31] Shireen: So, community engagement is a key aspect of your work. How do these foster a sense of community, especially again for those living with type 2 diabetes?

[10:42] Emily: So, I think finding a diabetes community is really important all across the lifespan because diabetes can feel like a really isolating disease. If you are At a work party and there’s all this food there and a coworker knows that you have diabetes and they say, oh, you can’t eat that or you’re not supposed to have that. And  I think it creates a lot of shame around diabetes, which is destructive to the empowerment of managing your diabetes. So finding a community of people who are dealing with the same things that you’re dealing with can really be motivating and help to keep you accountable. Communities also are a great source of knowledge and information sharing, like, Hey, my doctor recommended I try this specific medication. Oh, I’ve never heard about that. Let me talk to my doctor about it. Or I made this recipe using this ingredient and I really liked it. So I think finding people who also have diabetes and connecting with them is a really great way to share knowledge and stay accountable.

[11:46] Shireen: I think also just getting that local help, right? Like, kind of like you’re talking about, like this doctor, like, and I think sharing of those resources is so important to be able to say the other side of this, which is, this is not only my experience, this is others experience as well. My experience is not unique, it is that of others as well. You know, this becomes so important through a disease where not everyone around you really understands it entirely, right? There’s certain biases that may be there or stereotypes around diabetes and blood sugar and all of that. How do you help people sort of foster that community and draw strengths from it?

[12:24] Emily: So one thing that I started a few years ago, really just in wanting to connect more with the type one diabetes community and work on debunking some of these myths was I created a professional Instagram account. And through that account, I’m sharing my experience with diabetes, but also  sharing nutrition tips or medication information. And it’s really amazing to see the community that comes together in those spaces. Just, you know, the people that are following or commenting and talking to each other through this platform.

[13:00] Shireen: That’s helpful. And what role does this community support really play in nutrition advocacy?

[13:06] Emily: I would say that this Instagram platform plays a big role in nutrition advocacy, again, in debunking those myths. You know, what are things to not say to someone with diabetes? What are ways to support someone with diabetes that are beyond the typical public knowledge? That’s kind of that old school nutrition, right? Like you can’t eat this or you, you can’t eat that.  But really saying no, people with diabetes. can eat whatever they want, and usually it comes down to just tweaking small details to help your blood sugar stay in range.

[13:45] Shireen: Can you share a specific challenge you face in advocating for better nutrition for individuals with type 2 diabetes and how you overcame it?

[13:53] Emily: I would say the one of the biggest challenges, this outdated nutrition advice, I meet with patients all the time who come in and say, Oh, my doctor told me I couldn’t eat rice or I can’t eat mangoes. And the woman with the mangoes in particular, this was one of her favorite foods. And now she felt really deprived. At the same time. Mangoes are really nutritious and delicious. And so it was kind of reworking with her to figure out how she could reincorporate that food that she loved so much into her eating habits and still manage her diabetes. So I think that that has been a really big challenge and a similar story. I was working with a woman who had type 2 diabetes. She was on insulin. She had a continuous glucose monitor and.  She really loves sweets and desserts  and so I said, okay, let’s use this experiment model and You know go home try out some different types of cookies See how they impact your blood sugar and the next time we met she was so excited That she had figured out the specific type of cookie that she really liked and she could eat, you know, exactly two of them and keep her blood sugar in range. So, I think that is a really big win when you can help people to enjoy their food and to do it in a way that still manages their blood sugars.

[15:18] Shireen: And I love the emphasis that you have there, which is around, there isn’t anything around like, depriving yourself. You don’t need to deprive yourself. Can you speak a little bit to that? Because time and again we see people saying it’s a very like anything that’s our process around it, which is again, going back to the old school diabetes management, but which is more all or nothing. Either I’m completely, you know, like either I’m all in or I’m all out. And can you speak to some of those sort of binary approaches to diabetes management?

[15:47] Emily: Exactly. I think that one education practice that I like to use is, rather than subtraction, think of addition. So, if you want to have a bowl of cereal for breakfast, but you’ve learned that that bowl of cereal will spike your blood sugar,  instead of saying, I can never eat this bowl of cereal,  Think about what can you add to that cereal that would help your blood sugars. So an example of this is, you know, eating a spoonful of peanut butter before you eat the cereal. You’re adding something to it, and then that might help to keep your blood sugars in range. So really thinking about the addition rather than subtraction.

[16:31] Shireen: That’s a really good calculation. What you can add rather than subtract is always a good. Yeah. Yeah.

[16:37] Emily: Yeah. And going back to that example I used earlier with the toast. You know, if you’re eating toast and your blood sugar goes through the roof, the idea isn’t to subtract the toast, it is to add some type of fiber or protein or heart healthy fat to that toast to help balance out your blood sugars.

[16:56] Shireen: And I love that, in the same vein, can you speak to other examples that folks can do during their lunches, their dinners, of exactly those types of things where they can add healthy nutrients to their foods?

[17:08] Emily: I think a big one that most Americans can work on, just small steps, but adding in more vegetables. And one really easy way to do this is microwave veggies, frozen microwavable veggies. Some of them come pre-seasoned. I recommend these a lot because they’re quick, they’re easy, they’re well seasoned, and they can help to balance out your blood sugars, as well as provide you with a lot more nutrition and nutrients from those vegetables.

[17:36] Shireen: Lovely. Addressing the unique nutritional needs of individuals with type two diabetes, especially folks as they age, is quite crucial. How do you navigate this aspect of your work and what considerations are important in providing effective support to this population?

[17:52] Emily: A big thing to realize is that as we age, there are so many other things happening. So if you’re thinking of someone who’s in their seventies, eighties, nineties, they might have trouble with their vision. They might have trouble with their teeth. They might have trouble with their dexterity. So this is where that initial interview becomes really important, but also reassessing each time you meet with the patient to say, what are you having challenges with? Or even to say, can you show me how you check your blood sugar. Can you show me how you inject your insulin? And really using that teaching step, that teach back step, to see if that is effective or if someone might need more care and support around their diabetes. The other big part of this is As we get older, and especially, you know, the 80s, the 90s, if  folks have other health conditions, or if they have cognitive impairment in some form, at that point it really becomes a shift from a focus on health and wellness to a focus on quality of life. And this is a point where, sometimes with my patients, I will just tell them to eat whatever they want, whatever food they enjoy, whatever they love, because at that point, it’s more critical to enjoy life. Even in small moments, such as a meal, than it is to be overly prescriptive and regimented with their diabetes management.

[19:22] Shireen: Love that. What is the one key takeaway that you could give to our listeners here today to really understand, particularly, again, those navigating complexities around type 2 diabetes, of how they can seek to make positive nutritional choices?

[19:38] Emily: I want to bring it back to that addition is better than subtraction. Instead of thinking about overhauling your whole eating style and making all of these changes at once, eat the way you normally eat and think about if there’s something that you can add to what you’re eating that would help to balance out those blood sugars.

[19:56] Shireen: And for clarity, adding nutrient dense foods, because we can add a bunch of ice cream, if that’s what we’re talking about, Emily, so.

[20:05] Emily: Correct. Correct. The foods that you want to be adding are foods that are high in fiber, foods that are high in protein, or heart healthy fats that are going to help to stabilize the blood sugar levels.

[20:17] Shireen: Love it. Thank you for that clarification.  Yes. Yes. Awesome. With that, we are toward the end of the episode, Emily, can you tell our listeners how they can connect with you and learn more about your work?

[20:28] Emily: Yes, you can find me on LinkedIn, Emily Schilling. You can also find me on my Instagram page, which is Diabetes Glow Up.

[20:37] Shireen: Great. And we, what we’ll do is in the show notes, we’ll link up everything so folks have it easy, they can click and be able to follow your social pages. But then Emily, thank you so very much for your time. It’s such a pleasure talking to you and Thank you. And to our listeners, thank you for joining us on another episode. Head over to our social media and find this podcast post, comment below to tell us. What are some of your favorite recipes or cooking techniques that have worked well for you while managing your diabetes or a loved one’s diabetes? Again, head over to our social media, again, Facebook or Instagram at Yumlish. Find this podcast post, comment below to tell us what are your favorite recipes or cooking techniques that have really worked well for managing yours or a loved one’s diabetes. We will continue the conversation there, Emily. Thank you so very much yet again.

[21:25] Emily: Thank you.

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