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Diabetes Connections | Type 1 Diabetes
The Overlooked Challenges of Women with type 1 diabetes, with Courtney Pickett
00:28:19
Research is finally focusing on women with type 1 – hormones, periods, menopause. But there’s not a lot of guidance or conclusions yet. So what can you do to feel good now? I’m talking to Courtney Pickett this week – she lives with type 1, was...
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- [00:05]
A
This week on Diabetes Connections, research is finally focusing on women with type 1 hormones, periods, menopause. But there's not a lot of conclusions or guidance yet. So what can you do to feel good? Now I'm talking to Courtney Pickett. She lives with type one, was a labor and delivery nurse, and she's the founder of the CPTable, a holistic health coaching company. We'll get her takes on everything from food and to frustration of cyclical blood sugar fluctuations, the pressure to be perfect, and a lot more. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your healthcare provider. Welcome to another week of the show. I am your host, Stacey Sims, and I'm always so glad to have you here. I am glad to be here even though I'm so sorry I sound so bad. I am just getting over a cold and yeah, this is me getting over a cold. I had absolutely no voice a couple of days ago, so things are getting better, moving in the right direction, and I didn't want to skip this week of the podcast. I really wanted to bring you this interview and I sound okay in the interview. We did that a couple of weeks ago, so I won't say a lot here. I will go back to my hot tea with honey. But I will say that I spoke with somebody recently that I'm working on some future projects with and they said, like many of you say to me, especially at Mom's Night out, they said they would really love to have resources for every subgroup of people with diabetes. Older people, teenagers, men, 18 to 26, women in menopause, women who want to get pregnant. You get the idea because with a condition like diabetes, you know, it really does change throughout your life because your body changes throughout your life and your mindset changes, changes as well. So I can't offer everything and education to all of those subgroups, certainly. But I really like when we can dial down into one of those times of life for at least an episode. And truly, being a woman with type one is very unique. It is a unique experience no matter what part of life you are in. So I gotta tell you, I'm old school and the words holistic health coach. You heard me say that in the tease at the beginning. That makes my eyebrows go up. But I met Courtney in person at Mom's Night Out Atlanta, and I loved what she had to say and she explained it to me and I'm really thrilled to have her on the show this week. Our conversation right after this.
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B
Did you hear the pad drop?
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A
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- [03:35]
B
I'm doing great. How are you?
- [03:37]
A
I'm great. I'm so glad you could join us in Atlanta a couple of weeks ago. Thanks for doing that.
- [03:41]
B
Yeah, it was an amazing event.
- [03:44]
A
Cool. Well, I'm thrilled and we're always planning for the next one. But let me just ask you first, tell me a little bit about yourself. When were you diagnosed?
- [03:52]
B
Yeah, I was diagnosed when I was 5 years old. I've had it for 22 years now. So now I'm 27, and I am a former labor and delivery nurse who has now started holistic health coaching for women with type 1.
- [04:08]
A
When people hear holistic health coaching, some people say, oh, that sounds really interesting. And some people say that sounds really woo woo. I don't want anything to do with that. What are we talking about? Yeah, let's just take a moment to kind of set some ground rules here. What are we. When you say holistic, tell me a little bit more about that. Because as you said, you're a nurse.
- [04:24]
B
Yeah, that's a great point. When I say holistic, I'm saying every element of your life that influences your blood sugar, besides your carb ratio and your basal rate. Anyone who has had type 1 diabetes for long enough knows that there's so many things that influence your blood sugar, besides your insulin rates and how many units you take for your food, it's so much more than that. And so what I do is I work on the 90% that goes into diabetes, and for every average person, and I focus on those elements of your health, which then has a high impact on your blood sugar and your diabetes.
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A
Before we delve into it, let me just revisit being Five years old.
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B
Yeah.
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A
Not a time when I. Well, it's not, it wasn't that long ago, but it's not a time when I imagine there was a lot of holistic talk. Do you remember your diagnosis?
- [05:17]
B
I don't remember a ton of my diagnosis. I remember being in the hospital. I have like a few very like minimal memories of that, but definitely not a holistic space like we didn't have. I was on a pump for a while, didn't have CGMs, like not the most technology for diabetes at the time. So it was very like minimal. My mom was sent home with like NPH and Humalog and. Or not. I don't even think it was hemolog, just like rapid acting and it was very, it felt like the stone ages of diabetes. Um, but she did really great with that. So no talk of holistic, any sort of care. It was very. I think diabetes has come so far just in my lifetime. But yeah, very much just insulin. The basics for a long time.
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A
It's been really interesting over the last few years how the idea of focusing more on women, which shouldn't have been a novel idea but you know, really seems to have taken off in the diabetes community because it's amazing how little attention was paid, it seems, from where I sit, you know, raising a boy with diabetes. So I can't speak firsthand to that about hormones, about blood sugar changes, other than people complaining in Facebook groups and saying, you know, she gets her period and things go bananas. So when you talk to women about this kind of thing, what kind of advice do you give? Or maybe we should start with when you talk to women about this, like, where do you start?
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B
That's such a great point. When I talk to women, I kind of start with a baseline of what they notice in their patterns around their cycle and see if they have any trends that they notice. The advice I would give is on a very basic level to track your cycle. Because if you don't know what phase of cycle you're in, you're going to have a hard time mapping out the way that your blood sugars connect. So I would say on a very minimal level, like track your cycle and see if you can find the phases and then find out if there's any patterns related to your blood sugar according to your cycle. That's just like a very basic rule to then see and start to notice how your blood sugars are changing throughout the month.
- [07:27]
A
This sounds so dumb. Are there any general trends? Because everybody is so different. But are there things that Most women do see, yes.
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B
So the general trends, and this is with any woman's body, is you have a fluctuation of hormones throughout your cycle. And you'll start out, and your progesterone will be at a look a lower level. Your estrogen will rise well after ovulation. You'll see an elevation of progesterone and estrogen, which causes insulin resistance. So the typical trend that if you're not on hormonal birth control, that you will see is a rise in insulin resistance in that luteal phase, which is about a week and a half before your cycle starts over again. And so with that trend, that highly influences the way that you approach your diabetes when you're tracking. Because if you know you're gonna be more resistant for two weeks, you can expect different results based off of how you're dosing, based off of different activities and so on.
- [08:31]
A
I'm kind of feeling my way through this since I don't have any experience with. Apologies for that. Um, so. Okay. More resistant. At some point, when you talk to women, do you. Is it like pump changes? Is it basal rate changes? You know, you're really digging in and talking about those things.
- [08:47]
B
Yeah. So when I'm digging in, I'm looking at, what are they noticing? So when you see insulin resistance, you're going to notice that your carb ratio may not be strong enough, your basal rate may not be high enough. You will eat the same foods, and your blood sugar will spike higher than normal. Your blood sugar may be on, like, a roller coaster throughout the day, whereas that's not your, say, normal. What I do is I will tell them different ways that you can strategically help lower the insulin resistance without the component of medication. For example, if you go on a walk after eating, your insulin sensitivity will increase by 30%. So if you are in your luteal phase of your peak insulin resistance, and you know that, like, your body isn't as compliant with carbs, in that scenario, I would offer, maybe you don't have to remove the carb, but you could go on a walk for 10 minutes after you eat, and you will see that it won't spike as high and that you will be able to improve your insulin sensitivity in that scenario. So it's really learning with diabetes and hormones, it's learning how to work with your body instead of against your body. So instead of saying, I'm going to remove carbs, I'm gonna remove all these things that are a part of my life and just takes over. It's Saying, what can I add in to help my body compensate for this? 2 weeks of insulin resistance?
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A
Yeah, it's amazing. I've reported on so many studies that say how great walking after a meal is for blood sugar, insulin resistance, heart. It's. It's incredible. And I try to remember to do that all the time, especially after lunch.
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B
Yeah.
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A
But sometimes life gets in the way.
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B
Yes, it does. That's real. So, like, for me and my clients, I look at what makes sense, because that's another really big element of diabetes, of hormones, of if you try and go from zero to a thousand and say, okay, I'm going to walk after every single meal I eat, and so on, like, that's just not realistic. So you think, well, what is realistic? And if it's just adding in, like a walk after dinner, that's a great place to start and to see how that affects your trends.
- [11:00]
A
What about the weeks then when you are less insulin resistant?
- [11:03]
B
Yeah, absolutely. So then you get into your cycle starts and you're hitting your follicular phase. In that follicular phase, your estrogen and your progesterone are dropping dramatically. So you'll find in an like, average or traditionally, you would find that you'll have an increase in insulin sensitivity. So that will create a way of expectation that you will be more sensitive to what you were just very resistant to. So you can expect. I may not need to dose as much for this food. I may go low if I go on a walk, or I may go low more in this first week because my body is more sensitive. And so what that does is it helps, you know, kind of a framework of how to adjust. So if you know that you are more sensitive and you have insulin on board, that if you go on a walk, it may make your blood sugar low. If you are eating the same food that you had a week ago, you know, I may not need as much insulin because I'm more sensitive in this phase. So it helps you kind of create an element of predictability around your blood sugar that often people get the most frustrated by the sense of unpredictability, because if you had no idea what was going on in your body, you would say, this is so frustrating. One week I'm all over the place, the next week I'm low. Well, the context in the background gives you an element of predictability because then you know what's going on.
- [12:28]
A
Do you have a tool that you recommend for tracking, especially in this time where we are really sensitive to this kind of information? You know, politically?
- [12:37]
B
Yeah. I use an app on my phone to track. All Apple phones have a cycle tracker just built in. So if you don't want to pay for one, that's like a basic way of tracking when your cycle's happening. And then. And then there's just like the basics of from days 0 to 14, you're in your follicular phase, and then day 14 is ovulation, and then you go on from that. Um, but no, I don't have like a specific app I recommend, or I think there's just a very many that you could choose from and then find whatever makes the most sense for you.
- [13:08]
A
Wouldn't it be great if there was one that was diabetes specific? Right. And you could overlay. I know tidepool is doing a ton of work on tracking periods and trying to line stuff up with blood sugar, so maybe in the future we'd have something like that. But as you listen, if you know something like that, even a diy, like, we'd love to know more about it because, gosh, I gotta tell you, my daughter, who doesn't have diabetes, you know, I know she. Well, she tracks with her paper calendar now because she doesn't want to do it online at the moment. But it's got to be so frustrating to. You know, I'm not a spreadsheet person.
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B
Let'S put it mildly.
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A
So. So to track blood glucose with your period and your phases, like, that would drive me bananas. That would be really hard to do. So kudos to everybody who's doing it because as you said, you need the information to be able to act on it.
- [13:53]
B
And I would just add one thing of that over what seems very daunting in the beginning. Like, if you were to first hear this and you don't do any of it and you say, oh, my gosh, like, track my cycle and my phases and my blood sugar, like, it seems so much what become. What seems so daunting is. Becomes very intuitive, right? So I don't have like a paper I'm writing down at this point. I've over years become to master this to where I see, like, okay, my cycle starts. And I know in my brain, like, okay, this is what my pattern is. And it becomes very intuitive and a lot less intimidating. So I just would like to encourage, like, the average listener that's like, ah, what do I do? This is so intimidating. Or like a mom of a daughter who's 13 and just like, oh, my gosh. Another thing to keep track of.
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A
Right?
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B
Totally relatable. But I think at having the framework of what can I add in and what makes sense then makes it more sustainable.
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A
You know, it's interesting, when you said a mom of a 13 year old, it made me think, so you were a 13 year old. And I don't want to get too personal, but looking back, obviously you didn't have all this knowledge at the time. What was it like for you? You know, going through puberty with diabetes is. It's tough for everybody. Anything you want to share? I'm going to leave that up to you. Right, back to our conversation. But first, Diabetes Connections is brought to you by Dexcom. Diabetes doesn't always have to interrupt your day. Dexcom G7, a continuous glucose monitoring system, sends your glucose numbers to your phone or receiver. Know where you are and where you're headed without finger sticks and without interruptions. Dexcom G7 is the most accurate CGM and it's covered by Medicare. Learn more go to diabetes-connections.com and click on the Dexcom logo. Finger sticks required. If symptoms or expectations do not match readings, see User Guide for instructions. Data on file must meet coverage criteria. For full prescribing information on risks and benefits, visit dexcom.com.
- [15:56]
B
Yes. So I remember being 13 and going to an endocrinologist appointment and the conversation was like, oh, like your blood sugar was high. Your blood sugar was X, Y and Z. And it was like, oh, it was just the hormones. And so. And it was almost like dismissed and never discussed in depth. And so when I was 13, I think it was just this, like, understanding of, oh, like, it's gonna be crazy because you're in puberty because of these hormones. But like, let's leave it there. When I was in high school, I had a lot of symptoms of hormonal dysregulation. So those would be chronic fatigue, cystic acne, anxiety and difficulty losing weight. Different things that at the time I was going to a doctor for. So I was going to my endo every three months. I was seeing a dermatologist for the acne every, I think at that time I was going every week for injections. There was zero conversation of an overlap. And that was through. So they put me on hormonal birth control. That was through college until I myself put the pieces together of my imbalanced blood sugar that was stated as normal was then contributed to these symptoms of imbalanced hormones. And when I finally was able to understand my hormones and balance my blood sugar around them, my cystic acne was gone. The stubborn weight loss went away. My inflammation was gone and my energy was back. And so I think this is a really important topic because there's so many band aid approaches of hormonal birth control. And just like Accutane went on Accutane for acne and all these different things were at the core root of it is imbalanced blood sugar and imbalanced hormones.
- [17:47]
A
So I get a little nervous when I hear balancing hormones. Right. Like I said at the beginning, there's a little woo woo in my brain. Tell me a little bit more about that. Like what does that look like when a woman comes to you and you say we're going to try to balance your hormone?
- [18:00]
B
That's such a great question because it is a very, I think thrown out phrase. And the conversations right now, what it looks like to me is when a woman says, I am always tired no matter how much I eat healthy and I work out, I cannot lose weight, I cannot get below X pounds, I have acne all over my face and I've tried everything. I have to be on birth control in order for it to go away. These are the different signs where I look at and I say, okay, so there's something underlying going on that's causing your body to have these signals. What it means when it's imbalance is just your body's essentially just like upset or angry and it's inflamed. It's calming down the inflammation to where your body's just going to balance is just the normal, like a normal, like what you're. What it should operate as. And then imbalance would be an inflamed aversion. Does that answer your question?
- [18:57]
A
No, it makes perfect sense. I'm curious practically what that looks like. Like a woman who is exercising and trying to eat well, yes. Is tired but has all those signs of inflammation. What do you do?
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B
How would we fix it? And this is where the holistic element comes in of health is so much more than just what you're eating and what you're exercising. So I would look at what are your sources of stress and how can we manage that? Because stress is what a huge indicator of hormonal health. Because your adrenal health is what creates your sex hormones. So if your adrenals are pumping out adrenaline and cortisol, they aren't going to be accurately or producing your sex hormones. So that's the basic level of why this works. So stress is a huge thing that we would focus on eliminating. Processed foods. Processed foods are the key to inflammation. Inflammation causes your body to be stressed out. And the stress, like I said, affects your sex hormones, stress, processed foods, inflammation, sleep. Sleep is the hugest way your body can recover. The I would say the. If you are struggling with any of these symptoms, the number one thing I would say is prioritize at least eight to nine hours of sleep a day because that is how your body recovers. Any type one would know like if you have a bad night's sleep the next day your blood sugar is kind probably going to be crazy because your body is inflamed and it's experiencing this sense of stress. So I'd say on a, on a very basic level those are different things we would look at and how we can add in practices or habits to support those things so that your body is able to come out of a very hyper stressed state.
- [20:38]
A
All of that makes perfect sense.
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B
Yes.
- [20:40]
A
As I am listening as a elder woman now who had my first child at 30 and probably didn't get a good night's sleep, diabetes aside. Right. Just with kids in general for 20 years. Right. Or the stress and everything else. And I know we're not talking about specifically parents here. If you could see this video. I was smirking a little when Courtney was talking cause I'm like that all sounds nice. It doesn't sound very realistic to how we live our lives. It's doesn't mean we shouldn't try to do it. I mean the sleep alone would be life changing. I think for a lot of people the processed foods. Right. Would be great. So little steps in this direction I'm sure help. I just don't want to discourage people who are listening and like ah, it's never going to happen for me. What is she crazy?
- [21:23]
B
Right? Yeah, I think that like I said, what can you do? Starting somewhere like the all or nothing mentality is what is going to keep you from going anywhere. If you say I have to like this non toxic lifestyle that everyone is talking about, talking about these days in the health world it's like eliminate bleach, eliminate fragrances, all these things. I mean that's impossible to do overnight. So I think having the mentality of what can I add in, what can I do today? And then over time you'll see that your life will look completely different now than it may have three years ago. But I think another element is what do you value? And then making your decisions align with your values. So are you valuing your energy? Are you valuing showing up to the spaces that matter most to you? Are you valuing like being an example of health to your kids and then making your decisions intentional with those values. I think that also helps move the needle in these different habits. That may not seem realistic, but I think that all or nothing mindset will keep you from going anywhere. But think if you're currently getting five hours of sleep, can you get six tomorrow? That's one more better than yesterday. That's a step forward.
- [22:37]
A
That's a great answer. Yeah, yeah, absolutely. So you were a labor and delivery nurse.
- [22:41]
B
Yes.
- [22:42]
A
Now you're working, you know, in this adjacent space, let's call it. It is a real source of frustration to me that we do not have more research into women's health, that we are just starting to learn much more about women's bodies. Like a lot of women my age, I turned the page into menopause and was furious to find how little everybody knows about it, including doctors. So I'm trying to, you know, I'm not angry today. It's all good. But, you know, are you hopeful that we're going to learn more about women hormones, type 1 diabetes, that this really seems to be just taking off?
- [23:15]
B
Yeah, I am hopeful. I see the conversations brewing in doctor's offices and like events going. So I think that there is more, at least more awareness than there was when I was growing up. I think that the beauty of health coaching specifically for women is that there's only so much an endocrinologist can offer in a 15 to 30 minute appointment. And so it's really that bridging the gap of like we just talked about, of what can you add in today and then bridge that knowledge gap that you may not be getting from your doctor's office. But I do think that at least there's conversations being had and an awareness of what's going on in our bodies because that wasn't just discussed 15 years ago when I was in, I mean, college. So yeah, I think that at least there's more and I think it can only get better from here. So three things that if you want to start to work to balance your blood sugar around your hormones, I would give you is one, adding in protein at breakfast. Because that is what I like to call the anchor of your day. Having a protein based breakfast and just adding that in is what will really ground your blood sugar and prevent you from getting on that roller coaster of blood sugars throughout the day that you're constantly going to be fighting against. I would recommend like 20 to 30 grams of protein in your breakfast, especially eating before coffee. That's a huge thing. And for me, I Am a coffee drinker. So for years I would get up, have a cup of coffee, go do an orange theory workout. Well, what I wasn't aware of is that that was just causing massive inflammation in my body because of the stress hormones that get released. So if you're a coffee drinker, I would Recommend eating your 20 to 30 grams of protein breakfast before or with your coffee. I think that will change the game in a lot of areas. The second thing I would recommend is strength training, which for any woman, building muscle is really important, especially before the age of 30. So really adding in, lifting weights, strength training. I think for a long time it was this emphasis on cardio, but they find that strength really helps, especially with insulin resistance. So strength training contributes to increase in insulin sensitivity, which you have better insulin sensitivity, then you will have more reactive blood sugars to your insulin. Strength training would be the second and then the third I would recommend is removing those processed foods because with more processed foods, you have more inflammation and the inflammation is going to create that insulin resistance as well, which will make your insulin have to work harder to do what you want it to do.
- [25:59]
A
All right, so as a coffee drinker, I'm going to try that. But I will also say strength training has changed my life. I've been doing that for 10 years and it is amazing. And ladies, I know a lot of you already know this. I don't know, it might sound silly. I feel so powerful when I'm lifting weights. Like, I'm not a power lifter. I don't do that. But I have a lot of low impact and lift stuff that I do. And it's an incredible feeling. It's just cool. And then you see the results and you feel good and it's awesome for bone health and everything else. So great. I love it. That the coffee thing, I'm. That's a little tough, but I'll try it. I'll try it.
- [26:30]
B
It's hard. I've been drinking coffee since I was in high school, but I kid you not, like I could show you the graphs. This last week I had a day where I was running out the door and I got coffee and I met someone for breakfast. But I was on the worst roller coaster the whole day. And then the very next day had my coffee with my breakfast and I had a completely different story. That's for someone that doesn't have diabetes as well. I would like to add that's just across the board, women in general.
- [26:57]
A
Well, Courtney, thank you so much for joining me. We will pick up all of the information and online and everything else. I'm glad to see you again. Like I said, we were thrilled to have you at Mom's Night Out Atlanta. I hope I see you again. Thanks for being here.
- [27:08]
B
Of course. Thanks for having me.
- [27:14]
A
More information about the CP table and everything we talked about, go to diabetes-connections.com and click on the show notes for this episode. Join us for Mom's Night out this fall. We are going to be in Minneapolis in September and we will be in Phoenix in October. This event is for moms of kids with diabetes and for women with Type one. You don't want to miss it. It is so much fun and it's really valuable. I'm so happy about doing it. And I have some surprises I can't announce yet, but we have some other things we're working on for this year, not just for those locations, so stay tuned. Thank you as always to my editor, John Buchenis from Audio Editing Solutions. And thank you so much for listening to me with this horrible voice. I'm Stacey Sims. I'll see you back here soon. Until then, be kind to yourself. Diabetes Connections is a production of Stacey Sims Media. All rights reserved. All wrongs avenged.