#1841 Practical PACEs: Routines, Safe Spaces, and T1D Resilience

Summary

Podcast Summary: Juicebox Podcast: Type 1 Diabetes

Episode #1841: Practical PACEs — Routines, Safe Spaces, and T1D Resilience
Date: May 4, 2026
Host: Scott Benner
Guest: Erica
Theme: How protective and compensatory experiences (PACEs) — practical supports and routines — help build resilience for those living with Type 1 Diabetes.

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Overview

This episode is the third in a four-part series exploring the PACES (Protective and Compensatory Experiences) model, particularly how practical resources and environments can foster resilience for people living with Type 1 Diabetes (T1D) and their families. Host Scott Benner and guest Erica break down actionable strategies and research-backed resources that can offer stability, connection, and hope—especially for children.

“Managing type 1 diabetes requires constant awareness… environments around people with diabetes can help make life feel steadier, safer and more manageable.” — Host, [00:11]

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Key Discussion Points & Insights

1. Defining PACES and Their Importance

• PACES: Positive experiences that build resilience, reduce risk of mental/physical health challenges, and particularly counter the effects of Adverse Childhood Experiences (ACEs).
• Research Base: The conversation builds on the work of Amanda Sheffield Morris and Jennifer Hayes Grudo (2023), including their PACES Heart Model.
• Clarification: Having T1D is not officially an ACE, but the model is adapted to address chronic illness.

Notable Quote:
“Positive influences that help build resilience and reduce the risk of mental and physical health challenges... even if they also face adverse childhood experiences.”
— Host, [03:07]

Insight:
Even adults with high ACE scores can intentionally develop some of these protective factors to help heal from earlier adversity.
— Erica, [07:23]

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2. The Power of Practical Supports

a. Participation in Hobbies & Community Activities

• Any hobby or activity—does not have to be diabetes-focused—can foster self-worth, satisfaction, and help integrate T1D into a full life.
• Access to learning (e.g., YouTube) has opened opportunities for self-teaching and new accomplishments.

Memorable Moment:
“If you want to go walking around in the forest and flipping over rocks looking for bugs, you got a hobby. You know what I mean?”
— Host, [11:18]

• Volunteering is highlighted as a resilience-building activity.

Quote:
“There was just an excitement in her voice that something else came up to donate her time to.”
— Host, [14:05]

b. Predictable Home Routines

• Regular schedules (sleep, meals, device site changes, etc.) reduce nervous system stress and provide comfort.
• Balance needed: Too much rigidity can breed anxiety around deviations; flexibility should be cultivated alongside routine.

Quote:
“It’s easy to get stuck in routine… then anything outside of that… can induce a lot of fear.”
— Erica, [16:52], [18:59]

• Emotional tone in responses to T1D routines—especially handling highs/lows—impacts kids’ sense of safety and self-worth.

Example:
“If every time your child… is high, are you asking… what did you eat? … That builds in the routine that they did something bad, that’s gonna lead to shame…”
— Erica, [22:01]

c. Safe and Supportive Schools

• School safety encompasses physical, emotional, and diabetes-specific needs (e.g., 504 plans, staff training).
• Staying in class for hypo/hyperglycemia care, rather than always going to the nurse, fosters inclusion and safety.

Quote:
“When you’re low, you don’t want to move… you want to sit and treat. That is the key.”
— Erica, [24:56]

• Role-playing advocacy for kids/teens helps prepare them to protect themselves socially and medically at school.

d. Neighborhoods Where People Look Out for One Another

• Community awareness (neighbors, friends’ parents, etc.) offers a broader safety net.
• Education of others about T1D helps reduce isolation and increases both actual and felt safety.

Insight:
“You can choose a few people who look like they’re open to it… create that neighborhood for yourself.”
— Host, [28:25]

e. Access to Healthy Foods

• Recognize access can be complicated (resources, geography, affordability).
• Build a healthy relationship with food, avoiding language of “good/bad” or “dangerous.”

Quote:
“Food is food… I would switch the language to: that’s hard to bolus for me… I might not nail it.”
— Erica, [32:42]

• The aim is flexibility, non-restriction, and stress-reduction around meals.

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Notable Quotes & Memorable Moments

• “Predictable routines and safe environments… can help prepare or strengthen the brain over time.” — Erica, [08:24]
• “Having comfort at home means predictability.” — Host, [21:25]
• “If you can surround yourself with good people who understand, you’re much more likely to have a good outcome.” — Host, [28:25]
• “This isn’t a list of… all things you should be doing and shame on you if you’re not…this is what research shows helps build resilience in children and adults.” — Erica, [39:38]
• “I think of this as aspirational…do your best to mimic some of it. It might help you.” — Host, [40:27]

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Important Timestamps

• [02:21–07:00] — Overview: PACES research and definition; hope for adults
• [09:29–14:25] — Hobbies, volunteering, and community activity
• [14:33–23:02] — Predictable routines at home, emotional tone, flexibility
• [23:10–26:09] — Attending safe/supportive schools and advocating for oneself
• [26:55–30:33] — Neighborhood/community involvement for T1D safety
• [30:42–35:45] — Access to healthy food & healthy attitudes toward eating
• [35:52–37:30] — Summary wrap-up: resilience-promoting qualities
• [37:30–42:18] — Reflections on common sense, aspiration, and hope for listeners

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Final Takeaways

• PACEs provide a roadmap for building resilience in T1D—practical resources and environmental supports can make a meaningful difference.
• Resilience is not static—both children and adults can add protective factors over time.
• Even incremental changes—adding a hobby, fostering routine, creating safe school/community networks, and positive food language—promote well-being.
• The research is “aspirational”—not a source of guilt, but of hope and direction.

Erica:
“These things… are resilience-promoting qualities of children’s environments… the structure and support… will ultimately integrate your ability to have more coping skills and more emotional resilience.” [35:52]

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Next Episode Tease

Part four will offer a concise, positive summary of all eight PACES factors—“an audio bullet list”—and potential upcoming online tools for community self-assessment.

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This episode emphasizes practical hope: regardless of history or obstacles, everyone can take steps to help themselves or a loved one living with T1D build a safer, more resilient life.

Transcript

[Host (possibly Pat)]

Here we are, back together again, friends, for another episode of the Juice Box Podcast. Hey everybody. Welcome Back to the third episode in my four part series, Looking into the Paces. Managing type 1 diabetes requires constant awareness. You know, that problem solving and flexibility, that's a lot for anyone, especially, especially a child. Research into PACES shows that beyond relationships, practical supports in a child's environment can also build resilience. Things like routines, safe schools, supportive communities and opportunities to grow. In this episode, we're exploring the second category of paces, resources that build skills and resilience and how the environments around people with diabetes can help make life feel steadier, safer and more manageable. If you're looking for community around type 1 diabetes, check out the Juice Box Podcast. Private Facebook group Juice box podcast type 1 diabetes but everybody is welcome. Type 1, type 2 gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juice box podcast type 1 diabetes on Facebook. Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. The episode you're about to enjoy was brought to you by Dexcom, the Dexcom G7, the same CGM that my daughter wears. You can learn more and get started today at my link dexcom.com juicebox Today's episode is also sponsored by the Omnipod 5. And at my link omnipod.com juicebox you can get yourself a free. What'd I just say? A free Omnipod 5 starter kit. Free. Get out of here. Go. Click on that link omnipod.com juicebox check it out. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox links in the show notes [e-mail] so we are back. This is the third part, am I right? 1, 2, 3.

[Erica]

That's right.

[Host (possibly Pat)]

In the pace series. Look at me go. What are we talking about today?

[Erica]

Yes, so today we are talking about the second category of from the paces, which are the protective and compensatory experiences. We're going to focus on the resources and the tools that help build the skills and resilience. And again, that we're getting this research from the Amanda Sheffield Morris and Jennifer Hayes Grudo, who did the research and published a paper in January of 2023. And then they also consequently created the pace heart model that we're going to be talking about today.

[Host (possibly Pat)]

Okay.

[Erica]

And I think There's a great summary here of what the PACES are, if you want to share that.

[Host (possibly Pat)]

Am I reading protective? Hold on a second, let me get this right. Protective and compensatory experiences. Paces are positive influences that help build resilience and reduce the risk of mental and physical health challenges. Individuals who experience numerous paces during childhood tend to have better overall health and well being, even if they also face adverse childhood experiences. Or the aces. That's pretty cool.

[Erica]

Yes. Which we have defined in our first. In the first episode and also had another series on resilience, defining what those aces are. And as I was thinking about our conversations, I don't think we clearly stated that living with a chronic illness such as diabetes is not actually considered one of the aces from the studies. But we are using the research from the landmark ACE study and all the subsequent studies on resilience, such as the PACE initiative, which we just referenced in the PACE heart model, and trying to, you know, take the research and tools from all of those studies and hopefully discussing them to build resilience in people living with diabetes and also their caregivers. So in that, I think it might be helpful to just kind of review what we've been talking about, that the early stress that can come from either living with a chronic illness or the other aces can shape the brain, but also which builds hope is that safety and connection and positive experiences can also shape the brain because the same parts of our brain that are sensitive to stress are also sensitive to healing. And in our last episode, we talked about the first part of the protective and compensatory experiences. And that was the significance of having these warm relationships and supportive caregivers and how that can build resilience even in the context of living with a chronic illness.

[Host (possibly Pat)]

Yeah. It actually struck me that when they're kind of held up against each other that the ACES list seems. It's rough. Like it. I mean, if you're having those things happen to you, it's a rough go. But in the PACES list, it's pretty simple concepts, right? Like having an adult around who cares about you. With this, it wasn't like 17 people have to celebrate you all day long and pick you up over your shoulders and tell you how great you are. And it was just very simple. Supportive things need to happen around you and if they happen, statistically speaking, you have a better outcome. And I don't know. Does that make sense to what I'm saying?

[Erica]

Yes, the research does indicate that people who have a higher PACE score saying the protective and compensatory experience score also seem to have a lower ACE score. So what does that mean? I don't want to extrapolate too much, but I think you could wonder, like, okay, if you have more exposure to these protective factors. Right. These are. That compensate for the trauma and stress that can come from the aces. It's hard to say. Does that mean that you live in a different place that we don't really know? Like, if you have a higher PACE score and you have a lower ACE score, did those paces mitigate and buffer your experience of those exposures to the adverse childhood experiences? Maybe.

[Host (possibly Pat)]

Or are people who have one or the other experiences more likely to be in homes where those things are happening and not the other thing?

[Erica]

Yes. Yes. It could be one or the other or both.

[Host (possibly Pat)]

Like, if all your brothers went to prison, but you had two parents around you that felt like you loved. They loved you, and they were concerned for you, like this one of those outweigh the other, if that's your scenario. Or is the fact that, you know, are people who, you know, live in a house where everybody's going to prison also experience other aces more frequently and vice versa? Somebody who's got, you know, parents who are, you know, warm and loving or whatever else is on that list, are you more likely to also be around other things on that list? It's interesting to think about it that way. Okay.

[Erica]

But ultimately, the kind of. The hope in all of this research and conversation is that even if you're listening, and I think we've said this before, but as an adult and you have a higher ACE score, you can still work on and engage in and build in some of these protective factors, even as an adult, to help heal from some of that trauma.

[Host (possibly Pat)]

Yeah. You could maybe take it backwards, take it back and. And make it a little better. All right, cool. I like that. The hopeful nature. I know we brought it up before, but it is nice to know that just because something horrible happens to you doesn't mean you can't recover from it or heal or whatever. I would also guess that that means that just because you grew up great doesn't mean something terrible couldn't happen later to, you know, put a dink in the. In your charmer, in your. But I just messed up a chink in your armor, I think, is what I meant to say. I said dink.

[Erica]

A chink. Yeah. Yeah.

[Host (possibly Pat)]

Anyway. Okay. Okay, good.

[Erica]

Okay. So why. Why do the practical supports, you know, these resources and tools, why are they important? Why do they matter? Well, obviously, as we talk about these Things through the lens of living with diabetes. You know, we're. We're always making decisions. We are very aware of our body and how we're feeling. There's a lot of uncertainty, so many variables every time we bolus. And consequently, when the environment around the person living with diabetes is predictable is well supported. We're going back to the brain research. The brain is able to stay more calm, more focused, and hopefully the nervous system is more regulated more of the time. The important part that you'll hear us probably reiterate is that predictable routines and safe environments, as much as you can provide, can also help prepare or strengthen the brain over time. So these tools, we can list them really quickly and then go into detail, or should we just go for it?

[Host (possibly Pat)]

Oh, why don't you do them one at a time?

[Erica]

Okay, we'll do them one at a time. So the first one is participating in hobbies or community activities. So again, that, that might seem like, oh, I'm already doing this. That's really easy. It might be difficult for, for some. Right. And this can look like any, anything. It does not have to be diabetes related. So, you know, dance, sports, art, STEM classes or clubs, robotics, music, theater. And the important piece for, for the person living with diabetes is knowing that, okay, this might happen. Obviously, right after diagnosis, things kind of pause. You're trying to figure out how to integrate diabetes into your lifestyle. But then once you feel at least a little bit more comfortable, you know, you want to go back out and reintegrate the other parts of your identity and your other interests and your other hobbies so that it doesn't feel like diabetes is always going to be this huge interruption.

[Host (possibly Pat)]

Yeah. And it can look. I think your point is good, too. It doesn't have to look like the things that just pop into your head when you say hobbies or activities. I mean, I'm involved in a community activity every day, but I don't think I'd put it that way if you asked me. My son just recently grabbed an inexpensive guitar and was like, I'm going to learn how to play the guitar. And I can tell you that, like, since he began doing that at the end of his days, where you would usually, like, he'd go, he used to get done, go work out, eat dinner. And then he kind of looked like, well, I don't really know what to do anymore. And you could see it almost like just kind of like his day just sort of just became a little rudderless at that point, even though he'd accomplished a number of things during the day. Now he just picks the guitar up and tries his hardest. And there you go, he's, he looks content. I think he's sleeping better now because like, it's all kinds of stuff, you know what I mean? So, yeah, whatever a hobby is to you, it doesn't have to be on a list. It just, you know, if you want to go walking around in the forest and flipping over rocks looking for bugs, you got a hobby. You know what I mean?

[Erica]

Yes.

[Host (possibly Pat)]

Cool.

[Erica]

That's cool. You know, I was just thinking, I wonder, this is kind of related, but not. I wonder if there's like an increase in hobbies based on being able to YouTube something like wanting to teach yourself how to do something. You're. Yes, you're, you're using the Internet, you're using these YouTube videos, but then you're still reaping the benefits of teaching yourself something new and then experiencing that sense of accomplishment.

[Host (possibly Pat)]

Access is, is huge. Right? And now suddenly you have, you know, hopefully you'll find somebody that's doing it, know pretty well or something. But I don't think, I think anything you can imagine right now, you could YouTube and probably find somebody doing it in front of you, at least to give you an idea of like what it looks like. And. Is this something I'd be interested in? I'll tell you. Have you, have you ever watched people go camping by themselves on YouTube? Yeah.

[Erica]

Oh, not on YouTube. In real life, actually.

[Host (possibly Pat)]

Real life, I don't want to go outside where it's cold. There are people who just go out places, just set up a camp. You watch them, set the whole camp up, live, pack it up and leave. And there's something incredibly satisfying about that. I think maybe you should actually go camping if you're looking for it to be a hobby. But my point is there's no world where me and you growing up would have thought that one day there'd be videos detailing how to set up your campsite.

[Erica]

Right.

[Host (possibly Pat)]

You know what I mean? So, yeah, absolutely. Can I do number two?

[Erica]

Well, yes, before we do that.

[Host (possibly Pat)]

Oh, I got ahead. Go ahead.

[Erica]

Yes, you can do number two. So I think, like, we maybe already kind of discussed this, but I think it's easy and also beneficial. When we think about hobbies, activities, getting involved in the community, we are, our default is, you know, wanting to participate in diabetes related groups, whether it's, you know, online or in real life. And that is important. But there is such a, it's so important also to show up for the other parts of your life.

[Host (possibly Pat)]

Not to make diabetes the whole thing.

[Erica]

Yeah, yes, yes, for sure. And in this participating in hobbies or activities, it's also important to note that volunteering is a really helpful tool as well that helps build resilience. And I don't know if we've talked about that significance of volunteering.

[Host (possibly Pat)]

I just put up an episode today with a lady who is an attorney and she said she was finishing up, she was doing volunteering for something and then she got diabetes and then she volunteered for like Health Canada or something like that just to chair their board. She was an attorney, so she was a good person to chair the board for them. And, and she's like, I'll do that for a couple of years. There's, you know, nice way to give back and everything. But there was something about the way she talked about, like the one thing that she was donating her time to was coming to an end and there was just an excitement in her voice that something else came up to donate her time to. That's what stuck to me, was how excited she was at the possibility of being able to donate her time again. So, yeah, obviously there's a lot of positive feedback with that. I thought after listening to her, yes.

[Erica]

Okay, so I think we've, we've discussed part one and the benefits of all of engaging in other activities.

[Host (possibly Pat)]

So have hobbies, community activities, and number two, predictable routines at home. Predictable routines. Is that down to like, what time we get up, where we eat, when we go to bed? Like what? What do you mean by that? Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod 5 users pay less than $30 per month at the pharmacy. That's less than $1 a day for tube free automated insulin delivery. And a third of Omnipod 5 users pay $0 per month. You heard that right. Zero. That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was 4 years old and she's about to be 21. My family relies on Omnipod and I think you'll love it. And you can try it for free right now by requesting your free starter kit today at my link omnipod.com Juicebox Omnipod has been an advertiser for a decade. But even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com Juicebox terms and conditions apply. Eligibility may Vary. Why don't you get yourself that free starter kit? Full terms and conditions can be found@ omnipod.com juicebox you can manage diabetes confidently with the powerfully simple Dexcom G7. Dexcom.com juicebox the Dexcom G7 is the CGM that my daughter is wearing. The G7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch. The G7 is made for all types of diabetes, type 1 and type 2, but also people experiencing gestational diabetes. The Dexcom G7 can help you spend more time in range, which is proven to lower a 1C. The more time you spend in range, the better and healthier you feel. And with the Dexcom Clarity app, you can track your glucose trends. And the app will also provide you with a projected A1C in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom. Dexcom.com Juicebox when you use my link, you're supporting the podcast Dexcom.com Juicebox Head over there now.

[Erica]

Yes, I think we did talk a little bit about kind of having the predictability around how caregivers people show up in the home is really important. We talked in more detail about that in the last episode. This, this is more focused around the routines of, yes, bedtime, morning time. I think having there, there are probably pros and cons to both of this, like having the consistent meal time or snack. Now back in the day we had to eat at a certain time based on the insulin that we were dosing ourselves for and that created a lot of rigidity. However, if having consistent bolus timing, particularly in the morning, brings you convenience, brings you kind of a calm morning and feels manageable, then that is something I would, that I would kind of lean into. But also we want to be holding space for flexibility because particularly with diabetes, we find comfort in routine. Like when what we eat in the morning where we put our devices and I think that's such a beautiful thing. But sometimes we might get stuck in that routine and then anything outside of that, whether it's we're thinking about carbs or no carbs or putting the pump on a different location on your body can induce a lot of fear if we're so stuck in our routines that cause comfort. Okay, so it's a hard, that's a hard space.

[Host (possibly Pat)]

I've witnessed this for so long with Arden and then with other people online and I have to tell you, like it was a thing I didn't Understand at first, but I'm with you now. Just the idea of, like, no, I wear this on my thigh or I inject this in my arm, or like, that's the rule. Like, and it sticks to people so quickly. Little kids, even just very quickly, like, no, no, it goes here. And you go, no, it could go here, too. They go, no, it don't. It goes right here. And then trying to get them to change is a. Is a monumental lift. It really is at times.

[Erica]

You know, even having, like, the routines around your site change day, or what do you do before and after a lab draw? What do you do before and after a doctor's appointment? How do you comfort or calm, you know, a CGM site change if it's painful, or pump change. Those are all great. And we talk a lot about building and predictability around those things and knowing that once it feels like you're coming up against some pressure or tension around. Well, or even for yourself, if you're thinking about this as the caregiver, if there's a lot of fear around change, not that that's bad, but just noticing it and saying, I wonder if we can kind of lean into some. A flexible mindset of trying something new, even though it is going to feel scary acknowledging that.

[Host (possibly Pat)]

It's interesting how when I saw routines, my brain went one way and then there was a whole other part of it that I didn't really consider. And I think it might be in my head right now because Dr. Fernandez was on the podcast recently. He's an endo, and he just wanted to come on and talk about sleep patterns for kids with type one and how important it was to stop anxiety. And anyway, it's a good episode if you want to check it out. I think that's why when I heard routines, I thought about what time to go to bed, you know, because he talked about, like, maybe try to put your phone down an hour before bed, have a routine to wind down with. And then, you know, I'm going to do a poor job of explaining it. But. But moreover, what he was saying was that if you have autoimmune in your life or, you know, inflammation, or you're just a person who has to think about so many other things all the time that if these little, I don't know, physiological things get off balance, it could really hit other things hard. It was the way he talked about. He. He's like, you have to remember your kids have a job. It's taking care of their diabetes. It's like, it's always in their head, they're always taking care of that job. And then if you add extra anxiety on top of that or sleeplessness or that kind of stuff, that it can snowball really quickly. Anyway, I thought that was interesting.

[Erica]

Absolutely. Having predictable nighttime routines, even though your child might resist, they know that brings that kind of comfort and kind of. And boundaries around. This is what I do before bed and this is what I do next. And then this is what mom or dad or caregiver does next. And it, and it, it, it's all part of regulating their nervous system and knowing what is next.

[Host (possibly Pat)]

And also all of that leans very heavily into the paces. List of like, knowing like so much of like, having comfort at home means predictability. It means like if I come home, like I said in an earlier episode, but I always thought it was very important I was a stay at home dad, that when the kids walked in the house, I was there so that at least they would know every day when I get home, no matter what's happening, that guy is going to be standing right about there. And I just. That to me, I think paid off over time. And you can build predictability in all kinds of little places.

[Erica]

Yes. And I think we spoke to the emotional response last episode. But just while we're talking about predictable routines and blood sugars, as you're going in in the middle of the night to help treat like the child knows. And you know, I'm going to look this way, I'm going to respond this way, I'm going, my face is going to look this way and it's all around trying to regulate and keep things calm and even your predictability around your responses to blood sugars, you know, variables, highs and lows. Every time your child or you see your child being high, are you asking the question, what did you eat? That is going to build in the routine that they did something bad, that's gonna lead to shame, that's gonna lead to hiding as opposed to, wow, like, I see that you're, you're 300. Like, how are you feeling? What? Okay. And then like, let's what, what do we need to do right now? But I know it is not a comfortable feeling as the person living with diabetes being that high. And it's scary for you as the caregiver.

[Host (possibly Pat)]

Yeah.

[Erica]

So building in those kind of predictable routines and how you respond is also just as important. How you show up like you shared, that's important.

[Host (possibly Pat)]

I'm glad you said that.

[Erica]

Okay.

[Host (possibly Pat)]

Attending a school that feels safe. How do I put myself in that Position, Erica.

[Erica]

So again, you know, this is going from the research and this, it would be nice, wouldn't it be nice if every single child had this experience? Right. Not only like safe as we think about physically, but also emotionally and through the diabetes lens. Obviously that means having a 504 plan that is hopefully understood and implemented well and also hopefully has the end goal of keeping the child, the teen, in the classroom. Right. Like that's what ends up. And learning. That is what the 504 plan is meant to do. To provide accommodations to prevent interruptions to their school experience.

[Host (possibly Pat)]

Yep. Super simple. You don't want to leave the classroom if you don't have to.

[Erica]

Yeah.

[Host (possibly Pat)]

Especially for this.

[Erica]

Yes. Because then that, that makes them. Again, if we're going back to. They feel safe. They feel like they don't have to leave to walk to the nurse's office if they're low. Which I still hear all of the time like, no, when you're low, you need to stay and treat. But, but I know there are different variables for different reasons of why people

[Host (possibly Pat)]

do that, but Erica, let's say for a second, common sense wise, hey, that kid's dizzy. Well, let her walk through the school to get to the nurse's office. We'll hope the nurse is there when she gets there. Well, what if something happens to her on the way? That's okay. We'll send another seven year old with her. Because who would you want, who would you want in charge of that situation? But random girl from near the door in your, in your seven year old's class, the kid who's just like, oh my God. Because, you know, the kids that raise their hand are the kids that want to get out of class too. They're not exactly the most studious.

[Erica]

Well, and even just the experience of feeling low, and I know I've said this before, as probably multiple people on the, on your podcast, that when you're low, you don't want to move. Really. I mean, like you want to sit and treat. That is the key is, you know, trying going back to how is, how are you going to be feeling safe at school when you're low anyway? Having obviously staff that are trained teachers. We talked a bit about this. You know, responding with empathy, which is not always something we can control and you know, role play. If you are hearing that your child is coming home and saying, why I got made fun of, or this teacher said this, or this friend said that, one of the best tools you can, I think, is, you know, empowering your child or Teen by role playing. Even though it's hard to remember, it's hard to pull those phrases out. Sometimes with enough practice and role play, they'll feel like empowered to be able to advocate and at some point say what they need to say in that moment.

[Host (possibly Pat)]

So, once again, this takeaway means more than I thought when I read it. Like, safety really encompasses a lot. Not just are you in a place where someone might punch you. It's really well beyond that. And you can.

[Erica]

Yeah. Although that's important, too. You're bullied.

[Host (possibly Pat)]

Yeah, I've got a great 504 plan, but they kick my every time I walk out in the hallway. It just meant, like, there's other avenues where you can create safe feelings in places that I wasn't thinking of when you start talking about. That's all. Look at you pulling together great information. But, you know, I saw somebody online the other day say that the episodes that exist with you have been incredibly helpful for them and that they thought when they first started coming out that it wasn't something they were interested in and they were encouraging people to listen to the mental health stuff in the podcast.

[Erica]

Wow, that's really nice. That's really kind. Thank you.

[Host (possibly Pat)]

Well, you deserve it. I mean, thank you. I'm just listening to even just the way you're pulling this apart, I don't think it's just the way that it would occur to a lot of people. So what's number four?

[Erica]

Yes, so number four neighborhoods where people look out for one another. You know, that is kind of obvious, but then if we're talking about it through the lens of living with diabetes, you know, does your block, does your condo complex or apartment complex, does your hallway. Do they know if you feel safe enough for them to know, what does it low look like if your kid is running up and down the street or up and down the hall, what do the alerts, if they hear them, what does that mean? How can they be of assistance? When your child goes to a friend's house or a sleepover, or you yourself are going and engaging in other activities with your neighborhood, do they feel confident? Do these other caregivers feel confident? Do you feel confident in them hosting and having a community that normalizes the condition? I really like this. When I think about, do your neighbor, like, let's say you're participating in a fundraising walk? Do they contribute? Do they understand? Do they show up? Do they encourage you? Do they know enough when you're at a party and they say, can you eat that, you know, or do You. Does your neighborhood know enough that you feel safe and understood? These are things that are hard to control. I understand. But this also goes back to. This is the protective factors that are helpful in increasing resilience.

[Host (possibly Pat)]

Yeah. So if you can surround yourself with good people who understand, you're much more likely to have a good outcome. Like, not that you can control the neighborhood. I like the way you put that. It's not that we're saying to you, like, go out there and fix your neighborhood. Make sure there's all decent people in it who care. You can choose a few people who look like they're. They're open to it and. And have a conversation with them and. And create that neighborhood for yourself. Right. It doesn't have to be a thing that the world gives you. It could be a thing that you make for yourself, too.

[Erica]

Yes. And ultimately, when we're thinking about it in terms of growth and resilience, you're teaching now. I'm speaking to more, I guess, to caregivers. Like, you're teaching your child that they can go out and live their life, that they're increasing their safety net, you're increasing their independence, that diabetes isn't the scary thing where they only can be with you and this one other person. Now, I get there's gonna be an age and stage when that is the reality for sure. But as it feels age and stage appropriate to increase the world for your child and teen builds in that sense of resilience that they can do hard things.

[Host (possibly Pat)]

Yeah. Okay. Hey, can I tell you something funny? And I think the people listening will find amusing? I know we talk about this a lot, but you had, like, the five ideas that we were going to talk about here at the top of. Of the sheet, and then underneath of it, you put like, really? I'm sorry, I'm laughing at myself. No, I'm making fun of me. You put, like, great examples of all this stuff, but I didn't scroll down, so I didn't see any examples. So I was just making them up out of my head and I was like, oh, she's trying to help me with. With her preparation. And I didn't even see it.

[Erica]

You didn't see all these other notes below the list?

[Host (possibly Pat)]

But. But guys, on number five, I'm going to be rock solid. Watch this. How do I do, by the way?

[Erica]

You're over. You're doing great.

[Host (possibly Pat)]

Okay.

[Erica]

Oh, my God.

[Host (possibly Pat)]

Listen, number six, listen to a better podcast. I'm sorry, number five, go. Are you done on number four?

[Erica]

Yes.

[Host (possibly Pat)]

Okay.

[Erica]

I think yeah, yeah, I'm done. I'm done. Feeling less alone. In. In. It is part of that point of having a neighborhood where people look out

[Host (possibly Pat)]

for you and coming in at number five, access to healthy foods. Okay, what is. I mean that this sounds like a tough one. No. For some people, yes.

[Erica]

Having access to healthy food, it can be very challenging. So just wanting to note that whether it's, you know, resources, getting to a place where you can access healthy food, purchasing it, all of those things, I think in this kind of category, what we're. Well, I think what would be important to highlight is learning the flexibility and not restriction. Right. So it would be nice if we all ate balanced meals and had these healthy, well rounded meals all the time. That's hard to do. But if you are able to build kind of. I'm thinking about it through the lens of like, having a healthy relationship to food and being mindful of the language we use. I, I myself am still kind of guilty. This of like, ooh, that's a dangerous cookie. Right? Like, meaning, like, what do I mean by that? But I say that like, oh, it's, it's tempting. I want to eat too many. Like, no, the cookie's not dangerous. It's probably really good.

[Host (possibly Pat)]

I wish someone would have said that to me when I met my wife. I think my life would have gone easier. Wait, wait, so you're telling. You've been at this. Tell me again, how long have you had diabetes?

[Erica]

30. Where are we? 26. 36 years. This in like this summer sometime.

[Host (possibly Pat)]

36 years and you still sometimes see a piece of food and you think of it as bad.

[Erica]

Yeah. Or I'll say. I don't know if I'll say bad, but I probably will use like, oh, those are dangerous. Meaning, like, I'm going to want to eat 20 of them and I'm going to have to bolus for them. I don't necessarily. I've worked really hard to not say, like, bad food and good food because that creates an unhealthy relationship towards food.

[Host (possibly Pat)]

And you know this firsthand.

[Erica]

Yes.

[Host (possibly Pat)]

Yeah. Right.

[Erica]

So I would say that, you know, there's food is food. There's. I would switch the language to like, that's hard to bolus for. For me, like, I'll eat that, but that's going to be hard to bowls for. I might not nail it. And then I make the decision, do I want to eat it or not? I hear this, like at parties or in grocery stores, like, ooh, those things look dangerous. Like, we're not going to be able to control or what? You know, just kids are hearing that when we're talking about, yes, this is about having access to healthy food, but then being mindful of what is. How are we defining, experiencing and communicating about food to other people around us?

[Host (possibly Pat)]

I would say that you could put a kid into my experience. You could put them into two different perspectives too. Because if you said, oh, that's a, you know, a dangerous food or that's going to cause trouble, you either maybe put them in a situation where they end up limiting themselves and aren't flexible and start restricting, or you put them in a position where they're like, nah, it'll be okay. And it doesn't go well. And they just go, that's okay because I don't want to restrict myself. Like, people tend to like fly to the edges on things. You know what I mean? It's hard to stay moderate on ideas all the time because your brain really does protectively pick one way or the other. Either I'm not going to eat that because, oh, gosh, it's not going to go well, or I'm not going to restrict myself. So maybe I'm not going to pay as close attention as to the health outcome of this bolus because I don't want to restrict myself. I hope that made sense because in my mind it was crystal clear. But do you know what I'm talking about? Maybe you can make it more clear for me.

[Erica]

Yes. I mean, often we talk about like, you're going through this decision tree of when you're looking at a piece of food that perhaps maybe you don't eat as often. So are you then making the decision of like, I'm gonna, I'm gonna try to bolus for this thing. You're, you're, you're kind of weighing the scales. What's the, what's the risk? What's the benefit? I really wanna eat this thing. I might not nail the bolus, but I don't really care. Cause I want this thing. I don't wanna experience restriction. But sometimes, maybe at the expense of being in range for the next two hours, you know, one would argue maybe there's more of an emotional benefit of not experiencing that restriction then maybe going a little bit higher or lower than you typically would for those two or three hours.

[Host (possibly Pat)]

So for the moment, taking financial considerations out, if you're able to put healthy, balanced meals together, you're going to reduce family stress around meal time. You're going to help your kids to build a positive relationship with Food. And, you know, if you can not talk about bad food, you know, which I, by the way I look at it, I did it when I was trying to get you into the conversation. And I don't mean it that way at all. Like, and it's the word that came right out of my mouth, if you can do those things, it gives you a better chance to have success later. Like, I'm not saying, you know, hey, if you can't afford it, then you're doing something wrong. We're just saying that, you know, perfect world situation, give yourself all the opportunity you can to succeed. This is one of the things that impacts that.

[Erica]

Yes, yes, A good summary.

[Host (possibly Pat)]

Oh, how do we. I want you to bundle this all up, put into a neat bow for me. Go ahead.

[Erica]

So the research defines these protective and compensatory experiences, right? Things that protect you and will compensate in your brain if you are exposed to, to some of the adverse childhood experiences. In this conversation, we are talking about obviously living with diabetes, but they define it as the things that we just talked about and the relationships as resilience promoting qualities of children's environments. And also the research indicates, as we've talked about, you can also introduce these and adapt these as an adult. But I love that phrase of resilience promoting qualities. So these things that we've talked about today, the resources of participating in hobbies or community activities, predictable routines at home, attending a school that feels safe, neighborhoods where people look out for one another, and having access to healthy food, the research shows those are resilience promoting qualities or tools. Yeah, resources ultimately, going back to the brain and your experience living with diabetes, you'll feel, you know, safer. Things will feel more predictable. Having this structure that we've talked about today and the support that we talked about in the previous episode will ultimately integrate your ability to have more coping skills and more emotional resilience. Even when you're faced with hard things stay. Such as living with diabetes.

[Host (possibly Pat)]

I have to tell you, I mean, you know me a while now, I enjoy conversations like this because I'm endlessly fascinated by how people think and what motivates them. But I mean, it's hard not to just want to say at the end of this, this was great, but be nice to people, don't hit them. Your life will probably go better. Love them and support them. It'll probably go even better than that. I mean, it does really sound like, I know, it's common sense. Like it really. I mean, that's got to be common sense to people, right? But for those who it isn't like, or for those who are not seeing the forest for the trees, you know, when they're raising a family, I just, I really think it's important to sit down and break this stuff down more granularly and point it out to people like, hey, you know, what if somebody in your home goes to prison? That's a check, you know, and if you are, you know, if you witness a parent. Well, you know, it's interesting because we've talked about this a couple of times, but I've been really digging into all this list. That original ACEs list specifically said if you witness your mother being physically harmed by your father, that that's. But now, you know, research since then says, like, if you witness your father being, you know, abused by your mother, like, it's, it's got the same impact on you. So they've changed language a little bit along the way. But all in all, like, I don't know, it doesn't seem. I'm always going to be confused by why this needs to be explained to somebody. Like, I'm glad this research exists. I don't understand why it needs to exist. That in the end is, I'm going to be very happy we did this, but I'm going to be a little sad that this stuff is necessary, I guess, which is maybe nothing to do with what we're talking about, a little more to do with me, but I hope this helps somebody. I hope somebody hears one of these things and says, oh, gosh, you mean I could just be doing this and give my kid a better shot or that happened to me when I was little. I could maybe mitigate that by doing some of these positive things and create a better situation for everybody. Maybe some more happiness for yourself and your family. I hope it helps people that way. I don't know if we did a good job or not. I never know when I get done doing this, how I did. But I trust you, so I figure we're okay.

[Erica]

Well, I think, yeah, it is. Some of it might feel and seem like common sense. Some of these things might seem and feel impossible for various reasons, because of your own trauma, because of your own situation, emotionally, financially, relationally. And so I think that the hope is this isn't a list of like, these are all the things you should be doing and shame on you if you're not. As we've introduced, as we said in the introduction, this is just more a reflection of. This is what the research has shown has helped build resilience in Children and adults who even, who were exposed to these adverse experiences. And yeah, we hope that it's landing as hopeful because it is. It's hard to do all these things all of the time. No one is perfect.

[Host (possibly Pat)]

Yeah, no, I, I, I couldn't possibly agree with you more. And I, I would like to echo the idea that I just, I think of this as aspirational. I hope that it works, too. I really kind of attack the diabetes conversations the same way. Like, I think you should just, this is maybe the gold standard path. You know, do your best to mimic some of it. It might help you. You know, I don't, I don't always use the words that Eric is comfortable with, but I think my intention comes across

[Erica]

anyway. Yes.

[Host (possibly Pat)]

I really appreciate this. We're going to get together one more time on this. Right. And we're going to build. Well, we're, we're just, we'll tease people here a little bit.

[Erica]

Okay.

[Host (possibly Pat)]

We're talking up, we're going to do. Why don't you tell them what the next piece of this will be?

[Erica]

I think we're going to do a summary of kind of the things that we've been talking about. Yeah. Reviewing. There are eight things that are what built, you know, the opposite of aces, even though it's kind of what we've been discussing, but coming from the positive, the protective experiences. So we're going to summarize this list of what builds resilience and lasting health in the last episode.

[Host (possibly Pat)]

Yeah. Hopefully, if you found the three conversations interesting, you'll go to the fourth one. It'll be shorter and it'll just more be like a, like an audio bullet list of, you know, reminders for all of this. And then if, if we have time, we're thinking about. I've been toying in the background, like putting together an online kind of quiz that shows you what may have happened in your past or what could happen in the like. Anyway, Eric and I are thinking about ways to put that together. So if you end up seeing a fifth episode of this, it's going to be very specifically about an online tool to help you understand all this. So. And if that doesn't happen, then it didn't work out or I gave. That's all.

[Erica]

That's good.

[Host (possibly Pat)]

Yeah. I'm doing my best over here. Thank you, everybody.

[Erica]

Okay. Thanks,

[Host (possibly Pat)]

Dex. Dexcom sponsored this episode of the Juicebox podcast. Learn more about the Dexcom G7 at my link dexcom.com juicebox this episode of the Juicebox podcast is sponsored by the Omnipod 5 and at my link omnipod.com juicebox you can get yourself a free what'd I just say? A free Omnipod 5 starter kit. Free. Get out of here. Go click on that link omnipod.com juicebox check it out. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox links in the show notes links@juicebox podcast.com hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. Listening I'll be back very soon with another episode of the Juice Box Podcast. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing, adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip Series runs between episode 1000 and 1025 in your podcast player, where you can listen to [e-mail] by going up into the menu. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com.