Ep 141: Type 1 Diabetes and children: a conversation about treatment, support and hope! with Dr Laura Jacobsen

Dr. Laura Jacobsen, a pediatric endocrinologist at the University of Florida joins Ask Dr Jessica for a conversation about Type 1 Diabetes. She explains the differences between type 1 and type 2 diabetes and the symptoms associated with type 1 diabetes. Dr. Jacobsen emphasizes the importance of a balanced diet and regular exercise in diabetes management. She also discusses the screening process for diabetes and the advancements in treatment, particularly the use of continuous glucose monitors (CGMs). This conversation explores various aspects of diabetes treatment and support. It discusses the benefits of real-time information and alarms for low blood sugar, as well as advancements in insulin delivery devices. The conversation also touches on the future of diabetes treatment, including the potential for devices that combine glucose monitoring and insulin delivery. The possibility of a cure for diabetes is explored, along with the need for further advancements in the field. The importance of supporting parents and dispelling myths about diabetes is emphasized. Psychological support for children with diabetes and the value of diabetes camps are also discussed. 

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, paediatrician and mom of three. On this podcast, I like to talk about various paediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Welcome back to Ask Dr Jessica. Today we're going to talk about type one diabetes. My guest is Dr Laura Jacobson, and she is a paediatric endocrinologist, and as you will quickly learn, she is truly devoted to caring for kids with type one diabetes. We will talk about signs and symptoms of type one diabetes, current treatment options. We're going to review common misconceptions, and she will also review the great research that's currently happening. Please share this episode with anyone who you think may benefit from learning more about type one diabetes. So Dr. Laura Jacobson, thank you so much for being here. Thank you for coming on the podcast. You are a paediatric endocrinologist, correct, correct. So I'm curious, how did you end up in this field? What drew you to paediatric endocrinology? Yeah, it's a great question, because I didn't know what a paediatric endocrinologist was. You know, when I was in high school or college, but I knew I wanted to go to medical school, so I applied for different volunteer positions. So I did different camps for kids, because I like working with kids, and one of them was the Florida diabetes camp that I volunteered at as a sophomore in college, and that just changed my whole career trajectory. So I've seen these kids with type one diabetes having the time of their life, not letting their diabetes hold them back, teaching other people how to, you know, manage their diabetes when they're newly diagnosed. It was incredibly motivating, and that's why I became a paediatric endocrinologist. That is so cool. So that camp that you volunteered at in college, you still volunteer there today. I do Yep, as a doctor, what is the name of the camp? Out of curiosity, Florida diabetes camp. Wow. And so do you look forward to going every summer. Do you see the same faces every summer? Yes, it's great there. There are about five different summer camps, and then four or five weekend camps throughout the year. So it's a huge endeavour. It's a nonprofit organisation that just does great work and sets up great programmes. So yeah, every year it's I do at least one or two camps. That's incredible, that that camp influenced you to be the doctor that you are today. I love that. So now, where do you work, and do you primarily take care of diabetes, or do you take care of other conditions as well? Yeah. So I work at the University of Florida in Gainesville, Florida, and I do both endocrinology and diabetes. So endocrinology is the study of hormones. So wherever they're made in the body, and then they're sent somewhere else in the bloodstream. So that can be insulin as the hormone, and that's type one diabetes or other forms of diabetes, but then other hormones, like growth and puberty and thyroid manage those conditions too. Amazing. You're so needed. We need more people in the field. So, you know, new medical students and undergrads. Yeah, this is true. I can attest to this. When I have to refer patients to paediatric endocrinologists, there's definitely a weight out here in California. Yeah, I agree, everywhere, but definitely, I'm sure out there. So I'd love to use this opportunity talking to you to demystify what diabetes is explain the condition and explain how we treat it. And honestly, I'd love to offer hope to those listening, so that they know that diabetes is a condition, that there are things that we can do for it. There's a lot of improvements happening in with the disease. So tell everybody explain what is diabetes type one exactly, and how does it differ from type two diabetes? Yeah, I So, I am so excited that you asked these questions, because I think these are important things for everyone to know, right? Even people who don't have diabetes in their family, because I feel like people with any form of diabetes, they get a lot of misconceptions from the community and people trying to force their limited knowledge onto them. So I love sharing knowledge about the different forms of diabetes, just so people can be more aware in general. So type one diabetes, any diabetes, is usually a condition where you are not able to effectively make or utilise insulin. So if you're not able to do that, you're going to have higher blood sugars, because insulin is needed to take the sugar in your blood and put it into your cells for energy. But there's a couple different kinds of diabetes that that result from that. So you can have type one diabetes, which is more common in children, but still happens in adults as well, and it's an autoimmune disease, so it's actually where the immune system gets confused, and instead of attacking viruses and bacteria like it's supposed to, it attacks the cells in the pancreas that make insulin. So there currently is no curative therapy, but those are things that we can still give hope about and talk about the great research progress that's happening. But these are people who. Once those insulin producing cells in the pancreas are destroyed, they have to be on insulin injections or through an insulin pump for life. So we have to just replace the hormone that's missing, type two diabetes, which can occur in kids or adults, much more common in adults, is more of an insulin resistance. So your pancreas still makes insulin, but when it tries to act at your muscles and your other tissues, it meets what we call resistance, where it's just not working as well, so you have to make more and more insulin to try and overcome that. And a lot of that could be related to weight gain, but a lot of it's also due to genetic factors. So there's no one cause for type two diabetes, either. And there's also some dysfunction of those cells in the pancreas because they're having to work so hard to make insulin. So it's multifactorial as well, and can each disease can run in families. I love that you mentioned that type two does have a genetic component, because I do think there's a misconception out there that type one is genetic and type two is all diet related. But that's not true. No, no, there's actually a very strong genetic risk for type two diabetes that runs very strongly in families, probably actually stronger than type one diabetes. But yes, if you have a first degree relative with type one, you have a 15 times increased risk of developing type one. But we see even more so in type two if you have a strong family history, then your other members of the family are going to have it as well. Probably it's interesting. So point being, you can be quite obese and still not develop Type Two Diabetes. Correct? If somebody has type one diabetes, what are the symptoms that one could expect from the disease? Absolutely. And we try, and you know, get this information out to as many paediatricians and you know, community groups as we can to try and prevent severe presentations of type one diabetes, which is DKA or diabetic ketoacidosis, where you get so sick from not having enough insulin that you start breaking down your own fat and your own muscle, and make these ketone bodies that are acidic and can cause you to be very sick. So the symptoms of type one diabetes, similar to all forms of diabetes, are, if you have a high amount of glucose or sugar in your bloodstream, you are going to be processing that through your kidney, and it's going to make you pee more. So you're going to have increased urination, you know, during the day, maybe at night, if you're a young child, maybe you have new you know, bedwetting at night that's not previously been a problem, so that's kind of a trigger for a lot of families. And then, because of all that extra urination, you're going to be thirstier. So you're drinking more water, you're drinking whatever you have access to, and then you may start to lose weight, even though you're drinking more throughout the day, because you're kind of losing a lot of calories when you're peeing out all that glucose. So you know, increased thirst, increased urination and weight loss are the classic symptoms of type one diabetes. And then if that progresses, because they're very nonspecific. A lot of families, you know, may attribute it to, it's a hot summer, or they're, you know, they got over a cold or something. You know, there are lots of other things that could be those symptoms, but eventually you might have nausea, vomiting, rapid, heavy breathing from that acidosis building up. So we really try, try to have families catch that frequent urination, frequent thirst that's new and at least evaluated at their pediatrician's office. And do you also find that kids don't feel well in general when they have type one diabetes that's not in good control well? So when at diagnosis, you know before you know you have diabetes, you definitely from having high blood sugars, feel really tired. You can also have headaches, like, definitely not yourself. And then, once you're diagnosed with type one diabetes, if you do have high glucoses, so your your haemoglobin, a 1c like an average blood sugar reading, is kind of above the target that we aim for. You may feel more tired, you know, have less energy. Just feel blah. So definitely, we want to help kids feel better by keeping their sugars in range as much as we can. But we know, you know, it's not, no one's as good as the actual pancreas, so we all just do the best we can, and kids do a great job. So I'm also curious, is there a lot that I want to talk about treatment, but first, are there current guidelines and recommendations in terms of what someone should think about eating and not eating and exercise guidelines? Does that play a role in maintaining health with diabetes? Yeah, so that's a great question, and what a lot of families focus on at the beginning, because that's things that they're more attuned to and they have more control over so you can have glucoses that are more in range with regular exercise and with eating very, very balanced diet. You know, it's tough in the United States. We have a lot of high calorie, not very nutritious foods, but. You know, for kids with type one diabetes, especially, you know, they need carbohydrates, which are, you know, things you have to take insulin for. You need those things to grow. So I think the most important thing is not to have a restrictive diet, but one that includes all the nutrients that a kid needs. And I tell families, this is not something I'm telling them because they have type one diabetes. It's because this is good recommendations for all families, so they're not specific guidelines that you know you need to eat this many carbs or reduce this food. It's really just we have this engaged audience to try and promote healthy eating or nourishing foods and regular exercise, and that is reflected in glucoses that are more in range, but just trying to make the change as a whole family. As you know, if one person has to make a change, but no one else in the family does, it's very unlikely to persist. So I have to say, some of the families in my practice where a child has diabetes, they're the healthiest families I find. They're just so aware of how of What food does to the body, how it makes them feel, how it affects the, you know, your blood glucose levels. And it's interesting, because I think some people take that diagnosis and actually make improvements in their lifestyles, yeah, yeah, which is something we all need to do, right? So, yeah, some families are like, I realise now that, you know, these foods are empty calories. I can avoid them, you know. And oh, my blood sugar is, you know, kind of flatter throughout the day with doing that. But do people with type one need to avoid sugar altogether? No, we can't avoid sugar altogether. And my philosophy is that we want to have the healthiest diet we can have. But kids, you know, can have, you know, sweets in moderation. Like all kids, no kid should have seven pieces of birthday cake. But also, a kid with type one should not be excluded from having birthday cake because they have type one diabetes. That is something that they can take insulin for, and then, you know, the rest of their day eat healthy, nourishing foods. That's nice. So it sounds like your philosophy is that be mindful of what you're eating, but at the same time, diabetes shouldn't get in the way of how one can normally live a life. Yeah, absolutely. And I'm curious, do you find that there's a certain time when people are diagnosed with diabetes? So we used to think that. So there are two peaks in childhood, so kind of in around age five and around age 15, you see more cases coming in. But the more people are aware of type one diabetes, we're realising it happens at all ages. So people used to think that type one only occurred in kids. That's why it used to be called juvenile diabetes, but we don't call it that anymore, so now you know almost half of cases that are being diagnosed for new type one diabetes are occurring in adults. So I think the important thing is spreading this awareness that you know you may get type one diabetes at two, at 17, at 25 at 55 those are all possibilities, and we need to be aware of the symptoms and what testing may include to evaluate for that. It's fascinating. I have to say, as a paediatrician, it's the little kids that I get nervous about missing because it's hard to you know those symptoms of peeing throughout the night that's typical for a one two year old. It's a good reminder that we should always have it on our radar no matter what somebody's age is, and the young kids, they usually come in more sicker, because these are hard symptoms. They're not telling us, Hey, Mom, I don't feel good right there. They're not able to verbalise that. So absolutely, we've got screening programmes where we can screen especially family members. So since we know family members have a high risk, if someone in the family has type one and they have a young child, we can screen them for their risk of type one diabetes by testing for auto antibodies, and we can do that now as part of research studies across the United States, and because of a new therapy that's been FDA approved to delay the onset of type one in some people, we're starting to explore screening for auto antibodies in a wider population of people as well. Oh, that's good to know about. So if there's a family member that has type one diabetes and they have a child, they should be asking or inquiring about screening at what age? So usually, I mean starting at at two years old is probably like the an early age that I would start screening. Because the of that young, those young kids that can progress without us really noticing. And then, you know, in childhood, we recommend screening a couple times, because there's such a risk of rapidly developing those symptoms. And then in adulthood, you know, it's good to screen once too. So I would say starting at age two. And there's no clinical guidelines yet, but hopefully some will be coming out soon, about recommendations around screening, but definitely in the research setting and for relatives that can be done through organisations like TrialNet. So trialnet.org is a research programme that we are a part of throughout the country that screens relatives and follows them over time. And then there's a study out of Colorado called. Ask the autoimmunity study in kids that will screen non relatives as well for those antibodies. So I find diabetes such an interesting disease, because in my lifetime, I feel like there's been such an improvement in how we treat it and how people care for their illness. So for example, I remember when I was in elementary school, I knew somebody, there was somebody in my class who had type one diabetes, and they would check their blood sugar, and every time they would check it, it seemed like a big production. It would take literally a minute for the for the blood glucose to come back. And now I know when I see kids check their blood sugar levels, it comes back almost instantaneously, right? Can you paint a picture for everybody? How has the treatment of diabetes improved in other ways? So I think the most exciting thing about managing type one diabetes, especially for families and people living with it, is the technology. So because what you described is so intrusive and so not part of what your normal day would be like, and even before that, they used to have to test for glucose only in the urine, and it would give you this, like estimate of where your glucose was. And then we had, you know, you had to wait a minute for a glucose from a finger prick. Now you can get a glucose back in seconds from doing a finger prick, which is excellent. But even better than that are things like continuous glucose monitors, where you have a wearable device that you can wear for seven to 14 days, and it tells you what your glucose is. It's a capillary glucose, or it's a interstitial glucose, excuse me, so it's right under the under the skin and the interstitial fluid. And what it does is it's going to give you a glucose reading every one to five minutes, and you can get that to your phone or to a separate device, and that information then allows you to know what your glucose may be doing, what you may need to do to prevent low blood sugars, to prevent high blood sugars. So that has been a huge relief on some of the burden of type one diabetes, and also safety wise, so families can now know if their child's having a low blood sugar, especially while they're sleeping at night, because we still worry about overnight hypoglycemia. So that has been, in my mind, the biggest advancement is in these continuous glucose monitors. And then, when you talk about insulin delivery, it used to have to be through these big glass syringes. Now we have very, very small subcutaneous needles that are used, and we have these pens that are easy to use. We even have smart pens that will tell you when you last got a dose of insulin, and then moving on to insulin pumps, where you wear a device for about three days that delivers insulin, and then you just tell it, you know, I'm going to eat this many carbs, or this is I'm about to exercise, and it's taking away some of that day to day behaviour. I mean, I love hearing this, because I think what's so hard about diabetes is there's really is there's really no getting away from it. If somebody has diabetes, it's a constant they're constantly checking their sugars. Are constantly aware of their sugars. It can feel so intrusive into someone's life. I have a patient once told me that they just wish they could take a vacation from their diabetes, but they can't, right, just for one day. But yeah, no, they they could get seriously ill, right, if they ignore their diabetes even for a day. So that's why there's such psychological burdens of having type one diabetes, because you can't turn it off. This technology can help some, because as algorithms have gotten smarter and smarter, some of these devices actually can communicate between the insulin pump and the continuous glucose monitor and help adjust insulin doses, you know, in the background some but you still have to interact with the pump. There's still not a completely, you know, hands off approach yet. But you know, we're getting closer and closer. So I just want to ask you more about the continuous glucose monitors, the CGMS, because I think it's so fascinating, this technology. How long have CGMS been around? For 10 years? Okay, 1010, a little more. So, yeah, so I, I find them so interesting because so what you're saying is people with diabetes used to have to actually poke their fingers assess their blood glucose levels multiple times a day, and now they don't have to continuously poke themselves, because there's what did you call it that goes into the capillaries. It's not a needle, it's no it's just a cannula. So it's a thin plastic cannula that sits under the skin. So a needle inserts that cannula, that little plastic tube, and it's very, very tiny, and then the needle is completely removed, and the only thing left in there is a very short little plastic cannula. So when somebody's wearing the monitors, do they feel it? Are they bothered by it? So, and I've. I've worn them just to know what my patients go through. So I mean, you know, it's on your skin, because also we usually try and add extra tape to it, because we want that sucker to stay on for the full time. But you don't feel it under your skin. So there's nothing like foreign that you're feeling underneath your skin. It's mostly that you feel something taped to your to your skin. I think that's so cool, because clearly that sounds better than poking your finger multiple times, 15 times a day, especially for young kids, right, where you really need to know, you know frequently, what their blood sugar is. Yeah, and we still want people with type one diabetes who have a CGM to have their glucose monitor, in case their blood sugar's very high or very low. The accuracy is less perfect at those ranges, but it helps so much in seeing where your blood sugar's going. Is it trending up? Is it trending down? And so you may check your blood sugar with your metre once a day, or once a week or a couple of times a day, depending on you know where your blood sugar is sitting, but otherwise, your fingers have a huge break. I've also heard, I've had patients that tell me that if they do get low while they're sleeping and alarm sounds, so that's very relieving to parents who, as you mentioned, can be concerned that they could their blood sugars can really drop while they're sleeping. So for a lot of parents, I think that offers some relief that they're notified if they get too low, absolutely, that's parents of young children are very afraid of low blood sugars appropriately, so and so those alarms are lifesavers. Amazing. You also mentioned that the insulin delivery is much more advanced than it used to be as well. That's great. Yeah. So you can wear a device similarly, where you have a device that inserts a needle and a small catheter under your skin. The needle's removed. In most cases, you're just left with this tiny catheter that's hooked up to a tube or hooked up to a device that's taped on your skin and that delivers insulin. And you change that about every three days. So instead of having to inject yourself, you know, four or five times a day with insulin, you can just change this device out every three days, and then where do you see? Where do you see the treatment going in the future? I've read that there's been a lot of talks about having devices that have the capability to monitor the glucose and as well deliver insulin. Do you think that's something that we will see in the foreseeable future? I think people are working on that. I think it's tough, because you don't want those two processes interfering with each other. So right now, you know, those two things are at least separated by a few inches on your body, if not on completely different body parts. But obviously that would be ideal to only have one device. I think we're still a little ways from that. I think different companies are working on how long the pump device can stay on your skin for. So can we do it for longer? The biggest thing to me, that I think is is really still improving at lightning speed, is those algorithms that help, you know, if you forget to tell your pump that you ate 30 grammes of carbs, you know, you ate a sandwich, then it can help a little bit, because forgetting happens. So those algorithms that are saying give this much insulin now or do this, are kind of getting us closer to what we call an artificial pancreas, where we have these devices that someone can wear that can really act like a pancreas, so the person with diabetes doesn't have to do anything, just the continuous glucose monitor senses the glucose and the insulin pump reacts. The reason we are not there yet, honestly, it's just because our insulins are not fast enough. So the insulin in our body works like that, the insulin, even though our rapid acting insulins are just not quite fast enough yet, but these device companies and individual families who are working on this technology are just doing great things with computer algorithms. So it's very exciting, amazing. I mean, the tech advancements in diabetes, it's honestly hard to keep up with. I feel like I'm constantly reading about something new in the field, which is exciting. Yeah. So they always talk about, or I always hear rumblings about the potential, or the imminent cure for diabetes. Do you think that will ever be a possibility finding a true cure? So when I give talks and I talk to families, because a lot of my research is in intervention, therapies for people at risk for type one, or people who've newly developed type one to try and like, preserve those beta cells, those insulin producing cells. I don't talk about it in terms of a cure, because one, I think the field of type one diabetes has gotten a lot of false hope in the past and and promises that are hard to keep. So I think knowing a timeline for that is very difficult. I also think that it's going to be more staged and not a yes, you're no longer have to take insulin exogenously anymore. I think it's going to be Hey, maybe this will prolong your honey. Moon period, or, Hey, maybe this therapy will reduce your risk of complications because you're making C peptide, you know, from your own insulin, from your own pancreas a little bit longer. But to truly be off insulin is is gonna it's hard. So while I do think there will be therapy someday that will allow that, I do not have a timeframe available, but things to watch are companies that are trying to make beta cells, even for people who had diabetes for a long time. So make beta cells and then hide them in the body and hide them from the immune system, because we can give beta cells from someone who's passed away to someone with type one diabetes, but you have to be on immune suppression, because that's a foreign organ, basically. So the beta cells are what produce the insulin. So if we can somehow preserve some beta cells or introduce new beta cells, that would be a way to make insulin on our own, which, yeah, that's interesting, because you were saying that the hard part is having the insulin delivered timely and quickly. So if the body does it on its own, that would solve that. Yes, so, yeah, if we can do that safely. So give transplant those beta cells, and they live and they're healthy, but the immune system isn't trying to, you know, still attack them, because you still have this predisposition for autoimmunity, and that's those are not your beta cells that are in there. So we've got to come up with ways to make it safe. But people are are working on this. So I do think it's in the future. It's just, you know, trials are taking place, and everyone just needs to keep keep their eyes out. But also, if you hear news stories you know, maybe ask your endocrinologist, who knows, like the primary literature, so that people aren't getting false hope from overly promising news stories. It's so fascinating. There's not that many fields in medicine that I feel have made such advancements as diabetes. It's made a lot of advancements, but we have a ways to go. I mean, we've had insulin for 102 years, 103 years now, so we're doing good, but there's a ways to go. All the new devices, all the new apps, seems very exciting, but I agree with you, there is, there is a ways to go, but there's lots of hope, which I like hearing from you absolutely. So tell me more. Okay, so is there anything that you'd like parents to hear about kids that have diabetes, that you've learned over the years, treating treating patients. I think the main thing that I tell most parents of kids with type one diabetes is that the parents, they're doing a great job. This is incredibly hard. It would be hard for us as doctors to manage a child with type one diabetes that it is a day and night. 24/7 just like the child is living with this 24/7 a parent, especially if a young child is as well. So all parents are doing great, even though it may feel at times like they're not. They may feel that, oh, my kids, blood sugar's too high. Their a one C's too high. It's just to keep trying right, to keep working with your doctor, working with your kid, trying to make it easy for them, but also teach them skills so that as they get older, they'll be able to assume some of that care. But, you know, parents never really let go of all that care, so always, kind of being there to always support them, even when they are teenagers, that's the most important thing. That was a good point. I do think, I think it would be near impossible to be a physician or to have a busy job and have a child with type one diabetes. How do families do it? I mean, they're they're rock stars. They're rock stars. Yes, and is there anything that a child can't do who has type one diabetes? No, there's nothing that a child can't do. The only technical thing is you cannot join the military with type one diabetes. I think like NASA would be the other thing, but they recently allowed commercial pilots who have type one diabetes to fly, and you can obviously do lots of other jobs that military officers perform. But otherwise there are no limits on people with type one diabetes. They can do anything. Nothing holds them back. People are Olympians. People are world leaders. Anything you can think of someone with type one diabetes has done it. I love, I love hearing that there's a lot of confusion out there. I've heard a lot of myths out there about type one diabetes from you know, can I still swim in a pool? Can I still get pregnant? Is this contagious? I love, I love just hearing it out loud that there's nothing that they can't do, aside from very small, unique fields, right? And I feel like that's one of the things that that really drains people with type one diabetes is, you know, they know they can then do anything, but the the general public is just not well versed. So they may find someone who says you can't eat that you have type one diabetes. Well, of course, they can eat it. We should all make good food choices, but you know, they are not withheld from eating certain foods or Yes, oh, I don't want to catch type one diabetes. We know type one diabetes is not contagious. It is an autoimmune disease that child, that parent, did nothing to cause that autoimmune disease, and it cannot be passed from one person to another. There, or definitely, women with type one diabetes can have very successful pregnancies. They work very closely with their OB doctor. Have lots of, you know, very healthy pregnancies, no concerns, as long as they're working closely with someone. I'm trying to think, what other myths people are told. I think you mentioned the big one. So I appreciate that too, because as more people we can teach, the the less they'll, you know, frustrate people with living with type one diabetes, who have to answer this question probably all day long. Everyone comes up to them like, Oh, can you drive? Yeah, I can drive. Like, I'm a human, you know, those kind of things. You know, I think, I think for teenagers in particular, it's just hard to be different. So I think when they have the monitors on, or they're wearing the pumps, I think people give them looks, and maybe they're afraid to ask questions. So I do think it's really helpful to get it out in the open, ask the questions, demystify the illness, absolutely, because it's a it's the teenagers choice whether they want to, you know, show those devices or talk about it. I mean, they should be able to keep that private if they want to, but if we can inform everybody, then they won't be singled out. You know, as often. So for those that have type one diabetes in the family, are there any recommendations that you have in terms of staying psychologically healthy? For example, do you think it's helpful to meet other families that have type one diabetes to be part of the camp that you're part of any general recommendations that you have for people? I have lots of general recommendations for mental wellness and type one diabetes, so I think all of your suggestions are absolutely perfect. And what we do recommend, it is great to meet other families, to know you're not alone, for kids to meet other kids with type one diabetes, so families with type one in their family can meet people through different nonprofit organisations like the JDRF, or events that the American Diabetes Association puts on. There are walks and runs and fundraisers. JDRF also holds these summits in different cities, where people just come and and provide information about type one diabetes and new insights and technologies. What is JDRF? What does that stand for? Oh, it stands for the Juvenile Diabetes Research Foundation. But they they just go by their acronym, JDRF now, because we are not focused on just juveniles, all ages. So it's a very long standing nonprofit organisation supporting people with type one diabetes. What is the incidence of type one diabetes? Yeah, it's different country by country, but it's about one in 300 people in the United States. So pretty, pretty common. It's not, it's not as common as type two, but it's not as rare as, like, rare diseases. So it kind of falls in this, like, middle ground that makes it hard sometimes to get the funding and support that we need. Yeah, it's, but it's, it's common enough that I feel like most people out there know somebody who has type one diabetes, lovely. Yeah, and then another. So besides the JDRF and the ADA, the American Diabetes Association is children with diabetes is a nonprofit organisation started by families parents of people with type one. So they have meetings throughout the country as well. So it's like a family run organisation, and then for kids to meet other kids with type one. Because even though it's relatively common. You may be in a school by yourself. You may be the only kid in your school with type one diabetes, and that's very isolating. So if they could go to a diabetes camp, and there are a bunch throughout the country, then they the whole camp has type one diabetes. Everyone has to know what their blood sugar is before they get in the lake. Everyone eats the same food, and we figure out the carbs, and they go about their day. You know, it is such a great environment for families, especially newly diagnosed, for those kids, to not feel alone. So highly, highly recommend. In Florida, we have the Florida diabetes camp. The American Diabetes Association has camps throughout the country. So you can look up, I think it's Ada and diabetes camps, there are in lots of different organisations, but those, those two, especially, are highly recommend for all, all kids with type one. I did my residency in Los Angeles at UCLA, and I remember doing a rotation in paediatric endocrinology and meeting a child who had just gotten back from a diabetes camp, and they were so excited because they bought this brand new pump, this brand new, colourful pump, and they learned about it from the camp. They saw another kid that had a cool pump, and they were all sharing and comparing notes. And you know, it was a it was a fashion piece, rather than looked at as a as an inconvenience or a burden. And I agree with you that a diabetes camp just seems like a perfect place for the young child to attend. They get more confident, right in having that disease. And if they may have been nervous about, oh, I don't want an insulin pump. That makes me very anxious, they can talk with other kids their age at diabetes camp who may have that and that may make them excited about trying something like an insulin. Pump. So it's, it's magical. What a what a great thing that you're a part of. It's, it's awesome for all the volunteers and everyone that that runs it and works at it. It's, it's entirely volunteer run, except for the very, very top organisers. So it's, it's incredible. I'm enjoying this conversation so much because clearly you're knowledgeable, but I can also really tell how enthusiastic and excited you are to be working in the field of diabetes. Thank you. I appreciate that. Tell tell everybody, where do you work? Where can somebody see you? Yeah, so sure. I work at the University of Florida in Gainesville, Florida. We have a paediatric Diabetes and Endocrinology clinic here, and I'm also happy to answer questions from families if they, you know, had some kind of general question. Again, medical advice is tough, you know, over long distances, but people are absolutely welcome to reach out to me and email me. My email is my first name and the letter j@ufl.edu but trial net is also kind of a organisation I'm very, very proud to be a part of. So trialnet.org, also has a lot of great information for families. What do you think about Facebook groups? I have a lot of families that find information on Facebook. It's always tough, right? Because you, while there are amazing people leading some of these groups, there are other people that may not be there for the best reasons, and may be providing advice that's not, not applicable to everybody. So I always just try and have them tell me what things they've learned, so we can try and maybe kind of vet some of those so it's it's hit or miss, right? That's why, if you go through organisations like JDRF and sign up for some of their, you know, social meetings, or some of their newsletters and things, you're probably getting more accurate information. Not to say that it's not on Facebook, it's just you don't know who it's coming from, yes, yeah. Thank you so much. Dr Jacobson, thank you so much. I've really enjoyed talking to you, and I appreciate you being here. Thank you so much for having me. I'm so excited that we could talk about type one diabetes. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr Jessica. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. You.