EPISODE SUMMARY
JoAnne Robb is a psychotherapist from Oakland, California, who counsels adults and parents of children with Type 1 Diabetes. She is a mother of three. Her oldest and youngest have diabetes and her middle child does not, although as you'll learn through our conversation, he is still very much impacted by the disease. In this episode, JoAnne shares first-hand knowledge and personal stories. We learn why managing Type 1 Diabetes is as much an art as a science; why children and teenagers have their own dynamics, how technology can be a double-edged sword when it comes to managing the disorder, and how support is available if you know where to look.
JoAnne explains why Type 1 is a family disease and the importance of finding support and community. She speaks of the advantages and disadvantages of different insulin delivery systems, the role food plays, the intense financial implications of managing Diabetes, and much more.
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You are welcome to share the wisdom from this episode. Please be sure to credit: “_Ep. 11, JoAnne Robb, Courtesy of Wisdom Shared Podcast with Carole Blueweiss.”
“When we first were diagnosed—you'll see that I'm using the word ‘we’; I think of [Type 1] as a family disease in a lot of ways, especially when kids are young. It's too much for the kids to carry by themselves.”
“When I thought about what would be hard for a kid around diabetes management, I would have thought of the shots and the needles and the pokes, but really what's hard is having this constant numbers game.”
“There's a lot of anxiety about being a parent of a kid with Type 1. And I feel like some of the information out there kind of heightens that anxiety. I feel like my contribution to this dialogue is to say, there's a way to do this more calmly.”
"Pump supplies are really expensive, CGM is really expensive, insulin is really expensive."
“How we approach [Type 1 Diabetes] emotionally truly makes a difference in our relationship to the disease…and ultimately in our children's relationship to the disease.”
"And the other thing that's been completely invaluable, which I could not pitch more strongly, is diabetes camp...we went to family camp and we gained a lot of community, but also a lot of information.
“Restricting food too much can have a mental health boomerang effect that you really don’t want.”
"This is not just a medical condition, even though it seems like it is, It's also an emotional condition...and a lowercase t trauma."
"I do think that the way that parents talk about this trauma of diabetes makes a difference in the child's relationship to the disease."
“Learning Diabetes is like drinking from a fire hose.”
“The Diabetes community in general is very generous about wanting to help each other because we all know exactly what we're going through.”
“My biggest piece of advice is that you will learn this and your child will be okay and you will be okay. And that doesn't mean everything will be good all the time, but this is survivable.”
Resources from this Episode
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LEARN MORE ABOUT THE HIGH PRICE OF INSULIN
[00:00:00] JoAnne Robb: My daughter was diagnosed at four. But she was one year old, she would lift her shirt and take a crayon and poke it into her belly because at that point my son was still on injections and so she watched him getting shots all the time, and he was her hero because he was her older brother and he was cool and would play with her.
[00:00:17] So she was always giving herself little insulin shots and pretending she had diabetes. So when she was diagnosed, we had a friend over. She said, guess what I got? And he said, what? She said, it starts with a D. And he was like, I don't know, a dog? No. A doll? No. I got diabetes! And he was so floored he didn't know what to say.
[00:00:40] You know, because for adults that was not a triumph. But for her at four, because she had a brother with it, it wasn't a stigma. She was proud to be part of the club.
[00:00:51] Carole Blueweiss: Welcome to Wisdom Shared, where parents are the experts and community inspires change. My name is Carole Blueweiss, and today on my 11th episode, I have as my special guest JoAnne Robb, a parent of two kids with type 1 diabetes and a psychotherapist living in Oakland, California, who counsels people who have type 1 themselves and parents of children with type 1.
[00:01:16] She runs a coaching group called Sweet Talk, where people can get support to lower their anxiety about diabetes. It's one thing to study and read about what type 1 diabetes is as a disease and another thing entirely to hear what it's like to live it from a parent's point of view. In this interview, JoAnne tells us about what it was and is like for her to raise her two kids who have type 1 diabetes and what it was like for her non-diabetic child.
[00:01:47] Each child's experience was unique. In JoAnne's family, they see type 1 as part art and part science. The science comes in when we learn about the hormone insulin and what happens in type 1 diabetes when the body doesn't produce it. The art comes in when looking to keep the blood sugar numbers in range. For a preview of the main scientific points about type 1, which incidentally used to be called juvenile diabetes, but because it's now diagnosed in the very young, as well as at older ages, it's been renamed type 1.
[00:02:22] And now for the science. Someone with type 1 diabetes cannot depend on their own pancreas to produce insulin to control the sugar in their bloodstream. And since insulin is that hormone that transfers the sugar from the bloodstream into the cells that ultimately nourishes the body, not having this insulin means the body can starve.
[00:02:43] That is the reason why people with type 1 need to either inject insulin with a syringe or they can try using an insulin pump, but it's more complicated than just adding insulin. The real dance is trying to keep blood sugars in range. Numbers that are too high or too low can be dangerous, and so keeping numbers in range is where the art comes in.
[00:03:05] There are many different variables that can affect this blood sugar number. It could be your mood, your stress, time of the month, time of the day. So at times, it's just a guess as to what is the right decision. Working on this episode brought home to me how powerful it is to listen to parents tell their stories.
[00:03:24] There are so many themes that are universal that all people can learn from, including healthcare workers, teachers, and non-diabetic friends and family members. This podcast represents the opinions and experiences of one mom and her family. It is not meant to take the place of a medical professional. And now let's listen to what JoAnne has to say.
[00:03:48] Hi, JoAnne. It's so great to have you here on Wisdom Shared.
[00:03:52] JoAnne Robb: Hi, Carole. I'm really, really excited to be here.
[00:03:56] Carole Blueweiss: Why do you think it's important that people hear what you have to say about type 1 diabetes?
[00:04:02] JoAnne Robb: I mean, there are a lot of us, parents of kids with type 1 in the US right now. It's a pretty isolating experience to be a parent of a kid with type 1 because we all look kind of normal, and I think that for parents who don't have experience with it, it's pretty invisible.
[00:04:19] The other piece is there's a lot of anxiety about being a parent of a kid with type 1, and I feel like some of the information out there heightens that anxiety. My contribution to this dialogue is to say there's a way to do this more calmly, and that that's actually an important goal in and of itself.
[00:04:36] It's not just the numbers, it's also how we approach it emotionally that I really, truly believe makes a difference in our relationship to the disease. But more importantly, ultimately our children's relationship to the disease.
[00:04:50] Carole Blueweiss: How many children do you have and how many of your children have type 1 diabetes?
[00:04:54] JoAnne Robb: I have three children. Right now, they are 13, 17, and just turned 22. My 22-year-old was diagnosed when he was nine, so we've been at this quite a while, and my 13-year-old was diagnosed when she was four.
[00:05:13] Carole Blueweiss: Do you remember what it felt like when you first found out that your first child had diabetes? Do you remember what your emotional response was?
[00:05:23] JoAnne Robb: The better question, oddly, would be what was my emotional response when my second child was diagnosed. Because I think only then did I have enough room to have an emotional response. I think when my first child was diagnosed, I just got so busy. Another parent said, learning diabetes is like drinking from a fire hose.
[00:05:41] And I think that's true. The first year is just massive learning curve about what everything means because there's so much jargon, basically, that's all really essential to learn. But when my second child was diagnosed, I actually had space to weep and to just be so sad. And I remember lying in bed, cuddling with her and feeling like, oh no, there are gonna be track marks all over her body.
[00:06:06] Like her sweet little perfect four-year-old body is gonna be covered with needle print. And I think because I knew more what it really would look like, but also because I had more space, it was less shock and there was more time to process the actual emotional state for me.
[00:06:22] Carole Blueweiss: What is type 1 diabetes and how is it different than type 2 diabetes?
[00:06:27] JoAnne Robb: The type 1 diabetes is an autoimmune disorder where the pancreas shuts down insulin production. That's an oversimplification, but basically the body no longer produces insulin, and insulin is a hormone that the body makes to essentially help the body digest food. Someone with type 2 can manage their diabetes through lifestyle, exercise, diet, some oral medication.
[00:06:54] I am, in no way, an expert in type 2, but someone with type 1 actually just doesn't have insulin, so they become an insulin-dependent diabetic. They need insulin at all times because without insulin, what happens is, the body starts to break down fat to get what it needs. And then one of the byproducts of that process is ketones.
[00:07:16] And if the body becomes ketotic without having insulin, it's dangerous. And that's what used to kill people with type 1 diabetes.
[00:07:24] Carole Blueweiss: And is that the sweet smell that...so, I asked that because I recently listened to a parent realize that the sweetness coming from their child's urine was not a good sweetness. It was actually an alarm bell that, oh, this is what's going on with my child.
[00:07:43] JoAnne Robb: That's a super astute parent. So that's just the buildup of sugar in the blood. If you don't have a working pancreas for one reason or another and don't have insulin, your blood sugar builds up over time. You can have that sweet smell in urine and that can be an indicator. Although if you had asked me for symptoms to look for, I never would've listed that, because that's pretty sophisticated.
[00:08:08] Carole Blueweiss: Well, since you mentioned it, what are the symptoms?
[00:08:12] JoAnne Robb: Generally, what happens for people who have type 1 is they start to lose a lot of weight because their bodies can't actually nourish themselves. They're incredibly hungry and they're very, very thirsty because when the blood sugar is high, they are needing to drink a lot to try to offset the sugar in the blood. So peeing a lot is one of the main symptoms. I'll hear stories from parents that their kids started suddenly wetting the bed at night again, you know, things that they never would've expected given the age of the child or how long they had been potty trained, for example. Those are big symptoms to look for.
[00:08:48] Carole Blueweiss: How were your kids diagnosed?
[00:08:50] JoAnne Robb: They were diagnosed in really different ways.
[00:08:53] Carole Blueweiss: Tell me their story.
[00:08:55] JoAnne Robb: So with my son, he was nine. I had really just had my daughter, so I was still in that sleep deprived place and nursing her and really not focused on anything except that transition back into early parenthood.
[00:09:11] And there were a number of signs, and now I want to note that my dad has type 1 so I do know a little bit about it, but really it was interesting becoming a parent with type 1 to figure out how little I really knew. Even though I had always grown up with it, I really still had the same steep learning curve that every parent has when they have a new diagnosis in their family.
[00:09:33] But I remember certain things, like I was sitting with a friend and I was nursing my baby, and she said, have you noticed how many times your son has gone to pee in this hour and a half that we've been here? And I hadn't. And I remember calling the doctor and the doctor saying, oh, it's probably nothing. Don't worry about it.
[00:09:52] And then one day I thought, he's looking very thin and I put him on our scale, which I never did. Like I didn't even know what his real weight should have been. And I called the doctor again and I said, what's he supposed to weigh? The nurse said, I think you should come in because you've called so many times. So we went in and lo and behold, he was diagnosed in the office.
[00:10:14] And the way they do that is they just do a urine sample and then they can check for ketones in urine, which is not a super reliable way of checking, but it's a good rough check. And then they did a finger stick for a blood sugar and his blood sugar was in the 400s. Looking back now, there are more things I would've seen, like he had a lot of stomach aches a lot of the time, and that can be a sign that the body is ketotic.
[00:10:39] So she sent us directly to Children's Hospital in Oakland, and we were checked in, but not for very long. I caught it early enough that we were released in one day and then we were launched into this crazy world.
[00:10:51] Carole Blueweiss: Then what happened?
[00:10:53] JoAnne Robb: It was rough. It was really rough. For the first week after he was diagnosed, I kept him home. I did not know how I was gonna manage. And I literally would watch every single bite of food he ate. We left the hospital on shots. So the standard old fashioned way of delivering insulin is that you get a shot of what's called long-acting insulin, and that covers all your basal metabolic needs. And then you have to do a shot with every food intake.
[00:11:22] So you'd need one shot of long-acting insulin, let's say, in the morning or at night. It depends when the doctor wants you to do it, and then a shot with every meal. So every time he'd put a bite of food in his mouth, I would be saying to him, how much do you think you're going to eat? Which is an absurd question to a nine-year-old, but I wanted to give him the insulin up front because if you give it too much later, the blood sugars rise a lot more because the artificial insulins that we use for our diabetes aren't as quick acting as the insulin that our bodies already produce. So they don't regulate the blood sugar as well. And I was very, very anxious. Of course I was. And he ate, I remember, grilled cheese and an apple every single day for lunch his first week after diagnosis because I knew how many carbs it was and I knew he would eat it.
[00:12:09] And then I sent him back to school. So I literally would wake up my baby from her nap and haul back into school every day at lunch to check his blood sugar and wait till he was done eating. And give him a shot. Until finally after weeks of this, I went to the school and said, hey, I need help.
[00:12:27] Like, I'd let everyone know he had diabetes. My son was in a private school at the time. In public schools, you have legal rights, actually, and you do it through 504 plan. But in a private school, you are hoping for the goodwill of the community a little bit more.
[00:12:43] Carole Blueweiss: How do you think your son felt in school? Do you feel there was a stigma for him?
[00:12:48] JoAnne Robb: For some kids, it really is, absolutely. My son doesn't care what people think of him, and so for him, I think in some ways this was easier. And my daughter was lucky enough to have him. So she never felt like she was the only one, but she definitely is more in the camp of the kind of person who would feel self-conscious.
[00:13:12] And I think she is starting to really recognize how much of a burden this is and how much she doesn't like it. And I joined her there. And I think as a parent, that's really important. So when she says, this is hard, and I hate this, I just say, absolutely. And I used to say to my son, yeah, wouldn't it be nice if we could go to some beach somewhere where there were no diabetes and just hang out there for a week?
[00:13:36] I think to join them in the misery of them carrying this thing is actually, I think for a lot of parents it's counterintuitive because they feel anxious about what it means that their kid wants to set it down. But like of course they wanna set it down. Why wouldn't they wanna set it down? It'd be crazy to think that they wouldn't. The power of validation is real, and I would never want them to feel like I couldn't be that for them.
[00:14:00] Carole Blueweiss: How did you learn how to do all the tinctures and even the education that you need for type 1?
[00:14:07] JoAnne Robb: I started where everyone starts. I started giving shots of saline to an orange. That's where we all start in the hospital. They're like, here's an orange, here's saline. Pull it up into a syringe. You learn how, step by step. Yeah, I mean there's support at every step of the way. The diabetes community in general is very generous about wanting to help each other because we all know exactly what we're going through. The other thing that's been completely invaluable, which I could not pitch more strongly, is diabetes camp.
[00:14:38] It was the one recommendation we got when my son was first diagnosed that I actually followed through on, because people had a lot of advice, which wasn't always helpful. But family camp was the one thing we did and we gained a lot of community, but also a lot of information. I sent my daughter to Buddy Camp.
[00:14:54] There was one year where all three of my kids went to Buddy Camp. A lot of parents will say, my kid doesn't wanna go. Of course they don't. My son didn't wanna go, but we all went and it made it so that he felt more normalized. He wasn't the odd man out basically, and he got so much out of it. One of his closest friends still is someone he met at camp.
[00:15:15] Carole Blueweiss: This son is now how old?
[00:15:18] JoAnne Robb: He's 22. He's graduating from college in a few weeks.
[00:15:22] Carole Blueweiss: Okay, so he's your oldest.
[00:15:23] JoAnne Robb: Yeah.
[00:15:24] Carole Blueweiss: So that brings me when you were telling a story, when you first let him go on his own, on your website.
[00:15:29] JoAnne Robb: Yeah.
[00:15:29] Carole Blueweiss: Tell us that story, what that was like for you.
[00:15:32] JoAnne Robb: Yeah, that was hard. That was the summer between I think his sophomore and junior years in high school, and he's a very talented jazz pianist and he wanted to do a program at the Berkeley School of Music in Boston in the summer, and we live in California.
[00:15:48] Right? That's far away. And when we first were diagnosed, and you'll see that I'm using the word we, which is so unfair to him because it's really his disease. But I do think of it as a family disease in a lot of ways. Especially when kids are young and it should be. Right? It's too much for the kids to carry by themselves.
[00:16:08] I'm a pretty big believer in the community aspect of this thing as much as it is possible. At any rate, when he was first diagnosed, we were on injections three, five times a day, and he really was resistant to going on an insulin pump. We finally got through that hurdle, but then there's another technology called a continuous glucose monitor, which is another device that these kids have to wear on their body, but it reads their blood sugars, continuosly.
[00:16:35] He had a lot of resistance to wearing it. And I think it was before that summer where I insisted because I was having to wake up every single night to an alarm to literally do finger sticks because they could bottom out in the night and have low blood sugars that I wouldn't know. And the research really does back up that most people don't wake from a low blood sugar.
[00:16:55] Until they've been low for a while, so it's super, super dangerous. Low blood sugars are what I most want to avoid. And so before he went to that trip, he was on a CGM. Because I could then track his data because it gets Bluetooth through his phone and through the cloud and I could see it. And that was really, really important.
[00:17:16] And that program, actually, I have to say, they were wonderful in terms of teaching music, but not so wonderful in terms of collaborating with me. So it was really just him and me. And he was the sophomore in high school and he was on the other side of the country. And there was one time where actually I sent him to the hospital.
[00:17:33] His blood sugar was bottoming out. He couldn't seem to bring it up and it was too scary. And I said, you need more medical support than this. Like, if he had been with me, I would've known what to do to help him, and I could have helped manage it probably so that it wouldn't have been so frightening.
[00:17:51] Carole Blueweiss: What would you have done?
[00:17:53] JoAnne Robb: First of all, I probably would've caught it and intervened earlier. I tend to intervene a little sooner than my kids think it's important to do. And there have definitely been times where I've had to take them to the hospital. But for more complicated situations, like when there's vomiting, kids can get really, really sick and it can get dangerous.
[00:18:10] They can become ketotic. Fortunately, he wasn't sick like that, but I sent him because I thought he might have needed an IV line with sugar in it because he couldn't seem to bring his sugar up.
[00:18:19] Carole Blueweiss: What is the sequela of not catching it on time? What can happen?
[00:18:24] JoAnne Robb: What happens if the blood sugar is low for an extended period of time is that the body has weird reactions to it. So people start acting kind of drunk and kind of doing strange things like flapping your arms or strange, you know, just very strange things. And then you can pass out and then you can die. I mean, you can actually die from having a blood sugar too low for too long. So low blood sugars are something to really be avoided.
[00:18:53] Carole Blueweiss: There's low sugar, that's the danger. But didn't we also talk about levels being too high?
[00:18:58] JoAnne Robb: That's a lot of what the confusion is, right? So too high is also dangerous. It's just dangerous over time.
[00:19:05] Carole Blueweiss: Why would someone with type 1 diabetes have too high?
[00:19:09] JoAnne Robb: Mostly actually people with type 1 have too high. Right? Just like with type 2.
[00:19:13] Carole Blueweiss: That's what I thought.
[00:19:14] JoAnne Robb: Totally legitimate question. What happens as the sugar gets higher, if you think about it, there's literally more sugar in the blood. There's more glucose in the bloodstream, and so the blood gets thicker, it gets more viscous, and so if there's more sugar in the blood, all those little capillaries get kind of clogged up.
[00:19:34] Diabetes is relentless, and so the idea of managing it constantly to be in range is really quite hard. I have a close friend who said, wow. When I thought about what would be hard for a kid around diabetes management, I would've thought of the shots and the needles and the pokes. But really what's hard is having this constant numbers game, and it is really so exhausting.
[00:20:01] And so kids manage really well by the data when their parents are in control, and then as they start getting control of their own, the data, the measurement of their A1C, which is sort of the standard measurement, they shoot way up. And the average A1C in the teen years and the early 20 years is quite high.
[00:20:23] Like really, really out of range. And actually the only age group that's in range with their A1C is like the over 70 crowd. Because it's really hard.
[00:20:36] Carole Blueweiss: How important is it to keep a good A1C number?
[00:20:39] JoAnne Robb: It's important. So A1C is a measure essentially of the average blood sugar over the past three months. It's an indicator of health and sort of a, almost like a prognosis of long-term health. It's not something you wanna play with too much. It also gets kind of weirdly competitive and sort of inappropriately driven towards these low numbers, which I think have their own danger, but also create a kind of anxiety in parents about making every number perfect at every moment. Which isn't possible.
[00:21:10] It's a marker of where your child is right now. And is there room for improvement? There's always room for improvement with diabetes, there's always room for alteration, and we have to take these things one micro step at a time. And so I think sometimes A1C is too big a bite. If your kid is a teenager and really struggling and never checking their sugar and doesn't wanna give shots at school, looking at their A1C and having a fit that their A1C is like 9.6 is not the thing to focus on.
[00:21:41] The thing to focus on is how could we get you to check your blood sugar four times during the day? How can we take a micro step towards you being safer? And yes, A1C for sure is an important health marker, but I think biting it off as a parent as the only thing to be looking at, it's like kind of having blinders to all the little steps and also all the sort of psychological ramifications of just holding a number as the only measurement of goodness.
[00:22:09] What I wanna say to parents out there in particular is if you look at the data on average A1C by age, teenagers and young adults have the highest average A1C, and those are high. They're like in the eights or maybe even close to nine, I can't remember. Because those kids and baby adults are really struggling.
[00:22:29] It's hard enough to learn to go out in the world and feed yourself and do your laundry and get a job and show up on time and make friends and pay your rent. And then you add diabetes. It's huge. It's monumental. It's no wonder that they are struggling. The lecture isn't what are you doing with your A1C? It's how can I help support you in paying attention to this thing that we all know is a huge monkey on your back?
[00:22:54] I have to say, the longer I work with people with type 1 professionally, the more I see the level of trauma they carry around it. And it's not small and it's ongoing through their lives. It's not going away.
[00:23:07] Carole Blueweiss: Even with children in general with disabilities, we often talk about the younger years, but what about the years when they start to become more independent? What are the issues or challenges that happen? They're very different, right?
[00:23:18] JoAnne Robb: Yeah, they are. And I think that that's where the anxiety of parents starts to go up even higher. So yes, you're super anxious if you have a two-year-old or four-year-old who's been diagnosed. How could you not be? Any age, actually. But then they hit their teen years and they become more independent.
[00:23:34] Or they're eating crazy food that you don't actually think is a good idea. Or they're not dosing, which happens quite a bit. Or they're hiding the fact that they're diabetic from everybody at school because they don't want them to know. So they won't wear their pump or CGM or anything. And they're not taking care of their diabetes at all.
[00:23:51] And their A1Cs go skyrocketing because their numbers are really high and they're out of range a lot of the time. This is not just a medical condition, even though it seems like it is. It's also an emotional condition and have seen in my practice and see in the data is that I think of diabetes now as a trauma, like a lowercase t, not an uppercase T trauma, but a trauma that pretty much any client I have who's living with diabetes in some way is grappling with. And sure, that's to lesser and greater extents.
[00:24:25] But I do think that the way that parents talk about this trauma of diabetes makes a difference in the child's relationship to the disease. So a really common response that kids can have is that they feel anxious when their numbers are out of range because the messaging they've gotten from parents is that that's a catastrophe in some way.
[00:24:46] Right? So if it's a catastrophe to have your numbers be in the 200s, but you might, and I have seen this, not even look or check your blood sugar or dose for those numbers. You know, the truth is, your numbers are gonna be in the 200s sometimes. There was one study I was in and we talked about the diabetes fairy who comes and kind of like, poof, poof. And now you're high. Poof, poof. Now you're low and you have no idea why. And someone in the group said, wouldn't it be more like the diabetes terrorist? And I'm like, yes. So the diabetes terrorist will come. And it's not always fully in your control or your child's control and your reaction to the diabetes terrorist is really an important modeling for your child in their relationship to their diabetes and also for your child in their relationship to you.
[00:25:32] I've seen kids who like hide their numbers from their parents or hide their numbers from themselves, even worse. Because they just don't wanna know because they feel so bad about it. And that's the kind of way I want parents to think about how their reactions can have impact.
[00:25:48] Carole Blueweiss: Do people manage type 1, like they do type 2 with what kind of food they eat?
[00:25:54] JoAnne Robb: Yeah, that's such a good question. And people with type 1 can't manage their diabetes the way people with type 2 can. It's an autoimmune disorder. There isn't insulin. You can't make your body behave like it has insulin just by controlling your food.
[00:26:10] However, you can do a really much better job of controlling your blood sugar if, for example, you take in fewer carbohydrates. So there's definitely a movement of people who basically eat, I'm not even gonna guess, 30 grams of carbohydrates a meal, 30 grams of carbohydrates a day, which is nothing, right? There are 15 grams of carbohydrates in an apple. So you can imagine how little that is.
[00:26:36] And there are definitely some people who choose to go that route. I personally feel like doing that with kids is a big mistake. And a lot of parents do that. I am guilty of doing that to some degree. I remember when my son was not on a CGM and I was waking up in the night and doing finger sticks if we were gonna go out to dinner, which we stopped doing really. Whew. Eating out with diabetes just was so hard, and especially something like just going to a burger joint and getting a burger and fries. He would wanna do that, and I would say to him, please don't. I will be up at least two times in the night if you do that. You know, those were the kinds of conversations we were having back then.
[00:27:17] So there's no doubt that I also wanted to shift our eating. That said, I think putting too firm a restriction on it, like, I don't ever eat these things, kind of things is pretty much a surefire recipe for a kickback around food and eating behaviors. Restricting food too much can have a mental health boomerang effect that you really don't want.
[00:27:43] There's a very natural and normal response that type 1 parents have to sort of control diet as a way to control blood sugars. And while absolutely I do that, too, like we have weird things that we do in our family. We never eat pasta, for example. But when taken to the extreme, it causes kind of disordered eating patterns and I see that a lot with people with type 1, and I think eating disorder is already a problem in our society, especially for women, but girls who have been messaged for years to not eat a whole bunch of things, it creates a setup for a kind of anxiety and relationship with food and type 1 that is really unhealthy.
[00:28:22] Not to scare parents and say these things will happen, but to think about what their anxieties are. Because those anxieties actually matter in the gestalt of what's happening in the family around the disease.
[00:28:34] Carole Blueweiss: Right. That's so interesting. I mean, it reminds me when I speak to other parents of neurotypical kids as well as kids that are not neurotypical or kids that just have whatever challenges. One of the hidden ingredients, I think, is how the parents think about their kids. And it's an invisible influence on the child, right?
[00:28:54] So you could have two children with the same condition and one parent be very anxiety ridden and fearful. And another one be like, oh, it's not a big deal. And that child will learn, right, from the parent, an underlying attitude that is invisible.
[00:29:10] JoAnne Robb: Absolutely.
[00:29:10] Carole Blueweiss: So you're saying the more aware the parents can be of how their response is, that it really is important because it influences their children so much.
[00:29:19] JoAnne Robb: That's very well said. Yes, exactly. And it's never a formula. Let me name that every day is different with diabetes, but there is a permission that needs to be given to eat the quote unquote bad food or the quote unquote hard food. Because otherwise you end up in a place, you know, eating disorders are about state of mind around food, and you end up in that place and that is dangerous.
[00:29:41] And we don't want that for our kids. That's not what we want, that they have this constant conversation in their heads about whether or not they're allowed to eat something. That's horrible. They can eat it. Will it make their blood sugar spike? Maybe. Can they practice on it so that it happens less? Yes, absolutely. Go for it.
[00:29:59] Carole Blueweiss: So in a way, you're saying, you know, to give yourself permission, even with something, with a disease like diabetes, giving yourself permission is actually advised.
[00:30:09] JoAnne Robb: I would advise it. I think there are people who would not. Right? And there are people who feel like tight, tight control is the most important thing.
[00:30:19] Carole Blueweiss: Tell me, JoAnne, if I got this right. Someone can have their food plan and know what they're supposed to do when you have type 1 diabetes, but there is some kind of mysterious, unpredictable part of it that sometimes the numbers can go up or down even if you're following all that you were told to follow. Do I have that right?
[00:30:41] JoAnne Robb: Yeah, so let me make a few small corrections. A kid is diagnosed today, they're not really given a food plan. That was the way it used to be managed. Like back when my dad was diagnosed. My father is a very rigid eater and it does absolutely help with his management. There's no doubt about that, that if you were going to eat the same breakfast and the same lunch, which is what he does, every single day of your life, you're going to have a better, clearer sense of what is gonna happen with your numbers.
[00:31:09] That said, you are also correct that in our house we say it's an art, not a science. That depending on the day, depending on the hormone structure in your body that day, depending on, you know, which way the moon is, depending on your stress levels, and for growing kids, right? As they move into puberty, all of these hormonal responses in our bodies affect, how much sleep we've had. It all affects blood sugar, so you could eat the exact same thing and have really, really different results.
[00:31:40] My son is actually a really good diabetes manager, kind of incredible, and he has periods of time where the exact same amount of insulin drives him so low. He has endless lows and he once ended up in the hospital because of it. He just was so low and he just needed extra support and IV line and they gave him a lecture that he shouldn't be overdosing. He wasn't, he was giving what he had given always, and it's just his body was responding differently. It can be because the body becomes less or more insulin resistant. There are a lot of different factors, not all of which are mapable.
[00:32:14] Carole Blueweiss: And this emotional roller coaster I'm sure is different for you, the parent and for the child. How do you separate that? How do you take care of yourself and recognize your needs and your emotional rollercoaster and also empathize with what your child is going through? It just seems like so much.
[00:32:36] JoAnne Robb: That's a good question because I think at the beginning, it's a little hard to sort that out. Now, I remember one moment with my son yelling at me like a foot from my face and it was definitely something around diabetes. Like I will not dose for that or I will not eat that thing. You know? And we were, whatever it was, I remember feeling like we were in pretty precarious territory. If he didn't comply and quick, we were gonna be medically in a bad place. But it was so heightened because he didn't wanna do it and I didn't blame him, but he had to.
[00:33:08] And I think the feeling of panic that probably we were both in, I mean, I remember in that moment feeling like, boy, I'm glad I'm in a two parent household. And I turned to my husband and said, you've gotta take this. I can't do this. And I walked away because I just couldn't engage with it anymore. It made me so anxious. And I think he was anxious, too. So how to separate is hard, I think, at the beginning.
[00:33:30] And I think as a parent, I think I felt like he should have been grateful that he lives now. But that was not a place that he could have gotten to at nine years old. Being poked with needles multiple times a day and having his life turned upside down. All that took time. I think he feels grateful, for example, that there's the technology that there is really helps keep him safe and more in range.
[00:33:51] Carole Blueweiss: Did that technology develop for him as he was growing older, that he saw that these were these new discoveries or were they already there and he just was old enough to try them out?
[00:34:02] JoAnne Robb: No, good question. Again, they really weren't there, so pumps existed and he did not wanna go on a pump. Absolutely was adamant about it. And at some point I sort of adamantly said, you have to. It took me a long time to get there because I've had a very strong feeling as a lot of parents do in today's society about his autonomy, especially with his body. But in the end, I said to him, this is a family disease and I need you to try this because I think this is gonna make our collective lives so much simpler.
[00:34:31] And actually it was the same thing with the continuous glucose monitor. He really didn't wanna wear it. At that point, I had two kids with type 1. I was actually working three jobs. My husband travels a lot for work. And I remember I'd have to set alarms to wake in the night to test their blood sugars. And I remember going into a bathroom and just sitting on the floor and sobbing because I was gonna have to wake up a second time, and I just couldn't manage.
[00:34:55] And the next day I said to him, we don't have a choice anymore. Like I'm falling apart here and I really need your help. I need you to wear this. And as soon as he did, my daughter did as well. So, no, the technology didn't really exist. The CGM technology was very clunky when he was first diagnosed. So parents today, actually, I mean, this is a horrible thing to say, but they have the opportunity to make it easier.
[00:35:19] Like it's not easy by any stretch, and the anxiety's still there, but it's a double edged sword. They can always read their children's blood sugars if they have their kid on a CGM, and that raises anxiety in a different way.
[00:35:31] Carole Blueweiss: Do you recommend that everybody get this CGM? Like it just sounds like such a stress reducer, but am I missing something?
[00:35:40] JoAnne Robb: Well, the main thing you're missing is the cost. Diabetes is, I think I'm accurate saying this, the most expensive disease to manage. It is incredibly financially burdensome. So yes, I do strongly recommend a CGM. I know plenty of people who aren't on one, but I do recommend it. There are some downsides to a CGM, especially as a parent.
[00:36:04] I think it can drive a certain kind of perfectionism, right? Because you're seeing blood sugars literally every six minutes, it updates. And so you can become kind of compulsive about it. That's not good for anybody. And the cost.
[00:36:22] Carole Blueweiss: Are you saying that insurance companies will not pay?
[00:36:26] JoAnne Robb: They will, but it's still really expensive depending on what your deductibles are. I mean, we meet our out of pocket almost every year. We're up bumping up against our out of pocket maximum. It's really, really a lot of money. Pump supplies are really expensive. CGM is really expensive. Insulin's really expensive. Even with my insurance, I'm paying $85 a month per kid for insulin.
[00:36:52] Carole Blueweiss: That's just mind boggling because I just, in my naivete, I would just assume something like this would be covered completely by insurance.
[00:37:01] JoAnne Robb: Yeah. Nope, it's not. It's not.
[00:37:03] Carole Blueweiss: What do people do when they can't afford it?
[00:37:07] JoAnne Robb: It's scary. I mean, I haven't heard of any children in our community whose parents can't afford it. I do think that it probably depends in part on what your health insurance is. Like some people probably have better coverage than I have.
[00:37:21] I actually know a family who has such good coverage, they get so many more supplies for cheaper than I get. But I have heard stories about people who give themselves less insulin, who check their sugar less frequently. So they're dancing with their own health. They're dancing with their long-term health.
[00:37:36] They're dancing with their wellbeing because it's not affordable for them. I have to say, Carole, I don't know what all the programs are that would allow low income folks to get access to insulin, but I do think it's crazy that it's so hard. I have a nephew who's in college in Canada, and he can literally walk into the pharmacy and buy insulin for the equivalent of, you know, $30 a vial.
[00:38:01] You know, something like this. And so he doesn't even need a prescription. He actually did that for me once, right before Covid. I was really afraid of what was gonna come and what would the supply chain be, and so he bought me some insulin in Canada and got it to me. It's crazy that in this very wealthy country, people are up against these kinds of costs to manage something that they had no liability in.
[00:38:24] Carole Blueweiss: I know you said it's an autoimmune disease. Is it genetic?
[00:38:28] JoAnne Robb: So they think it's epigenetic, meaning that it's yes, genetic, but they think there's some environmental trigger. So there's definitely something that has shifted in where more and more people are being diagnosed with type 1. More and more people also worldwide are having autoimmune issues. They don't know the why of that.
[00:38:47] So in my family's history, it makes sense, right? My father has type 1 and my husband's first cousin has type 1, but there are families who have no history at all, no idea where this came from. And so there's something environmentally that's triggering a genetic sequence, I don't even know what to call it, that wouldn't have maybe been activated otherwise. But yeah, there's definitely a rise of diabetes, of type 1.
[00:39:12] Carole Blueweiss: Your husband, how did he deal with finding out that first one and then another child has type 1?
[00:39:19] JoAnne Robb: We had a pretty clear division of labor where I was the lead diabetes parent. He also, I will say, is less anxious.
[00:39:28] Carole Blueweiss: What's all this been like for your middle child?
[00:39:30] JoAnne Robb: Poor kid, yes. My middle, he's now 17 and he's the one who dodged this bullet. Soon after my son's diagnosis, I had a nursing baby and a son with type 1. My middle child got ignored. I mean, I fed him and I got him to school, but he really regressed. He was really struggling and I could see it. And I really literally couldn't do anything to help him.
[00:39:58] I just was struggling so much. But when he was about 10, we ended up going to do some family therapy that was really focused on him and it was really helpful for him because he was anxious and I don't wanna draw a line directly from diabetes to his anxiety. That feels unfair to him. Like, he's his own person and had his own experience.
[00:40:18] But I do think that he got pretty dropped in there for a while because I really just couldn't, I couldn't manage what his emotional needs were as everything else was going on. And it's definitely something that I am keenly aware of. It's actually at that annual symposium, there was one year where I did a lot of research and gave a talk on how to support your non-diabetic kid, because I do think it's sort of under-thought about.
[00:40:44] And I will say that he is truly one of the most generous, sweetest people you will ever meet. He's very nurturing and he's really there, like if his brother's blood sugar goes low and I'm asleep, because they're so much older now, he'll stay with him. You know, he'll hang out, he'll go get the juice, he'll just be with him because he knows what it's like.
[00:41:07] And he's very maternal, actually, with his younger sister. And a little bossy, but you know, but it can totally manage her blood sugars and can be with her and can help and support her in a way that I think has grown his empathy. But at a cost to him on some level.
[00:41:25] Carole Blueweiss: I found on Sweet Talk on your website, the stories that you wrote, one was about the diabetic police. Can you tell me what you mean by the diabetic police?
[00:41:34] JoAnne Robb: Think about what it means to be a parent. So much of it is about essentially policing your kid. That it's not the word you would use. Like, did you brush your teeth? Or let's go brush our teeth, depending on the age of your kid. Or what do you want for snack? Or did you eat your snack? Or like, did you wash your hands or did you get your mask for Covid? Now add diabetes. Did you dose for your blood sugar? What are you eating? But that level of policing, like the should you be eating that or did you dose for that can get really wearying for people. And they can feel really burdened by the outsider policing them in that way.
[00:42:09] And some of it is real. Like I will name that my 13-year-old daughter just forgets to dose all the time. I literally can say, did you dose for that? And she'll say, oh no. And then two minutes later I'll say, did you dose? And she's like, oh, I forgot. I mean really, literally. And she's not, but she's also not annoyed with me for asking.
[00:42:29] I think at this point she recognizes that she's having some trouble tracking it. And so she's mostly more or less grateful that I'm helping her. My son, on the other hand, around the same age, I'd say middle school, I would say to him, did you dose? And he said to me, stop asking. Like, just leave me alone. And we actually went to his endocrinologist and I said, we're struggling with this. I wanna be in this conversation with him and he doesn't want me. And the endocrinologist was brilliant and said, okay, well, here's the deal. If you miss more than two doses in a week, and if you're not checking your blood sugar - this was before CGMs - if you're not checking your blood sugar at least four times a day, which looking back on it, I'm like only four times a day?
[00:43:17] But if you're not doing that, then your mom can be involved. So basically if you can meet this minimum standard, which was really, truly a minimum, then you're independent and you get to operate on your own. And I was comfortable with that. And so I stepped back and stopped asking, and he stepped up. I think that's part of why I created my parent coaching group called Sweet Talk because I wanna help other parents manage their anxiety. It can come up in some predictable ways, and I feel like we all need to help each other in lowering our anxiety so that our kids know that this is manageable as much as it is.
[00:43:52] Carole Blueweiss: What have you learned from your kids?
[00:43:55] JoAnne Robb: What a beautiful question, Carole. Something about resilience, I think. And their capacity, I mean, it's profound how much they manage on a daily basis and how they do it with, largely with good cheer. It's not like that every moment for sure. And there's a lot of anxiety in there, and there's a lot of misery in there. But I think I've learned about how much people can withstand in some way.
[00:44:27] Carole Blueweiss: That brings me to some questions that I wanted to ask that others have asked. Is changing my diet, could it help me to the point that one day I won't need insulin?
[00:44:38] JoAnne Robb: Hmm. It's so hard, right? There's so much wish in there that there could, that that could be so, and no, it can't. Right? Because you have basic metabolic needs no matter what. Your body needs insulin to survive. I mean, yes. can you change your diet so you need less insulin? Sure. Right? Like if you go on one of those crazy keto diets, and that would never be recommended, I think, for someone with diabetes because of the insulin balance in their bodies is different than for non-diabetic people, I think that would actually be physically unsafe. But if you went on a low carbohydrate diet, which I know is very fashionable, you would need less insulin, sure. But you would never need none.
[00:45:22] Carole Blueweiss: And what about exercise? How does that play into - this was actually one of the questions - does that help low keep low? The sugar levels.
[00:45:30] JoAnne Robb: So exercise is good. It definitely helps reduce blood sugar and it can help it reduce blood sugar over time and it also helps with insulin resistance, which isn't a thing you think of with type 1 in the same way you think of it with type 2, but you actually start to need less insulin the more exercised you are. For sure.
[00:45:50] And like I've noticed in the pandemic, my daughter wasn't exercising so much and so when she started exercising again, oh my goodness, her blood sugar would drop like a rock. Like there's something about keeping regulated with regular exercise, that's easier. So my son had said that, too. He's like, if he starts running again after a long break, he has a harder time regulating his blood sugar. But if he keeps at it, then he has an easier time regulating and it sort of helps his blood sugar stay more in range over time.
[00:46:19] Carole Blueweiss: Mm-hmm. Like the idea of having a routine.
[00:46:23] JoAnne Robb: Yeah. But diabetes demand so much routine, it can get a little tiresome. Not that I'm, I mean, I'm a big fan of moving the body, but I also get that diabetes is pretty burdensome in those ways.
[00:46:36] Carole Blueweiss: Right. But with exercise, it can definitely help, it sounds like.
[00:46:41] JoAnne Robb: Definitely. Yeah.
[00:46:43] Carole Blueweiss: So someone asked me what are the benefits of using the insulin pump instead of using regular insulin?
[00:46:48] JoAnne Robb: Instead of just multiple daily injections, right. It's a personal choice. I wanna start by saying that. Like, my dad is still on multiple daily injections and his A1Cs are beautiful. I think that outcomes for people in terms of A1C, for example, on average for people with multiple daily injections versus an insulin pump are essentially the same. Like I don't think you really get better control. That said, it's easier, right? Yes, you're wearing a device. Yes, that can be bulky and cumbersome, and there are reasons around your body that it might feel like you don't want to do that.
[00:47:25] However, you don't have to always be carrying all those supplies with you, right? Like you have to remember leaving the house to have insulin and a syringe and the this, and the this, and the this, and you really mostly don't have to do that. Like in the Bay Area, if we're going across a bridge, given that I live in an earthquake area, I don't go across the bridge without having backup supplies.
[00:47:48] Like I wouldn't go from the East Bay where I live to San Francisco without bringing new pump supplies, which includes insulin. I wouldn't do it. Yeah? In case my daughter's pump fails, right? Because if my daughter's pump fails, I don't have very long before she starts to get really sick. I mean, there was one time we took an international trip and on the flight home we had a stop over and we realized we had left the insulin in the refrigerator in Italy and we had no insulin for the flight from Germany back to San Francisco.
[00:48:19] How long is that flight? Hours. If either of their pumps died or we had a problem, they would have to do an emergency landing. They would have to. They would be so ill and we would be in the middle of the air over the Atlantic Ocean. And so we actually, I figured out that in Germany you can get insulin at the pharmacy.
[00:48:38] And my son and I went running through this humongous airport because we had to first get a prescription from the doctor in the airport. We were running, I mean like I was so outta shape compared to him. He was a sprinter and we ran and we finally made it through somehow this German-English barrier and got a prescription for a different kind of insulin than the one we used.
[00:49:01] But it would have worked if there had been a problem on the plane. Yeah, we can't go too far without having supplies. If you're on a pump, to get back to that question, you don't have to carry as many supplies in your local circle where you normally go. If you go someplace further, you might need to have extra supplies, but it's attached to you, so that's easier.
[00:49:21] And also every time you put a bite of food in your mouth, you don't have to give yourself a shot. That's easier. And the smallest amount of insulin you probably give yourself through a syringe is half a unit. But on a pump you could give like 0.05 of a unit. You know, it's a little more granular. I'm very grateful for technology and I haven't even talked about closed loop technology, which my children are both on that technology now, where the CGM talks to the pump.
[00:49:50] And it makes regular adjustments for, gives more insulin when they're going high and so their blood sugars are more in range. I definitely have seen that and it shuts them off as they're going low, so there's more safety nets and so I sleep better at night. I mean, not just because I'm less anxious overall, but because literally I get awakened less because the pump is taking care of some of the things that normally I would've had to get out of bed to take care of.
[00:50:17] Carole Blueweiss: One other question related to this. Is using a continuous glucose monitor system without an insulin pump effective?
[00:50:25] JoAnne Robb: Yeah, I think it really, really is. If I were to get type 1 diabetes, I'd go on a CGM before I'd go on a pump.
[00:50:32] Carole Blueweiss: What your children, though, are using, are they using the pump and the monitor?
[00:50:37] JoAnne Robb: Yes. And the CGM. Correct. So they both wear two devices all the time. Think about small people's bodies, right? Literally, where's the real estate to put this stuff on little bodies? It's really hard. And it affects things like my son really likes very soft beds because when he lies on some of the technology, it's awful. It's awful for them. It's really terrible.
[00:51:03] Carole Blueweiss: Where you recommend people go if they do have questions?
[00:51:07] JoAnne Robb: Your community first. Your local JDRF I'm sure has meetings and there's organizations all over that have that kind of community building. And I think that finding other people is really important. And as I said, camp. I think another place to get information and resources is definitely talk to your pediatric endocrinologist about what the local resources are.
[00:51:33] Carole Blueweiss: Thank you, JoAnne. You've had so much information to share and your personal information, I really appreciate that you shared it with all of us. And, just wanna make sure there's nothing else you'd like to add?
[00:51:44] JoAnne Robb: Yeah, there is one more thing I wanna add, and that is that for me, I have felt like this is something that has sunk in over time. The hit to me, the recognition to me that this is something that my children will always have and will always carry, is something that I keep learning again and again and again. So it's this strange way where I can't describe it. There was one time where we were out snorkeling and I was on the boat and my son was in the water and he was a little far from the boat.
[00:52:20] And I just had this gut feeling that his blood sugar was going low, and that's not an easy situation, right? You can't check blood sugar on wet fingers. He's far away. And I made the people in the boat go near him and I made him stick his hand out and I dried his fingers off and I checked his blood sugar and I was right. And so I made him get in the boat.
[00:52:40] But in that moment, it really sunk in for me that this is his reality. Like he can't go snorkeling, without having a whole system of safety around him. And I think it sinks in again and again. And I know when my daughter was diagnosed, I had this very bizarre sadness about her wedding dress and how was she gonna wear a wedding dress with a pump? And I had a friend who was like, don't worry, we're gonna figure it out. There's gonna be a tube and a bustle and it'll hide the pump in the bustle. It's gonna be just fine. And you know, she might not even get married, you know? Who knows? She might not want a dress, but this was where I went.
[00:53:24] There's just another layer of it sinking in, like this is real for them. This is what they're living, this is what we're up against. And I feel like the mourning of that is ongoing. It's not an all at once thing. Like with diagnosis, of course there's shock and for a lot of parents, there are a lot of tears. But I think the actual true mourning of what it is for your child is an ongoing process.
[00:53:53] Carole Blueweiss: And also to have the awareness about your own anxiety and the dedication to taking care of yourself so that you can parent your child more healthily. So because many parents, I find, you know, all about the child. All about the child. All about the child. But actually if you take care of yourself, you're also taking care of your child. I think that's what you're saying, you know? And how parents are with their kids. Of course we should all be aware of how our attitudes influence and that's just something, I don't know, it's not really talked about so much because parents, what they have a child and you worry so much.
[00:54:30] JoAnne Robb: Yeah. Yeah. That was the perfect summary because it is what I feel like I see a lot is the anxiety is so high and you can't say to someone, stop being anxious. Like that doesn't work. But it's sort of like to validate that of course you're anxious and to think through some of the realities about the anxiety and also like how do you titrate it so that you can be giving messaging that allows your kid to thrive?
[00:54:55] Carole Blueweiss: If you were to give one or two pieces of advice to a parent who's just learning that their child has type 1 diabetes?
[00:55:04] JoAnne Robb: My biggest piece of advice is you will learn this and your child will be okay, and you will be okay. And that doesn't mean everything will be good all the time. Like I would never say that. But this is survivable. I think that when parents talk about like, my child could die because they have diabetes, it's totally true. They could, and it is really scary. But it's also true that given our modern technology, the likelihood of that is very, very slim. And so to hold to the greater truth of their survival and their ability to do anything they want, pretty much, and they can live relatively normal lives, is an important thing to keep focused on for their sakes.
[00:55:46] Another piece of advice I have, and this is tricky because it depends on the age of the kid, but is to try to normalize it in their community as much as possible. I think that a lot of kids with diabetes hide and really this is so variable, and my kids were both fairly young when they were diagnosed, so there was no reason to hide.
[00:56:06] They weren't teenagers, they weren't embarrassed. So it got normalized in a way for them that was quite nice. And so I think if your kid's a teenager and/or one of those kids who wants to hide, creating as much community around it as you can through something like diabetes camp is really important because then they can see that there are other kids who also have diabetes.
[00:56:27] I know a lot of people will say, we don't wanna make diabetes the focus of our lives, and I get that. I really do. And I still think it is important to create some community so your kid doesn't feel like they're the only one wearing a pump or the only one who is checking their blood sugar.
[00:56:44] I mean, the first time we went to camp, this was a really profound moment for me. I was walking through camp and I saw a test strip on the ground, and it really hit me because I thought, maybe that's not my test strip. Like everybody here has diabetes. That trash on the ground isn't mine. Because at my son's school, if there was a test strip on the ground, I knew that we had made that trash. And so the idea that I wasn't the only one was really, really profound for me.
[00:57:16] Carole Blueweiss: Well, thank you JoAnne, for being on Wisdom Shared, and I appreciate all the wisdom that you did share with us.
[00:57:22] JoAnne Robb: You're so welcome. You're so, so welcome.
[00:57:25] Carole Blueweiss: And if people wanted to get in touch with you, what's the best way if they had questions?
[00:57:30] JoAnne Robb: I have a website, diabetessweettalk.com, and my goal with that is it's a coaching group for parents of kids with type 1, and my goal is to help parents who have kids with type 1 and who are anxious about that, who are checking the CGM multiple times a day, who feel like they really have to control food, who feel like the relationships in their family are all about diabetes.
[00:57:54] My goal is to help parents who are struggling with issues like that to be less anxious in the world and to be able to turn the volume down on diabetes so they can have the relationships in their families with their kid and with everyone else in their family that they really want, and so they can thrive.
[00:58:14] Carole Blueweiss: Fantastic.
[00:58:14] Thank you so much for listening to Wisdom Shared. If you enjoyed this episode, please be sure to check out all our other episodes. Visit caroleblueweiss.com. If you like what you are hearing on Wisdom Shared, please spread the word and share this podcast with your friends. Leave a review and subscribe so you can receive wisdom every month.