Nicole Johnson, DrPH, MPH, MA  has worked professionally in diabetes for over 17 years and has lived with Type 1 diabetes since 1993. She is most well known for her time as Miss America 1999. In recent years, Nicole has gained a reputation for her engagement in diabetes research focused on quality of life, psychosocial issues, and family dynamics in diabetes.  At the University of South Florida, Nicole serves as the Executive Director of Bringing Science Home, a $6 million diabetes research program that focuses on those very topics. 

Nicole is also the Chairman of the Diabetes Empowerment Foundation, an organization focused on adults with Type 1 diabetes. Examples of the foundation’s work include the programs Nicole created Students With Diabetes, Young Adults With Diabetes and Diabetes Partners.

Over the years, Nicole has served on many diabetes advisory boards including the JDRF International Board, the American Diabetes Association National Board, the Florida Governor’s Diabetes Advisory Council and the National Institutes of Health Council of Public Representatives. Since 1999, Nicole has helped raise more than $27 million for diabetes research and programs

In her journalism career, Nicole won a Telly Award for her work on dLife.  Her love of communication lead her to be a columnist for numerous diabetes magazines over the years, as well as the author of 7 books related to diabetes.  Her most recent book is Young Adult Type 1 Diabetes Realities.

Alissa:        When did you start competing in pageants and what kind of training did it require?

Nicole:         When I was younger my parents entered me into a pageant with the hopes of breaking me out of my shyness shell. After my first one as a pre-teen, I didn’t enter another until my senior year in high school. It was then that I entered the Miss America program because it offered scholarship opportunities. (She didn’t win that first year.)

Alissa:        Can you tell me a little bit about your early years leading up to your type 1 diabetes?

Nicole:         I was a typical kid who loved to play outside, riding my bike. I wasn’t particularly athletic but I did run track. Because I was so tall I did well at hurdles and high jump. I loved music and was always active in my church, which was a big cornerstone for me.

Alissa:        So many people are misdiagnosed and one of the reasons I really appreciate you speaking to me today is because this is what I often hear of misdiagnoses. How were you diagnosed? What were your signs and symptoms? I believe you were originally misdiagnosed. Am I correct?

Nicole:         I was 19 and in college when I was diagnosed. I was sick for a really long time and I'm sure my blood sugar was high for a while as well.  I was misdiagnosed several times. I had lost so much weight from being sick that I was initially sent to see a psychologist because many people thought I had an eating disorder. Then, I was treated for various strains of the flu. Finally, I was correctly diagnosed as I was being prepped for surgery to remove my appendix – which they were taking because that too was suspected as the cause of my illness. 

Alissa:        You had an appendix surgery without it being appendicitis?

Nicole:         Almost. They didn't take it out because they realized my glucose levels were so high. The surgery was cancelled because I didn’t have appendicitis.  I was misdiagnosed because I had immense abdominal pain with flu like symptoms. Finally someone put it all together, the weight loss plus vomiting and constant thirst, I had Type 1 diabetes.  I am the only person in my family with T1D.

Alissa:        How did you handle your type 1 diabetes emotionally and who was your support system?

Nicole:         Because I was a young adult, it was an awkward time. I was in that process of separating from my parents and establishing my independence. My family was very supportive of me but in a very different way than when people are diagnosed when they're a teen or maybe later into adulthood.

Alissa:        Were you depressed at all from it or did it change your emotions?

Nicole:         I was sent into a downward spiral emotionally. The healthcare professionals were advising that I needed to do this on my own but no one realizes that when you are diagnosed with a disease you automatically feel isolated and depressed. When I was diagnosed, I was immediately given a list of all the things I couldn’t do. Everything seemed so negative.  I followed the advice I received.  I quit school, shelved all my dreams and tried to create a new way of living.  It [the advice] was so extreme.  I was told to NEVER enter in a competition like the Miss America program because I wouldn’t be able to handle the stress and that having children was no longer a reality for me because of my diabetes.

Miss America 1999, Nicole Johnson with her daughter

Alissa:        How long do you say emotionally it took you before you felt like you were in a good place again?

Nicole:         Probably a year or two.  After a few months I started trying to live again, but the process of dealing with the grief and shock took me a while.

Alissa:        When did you start preparing to compete for Miss America after your initial diagnosis?

Nicole:         About six months after being diagnosed, I decided that I needed to start trying things. The Miss America program was the impetus for me being able to have a positive outlook. It gave me a goal, a sense of purpose. It didn't matter if I won or if I lost. (And I lost a lot of times.) Getting on a stage with a disease was the push I needed to turn my life around.

Alissa:        How did you find a doctor and a medical team to help support you?

Nicole:         The old fashioned way – looking in the phone book and talking to friends was how I finally found someone that was right for me.  

Alissa:        Was it hard to maintain well regulated blood sugars, especially when you were competing with the restricted diet?

Nicole:         Yes, it was incredibly hard. This was more than 20 years ago. Continuous Glucose Monitoring (CGM) sensors weren’t available nor were Insulin pumps common. The first five years I gave myself injections. Thankfully, I never fell into any traps of dia-bulimia or anorexia but, I did become a really diligent high cardio exerciser when I was preparing for Miss America.

Alissa:        What was your diet like and did you see a nutritionist?

Nicole:         No, I didn't see a nutritionist.  My diet was very basic. Including a lot of steamed vegetables and some chicken. For breakfast, I would eat Fiber One. Lunch would be some kind of salad or protein and dinner was steamed vegetables and chicken.

Alissa:        Did the stress of competing impact on your blood sugars?

Nicole:         Yes it did. Being able to compete for five years before the Miss America program allowed me to learn a lot about mind control. I would intentionally decelerate my emotions and try not to be excited or anxious about things. I would go through mental exercises to keep myself calm. When a person gets excited, the adrenaline can hit the blood sugar really fast.  I would do a lot of techniques similar to yoga to help control my breathing.

Alissa:        You were very well known as the first Miss America who competed with diabetes and an insulin pump. I'm curious to know what made you decide to wear an insulin pump on stage and how did you feel?

Nicole:         The year before Miss America I was competing at the state level when I was found unconscious due to low blood sugar. That was my wake up call. I decided from that moment on to not hide anything about my diabetes. One week later I was on the pump and vowed to not only wear it but use every tool available to maintain my blood sugar.

Alissa:        What kind of impact do you feel it had on the general public and the diabetic community or non-diabetic community? By any chance, do you feel that, to some extent, a pump created a possibility of you accelerating your win?

Nicole:         I wore the pump underneath my clothing. I didn't necessarily advertise that I was wearing it, but I did tell the judges that I wear the pump to stay alive.  I literally said during the interview “If you have a problem with the fact that I wear a medical device, don't pick me because I'm never going to hide it. It's under my jacket. It's clipped to my waistband. It is my lifeline."

I don’t think the pump secured my win, but I do think my win had a bit to do with the way I was fueled with passion to speak out about diabetes.   It was infectious and unusual at that time.

Alissa:        Are you currently still on an insulin pump?

Nicole:         Yes, have been now for almost 20 years.

Alissa:        Are you currently on a Continuous Glucose Monitoring System (CGM)?

Nicole:         Yes, I wear a Dexcom. Have been wearing it since the first one came out!

Alissa:        Since you're on a CGM, what advice would you give and why do you feel it's important, especially as an athlete or a competitor?

Nicole:         My advice is to wear one if you can. The reason I say “if you can” is that I recognize athletes may have challenges in physically keeping the device on. I get a severe skin reaction to my CGM, but I still wear it. It is my peace of mind and assurance that I can accurately control my blood sugar. I also recommend that people engage in the online community to seek guidance on everyday issues that we all experience – whether you are an athlete or not.

Alissa:        What do you think you've benefited the most from wearing a Dexcom?

Nicole:         There is great value in being able to monitor your blood sugar because it helps influence behavior. For example, I will know if my blood sugar spiked because of what I ate or not. There is an immediate connection between the cause and effect in my behavior. It's a great non-verbal, non-judgmental tool that guides me.

Alissa:        Tell me about your higher education as well as your career highlights.

Nicole:         I have a master’s degrees and a doctorate in public health. Currently, I run a research program that focuses on how those who have diabetes quantify their quality of life. Their feedback helps us develop programs, interventions and solutions all geared toward improving daily living. But … the greatest thing about it all is being a parent and sharing all of this with my child. My daughter sees the importance of science. In fact, this week she and I gave blood to help with diabetes research studies.

Alissa:        How does your daughter handle your title and success and is she interested in competing in pageants?

Nicole:         She's very funny about it, using it to her advantage when it's convenient. If she wants to show off in front of the class, then mom needs to bring the crown in. And I guess like every little girl, she wants to be like her mom so she talks about being in pageants when she is older. I explain that achieving the job of Miss America is a lot of hard work, but if she wants to do it then I am behind her. She really needs to live her own life, following whatever makes her excited and happy – which is why we do not participate in kid pageants. She does speech competition and piano recitals – that is what I feel is appropriate for her right now. You will never find us at a child pageant.

 Alissa:       What kind of message do you want to share as a role model to other type 1 diabetics and together, how can we make a positive impact on others?

Nicole:         We need to be inspirational, teaching the younger generation that diabetes is not a stumbling block. They need to go forward and chase their dreams. We need to be mentors.

Alissa:        Can you tell me a little bit more about the science of your company that you work for?

Nicole:         I initiated a program called “Students with Diabetes,” which focuses on young people ages 18-35. This is the time of your life when everything is ‘new’ whether it is college or first job. I remember what it was like to be a young adult diagnosed with diabetes. I was in a dark hole of depression, feeling so lonely and helpless. This program addresses all of those vulnerabilities and isolation associated with being diagnosed at a young age.  

Alissa:        What charitable organization do you support and how can people contribute? Is there an online website?

Nicole:         The programs that I've created have moved into a foundation, which is called the Diabetes Empowerment Foundation and the website is diabetesempowerment.org. It's everything from the students that I talked about to programs for partners of people who have type 1. In 2016, we will be rolling out a program with an emphasis on moms who have diabetes.  We'd love any support from dollars to volunteerism.

Alissa:        Thank you very much.  You were so informative and I know how busy you are and I really appreciate all of your time. Together, I hope we can make a difference!

Nicole:         Wonderful. I hope so too!  Thank you.

I started wearing the continuous monitoring system (CGM) approximately one month ago. After having the equipment since May 2015 my intention was originally to compete with it as a figure competitor. Due to the stress and anxiety of preparing for a competition, it was difficult for me to consider trying something new at the time.

Dexcom Continuous Glucose Monitor (CGM)

Two years ago I stopped wearing an insulin  pump. I had been on two separate pumps; first a wireless and then I switched to a tube pump. It had been burdensome with the rigorous training schedule to stay on an insulin pump. The pump would fall off easily no matter what kind of adhesives I would apply. The cannula always affected me and I often had irritation and rashes. I was hesitant to switch back to shots because I was used to wearing a pump. So, I took a pump break and went back on insulin injections and currently two years later I am still taking insulin injections.  There is always a good possibility that I will go on a pump again. Right now I'm still enjoying my pump break.

My sugars have varied drastically on insulin injections. I have been told by several other athletes the importance of having a CGM and how it helps them in their athletics. If you’re an athlete, it's highly encouraged to go on a CGM. It can benefit your training. When you check your blood sugar with a meter, that is one data point. Two hours later, you get another data point. A CGM like the Dexcom provides a data point every five minutes, so it really fills in the blanks.  I’ve learned so much more about my ideal basal rates at different times of the day and night. It’s just made a tremendous difference.

I check my blood sugar frequently. My regimen involves checking in the morning when I wake up and before each meal. I take insulin injections with each blood sugar check before a meal. It has been advised for me to wait  20-30 minutes after an insulin injection to eat a meal, so I usually check every 3 hours and wait an extra 1/2 hr after that to eat. 

It's so important to have a doctor work closely with me and I'm lucky that I have wonderful support in Austin Texas with Dr. Blevins at Texas Diabetes and Endocrinology.   Dexcom tracks my blood sugar at all times. It is the device that allows me to track any changes and has become my safety net for informing my doctors of my blood sugar levels. 

Dexcom G4 Sensor 

I'm on a strict calorie and carbohydrate (carbs) restricted diet. My diet involves eating the same foods with the same amount of carbs at the same times every 3 hours 6 times a day. I now have a set ratio. I see the doctor every two weeks due to my training schedule. I log everything daily. Everyone is different and a regimen is individualized so what might be right for me may not be right for you.

When I train with Dexcom I am able to monitor what my blood sugar is before I start. I'm often asked if I make adjustments during exercise and the answer is yes I absolutely do. Everyone is impacted differently, so you may never have the same blood sugar daily. For me, some days I'm high afterwards, but typically I am low. I take 1/2 unit less of insulin with a 1.5 hours both before and after exercise. Occasionally I drop low in the evening or if I exercise later in the evening. When I exercise in the evening, I reduce my dinner and bedtime dosage by .5 to prevent overnight lows. Dexcom has helped me track my blood sugars at the most difficult moments and it is nice to be alerted when I'm low so I can treat early enough and correct for a high.

So my fear of going on Dexcom has been completely wiped out of my mind. For me the application does not hurt at all. In fact it hurts less than a finger stick. I do not feel the sensor in my body at all. I wear it on my stomach. That seems to be the best area for me due to my rigorous level of activity. The sensor does not fall off or lose its adhesive. I am trying various barrier wipes to see if it eliminates some of the redness and small rash I have when I remove the sensor. I have found that I need to change my sensor every 7 days because that's when I start feeling the itching and irritated sensation and it often peels off. Although my skin is still sensitive to the adhesive, I've noticed it often goes away within the day. I'm very diligent with cleaning my skin thoroughly before and after the application of my sensor. I've heard there are people who have no rash issues.  

As of now, I cannot say good enough things about how how Dexcom has provided me with a sense of relief and the power of information.  It's hard to imagine what my life could be like without wearing the Dexcom CGM again. I am the most regulated I've been since my diagnosis in 2000. 

Thank you Dexcom for such a wonderful product!

This is the second and final part of a 2 part interview of Professional Snowboarder and T1D Sean Busby.  Click here to read the first part Professional snowboarder Sean Busby accomplishes his dreams as a Type 1 diabetic (T1D)

Riding On Insulin founder, Sean Busby, is a professional backcountry snowboarder with type 1 diabetes who travels the world exploring remote corners of the globe on snowboarding expeditions.

In 2004, while training for the 2010 Olympics, Sean endured a complicated diagnosis of type 1 diabetes. Considering leaving snowboarding all together, Sean was inspired by reading stories he found through JDRF’s Children’s Congress. It was the stories of 5- 7- and 13-year-olds that inspired him to keep living his dreams despite living with diabetes. He founded Riding On Insulin—which is now a nonprofit organization—to honor all the kids who inspired him to keep living. Today, Sean’s wife Mollie runs Riding On Insulin and Sean makes appearances at the organization’s global action sports programs (including ski/snowboard camps) for kids, teens and adults living with T1D, while managing his personal backcountry snowboarding career. In February 2014, Sean became the first person with T1D to backcountry snowboard all seven continents. His expeditions include trips to Morocco, Antarctica (twice!), Patagonia, Iceland, Norway, Japan, Kyrgyzstan, Alaska, Tasmania, and more. Sean graduated from the University of Utah with a degree in Health Promotion and Education, with an emphasis on diabetes.

Sean and his wife, Mollie live just outside Whitefish, Montana in a yurt with their two dogs, Daisy and Glacier.

Sean Busy (photo courtesy Sean Busby Facebook page)

Alissa:      I’d like to talk about your latest diagnosis. When were you diagnosed with Lupus and how are you managing it? 

Sean:        When I was going through that whole complicated diagnosis in Colorado at the age of 19, there were different blood abnormalities. All of the different specialists viewed me as an enigma that they were trying to figure it out.  I was sent to the Mayo Clinic in Rochester, Minnesota where I was tested for every autoimmune anomaly in the book.

Flash forward to August of this year, when I finally got diagnosed with Lupus. One in ten people that have lupus are men, which means it affects about 500,000 males in the world. So, it is actually very rare for a man to be diagnosed.

Alissa:      What were your recent symptoms that led to it?

Sean:        Most recently, I had gotten back from the Arctic Circle in Norway where there’s 24 hours of sunlight. I had suffered from debilitating headaches, which I had never had before.  A doctor detected really high multiple enzymes in my blood. I was immediately referred to a neurologist, who thought I might have some sort of muscular dystrophy. Tests now found a specific antibody that came back four times the normal value – which is only seen in a person who has Lupus. Looking back at everything, it all makes sense.

As a result, I’m on a heavy dose of anti-malarial medication to protect my body’s organs. I’m also on a bunch of different supplements. If the disease attacks my liver and kidneys again, I could have to be treated with chemotherapy and prednisone (steroids). My latest check up revealed that the Lupus is heading toward a “a remission like state” though remission doesn’t occur in Lupus. I know that a flare up can be caused by over-doing exercise. I am also photosensitive – basically allergic to the sun. Knowing that the sun goes down around 11 p.m. and rises before 4 a.m. in Northwest Montana during the summer, I have to really protect myself. Winter, it is always dark, so that is great.

Alissa:               What is a flare up like? Is there pain, side effects?

Sean:        The pain is excruciating. The headaches are debilitating. My body can’t move because everything hurts. I start running fevers and get very ill, depending on what organ it’s attacking.  If it happens to attack my skin, then that is visual because of the rash which is coupled with joint pain. I’m having to really, really tune into my body, but having Type 1 Diabetes, tuning in is something I’m accustomed to.

Alissa:      How does it affect your blood sugar?  

Sean:        It definitely affects my blood sugar. When you get sick with Type 1, your blood sugars start rising. But, right now my rheumatologist and I see Lupus as the big gorilla—not T1. My doctors monitor my health as a team. Right now, I am searching for psychological support. There is a men’s hotline that I call into. It has helped. I realize that there are some who are afflicted with really severe symptoms. Whatever my situation may be, there is someone who is suffering a lot worse. You have to accept that “it is what it is” and stop being consumed with the worst case scenario. If you don’t then you won’t get to live the life that you want to live.

Alissa:      Currently, emotionally and physically, are you handling it fairly well or do you still have your struggles?

Sean:        I still have my struggles.  I’m trying to get ready for winter. This summer was a wash for me. I didn’t go to New Zealand because I started treatment. I was also really weak from lack of exercise. I was able to snowboard the other day for the first time in a long time and it was an amazing feeling. Just being connected to that snowboard again was … I was almost ready to cry.

Alissa:      Do you climb with people so that you have that emergency support too or do you like to go alone?

Sean:        I like to climb with people so I’m sure to have emergency support at all times. This diagnosis is so new to me that I need to have others around. Eventually, I’ll get back to doing some stuff solo—as long as it’s in areas that are avalanche free.  If I’m in avalanche terrain, I have to always have a partner.

Alissa:      What advice would you give for people who are living with Type 1 Diabetes and aspiring to be athletes like yourself?  

Sean:        Be proactive.  Find out what is available to you.   Get involved. Talk to others that have this.  Try to connect with a local organization because they can really provide you with inspirational people to share advice with.  On top of that, if you want to be active with T1D, check your blood sugar.  Check and learn what your body does in activity.  That’s the solid piece of advice that I did that I learned.  It’s just knowing what my blood sugars are doing, I really learn how my body interacts with exercise.  Its check, check, check and check some more.  

Alissa:      Thank you so much, Sean. You’ve given me so much valuable time and I really appreciate you and all that you do and together, I hope that we can help make a difference because you certainly have to me and I can’t thank you enough.  You’re really, truly, a very special person and if you don’t know it, I’m hoping that somebody will tell you so or you could see so because it really is wonderful what you do.  Thanks so much and I appreciate it.

Sean:    No problem — thanks for the interview.

Riding On Insulin founder, Sean Busby, is a professional backcountry snowboarder with type 1 diabetes who travels the world exploring remote corners of the globe on snowboarding expeditions.

In 2004, while training for the 2010 Olympics, Sean endured a complicated diagnosis of type 1 diabetes. Considering leaving snowboarding all together, Sean was inspired by reading stories he found through JDRF’s Children’s Congress. It was the stories of 5- 7- and 13-year-olds that inspired him to keep living his dreams despite living with diabetes. He founded Riding On Insulin—which is now a nonprofit organization—to honor all the kids who inspired him to keep living. Today, Sean’s wife Mollie runs Riding On Insulin and Sean makes appearances at the organization’s global action sports programs (including ski/snowboard camps) for kids, teens and adults living with T1D, while managing his personal backcountry snowboarding career. In February 2014, Sean became the first person with T1D to backcountry snowboard all seven continents. His expeditions include trips to Morocco, Antarctica (twice!), Patagonia, Iceland, Norway, Japan, Kyrgyzstan, Alaska, Tasmania, and more. Sean graduated from the University of Utah with a degree in Health Promotion and Education, with an emphasis on diabetes.

Sean and his wife, Mollie live just outside Whitefish, Montana in a yurt with their two dogs, Daisy and Glacier.

Sean in Norway

Alissa:     How old were you when you started snowboarding and how did you know that this would be your profession?

Sean:        I started snowboarding when I was 12 years old.  Growing up in Southern California, beach sports should have been my thing. But for some reason, I was attracted to the mountains. A friend introduced me to the sport and I instantly loved it, even though the mountains were more than two hours away from my home. After a lot of pleading, my father would let me leave school early so I could practice in the mountains, and I would train until 10 p.m., squeezing in homework during the long drive home, and finally going to sleep after midnight.

By age of 14, my dad challenged me to compete. I excelled in the competition scene and began to pick up my first sponsors. Two years later, I was given the opportunity to go professional with snowboard racing.  I relocated to Whistler, British Columbia to train, compete and ride professionally. I then relocated to Steamboat Springs, Colorado after I graduated high school to train further. It was there that I was diagnosed with T1D.

Alissa:      Tell me about your career leading up to the diagnosis of T1D?

Sean:        My discipline was on the racing side of the sport, with a focus on the 2010 Olympics. I trained with prestigious athletes, which included members from the US team. Up until that moment, I had been healthy for my entire life. And then during the 2003-2004 winter seasons, I noticed on and off symptoms of a mystery illness.  I figured I caught some weird bug from my teammates that were returning back from Europe.

After the U.S. National Championships in Breckenridge, Colorado, I became violently ill.  I couldn’t stop vomiting. I was scheduled to fly to Quebec the next day for the Canadian National Championships. Luckily, I woke up feeling much better so I just assumed it was a 24-hour bug. I was able to go to Canada and participated in a great competition.

It wasn’t long until the mystery illness hit me again. I was constantly thirsty. I rationalized that the thirst was caused by the start of spring, combined with warm weather and training hard. I would down gallon-size jugs of grape juice, and feel horrible afterward—causing me to miss morning training sessions. The vomiting started again, too. I clocked it – two hours after I ate anything, I would get sick. I actually became afraid to eat.  Finally, I went to the emergency room. The doctors attributed by illness to some bad bug. They gave me anti-nausea medication and sent me home.  By the next day, I was vomiting again and unable to hold any food down.   

I visited the ER seven times within two weeks. Eventually, I was admitted to the hospital. During my 12-day stay, I lost more than 30 pounds and developed pneumonia. I was discharged to my parent’s care and went home to California to be treated by a general practitioner. The doctor ordered a glucose tolerance test, suspecting diabetes. It was shocking when a nurse called 24 hours later telling me the labs came back fine.

Alissa:    They said you were fine?  

Sean:    Yeah. I have no idea why they told me that. A family friend who is a cardiologist questioned it, too. He told me to get a copy of my labs so he could consult with a few colleagues for a second opinion. I asked a nurse for a copy of records, and noticed red flags all over the place. I questioned the labs and the nurse grabbed the doctor, who apologized to me and explained that I had Type 2 Diabetes.

Alissa: So you were misdiagnosed?

Sean:        Yeah. Big time. Being 19 years old, I grew up watching TV shows like “House” and “ER” where the sick person is diagnosed within 30 minutes. I assumed the doctor was right, and had no reason to question the diagnosis. I was advised to check my blood sugar and take pills daily. But, the vomiting started … again. Knowing my blood sugar was still high, I tried adding another pill to my regimen. When that didn’t work, I tried to eat an all protein diet.  Restricting carbohydrates only led to more immense weight loss. I was wasting away. None of my clothes fit.  Laying on my parent’s couch, doing nothing – I had to face the reality as some of my sponsors cut me from the team.

I became so depressed that I was determined to return to Colorado to get back into the gym. It was on that flight back to Colorado where I almost passed out. I was rushed to a teaching hospital, where I was correctly diagnosed with Type 1 Diabetes on July 3^rd — my mom’s birthday.

Alissa:      What I don’t understand is why they couldn’t detect it in a blood sugar finger stick?

Sean:        When I was hospitalized for the 12 days, they did suspect diabetes but I also had pneumonia.  Back then, Type 1 Diabetes was labeled as juvenile diabetes and Type 2 was adult onset. I think it was the theory that Type 1 only occurred in children and Type 2 was in adults. Being 19, maybe I was in a gray area? They did notice that my blood sugars were high and I had ketones in my urine.

Alissa:       You had mentioned that you became depressed. How did you handle your diagnosis emotionally?  How did your family help you through it?

Sean:        It was a struggle. I was so angry at the doctors for misdiagnosing me. My body was shutting down, heading towards death.  I wasn’t getting any nutrition. It wasn’t until the first insulin shot that I noticed an immediate difference. It was the most amazing feeling I’d ever felt in my life.

So I set out to learn everything I could about T1D. I started going to the gym around 4:30 a.m. because I was really embarrassed by how skinny I was. I had lost so much muscle mass.

I was also doing a lot of research, reading story after story about children as young as two years old living with T1D. Those kids inspired me. I wanted to give back to them what they had given to me. Winter sports are my passion and that is where the idea of founding “Riding On Insulin” came from. I wanted to host a ski/snowboard camp for kids & teens with T1D.

Alissa:      After your initial negative experience with doctors, how did you find an endocrinologist? And, what kind of regimen did they put you on?

Sean:        I wound up staying with Dr. Ping Wang, who happens to be the doctor that correctly diagnosed me. He is the chief of endocrinology at UCI Irvine California.  It was Dr. Ping Wang who helped me recognize and overcome the burnout that comes with chronic illness. He taught me how to deal with the emotions of feeling alone and isolated. I also started seeing a dietitian.  

My insurance didn’t allow me to get on a pump immediately – which is OK because I really didn’t want it. I had read this article about a professional football player who had Type 1.  He had talked about being attached to a pump. It was that word ‘attached’ that hit me hard. I started crying. I couldn’t imagine having something attached to me, reminding me every minute of the illness I have.

It wasn’t until I started volunteering at diabetes camps that I realized if all these kids could handle a pump – so could I. If I wanted to take my performance to the next level and start gaining back muscle mass, then I was going to have to try it.  

Alissa:    Which pump did you go on?

Sean:        At first, I was on a traditional tubed pump, but I have since switched over to the OmniPod tubeless system, and it has been the best compliment to my training as an athlete, especially for winter sports.

Alissa:      Do you feel a huge difference or do you sometimes wish you could take a pump break?

Sean:        I pump has helped me immensely. In the beginning, I was constantly traveling to competitions in varying time zones and I opted to take shots. But, if the forecast was wrong then my blood sugar would fluctuate too much, causing severe lows. The pump stopped about 80 percent of the lows, giving me much better control, and lowering my A1C substantially. I could set different basal rates for different sorts of exercises.  I recognized that for each individual living with T1D, it’s all about finding the technology that works for them.

Alissa:      Do you think you’ll ever take a pump break or are you content with it?

Sean:        I used to do that when I was on a tubed pump. I would go on pump vacations. The reason I switched to the OmniPod is because it’s tubeless and can attach directly to my body. With all of my remote snowboarding expeditions around the world, I have to worry about insulin freezing. The Pod is connected to me and my body heat keeps it warm so I can focus on my performance without fear of it freezing up. I don’t have to have anything else hanging on me.  I also just recently within the last two years, started using a Dexcom CGM.

Alissa:      What do you think is the positive impact Dexcom can have on training and competing or even non competing?

Sean:        I say if you’re an athlete, you should get on it. Even if you’re on shots, a CGM can benefit your training. When you check your blood sugar with a meter, that’s like one data point. Then another two hours, you get another data point. A CGM like the Dexcom provides a data point every five minutes, so it really fills in the blanks for me.  I’ve learned so much more about my ideal basal rates at different times of the day and night. It’s just been a game changer.

Alissa:       Do you have a specific diet that you follow? Where do you like to see your blood sugars before and after training in your competitions?

Sean:        I’m a big fan of oatmeal in the morning especially when I’m going out to exercise. It enables me to maintain a nice, stable blood sugar.

Alissa:       Lets go back to your snowboarding career. When did you move away from the competition scene?

Sean:        After the correct diagnosis, I turned my focus to the Olympics. However, I was getting burnt out on snowboarding.  I wasn’t having fun anymore. After I graduated from the University of Utah and was training with the Park City snowboard team, I was invited by some pro riders to join them on a backcountry

I interviewed Dr Ponder on his book "Sugar Surfing" . I asked him about the 6 key concepts and 3 virtues associated with sugar surfing, shots vs pumps, CGM, Texas Lion's Camp and much more!

I hope you all had a great summer – I had a busy summer , but I’m looking forward to posting more blogs and interviews with leading figures in diabetes and athletics – stay tuned because I’ve got some good ones coming up!

I recently was interviewed by Daniel Hargenrader, aka the DiabetesDominator.  Here’s the interview. 

Matt Allen with his family

Matt Allen is a 15 year old stock car racer, snowboarder, football player, straight A student and diabetic. He was diagnosed with type 1 diabetes in July 2006, but he hasn’t let that slow him down.

Alissa:           Tell me about your early years, before you were diagnosed with diabetes at the age of six?

Matt:             I was snowboarding at age five and right before I was diagnosed I started racing. I was actually diagnosed while on vacation with my family. The doctors told me that having diabetes would not stop me from doing anything I wanted to do. I totally believed them!

Alissa:           What kind of sports do you enjoy? How did you decide which ones to pursue?

Matt:              I snowboard, competing at a National level, as well as race stock cars and play football for my high school. My dad tried to introduce me to skiing when I was young, but it was not exciting enough for me. So, we learned to snowboard together instead. Now my whole family snowboards, often going on vacation together. As for football, all my friends started to play and I wanted to be a part of a team sport.

Alissa:           I admire you for being able to involve yourself and your family in snowboarding. Once you were diagnosed, how did you feel about continuing in sports?

Matt:              I was so young that I didn’t grasp that it could change anything about me. I never really thought about changing my lifestyle. My parents also helped me deal with my diabetes.

Alissa:           How did you manage your diabetes at the same time handling sports and school?

Matt:              I had a lot of help in the early years from the nurses at school. As I've grown older, I manage it myself. While participating in sports I’m very diligent, checking my blood sugar, making sure I'm in range - not too low, not too high.  My CGM monitor actually makes it a lot easier.

Alissa:           I also noticed that you're a straight A student and you have a very high GPA. How are you able to pursue you academic studies and such an advanced level in addition to managing your sports and school with your diabetes?

Matt:              My dad has always assured that school was a priority. I wasn’t allowed to do anything unless I did well academically.

Alissa:           Is it hard to manage school and sports all at once? What would you say your biggest challenges are?

Matt:              Sometimes assignments are missed when I travel around the country to race or snowboard. That is the most difficult part. However, I always catch up by the end of the semester.

Alissa:           You mentioned that you were diagnosed at six years old. Because I'm trying to provide helpful advice to other diabetics, can you tell me more about your symptoms and how were you diagnosed?

Matt:              I was very thirsty and had to go to the bathroom often. I was easily aggravated and tired all the time plus I lost a lot of weight. At one point, I drank a whole gallon of orange juice in less than one hour – and then went to the bathroom three or four times after. While we are on vacation in Cape Code my symptoms worsened. My parents took me to a doctor who advised that I was probably diabetic. From there we went to the Cape Cod Hospital, where my diagnosis was confirmed. Unfortunately, that hospital couldn’t treat me so I was transferred and admitted to another for two or three nights.

Alissa:           How did your parents and family handle it emotionally? Did you have any emotional struggles at that young age?

Matt:              It was definitely hard on my mom. My dad didn't struggle visibly, but I'm sure it was hard for him. I was so young that I didn't really know what diabetes meant. I just knew that I felt sick and that I felt better when I went to the hospital.

Alissa:           Does diabetes run in your family?      "

Matt:              Not on my mom's side. I am not sure of the medical history on my dad's side, but I don't think so.

Alissa:           How often do you see your endocrinologist and what kind of diabetic regimen are you currently on?

Matt:              I am on the pump, which helps a lot. I see my doctor every three months to go over my A1C levels – the graph of where my blood sugar and the changes required for my pump settings.

Alissa:           Who is your endocrinologist, where is he/she located and does he/she have experience working with other athletes?

Matt:              My endocrinologist is Dr. Criego in St. Louis Park , Minnesota. She has definitely helped us manage my diabetes and my sports.

Alissa:           How did you find an endocrinologist that you felt comfortable seeing?

Matt:              My mom’s friend whose son is also diabetic recommended Dr. Criego. The doctor helps me so much so I can manage my diabetes while being active in sports and traveling.

Alissa:           You mentioned that you were on a CGM. Are you also on a pump? How long have you been on a CGM and which one do you use?

Matt:              I'm on the electronic pump and the Dexcom CGM, which I started to use about four months ago. I need to know what my blood sugar is every 20 minutes so the CGM is very helpful.  Ryan (Reed) used it in his racecars so he could know his blood sugar at all times as well.

Alissa:           As a fitness competitor, I agree. I’ve ordered the Dexcom, am going through training and will be starting it soon. Every athlete I've spoken with has said how beneficial a CGM is for managing diabetes while doing a sport. Even my doctors have been encouraging me to go on it, so it’s great to hear about your experience with it. My next question is, how did you adjust your diet? What is your diet like?

Matt:              I've never really changed my diet or thought I needed to stay away from something because I am diabetic. I've tried to eat the way I always have, but I admit that diabetes definitely brings awareness to what you're eating.

Alissa:           My daughter is a diabetic in middle school and I know there must be many challenges as a high school student who has diabetes. There are so many parties, events and holidays revolving around food. Do you follow a strict regimen or do pretty much eat what any non-diabetic eats? If so, what would be a typical meal for you at a party?

Matt:              I don't follow a strict regimen and tend to eat like a non-diabetic. However, at parties and events I try to not eat sweets because even if I give my correct insulin dosage, my blood sugar can still be high. When my blood sugar is high, I don’t enjoy the party. I usually eat pizza and drink diet soda, but not much else.

Alissa:           I know when my daughter goes to parties, she is used to, like you, not having sweets and has been really good about it. But any time we have a party or take her some place, we always know what she is going to eat and carb count in advance. Do you do that also?

Matt:              I have an app on my phone that tells me carbs for pizza and different types of food. For the most part, I have a very good idea of how many carbs are in a pizza per say.

Alissa:           Which carb-counting app do you use?

Matt:              It's called Carb Control or Carb Count. It works really well.

Alissa:           What do you do when you have low blood sugar while racing? How can you prevent low blood sugar? Do you have a special racecar that is equipped for it? I know with your CGM it's helpful, but how is your racecar equipped?

Matt:              I carry a sports drink, like a Gatorade or something sugary in my car with a long tube, which I can drink if I go low. Fortunately, I've been very careful about watching it and have never gone low in a race.

Alissa:           Was Ryan (Reed) helpful with the design of your race car?

Matt:              I feel like I wouldn't be on CGM right now if it weren’t for Ryan. He also told me about carrying a sports drink.

Alissa:           Has he been a good mentor to you?

Matt:              Yes!, Absolutely!

Alissa:           I’ve heard that you're fundraising for Ryan Reed’s charity ‘Drive to Stop Diabetes’.   How did you get involved?

Matt:              My dad and I were watching a race and we saw Ryan Reed in a car that said ‘Drive to Stop Diabetes’. We couldn’t get over how awesome that was. My dad reached out to Ryan’s charity offering to help fundraise at a local level where I race. Now my car looks just like Ryan's – Number 16. . It is red and everything!

Alissa:           When you are racing, who do you work with medically to care for your diabetes?

Matt:              For the most part, it is just my parents, my brother and my family. There are other people in the picture who know I'm diabetic and know what to do, but my main support is my family.

Alissa:           How many races do you do a year?

Matt:              I'll do a little over 20 at the local track and then go south and do some races in the winter. I did winter nationals last year in Las Vegas and Florida, so that equals about six races in the off season. In total, I would say about 30 races per year.

Alissa:           Are you also a part of NASCAR racing?

Matt:              I am not a part of NASCAR racing but Legends cars have a division, which is supposed to be a size down, cost effective model. That was the idea behind Legends.

Alissa:           Do you plan on competing in the Olympics or becoming a professional racer? Which is your favorite sport?

Matt:              Being in the Olympics would be very cool, but I don't think it is likely. It's hard being from Minnesota where we have hills and it’s hard to compete against states like Colorado where you can live on a mountain and snowboard and train every day. I definitely love snowboarding – it’s like racing in a lot of aspects. But I would probably say that racing is my favorite. I would love to become a professional racecar driver. I'm going to go as far as I can in racing, but if I don't make it to a professional level, that's okay too.

Alissa:           Do you have different types of athletic plans in your future?

Matt:              I want to keep pursuing racing and do both sports as much as possible. At the same time, I plan on going to college and getting an education. That definitely plays a factor in it as well.

Alissa:           What advice would you give people with diabetes who want to compete in racing or any other kind of sport?

Matt:              You can really do anything you want with diabetes, as long as you’re willing to take the time to manage your blood sugar. It's not always easy to do that; especially while snowboarding when it's cold out. You don't want to take your gloves off and do your tests on a hill, but that's what you have to do with these types of sports when you’re diabetic.

Matt Allen with car race car

You can keep up with Matt at http://www.greatnorthlegends.com

Please consider donating to Ryan Reed's charity DriveToStopDiabetes

This is the second and final part of Alissa's interview with NASCAR racer Ryan Reed.  Please consider donating to Ryan's charity DriveToStopDiabetes

From Ryan’s website:

Ryan Reed began his first full NASCAR Xfinity Season at the start of 2014. He finished 9th in overall standings, with 1 top 5 finish and 14 top 15 finishes. His season best took place at Daytona Intentional Speedway, where he finished 4th. He will start his 2nd Season in the NASCAR Xfinity Series with the No 16 team in 2015.

Reed's racing career began at a young age, capturing the Kid's Kart Track Championship at the age of four. The Bakersfield, California native followed that up by becoming the Junior 1 Comer and HPV Karting Track Champion at age eight.

You can read the rest of Ryan’s bio on his site DriveToStopDiabetes

Alissa:       What team of people do you work with who medically care and support you in your diabetes while you're racing?

Ryan:        I’m mostly managing it myself with the help of my doctor. At the racetrack, one of my pit crew is trained to give me an insulin injection at a pit stop if necessary.  NASCAR has a medical team at every race.

Alissa:       I have looked at some of your videos and I saw that you have some kind of bulls-eye that gives you insulin?

Ryan:        That's a patch on my suit that’s a little bit thinner than the rest of the material. It’s to indicate where to give me the insulin injection if I need it.

Alissa:       What do you do if you're racing and have low blood sugar? What do you do to prevent low blood sugar while you're racing?

Ryan:        I have a drink inside of my car that's timed glucose. It's like a sports drink base that we add dextrose to for more glucose.

Alissa:       What is that? Does your CGM tell you when your blood sugar's high or low? How do you get the drink into your body?

Ryan:        I have a tube that runs to the front of my helmet—it's a camelback system. I have a bite-valve that's right on the side of my helmet so I can actually drink while I'm racing.  I also have my CGM that I'm looking at throughout the race, so I know if my blood sugar is high or low.

Alissa:       Does the stress of racing affect your blood sugar?

Ryan:        Yes. More than the stress, the dehydration is probably the biggest factor. Adrenaline plays a factor as well.

Alissa:       That's interesting. So what do you do for dehydration?

Ryan:        I do the best I can leading into the race to stay as hydrated as possible because there's no way around it. On a hot day I will lose up to 4 or 5 pounds in a race. On the days that I feel I didn't do as good a job as I needed to in order to stay hydrated, I pay the price.

Alissa:       I was wondering if you could tell me a little bit more about your organization. It's “Drive to Stop Diabetes,” right?

Ryan:        Yes. My personal foundation is “Ryan's Mission” and then “Drive to Stop Diabetes” is an American Diabetes Association organization, which I also play a huge part in. “Drive to Stop Diabetes” came out in 2013 and was centered around our racing platform. For me the biggest part is working with younger kids and spreading the message that you can do whatever you want despite having diabetes—don’t let someone tell you that you can’t chase your dream.

                The American Diabetes Association does a lot of work to spread general information at the racetrack—whether its risk tests or awareness information. Lilly Diabetes got involved at the end of 2013, beginning of 2014, and became a title sponsor. They have played a huge part in helping it grow, reach more people and funding.

Alissa:       You mentioned “Ryan's Mission.” How did you come up with that idea and what exactly is it?

Ryan:        “Ryan's Mission” was my first way of getting involved. It was just a website we put up and it was a place to go to tell my story. There is a woman who works for “Ryan's Mission” who does a lot of the day-to-day work with ADA, Lilly Diabetes and “Drive to Stop Diabetes,” but we are more behind the scene. We don't have a lot of events or fundraisers, but we'll have charities donate to “Ryan’s Mission” and a lot of the funds go back to ADA or to help fund an auction or a fundraiser.

Alissa:       Have you raised a lot of money through your organization?

Ryan:        We do a little bit here and there to help stay afloat, but most of our efforts go into the Drive program. It’s hard managing two different programs and my focus is on the Drive program because they've done a lot for me to help me to continue to chase my dream.

Alissa:       What kind of advice do you give people who want to become athletes and compete? Do they need a team of people or is it doable to manage independently? I have interviewed my doctor, Dr. Blevins, and I did an interview with him on this topic and he actually said it is doable. So I'm curious to hear what you think and what your advice would be to people.

Ryan:        I feel it's different for everyone. Meeting and talking to people like you, everyone has a different situation. Each sport, or each person, has their own challenges—not only with their own diabetes, but with whatever their passion is. A lot of it I can listen to and understand, but there is also a lot of it I don't understand and so it’s hard for me to give too in-depth of advice. For me it’s just going through it and dealing with it. With others I just try and tell them, "Don't give up."

                I still struggle with my diabetes.  I have a great doctor and I understand it, but I still have my bad days—just like everyone else. I try and give a positive message of "Don't give up. Don't let the frustrations beat you. Just continue to overcome and give 100%." That's all you can do and, at the end of the day, it’s worth it being able to go out there and do whatever it is that you love to do.

Alissa:       That's so interesting, and that's why I wanted to interview you. Those are all my questions, so I really want to thank you so much!

Ryan:        No problem.

From Ryan’s website:

Ryan Reed began his first full NASCAR Xfinity Season at the start of 2014. He finished 9th in overall standings, with 1 top 5 finish and 14 top 15 finishes. His season best took place at Daytona Intentional Speedway, where he finished 4th. He will start his 2nd Season in the NASCAR Xfinity Series with the No 16 team in 2015.

Reed's racing career began at a young age, capturing the Kid's Kart Track Championship at the age of four. The Bakersfield, California native followed that up by becoming the Junior 1 Comer and HPV Karting Track Champion at age eight.

You can read the rest of Ryan’s bio on his site DriveToStopDiabetes

Alissa:       Can you tell me about your diabetes, how you were diagnosed and what were your symptoms?

Ryan:        In 2011, I was living and loving life. One morning I woke up and was incredibly thirsty. It was so severe! It felt as if I hadn't had water in days. I was continuously drinking water and using the restroom. This went on for two or three months.

I had lost ten to fifteen pounds and didn't feel well at all. When my parents saw me they were terribly concerned and insisted that I seek medical attention. The next day my doctor checked my blood sugar which was 350 fasting. I was diagnosed on the spot with diabetes.

Alissa:       How did you handle your diagnosis emotionally, and how did your parents and family handle it?

Ryan:        My main concern was how it was going to affect my racing. My doctor said I was never going to race again and I was emotionally destitute. I started racing at age four and I was 17 when I was diagnosed. Because I had just started having a lot of success in racing, when I was diagnosed I thought my career was over. My family was very supportive.

Alissa:       Does diabetes run in your family?

Ryan:        No.

Alissa:       What kind of treatment did you initially receive, and how did you find the right doctors and medical support?

Ryan:        I was immediately put on insulin. I started researching athletes with diabetes and I found a story on Charlie Kimball, the Indy car driver. The story spoke of his doctor, Anne Peters, so I researched her. She was in Southern California, only two hours away from my home, and I contacted her and became her patient. The first time I saw her, she was optimistic and confident that I would get back into a race car. That's when things turned around.

Alissa:       How often do you see your endocrinologist and what kind of diabetic regimen are you currently on?

Ryan:        I see my doctor every three months. I used pens and I use a CGM (Dexcom).

Alissa:       You're not on a pump?

Ryan:        No. It gets very hot, about 150 degrees, inside the race car. We didn’t feel confident that the insulin would be effective at those temperatures. We decided the pen was the right treatment for me, and I’m really comfortable with it.

Alissa:       What benefits do you get from Dexcom that made you choose it?

Ryan:        I’m a huge advocate of Dexcom. I went on it very shortly after I was diagnosed. I sometimes go most of the day without checking my blood sugar, and it's always right on.

Alissa:       How did you educate your friends and family when you were younger in school about your diabetes? What kind of diabetic regimen did you follow when you were at school?

Ryan:        When I was diagnosed, I was already in the process of moving to North Carolina and my schoolwork was an independent studies program.  Although I was a senior in high school, I didn’t go to school.  My friends were not only supportive, but they wanted to understand diabetes and the changes that were being made in my life. If I needed anything, they were available. My parents were right there with me the whole time.  I had a really great support group around me!

Alissa:       What is the most common question that you're asked?

Ryan:        I get asked a lot about taking shots every day—does it hurt, or what’s it like?

Alissa:       How demanding is racing? What kind of shape do you need to be in?

Ryan:        There are guys in racing that are in great shape—they’re triathletes and world-class athletes—and then there are guys that aren't. I love being active, and I love being fit—whether racing or not. I do cycling, Crossfit and weight lifting to stay active. In doing so, it benefits for racing endurance.

Alissa:       How did you adjust your diet?

Ryan:        I was really concerned with training and diet limitations. My doctor and nutritionist made sure I could eat and train like an athlete and not have to sacrifice because of my diabetes. It actually motivated me to get in better shape and understand more about what I was putting in my body. I felt like I became healthier and a better athlete.

Alissa:       How did you persevere and become successful in this sport that you're so passionate about when you were told that you may not be able to race again?

Ryan:        It was horrible to be diagnosed and told I couldn’t race. At 17 years old, you take things for granted. My diagnosis motivated me and made me appreciate what I had.

Alissa:       Were you aware of any other colleagues of your race car drivers living with diabetes? If so, were they able to provide you with support or advice?

Ryan:        No one besides Charlie. He was always open to giving advice and I talked to him whenever I was first diagnosed. There really aren’t many people in racing with diabetes—some crew guys, but not any drivers. 

This concludes Part I of II, interview with Ryan Reed.  In the next(and final) part, Ryan talks about how he manages his diabetes while racing, whether or not he uses a CGM, what he does for dehydration and much more!  Register now to be notified when An Interview with Ryan Reed Part II is published!

I’ve been fortunate to have Nicole Brent as been my dietitian.  She has worked closely with me while training for my competitions to manage my diabetes through proper diet and exercise regimen.  Since I’ve known her, I’ve become much more knowledgeable and successful with regulating my blood sugars.  She has always been helpful with diabetic issues that have arisen.  It is such a treat that she has agreed to be interviewed on diabetes, her area of expertise.

Alissa:     Please tell me a little bit about your credentials and how you got involved consulting diabetic clients?

Nicole:   I'm a registered dietitian. I have a bachelor's degree then did an internship; Diabetes is very nutritional-related. Medication, exercise, and diabetes all go together and it's something that I was very interested in and felt that I could be helpful. You need 1000 hours working with patients to be able to become a certified diabetes educator. I attained that goal and became a Certified Diabetes Educator All of this education and experience has provided me with the skills needed to help my patients.

Alissa:     What would be the best way to find a dietitian who specializes in treating diabetics?

Nicole:   The National Certification Board for Diabetes Educators website is http://www.ncbde.org . Your zip code will give you a list of all the Certified Diabetes educators in your area.   Also, if you talk to your endocrinologist, then he/she may have a dietitian that they work closely with. We work very closely with Texas Diabetes and many other physicians and endocrinologists in Austin.

Alissa:     Cost is always a factor when making medical decision.  There are so many expenses that diabetics incur that create financial difficulties. If somebody needs to see a dietitian and they can't afford it for some reason, how do you advise somebody to be able to get that dietary care?

Nicole:   Usually, your insurance covers it if you have diabetes, but it just depends on your insurance.

Alissa:     Are there alternative methods of coverage if insurance doesn't pay for it?

Nicole:   I don't know about that. That would be up to your employer. 

Alissa:     Where can I find a dietitian who works with diabetic patients? Are there special certifications needed for this?

Nicole:   There is a certification, which is not just for dietitians, but for practitioners who works with diabetics. It is called a Certified Diabetes Educator or CDE. You can go to their website, http://www.ncbde.org, to find a CDE.  Practitioners working with diabetic clients, including nurse practitioners, physician's assistants, and dietitians should be a Certified Diabetes Educator or CDE.

Alissa:     Are there specializations or certifications for dietitians to work with children with diabetes?

Nicole:   There's not a certification for a diabetes educator to just work with children, however, there’s a Certified Specialist in Pediatrics or CSP.  You can find board certified specialists in pediatric nutrition at The Commission on Dietetic Registration website, www.cdrnet.org.

Alissa:     Craving sugar is a symptom of diabetics, but could something else cause this?

Nicole:   I don't know that craving sugar is necessarily a symptom of diabetes. It depends on the person. Sometimes, it will come from the fact that someone knows they shouldn't be eating a lot of sugar causing them to want it more.  That’s just human nature.  One thing that will cause craving more sugar is if we are getting inadequate carbohydrate in our diet.

Alissa:     What are the biggest differences between diets for diabetics verse non-diabetics?

Nicole:   If I’m working with a diabetic patient and their goal is weight loss, we would be focusing on carbohydrates, so the emphasis would be carbohydrate counting and making sure that their carbohydrates are under control. Not only does carbohydrate counting help with weight loss, but it also helps to reduce calories because the carbohydrates have the largest percentage of our calories. If diabetes is not a factor, I will still teach carbohydrate counting because it is extremely helpful in weight loss. For non-diabetics total calorie intake and getting adequate exercise are priorities.

Alissa:     What tips do you recommend for measuring carbohydrates?

Nicole:   There are many great apps available to help figure out the carbohydrate content of while eating out.  It is also helpful for foods that don't have labels on them like apples.

Alissa:     The size of apples can vary greatly.  How do you carbohydrate in an accurate way?  Do you need to weigh it with a scale?  Do you need to measure with cups?  What are your suggestions?

Nicole:   Either way.

Alissa:     Is there a rule of thumb, 15 carbs for certain vegetables or fruits?

Nicole:   No, because there are so many different amounts.  The best way to learn is to measure your foods for a little while. You will learn from practice and experience.  If you measure a cup of rice several times then you are able to eyeball it down the road. 

Alissa:     Are there any danger foods or unsafe foods for people with diabetes? What are good treats and desserts for diabetics?

Nicole:   There is no list of food that is off limits because you are diabetic.  Certainly there are foods that are better choices.  I know that there are certain triggers for me which can be danger foods if you are diabetic. Same thing with safe foods. 

               I teach my diabetics to try to keep their snack to around 15, and for sure less than 20 grams. 

Alissa:     What would you recommend if somebody with diabetes wanted to have a dessert?

Nicole:   Sugar-free Jell-O is carbohydrate free. Sugar-free pudding has only 15 grams. A granola bar that is high protein is a good choice. Desserts and snacks that range @ 15 grams of carbohydrates are wonderful options. 

Alissa:     What if somebody wanted to have a piece of cake or cookie - what would you recommend?

Nicole:   Keep it small, and then if you're on insulin, you have to cover it. You need to be mindful about checking your sugar and making adjustments with insulin. 

Alissa:     Is NutraSweet or saccharin?  Which would you recommend?

Nicole:   According to the Food and Drug Administration, they are all safe, so that's something that I leave to the client. Some people feel more comfortable with Splenda because it's made from sugar. Some people feel more comfortable with TruVia, green leaf, or SweetLeaf because they are from a leaf, so they feel it is more natural.  Be aware of the amount of these sugar substitutes that are being used, so they are not overused. 

Alissa:     Is there a limit on how much sweetener you can use per day? Do they have carbs?

Nicole:   They do not have carbohydrates in them.  Some of them are equivalent to 20 to 22 diet sodas a day, so be aware.

Alissa:     Do sweeteners have long term side effects?

Nicole:   Everything in life is about moderation. That's the key. If you're not comfortable with it, then don't use them.

Alissa:     I really, really appreciate you, Nicole, as my dietitian and how much you've helped me through my competition season.  I have learned so much from working with you.  I thank you so much for giving me your time and helping me so that I can help others.

Nicole:   You are very welcome, my pleasure Alissa.