The T2D podcast - Sinead Powell - Diabetes Ireland

This is the  first episode in the patient-led type two diabetes (T2D) podcast which aims to give you the answers to the questions that you want to know about type two diabetes.

Thank you for all the responses to the initial questionnaire that was sent out to see what questions you had about the condition; there were so many that one episode could not cover them all, but as most of them were about diet and nutrition, Sinead Powell, Senior Dietitian with Diabetes Ireland is going to try to answer as many of them as she can and there will be a second episode to answer the others.

If you could please take the time to  let me know what you think of the information contained in the podcast, I would be very grateful; you can leave a comment here - https://www.surveymonkey.com/r/NQNSQ7X  all responses are completely anonymous.

 If you would like any further information or a transcript of the podcasts, you can also get in touch with me via the following email address: olivia.crinion2@mail.dcu.ie.

The resources mentioned in the episode are below and a transcript of the interview is available by emailing the address above.

Resources:
Diabetes Ireland
Website: https://www.diabetes.ie/
Helpline: 01 8428118 (Mon - Fri, 9-5)
Email: info@diabetes.ie
Courses:
CODE: https://www.diabetes.ie/living-with-diabetes/living-with-type-2/diabetes-ireland-education-programme/
Diabetes SMART: https://www.diabetes.ie/living-with-diabetes/living-with-type-2/diabetes-smart-free-interactive-online-education-course/

HSE
Talking about Weight leaflet -https://www.hse.ie/eng/about/who/cspd/ncps/obesity/programme-resources/hse-talking-about-weight-guide-final-6.pdf
Courses:
DESMOND: https://www2.hse.ie/conditions/type-2-diabetes/courses-and-support/desmond/
DISCOVER: https://www2.hse.ie/conditions/type-2-diabetes/courses-and-support/discover-diabetes/

If you have any questions about the information contained in podcast or would like a transcript of any of the episodes, please get in touch with me via the following email address: olivia.crinion2@mail.dcu.ie.

Ethics approval has been granted by DCU for this study.

If participants have concerns about this study and wish to contact an independent person, please contact:

The Chair, DCU Humanities & Social Science Faculty Research Ethics Committee, c/o Dublin City University, Dublin 9. Tel 01-7008000, e-mail hss-frec@dcu.ie

Transcript

The Patient-led T2D Podcast - Sinead Powell Senior Dietitian Diabetes Ireland 

 Interview – Wed 12 July 2023

SPEAKERS

Sinead Powell, Olivia C

Olivia C  00:00

Hello, and welcome to Ireland's first patient-led type two diabetes podcast. And thank you to everyone who has completed questionnaires, volunteered for interviews, and who is listening now. Hopefully this will be a source of information for you. And of course one which can be updated as the science evolves, and your questions change. My name is Olivia Crinion. And this podcast is part of a dissertation to complete a Master's degree in Health and Science Communication in Dublin City University. But it's more than that, I'd like to produce something that will make a difference in the lives of people with type two diabetes, and to help provide the most up to date information available, so you can take charge of your own health and well-being. To start off an anonymous questionnaire was sent out via the diabetes art and Facebook page, personal social media and through friends and family, for anyone over 18, who has been diagnosed with pre-diabetes or type two diabetes. Thank you to everyone who took the time to reply to the questionnaire. Your responses and questions will now form the basis of this interview. So this is the first interview with a diabetes medical practitioner, Sinead Powell who is the senior dietitian with Diabetes Ireland, she will answer your diet and nutrition questions. And as there were lots of questions, there will be a second podcast to try to answer questions in other areas. Please remember to consult with your own healthcare professional before acting on any information that you may hear in this podcast. As general advice does not apply to specific individual cases. 

Olivia C

Good morning, Sinead. How are you?

Sinead Powell  01:48

very well, Olivia. And thanks for giving me the opportunity to be your first podcast. 

Olivia C 

You're very welcome. And thank you so much for talking to us, and explaining to us about diabetes. So first of all, I should say that this podcast is about type two diabetes. And I know that there may be a little bit of confusion between type one and type two diabetes. And I was wondering, could you please explain briefly what the differences are?  

Sinead Powell 

Absolutely. So diabetes is a condition where there's too much glucose in the blood, because the pancreas, which is the organ responsible for making insulin doesn't work properly. The main difference between type one and type two diabetes is type one is autoimmune. And it's the less common type of diabetes. So usually, type two diabetes makes up about 90% of people living with diabetes in different countries and 10%, then might be attributed to type one diabetes. What we mean when we say autoimmune is that the cells that make insulin, for reasons that are still unknown, stop making insulin, and somebody diagnosed with type one diabetes will require insulin via a pump or a pen, until there's a cure. Type Two Diabetes, then on the other hand, develops slowly over time, and may be prevented and can be managed by lifestyle, and medication or insulin if required.

Olivia C  03:20

So I know that levels of diabetes, and especially type two diabetes are increasing everywhere, including Ireland. So why is this a problem?

Sinead Powell  03:30

And we in Ireland, I work for Diabetes Ireland, we are the national charity who support both those living with type one, type two and their families,. We don't have a register of people living with diabetes in Ireland. So we don't actually know how many people have diabetes. But like the rest of the world, we do know that numbers are increasing, it's generally accepted that we have about 300,000 people living with type one and type two diabetes in Ireland. It's on the increase mainly with type two diabetes because of it's linked to lifestyle. And we know that obviously, with increasing weight, decreasing activity and increasing age, that the numbers are growing, so we're growing as a population and we're living longer, therefore our risk for type two diabetes increases, especially if we have unhealthy lifestyles.

Olivia C  04:27

Okay. So you mentioned there, age, lifestyle, and are they the main causes of diabetes? I know some people are talking about genetic links.

Sinead Powell  04:38

Hmm, yeah. So when I suppose unless you're specifically referred to type one diabetes, if we take for the rest of the podcast that I'm talking about type two diabetes when I'm referring to things like lifestyle, etc. So the risk factors for type two diabetes are increasing age so being over the age of 40 was one of the main risk factors, so having weight around your middle, so having a higher waist circumference than is recommended. So for women that's more than 32 inches and for men more than 36, then obviously decreased activity not getting the half an hour more than you know, every day like, or not every day, five times a week, having had gestational diabetes, which means a pregnancy where diabetes would have been diagnosed and usually reverts to blood glucose levels revert to normal afterwards, being on steroids, having raised blood pressure, and you mentioned there a family history. So if a parent, brother or sister has a history of type two diabetes, then the risk increases. So we really would hope that people would be more aware of the risk factors that are modifiable. I'm not saying it's easy to lose weight or become more active, but it can help push out a diagnosis of type two diabetes, because we can't do anything about our family history, or our age. So it's to consider the things that we could maybe modify slightly to reduce the risk of getting type two diabetes,

Olivia C  06:09

and you mentioned there losing weight. And I know diet and nutrition, obviously, is a very important part of that. But a lot of people are confused about diet and nutrition. And well, it's not just people with type two diabetes. But a lot of people who answered the survey asked, Are there certain foods that should be avoided? And I know, probably diets are different for everybody,

Sinead Powell  06:34

Absolutely. So my background is I am a qualified dietician. And I've worked in the area of diabetes for 25 years now. So the information hasn't changed significantly, from when I would have qualified. But how we communicate that information around food and making choices has, has changed an awful lot in that my role in Diabetes Ireland is to provide information that's evidence based, but in a supportive format. Because as you say, people are confused. There are so many myths and misconceptions around food and diabetes that I could fill  a 10 hour podcast talking about, you know, questions that people ask and what they want to know. So unfortunately, it's, it's not that it's quite confusing, it's healthy eating. So there is no one specific diet. And really, the emphasis has to be around building healthy habits. What we use is the food pyramid. So we base it on what adults should be eating in Ireland based on the different food groups and their portion size. So I've mentioned a couple of times already that one of the bigger risk factors for Type Two Diabetes is obviously the weight around the middle. And we know that we know that more fat around your pancreas means that you're less likely to be able to make insulin in sufficient quantities, that works well enough to control blood glucose levels. And food is obviously a really important part of that. But that comes with a lot of guilt and blame and negativity about food choices. So when we are giving information, it should be around, like I said already, that that supportive education and then giving people with a diagnosis of diabetes, better tools to kind of be more involved in their self-management, so where they can figure out what changes they can make and how they might be sustainable.

Olivia C  08:41

I know there are people who really are interested in losing weight, they've been told that they should and it will help their condition and they really want to but they just don't know where to start. So what would your advice to them be?

Sinead Powell  08:54

I would have advised that there's a lot of places to start. So it depends on the individual and maybe what they've tried before and who they are. And if they've been successful, there is quite, it's a very useful document on the HSE called Talking about weight. And it's a guide to developing healthy habits and is actually done in a way that is not stigmatising, it's supportive, but it's really about getting people to understand the whys of you know, weight loss, but how they can, you know, set their own goals and how they might achieve them. So that's where I might start, I suppose for anybody diagnosed with type two diabetes. And what we have now that we didn't have 10 years ago is there's an awful lot more posts around for dietitians, and for diabetes nurses in the community through the Slaintecare reform, saying that,  there are,  I don't even know where all of these posts are because an awful lot of them are in transition and an awful lot of them are unfilled, but you have a much better chance of seeing a dietician in the community for one to one information or  for group support around the dietary choices you should make. So I would start maybe with if you want to look online, and the HSE document I mentioned is actually just specific to weight. But there's a lot of useful information on our website Diabetes dot ie around food choices as well.

Olivia C  10:23

Okay. And then if people want to go further, they can go to the dietician themselves?

Sinead Powell  10:28

yeah, so they would probably need to do that through their GP.  just to find out if there is a community dietitian in their area, or again, visit the HSE if they were to wanted to find out about about the group supports that are in some of these chronic disease hubs. And they may access a programme called Desmond or Discover or our own programme online, which is called Code which I might come back to if if time allows, so it's discussing with the GP are, like I said, visiting diabetes dot ie.

Olivia C  11:06

You mentioned they're discussing things with the GP, sometimes people go to a GP and don't feel like I know I've had myself, you get brain fog? And you come out? Oh, no, I meant to ask, I meant to ask. So absolutely. What would your advice to people be before they go to a consultation.

Sinead Powell  11:25

So one of the things that we offer, we have two support programmes, that are free to those living with type two diabetes. And again, on our website, and our homepage, if you type in type two diabetes education, you will see that there's a programme course that you can do from the comfort of your own home called Diabetes Smart. And then there's our online group education programme. And I run and facilitate one of those with a couple of my nursing colleagues. So we run these quite regularly, but they are eight hours education, but it's not just me talking at people, it's the information is in the room. So people feel an awful lot more supported by their peers, who also have a lived experience of the condition. So I'm a bit like conductor, if you can imagine that. I'm, you know, the information we provide has to be in a structured format, but it is we cover certain things, but really, it's tapping into what people have done. And they're learning from each other and imagining that if such and such can do it, maybe I can do it, too. So it focuses on empowerment and self-efficacy. But yeah, sorry, Olivia, just go back to your question. after that. The first three weeks of education, we go through what is what we class, what should be covered in an annual review for those diagnosed with type two diabetes, so that they have an idea of what they can do themselves, but also what the healthcare practitioner, be it their GP or their diabetes team, if they attend a hospital? What should they expect from good care? So the end of any of these courses that are HSC supported, you should have an idea of, well, how often should I get whatever it has done? And maybe if I haven't had one of those before, right, but the easiest thing to do is if you've got 15, precious minutes, 10 - 15? What do you want to get from the session? So you go in armed with your questions, and it's really writing those down and bringing them in before the day. So you leave with, you know, because we can all have a tendency to ramble on so you leave with the questions you want answers to?

Olivia C  13:29

And do people have to be referred from the GP to Diabetes Ireland, or can they contact you directly,

Sinead Powell    13:34

they can contact us directly. So we can be contacted on email. At info@diabetes.ie, we have a helpline number, which is 01 8428118. But the two programmes that I mentioned, Diabetes Smart you do need to log on. And the reason that we say you need to log on to this and set up an account is that it will remember you so you, it takes about an hour and a half to do the course maybe less depending on how long you kind of stop and start. But it will remember what bits you've done. So it's on any learning platform, but it's very simple. It's literally like just logging into anything. And then the Code programme, which is the group one, you can self-refer. And that's very straightforward. You just need to take less than a minute just to you know, fill out a registration form that comes straight to us. So both are available without going through your GP and both are free.

Olivia C  14:26

Okay, that's brilliant. And now just to go back to diets and nutrition, some people were asking you about low carbohydrate diets, and especially in relation to remission or reversal of diabetes. So if you don't mind me asking you could you explain what reversal or remission is?

Sinead Powell  14:49

No problem, Olivia. So I suppose the low carbohydrate is separate to the so if you want to keep that in the back of your head because you don't have to go on a low carb diet to achieve remission so We'll talk about that bit first if that's okay. So we prefer to use the term remission rather than reversal. And the reason is that if you say that you have reversed your type two diabetes, it nearly implies that it's gone and may never come back. Whereas remission implies that, you know, you're you're still in the system. So it's it, there's a chance as you age, it may return. And, and what it means is, it's only been around, I suppose, the fact that you can achieve remission, since 2011, where there was a study done on a small group of people in through a University in Newcastle in the UK. And what they did for this small group people was they put them on a very low calorie diet, so 600 calories a day, which is not food, you know, it's like clear soups, salad without dressings. And then they were given meal replacements, so that they made, they made sure that the group had enough, you know, vitamins, minerals, fibre, protein, etc. And they did this for 12 weeks, okay, and so it's absolutely not easy. But what they found was at the end of the 12 weeks that the group had a significant amount of weight loss. But it was more especially the fat from around their pancreas and their liver. And this resulted in where they found that their insulin levels went back to normal. So they were able to now make insulin, and it was sensitive enough to keep the blood glucose levels within a normal range. Okay, so they could show that this was possible. But, and it was a really, it was a positive story. And it is a positive story. Because I mentioned I qualified long before that, and we were taught that type two diabetes was something that occurred, you know, in your 60s, it was chronic, it didn't go away. So now we have hope, I suppose, what I would say and look, what we know, since is that you can achieve remission, but it does require a lot of hard work, a lot of weight, you know, lost potentially up to 15 kilos. And for that, like that's, you know, under three stone, that's not achievable for a huge number of people. And so while it is hopeful, and it's positive, and it's a good news piece, it has come with it, what we have heard, with a huge amount of burden for people. So they're reading that you should be able to do this or that this is straightforward. And I would always say, with caution, as I've said, it's a cheat, and that's great. But, you know, for five to 10% of people, this may be possible for the majority it, it makes them report feelings of shame and guilt, and just that, that burden of living with diabetes. And that's not easy. And I think we have to acknowledge that as well. But anyway, sorry, just to finish off so. So remission is when you have got  your HBA1c which is a measure of your blood glucose levels down to normal. So it's down to under 42, for more than three months with no medication, okay? And because diabetes medication is going to bring your blood glucose level, so remission is achieved through lifestyle, weight loss, and it has to be consistent over three months. So that's what we classify for now as the definition of remission.

Olivia C  18:23

Okay, and to go back to the low carbohydrate diets as people were asking about that in, as I said, in relation to remission but generally....

Sinead Powell  18:33

So I suppose, as I said earlier, there is no one diet. An awful lot of  people will have asked, me in the past, can you just give me a diet sheet? Or can you tell me what to eat and like, well, that's so restrictive. You know, basically, you can eat anything the same as any of us should be eating. But the emphasis should be on trying to develop healthy habits. So you're not having too much of what we say the top shelf foods or so too much of the sugary salt, high fat foods, and watching portion size, watching alcohol. So it's it's not a specific diet, it's healthy eating, saying that, that doesn't work for an awful lot of people, and they would prefer something potentially more prescriptive. So other diets that have been shown to be beneficial for weight loss are things like the Mediterranean diet, and the intermittent fasting type diets and low carbohydrate diet. So when I'm educating my groups of people with diabetes, I'm trying to tell them to be more carbohydrate aware. So there's no getting away from the fact that carbohydrates when they're broken down, and they end up in the body as glucose. So it's the food group that people have to obviously get more of an understanding around. So there is a whole session in the course, where we talk about where carbohydrate comes from, how to look at portion size. So if you are going to restrict carbohydrate, you are going to improve your blood glucose levels, but a bit like any type of diet, if you find it very restrictive, it may not be sustainable at six months, a year. And in fact, the evidence shows that, yes, low carbohydrate diets do work. But the weight tends to resume after a year and obesity and the whole conversation about obesity is, is one where I say, that the booklet around Talking about your Weight, you know, obesity is a chronic relapsing disease. So, you know, it's so complex, and if anyone loses weight, the body really fights to try and regain that weight. So it's, it's time for that whole burden and stigma around obesity and diabetes to be managed, I suppose. Better in media and by healthcare professionals. 

Olivia C  20:42

Yeah. Because both are diseases, basically. 

Sinead Powell  20:45

Absolutely, absolutely. Because people with type two diabetes, 85 to 90% of them are coming with a lived experience of being overweight or obese. So for years, probably been experienced, you know, stigma, or maybe not good communication from family, you know, from health care professionals, they're coming into this diagnosis with type two diabetes, not everyone, but a lot of people will say to us, they're coming in with a feeling of shame and burden and guilt. And who wants that for anybody, you know, when it's I do think I don't know if you're familiar with it, Olivia, there's, there's a tide turning now with, with having different conversations around obesity. And I think that's really important for type two diabetes population as well.

Olivia C  21:33

And as you said, both diseases are complicated. So the treatment, obviously, is complicated.

Sinead Powell  21:41

Absolutely. And I say that it's complex, and I must put my hand up, I think and what I do, and for years of talking about diabetes, I tried to make understanding diabetes as simple,  as in,  sorry, I try to translate the evidence into everyday speak so that people can understand it but I think sometimes I may be guilty of, you know, saying that managing this is easy. So I need to be careful with my words too.  Yes, you can self- manage type two diabetes, but that does not mean it's easy. It's a difficult condition to live with but, I think with the right care and support and the right diabetes team and obviously joining Diabetes, Ireland, helping us push for better services, for more advocacy in the space. And we will hopefully have a better resourced environment for people to manage this condition because the the numbers are growing. And we don't even know as I said, already, how many people so we can target and treat those living with it in Ireland, if we don't know who and where they are.

Olivia C  22:45

Well, Sinead, you've been absolutely great. Thank you so much for talking to me and answering some of the questions that people have had on diabetes, and I hope it has helped,

Sinead Powell  22:54

hopefully, too. And then thanks for having me on. Olivia.

Olivia C  22:58

Thank you, Sinead, for talking to me today. And answering the questions that respondents to the questionnaire have had thank you to everyone who has listened and if you don't mind, please filling out a short questionnaire about the podcasts you've listened to. Even if you've only listened to a bit, I would love to hear your opinion. You don't need to have been diagnosed with pre diabetes or type two diabetes, but you do need to be over 18 Also, if you have been diagnosed with type two diabetes or prediabetes, I would like to talk about your experiences of your condition. And the information that is contained in the podcasts in the recorded interview. You can get in touch with me Olivia Korean via email at the following address. Olivia dot Crinion two at mail.dcu.ie That's Olivia dot c r i n i o n, the number two at mail dot dcu dot ie Thank you for listening.