Living the Good Life with Diabetes

Featuring a conversation with Kevin Frankish, broadcaster, former co-host of one of Canada’s largest morning shows and current host of his own podcast, the Happy Molecule, plus Lisa Maks, a Clinical Nurse Specialist, Diabetes, at the Juravinski Hospital in Hamilton. 

In this podcast we will hear how Kevin Frankish, who was diagnosed with type 2 diabetes in 2018, has learned to manage his diabetes and what words of advice he has for others living with diabetes. Lisa Maks will share her clinical expertise of counselling patients in an acute care setting when they receive a diagnosis of diabetes, the impact of complications, and improvements in diabetes management. Lisa will also comment on the beneficial role of flash glucose monitoring to assist in managing glucose levels.

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Recorded on August 20th and 27th, 2021.

Find out more information on upcoming podcasts and webinars at www.connexhc.com.

Transcript

Denise Balch: 0:00

Welcome to the Benefits Connexion Podcast: Living the Good Life with Diabetes. My name is Denise Balch. I'm the president of Connex Health and the host of this podcast. And today I'm fortunate to be speaking with two guests about progress in the management of type two diabetes. Our first guest is Kevin Frankish, who's a former co host of one of Canada's largest morning shows, and the current host of his own podcast, the Happy Molecule. Our second guest today is Lisa Maks, a clinical nurse specialists diabetes at the Juravinski Hospital in Hamilton. We'll start with Kevin, welcome to our podcast today.

Kevin Frankish: 0:38

Hello, Denise. Thanks for having me.

Denise Balch: 0:40

More than welcome. Now, Kevin, let's start with your career. You've had a long and successful career in broadcasting. And in 2018, you were diagnosed with type two diabetes, what were the circumstances around your diagnosis?

Kevin Frankish: 0:56

It was it was a doctor's appointment for something else. And while I was there my doctor said well, you know, we haven't done some blood tests lately and so he always likes to be proactive. And lo and behold, the numbers showed that I had crossed that threshold and was now diabetic

Denise Balch: 1:17

and were you experiencing any symptoms that would have caused him or you to be concerned?

Kevin Frankish: 1:24

No nothing and even to this day nothing so I'm going to say that that I never would have known had had we not done the test but I'm glad that we we found out before symptoms started showing up.

Denise Balch: 1:44

And I think that's one of the critical things in a diagnosis of diabetes is that many people unknowingly have a type two diabetes, but they aren't experiencing symptoms. So they go can go for many years without being diagnosed. So you were very fortunate

Kevin Frankish: 2:03

Yeah, because and I'm sure Lisa will attest to this the faster you catch something the earlier you catch something the easier it is to maintain.

Denise Balch: 2:15

Yeah, absolutely. So when you receive the news that you had type two diabetes Was it a shock

Kevin Frankish: 2:26

shock would be too strong a word it was it was it came I was surprised it was surprised I wasn't shocked I was presented to me in such a way that hey, we got this we're gonna take care of this but you need to know that you're going to have to change your lifestyle

Denise Balch: 2:48

and so what were some of the conversation that you had with your physician at that time

Kevin Frankish: 2:53

it was more or less a primer on on what diabetes is and what type two is etc. So it was it was an education and it was just you know, be aware and and now take some precautions

Denise Balch: 3:12

so your doctor but you know from what you've said, it's like don't worry we got this but diabetes can be challenging to manage. So what were some of your biggest challenges personally and professionally? Like what were your big learning curves?

Kevin Frankish: 3:30

I think like many people it was just saying yes you have to do something you have to manage it you have to monitor it and I think that's the biggest challenge the other the other stuff comes but but just staying on top of things is probably the biggest challenge

Denise Balch: 3:46

yeah no I can certainly understand that so there wasn't learning curve involved then

Kevin Frankish: 3:51

almost definitely most definitely It was a lot of it had to do with more if I could an awareness curve as opposed to a learning curve holy cow that has sugar in it can you believe that and by by saying oh I could use this as as an alternative you know diabetes doesn't mean not having sugar like not you know cutting sugar completely out that just I mean would be almost impossible and also it would be I think damaging because you would just get so fed up so it doesn't mean doing without so it means altering so when whenever you can try to find something else so can you use honey on that instead of sugar getting away from the processed sugar? Can you can you bake with with with dates and and things as to add your sweetness as opposed to having another you know, with syrup or honey or sugar added to a recipe. So that's that's more to the point there.

Denise Balch: 4:54

When you had your diagnosis and you mentioned or earlier that there are physical effects of diabetes on the body, and we talked about the most often that that diagnosis of type two diabetes can also affect your mental health. Can you tell us a little bit about the physical and the mental health aspects you have experienced? Since your diagnosis? has had those changed?

Kevin Frankish: 5:23

Um, no, I've always I've lived with depression for many years, I have it, you know, I, I try and control it as best I can. Such as, you know, through therapy and through medication. So a lot of it, you know, goes hand in hand with the way you have to control diabetes as well, being aware of it, and, and just trying to take care of yourself. So yeah, they go hand in hand, in fact, mental health goes, goes hand in hand with so many of our issues today. Absolutely. We don't realize, you know, mental health is a significant factor in in any in heart disease, in obesity in in anything that that we have. So that's why it's not so unusual, really, that diabetes and mental health, that, you know, you have to be taken care of hand in hand.

Denise Balch: 6:20

Yes, absolutely. And once you do have that diagnosis of, of a something like diabetes, then it takes a while to adjust. But as you said, yourself, you know, having a supportive physician, having a positive outlook, and really making the appropriate changes in your lifestyle, that are going to help you manage your conditioner are extremely important. It sounds like you've coped very well.

Kevin Frankish: 6:46

Well, yeah. And we have to remember as well, it works the other way as well. In fact, I mean, people who live with diabetes, are themselves at increased risk for depression, anxiety, even eating disorders, which can really throw a wrench into diabetes maintenance.

Denise Balch: 7:05

Yeah, absolutely. There are other ways to help individuals manage their diabetes, and I understand that you actually use Abbott's FreeStyle Libre, which is a flash glucose monitoring system, in the management of your diabetes, how does it work? And how did that help you?

Kevin Frankish: 7:24

you know, what it just made it so incredibly convenient and easy. To monitor the levels, therefore, you're going to monitor the levels, if it was just a needle, and especially with with us, folks with type two diabetes, you know, we don't tend to be as vigilant because we don't want just keep pricking your finger and and, and then having to monitor it after that, as well as you may have to pick it once. And then And then again, a couple of hours later. And it's not something you want to have to open up that that kept for all the time and you know, I'm on the subway. And if I you know, if I have to open up a kit, turn on the monitor, load up the needle, jab my finger, then put the the the testing strip into the blood, and then put it into the monitor. You know what I do, I'm sitting on the subway, I just take my phone, and I put it over my arm where my my sensor is, and that's it done. And it's done it, there's no mass, there's no fast, nobody even knows I'm doing it, really. So it's easy peasy.

Denise Balch: 8:38

And you can do that as many times a day as you want, right?

Kevin Frankish: 8:41

You can do it as many times an hour as you want. And you can also set it up, the nice thing is you can either set it up so that it automatically goes to a, you know, a loved one, like my daughter or to the doctor or the doctor asked for records on. Okay, I want to see what happened. And it will show you a lot better it will show you the trends in your levels as well.

Denise Balch: 9:05

Yeah, so you've got that history and, and probably helps you manage some of those peaks and valleys too. So you sort of learn more about your diabetes as well.

Kevin Frankish: 9:13

Yeah, and you're getting a you're getting a graph, you're getting a readout, oh my gosh, why does it seem to really go up around lunchtime? And if it does, then I got to be a little bit more careful. I mean, our body has, you know, natural points in the day in which our levels go up and down as it is. So if there's a particular part of the day where they're going up, well then maybe you need to be a little bit more vigilant at that part of the day, so you're able to actually see it visually. What's happening to it and when it's happening.

Denise Balch: 9:43

Yeah, no, that sounds ideal. Kevin, we've talked about your diagnosis, and I know that now you use a the freestyle libri system to monitor your glucose levels, but that wasn't always the case. I believe that you started with the old fingerprick method Initially,

Kevin Frankish: 10:03

the old the old fashioned way, right? Yeah, that's right, you know, take to the implications are not as serious right out of the gate and you may not feel any different. And so you don't check us off and checking does become more of a of a hassle. In fact, I'll tell you the first few months that I had my diagnosis, I may have only really done the fingerprick maybe four times, in all that time, it just didn't seem as as important and it was always such a hassle, right? Although there's nothing wrong with with doing it somewhere you know, on at your desk or something like that, you want a certain amount of privacy when you're doing it, you also have to go and wash your hands and and and then you have to dispose of everything and put it all away. So it becomes a process and it can also take some time out of your day to do that.

Denise Balch: 11:05

And particularly having been recently diagnosed, I think it's probably very, very important that you check those, those glucose levels very frequently. So So you must have found a big difference in the frequency level of up you're monitoring your glucose when you switch to the freestyle LIBOR system?

Kevin Frankish: 11:26

Oh, for sure. For sure. I mean, it was like Okay, now I can now I can be a little bit more responsible as a patient, maybe I need to be even more, I don't know. But at least now, I can be a lot more honest about it. Because it can be done anywhere. Anytime.

Denise Balch: 11:44

Yeah, makes life a lot easier. And you just have to remember to change your sensor every so often, right?

Kevin Frankish: 11:50

You don't have to remember it tells you Oh, fabulous. It tells you, it tells you Hey, you got a week left. All right, you got a couple of days left. All right, you got it, you gotta change it now. And and the nice thing is, is it is it will give you the trends for eight hours. So, so literally you don't have I mean, unless you're monitoring it to see what a certain what's happening right there. And then you only really have to do it, you know, three times a day, and you got 24 hour coverage, because it'll go back and say, oh, okay, I can I can now see the line. So it's not even a matter of doing it every hour or every three hours, something like that.

Denise Balch: 12:28

Yeah, it's very much a smart system. That's great. What about coverage because I'm a benefits professional. I've worked in the industry for a long time. And I know that sometimes access to particular new or technology is sometimes limited. So it's the freestyle LIBOR system reimbursed by your benefit plan.

Kevin Frankish: 12:53

My benefit plan, it is so unfortunate with that, it's not always the case. So it's something you should definitely check into however, you know, I think a lot of the plans do cover it. And you know, what, if it if it doesn't, then that's maybe something that you could try and lobby for, whether it's your benefits plan. And I you know, you just speak up and say listen, this is helping me out because in the long run, it conceivably is going to save your plan money to the fact that you're monitoring and taking care of your diabetes and there's no other medical intervention that's going to be immediately necessary all the time. Yes, so it would be wonderful if your plan doesn't cover it. That it you know, hopefully one day it will

Denise Balch: 13:47

so how are you finding things and it's been a while since you've been diagnosed and how are you doing how well manages your diabetes?

Kevin Frankish: 13:57

Oh you know what, there are some days it goes up but that's when you do have to work a little extra hard. Our bodies are funny. It can go up and down. Sometimes apparently for no reason. And so you know that's good to at least be able to monitor that but you know, it's just a it's just a fact of life now it's just part of life. Now. You know, I have to I have to brush my teeth to maintain my my tooth health. So that that is something that I that I do for myself. So this is something else I do for myself

Denise Balch: 14:33

and having that supportive healthcare professional behind you. I'm sure it's made a big difference.

Kevin Frankish: 14:40

I think it makes all the difference in the world. Unfortunately, so many of our I'm fortunate to have a doctor who really takes the time to to sit and listen and suggest and advise So yeah, it really, really does help. Sadly, because of our medical system. Some of our health care professionals are so busy literally running themselves silly that they don't have as much time to sit and talk with each individual patients. And but that does make a huge difference.

Denise Balch: 15:23

Yeah, absolutely. And I take your point, physicians are really stretched. And that's why I think it's great to have people like Lisa available. And we're going to be speaking to her in a few minutes, who is that clinical nurse specialist in diabetes. So she's got an expertise in diabetes, and she works with patients all the time to help them manage their diabetes, but there are public resources available too, which I think is again, that really adds as you've mentioned, your doctor is very supportive. So it really adds to the living with diabetes. So what I'd like to end with is really what advice you would give to those who either may be newly diagnosed or struggling with the management of their diabetes, and they may not know about or have access to Abbott's freestyle Libra system.

Kevin Frankish: 16:14

Well, it is, it's important first of all, to to always question especially as you get older, so you may not have it right now as a possibility you could develop it. So staying on top of things, and then maintaining it, not getting discouraged not thinking this is some sort of a death sentence living property manage. You shouldn't even be aware you have diabetes. So So yeah, just just, you got it, you got to face it head and head on. And all will be well, if you take care of it.

Denise Balch: 16:51

Yeah, exactly. Don't live in denial. I think that's a really good point. It's like any other any other condition, you know, health condition that you have to recognize and accept that you have it. That's the acceptance phase. And then you have to actually typically manage it. And you can, you can, as we said, you can live really well with diabetes, living life. So that's great. And you're a great example, as a public figure. You're a great example for those people that have been newly diagnosed or have been living with diabetes for some type two diabetes for some time. And I'd like to thank you very much for being so open and honest with us about your journey with diabetes. And it's been great to speak to you it's been just a pleasure to have you here today.

Kevin Frankish: 17:44

It was my pleasure Denise.

Denise Balch: 17:46

Our next guest today is Lisa Maks. Lisa is a clinical nurse specialist for diabetes at the Juravinski Hospital in Hamilton. We've heard from Kevin Frankish, today who is living with diabetes. And now Lisa will share more about the clinical aspects of type two diabetes. So welcome, Lisa.

Lisa Maks: 18:06

Thanks for having me.

Denise Balch: 18:08

It's great to to hear your voice. Um, I know we've talked a couple of times about this session. So very pleased that you're here with us for the podcast. Before we get too deep into type two diabetes, I'm wondering, can you tell us a little bit about your role as a clinical nurse specialist in diabetes and what your typical day looks like?

Lisa Maks: 18:29

Yes, it's actually a unique role in that when a person with diabetes is admitted to hospital, whether it be for diabetes issues, or related health issues like heart attacks or cancers or that sorts of thing. I am looked upon as the expert for diabetes by the physicians and nurse practitioner or the prescriber group. And I'm consulted to do the diabetes management. So I look at their medications their insulins, how are they testing their glucose levels? Can I hook them up with something that might be easier, like a flash glucose monitor, whether they have community supports, so that someone's going to look after them once they go home and and out of hospital and be able to transition that care, and then providing education for the prescriber group and the frontline staff to bring the best evidence so that every person that walks through the door has the same information of the most current information about diabetes, and they also do things like creating policies and fund quality improvement projects and research.

Denise Balch: 19:35

Very interesting, so you get the best of both worlds. I do. We've heard from Kevin today about his diagnosis of type two diabetes, and he really didn't have any symptoms. It was basically on a routine checkup that he was diagnosed is historic, quite common.

Lisa Maks: 19:55

Well, I'd like to preface it with the fact that I'm in hospital so I'm not going to be sitting People like Kevin who who just get some blood work, and incidentally they find out he has diabetes, I'm typically going to see the person who's coming in with glucose issues or with other health issues. And the diabetes is brought up in that, in that routine blood or blood work that we're doing here. And I'm really happy to hear that Kevin didn't have any symptoms. Although I do see many people with diabetes with some severe symptoms that come in, such as really high glucose levels are really low and and other things that go along with it like car accidents, or you know, falls and, and fractures because of this, like high or low blood sugars. And then, I guess, symptoms that that Kevin didn't experience, Well, thankfully, when the glucose levels are high, our extreme thirst, you can't get enough fluid into you having to avoid more often, so they're constantly in the bathroom, being tired and having blurred vision. And that's one thing I tell them is that don't go get glasses while you're having high blood sugar, because it will start to resolve if you had good vision before this, you'll have good vision afterwards. And Kevin talked about how hard it was to to learn about diabetes with with, you know, the shock of a new illness there. So it really is trying to debunk some of the myths because people go to the internet, of course, to find their information. So I send them to diabetes.ca, which is the diabetes Canada accredited website with evidence based information on it. And we're trying to debunk those myths. And those past history, stories that have been passed down grandmother lost a leg because of diabetes. Well, diabetes has come a long way. People had live long, happy, healthy lives with diabetes. Now with the advent of new medications, new insolence, new ways of monitoring their glucose levels has just changed the game completely, it's a much easier condition to manage than it ever was. And that's because of research and development, and more and more people getting diabetes. And so there's more of a market. In all honesty, a lot of research and development goes into diabetes, because there's more opportunity for people to provide those products to them.

Denise Balch: 22:25

Yes, thanks, Lisa. I think you've made some really great points there. And that kind of brings me to my next question, which is, you know, we already know that rates of type two diabetes are higher than they've ever been not just in Canada, but throughout many developed countries. How many people in Canada are diagnosed with Type Two Diabetes? Exactly?

Lisa Maks: 22:49

Well, I'm going to go through the combination of both type two, type one and type two, according to diabetes, Canada, which is our validated site, we send people to diabetes.ca to get validated evidence based information. 11 point 5 million people in Canada are living with diabetes and pre diabetes. 3.9 million are currently living with diabetes, both type one and type two. And above that 3.9 10% of them have type one diabetes. Okay, so that's what we're looking at for numbers.

Denise Balch: 23:23

So mostly type two diabetes, diabetes is

Lisa Maks: 23:26

that's corrected 9% 90% of people have type two diabetes and 10% have type one, and that 10% really has never changed in my 33 years of nursing.

Denise Balch: 23:39

Right. But it's the type two rates that have been increasing quite dramatically correct?

Lisa Maks: 23:45

Absolutely. When it first started again, 2004. They had predictive models as to how many what percentage of the population would have type two diabetes by 2020. By 2030. We're already exponentially blowing them out of the water. So unfortunately, the predictions have been under underestimated.

Denise Balch: 24:08

So many of those must be in the workforce. Is that

Lisa Maks: 24:11

right? Yes. And I did some stats collection here. So I can't tell you exactly how many people are working and have diabetes. But I can tell you that 1.2 million Canadians have diabetes in the age groups between 20 and 64. So still quite a significant

Denise Balch: 24:28

amount. Yeah, so that's typical. Typical workforce age, right? Yeah, no, that's, that's a big number. Now, it's not just about type two diabetes, is it? And we you mentioned briefly earlier about some of the comorbidities with the complications associated with type two diabetes. So can you give us some examples of what those can be and why these complications occur? Yeah, I

Lisa Maks: 24:55

wanted to take just one moment to tell you a bit about what the diagnosis Is is and why it causes these complications. And this is what I tell a person with diabetes when I see them that you have an organ in your body called the pancreas. One of its jobs is to put out insulin. As soon as you eat food that that absorbs as glucose in your bloodstream, you have to take that glucose from the bloodstream and move it into the cell. And insulins job is to grab that glucose and transport it the rest of the way, when you don't have enough good working insulin, so you can have lots of insulin, but it's not doing a good job. You have all that extra glucose sitting in the bloodstream. And that's where the complications from diabetes comes in. When you are making whipped cream, you put sugar in it secondsit sugar is a thickener. So it does the same things to your blood to your blood. So when your sugars or glucose levels are higher, your heart and your kidney which are the pumps for your body have to work harder to push that thicker blood through. And the other thing that happens is that extra glucose is like little diamonds running down a tube and it scratches all the insides of those blood vessels. People don't die from diabetes, they die from the complications of diabetes, and that's because of that extra glucose scratching the insides of the blood vessels and causing that thicker blood. So then when we go into the complications, we divide these into two sections, and that's the big blood vessels and the little blood vessels. In the large blood vessels, we are dealing with increased chance of heart attacks of stroke, congestive heart failure, and peripheral vascular disease, which are those large blood vessels that feed your extremities like your legs and your arms. And when you have peripheral vascular disease and you have narrowing arteries that don't allow the blood to get down there very well. And you have damage to the insides of the blood vessels that can lead to amputations, and so they are do have a higher chance of an amputation. If they have diabetes, and small blood vessels you're looking at retinopathy, which is I damage nephropathy, which is kidney damage, neuropathy, nerve damage, and erectile dysfunction. So 40% of men over the age of 40 with diabetes have some degree of erectile dysfunction. So some of the stats here are that diabetes or debt is definitely associated with premature death, and it can reduce the lifespan between five and 15 years of that employee with diabetes. And it's estimated that the mortality rate amongst Canadians living with diabetes is twice as high compared to those without diabetes, we need to get on these glucose levels early and prevent these complications. People with diabetes are more likely to be hospitalized with cardiovascular disease three times higher end stage renal disease or dialysis 12 times higher and non traumatic lower limb amputation, which are those amputations that are not the result of an accident 20 times higher. So we really need to get on those sugars quickly. But the evidence does show that you can reduce your chance of developing a comorbidity by keeping your blood glucose levels in the normal range, which is between about four and seven before you eat, and five to 10, two hours after you eat. I just want to know, make a note here that if a person with diabetes has other health issues that might cause them to fall more frequently. So low blood pressure, fainting, balance problems or they're fragile, palliative or elderly, the targets are going to be higher, I call it the fall down go boom, we do not want that to happen. And so if we're driving the targets down too low, then a patient of a person with diabetes could risk having a fall due to hypoglycemia, that could actually make them worse because they've now fracture to hip. And then they have to recover from that. And with new devices that can give real time and constant glucose readings. It's even more easy to track those trends. And we're aiming for about 70% of the glucose levels to be in that target range that I mentioned before.

Denise Balch: 29:07

So Lisa, what is the best way to prevent comorbidities or complications?

Lisa Maks: 29:12

Definitely checking glucose levels more frequently. Taking all your medication as you prescribed and have your visits with the health care team. They recommend having your eyes checked every year checking your feet every day, eating a healthy diet like we always should, and aiming for some exercise every week stopped smoking, reducing stress levels, blood pressure and reducing our cholesterol levels.

Denise Balch: 29:38

those are those are some great words of advice, but not always that easy, particularly in the world that we live in right now where stress seems to be at an all time high, but it's certainly something that individuals whether you have a diagnosis of type two diabetes or not. Individual should be aware that you know how Their living will affect their health, even if it's something that they may not think is going to cause them any damage in the long term like stress. So definitely people need to be very self aware. So let's talk a little bit about the workforce. Those with type two diabetes, that are not able to work because they're experiencing complications. Do you see that in your practice?

Lisa Maks: 30:28

I do see that on a very regular basis. A gentleman I just saw today was 33. And was in the hospitality industry. That's been absolutely annihilated by COVID. Absolutely. He now has no drug coverage. He's newly diagnosed with diabetes. And I would love to have put a flash glucose monitor on him. But that's just out of his realm right now. And I had to choose insulins that were less expensive. So it's a big problem.

Denise Balch: 30:58

Yeah, absolutely. And so that sort of leads me into my next question. And I, I know that you've mentioned this earlier about flash glucose monitoring technology. And Kevin mentioned it as well, he has the benefit of being able to make use of flash glucose monitoring technology. So how does that benefit me? Kevin's talked about his personal experience, but but if we take it sort of at a general level with patients, how does that how does that help them?

Lisa Maks: 31:30

Well, in the three decades, I've been nursing, the past three has been by far the most exciting. And that's because we have a chapter in the diabetes, Canada clinical practice guidelines titled self management. And it was always one of these chapters where you're like, Well, okay, they can only poke four times a day, that's really a lot to poke your finger with. And now with the advent of flash glucose monitoring, people with diabetes are actually engaged in their own self management, they see the result of the food that they eat, they know when they're exercising, that their glucose levels are trending lower. And they can see the effect of the medication, its true self management, its partnership, engagement, and engagement with not only the healthcare provider, but with family members who are interested in helping that person with diabetes, manage their diabetes better. It's absolutely of imperative value for someone with diabetes, to know what their glucose levels are doing, where they're going, and where they've been. And that's I equate this to driving a car, do you want to drive a car with your head down, because that's what testing your blood sugar is, is you know what it is right now, with flash glucose monitoring, you know, where you're going, you know where you are, and you know where you've been absolutely invaluable information.

Denise Balch: 32:51

So when a person with type two diabetes manages their conditioning, well, what are some of the workplace benefits? I mean, what do you think of, from a workplace perspective, if somebody is well managed?

Lisa Maks: 33:07

Well, they feel better, for sure, when your glucose levels are within target range, you feel better, and they not only have better productivity, but a happier environment. I don't know if you've ever been around someone having a very high glucose level or a low glucose level, they're not themselves, they're not happy, they can be very upset with things. And it's not their fault. It's the body is out of whack. It also reduces sick time. So I have many friends, colleagues who have diabetes, whether it be type one or type two. And although you can get a low glucose level up within about 15 or 30 minutes, giving some treatment of sugar, it sometimes takes them up to 24 hours to feel better, wow. Out of out of sorts. And so you've lost a whole day of productivity, and then they'll be able to get to work as well. You know, if you have frequent hypoglycemia, there's a chance you could lose your license over that. And yeah, live in a remote area, your hoops, you can't get into work. So there's a lot of benefits from having well managed glucose levels for sure.

Denise Balch: 34:12

Yeah. So a lots going on in the diabetes space. You mentioned that the last few years, you've seen some incredible developments in either assistive devices like the flash glucose monitoring, as well as medications to help individuals manage their diabetes. How do you see things panning out in the future for diabetes management,

Lisa Maks: 34:39

I just think that the finger stick is going to go the way of the dinosaur. And that's what I hope it does. Because that's a preventative thing for people with diabetes to not be able to check their how things are going because they don't want to poke their finger and I think that's a big barrier. For people, I have had a cannot count the number of people I have met and remit with readmissions, or people in my personal life, who have said, this has changed my life. And they really feel that they can manage their their glucoses better. I have a friend in the community whose a once he was 11%, and he's a big tough guy, put this son this library on him. And within six months is a once he is down to 7%. Now he gets a he almost gets teary eyed when he talks about it. And he said, You've changed my

Denise Balch: 35:35

life. That's amazing. That really is. Yeah, that's amazing. Well, Lisa, I want to thank you for being with us today, you've really given us some amazing insights into not only the incidence of type two diabetes, and the number of those that are go undiagnosed. You you've really given us some great information about some of the signs and symptoms that we not may not be aware of, as well as the comorbidities and complications associated with type two diabetes when it's not well managed. And I think it's really important for plan sponsors, employers to know that those folks with type two diabetes can be fully productive at work, and can manage their diabetes Well, with the right supports, and access to technologies and medications that are suitable to help them manage their diabetes. And once again, thank you for being here and sharing your expertise with us. And we wish you the best of luck in working with your patients.

Lisa Maks: 36:46

Thank you so much. Thanks for having me.