Empowering Women with Type 1 Diabetes with Dr. Anne Marie MacDonald

On this episode we talk to Dr. Anne Marie McDonald, national research manager for the JDRF in Toronto, mother of two, and Ironman athlete who has lived with type 1 diabetes since the age of four. We had a great conversation and got to hear about her presentations on T1D and pregnancy, and women with T1D and aging, at the 2024 Connected In Motion virtual slipstream.

Featured on this episode:
Anne Marie MacDonald, MD MSc, is a modern health care professional and passionate medical thought leader who advocates for chronic disease self-management, preventive medicine, and healthy active living. She holds an undergraduate degree in Physiology from McGill University (Montreal, Canada), a Medical degree from the Jagiellonian University Collegium Medicum (Krakow, Poland) and a Master of Science degree from the University of Toronto (Toronto, Canada). Her expertise lies in healthy active living, digital health and behavior change, and chronic disease prevention and management. Dr. MacDonald has been living with type 1 diabetes for over 35 years. As an Ironman triathlete and marathon runner she loves helping T1Ds reach their athletic goals. When she's not working out, drinking a coffee or chasing after her 2 young children, she leads the Improving Lives research portfolio at JDRF Canada, the world's largest funder of type 1 diabetes research.

Resources from this episode:
Connected in Motion Slipstream
Twitter: @AM_MacDonaldMD
drannemariemacdonald.com
Dr. Michael Riddell, expert on T1D and exercise

Transcript

0:24

Hello and welcome to Embracing Diabetes. Today Amy and I had a chance to talk to Dr. Anne Marie McDonald. Anne wears multiple hats as a national research manager for the JDRF in Toronto, mother of two, and Ironman athlete who has lived with type 1 diabetes since the age of four. We had an inspiring conversation and got to hear about her upcoming presentations at Connected In Motion's virtual slipstream that is scheduled for March 15th and 16th. We hope you enjoy. And thank you so much for joining us today on Embracing Diabetes. We're excited to have you here. and we usually start our conversations having the guests tell us their story of diagnosis. So if you don't mind sharing us what you remember from when you were diagnosed, we would love To hear your story. Yes. I think that's, I think it's a great question, especially when people have so many varying, stories of when they were diagnosed, how old they were, what it, what they remember. I, unfortunately don't remember much. I was, had just turned four. Our family was living in Malaysia at the time of all places. And so I was diagnosed in Singapore. My parents had heard that Singapore had a really great healthcare system. They could tell that I was, clearly something was off. There was no diabetes in my family. but I was, drinking a lot. Using the bathroom a lot, things that were just abnormal for a four year old. and so they brought me to Singapore and so I vaguely have some memories of, playing in the halls of the hospital. Cause I think I was there for, a decent amount of time, probably a good week or so. but yeah, I don't remember much, which probably is a good thing. Do your parents, did they tell you stories about what it was like, like in, in a foreign hospital with. Foreign speaking doctor that must have been a kind of overwhelming experience for them. Yeah. So Singapore is quite English and they have just tremendous healthcare there. So they just spoke highly of the healthcare system in Singapore and how everything was just spotless. And that's what the country is known for, but, nothing, I think, nothing really. Too new, but in terms of diagnosis, when you don't have family history, it was just overwhelming, right? Like it is for most caregivers and most parents just to switch that flip from having a carefree child and childhood to all of a sudden having to track everything, right? And so young, a little four year old. So young, I know. Because you have your own young children now. And don't you look at them? I do. I can't imagine having to. I can't. No, I can't imagine. And in many ways, and I've had this conversation with, a lot of friends of mine have a lot of friends who live with type one. And I honestly think it's more difficult for the caregiver and for the parent of someone with type one, Then with, then if you're an adult, of course, if you're going through adolescence, if you're dealing with other life stressors diagnosis, it's incredibly challenging, but for the parent, when it's not it's not your symptoms, right? Like you have to monitor. that much more closely. So in some ways I feel grateful that I did get diagnosed when I did, because I don't really remember any other way of life. Which in a way is a blessing. Way to look on the bright side of things. I have my bad days. Don't worry. But that's usually what I come back to. Yes. Yeah. okay. Just so everybody listening knows. and I think that's why we're having you here. You are, you have many varied expertise, and admirable experiences. And I read that you are not only are you an Ironman triathlete, but also a doctor and also a mom. And a woman with type one diabetes. So have how so talk to us a little bit about that. Have you always been athletic? Like, how did you get? How did you train? all or how do you continue to do all of those things like juggle all of those things? Responsibilities. Yeah. So one, it's hard, right? I think that's the first thing to say when it's hard. two, I think with type one diabetes and something that I tell people often is you can do everything, but and then you fill in the blank, right? But it might take you a bit longer, but you might run into a few more challenges. But you might need a bigger support network, whatever it is. I think being realistic about that is really important. growing up, I was always athletic, always into sports. I was never someone that wanted to do long endurance events. I did a couple of short races in college, played basketball, team sports, your run of the mill. Athletic, youth, but I really started running, longer distances in medical school, partly as a mechanism for just dealing with the stress and with just the day to day, busyness of it all. And I had a few friends who had run marathons, med school classmates, and they made it seem very doable. And as soon as you have crazy friends who tell you that something is doable and you trust them and they're like, of course you could do a marathon. You start thinking about it and. And I'm like, if they could do it, I could do it. Yeah. I'm like, why can't I do it? And as someone who's quite type a, I love the idea of having that goal and having it be just a little higher than something that I thought I could accomplish. and then when you accomplish that first goal, mine was the New York city marathon. when you get to the finish line, I remember even vividly, my mom was like, how do you feel? Like she was crying. she's very emotional. I love her dearly. She was crying so much. She's Oh, that must have been so hard. And I said, I put in the work like I was very pragmatic about it. I'm like, I put in the work. and then similarly that kind of marathon, then led me to connecting with others who are runners and triathletes and you surround yourself with people. Like I said, who are, making you seem that these goals are normal, that you can fit it into a busy work day or a busy life. but it will be a bit more challenging. And Before I knew it, I had the goal of doing an Ironman and, I had some roadblocks along the way. I, my first full Ironman that I tried to do, I didn't finish my blood sugars were through the roof. especially on the bike. I learned quite early on that, when it comes to exercise, you don't always go low, Which is something that medical clinics often share. And, I understand why they share that because that's really more acutely the medical issue. You don't want to go incredibly low and go into hypoglycemia. But for me, My blood triggers were all over the place. I had a lot of challenges, finally got to the finish line of my full Ironman. And I had the same sort of, I was very proud of myself, but I also know I put in work, right? I know that it took a lot of time, a lot of practice, a lot of early mornings. and then you do have that sense of accomplishment when you're done because you realize that you really can do anything. But like I said, with type one, there will be some kind of, stepping stones to get there. I have a question. So what were the resources that you used to help guide you? Because in my practice, we often have, I have people who are interested in exercise and I find that, people's experiences with activity are so varied and, it's often a little bit tricky to give them advice and often it does require a lot of preparation, understanding your own kind of response to things and then being ready for, cause every day is different. Yes. Yes. So I great question. I connected with a lot of type ones who were athletes that I knew. And even then it was difficult. I did my marathon in 2008 and there were some online communities at the time there was insulin dependence in the U S that I think has folded since there was a diabetes exercise and sport association, Dessa. They had a great conference that I attended. They were in Toronto one year. And so I was just trying to pull information from sources, right? Right now, I think it's a lot. easier because there's a lot more online and there's a lot of great resources online. throughout that time though, because I realized there was such a need for it, I took on that role myself. I'm like, with my medical background, I'm like, I am so interested in the science of it. I know I'm not only going low, things are happening, right? and so I discovered there's, I don't know if you're familiar with Michael Rydal in Toronto. He's a researcher who really focuses on type 1 diabetes and exercise. So I like, I printed out his research. I read the research, right? And I realized okay, the type of exercise I do will change a slow kind of zone to, I can still have a conversation run. will look a lot different than an all out sprint or going up a hill on a bike, right? And you learn what are those pockets of activity that affect my blood sugar and you, it's puzzle piecing, right? Like you put it together as you go. and then you just look at your individual trends. Like you said, Liz, like it really matters what happens to you during that activity with your diabetes. It might look very different to someone else who's doing the exact same activity. Yeah. A triathlon. So intense because the exercises are also different, swimming, running, biking. it's just Whoa. Yeah. It's very different. A race day. And I tell people this all the time, a practice or a training day versus a race day is also very different as we know, whenever we are stressed, whether it's giving a presentation or being sick, same thing happens race day. So I actually. Absolutely. Did some races as preparation to lower my adrenaline. Like I said, this is more of a B race here. I'm really focused. My goal is a diabetes goal. I don't care about what time I do. I don't care about the activity piece. It's more, how can I train my body to be calm at the start to not have my blood sugar, shoot up to 300 or 400, on the actual race. that's a really good tip. Cause I did. Did one marathon way back a long time ago. and and trained for months and the day of woke up and my blood sugar was like three 50 or something. Yes. and what was that? I had to, there was nothing I could do. I did go run and it stayed high for probably the first eight miles. yeah. And you're told to cut your insulin and Yeah. Eat more, give less insulin. And then before you know it, you're trying to do this race or activity. I often do. goals for races that are either diabetes or exercise related or activity related, because that way you can just focus on one thing for each. If you have, of course, the ability to do, multiple races to fit it into your life, that's, of course, a consideration. Wow. Yeah. Wow. I just have a lot to think about. This is also pre kids, right? This is pre kids. Okay. That's helpful. I don't know. I don't think I could fit it in now. I was waking up early, doing a swim before work in the morning. I was doing a run at night. My Saturday was devoted to a four or five hour bike ride, right? Like I had a very supportive partner and a dog. I had no children. Yes. It's different. I do a lot of my biking indoors on a trainer early morning. Like today I was up at five to get a workout in before the kids were up. and it's nice. it's quiet, everybody's sleeping and you start your day with a bit of activity and it helps your insulin sensitivity all day too. Which is a bonus. So now tell us about your title is JDRF, National Manager Research Programs and Knowledge Mobilization. So I like that. Yes. What is knowledge mobilization? Yes, that's it. You know what? It's a question I do get often. You might hear varying terms, you might hear knowledge, translation, knowledge, exchange, knowledge, mobilization, and what it really boils down to is the sharing of ideas, research ideas and research results with others, whatever your target audience is, right? So for us at JDRF, we really focus on funding research into type one diabetes. And so we want to make sure that the research that we're conducting. And I think that's a really important question, because research isn't lost, right? We know that so much research happens. There are so many publications out there. But what actually happens at the end of a grant term? What do we do with that information? Can it change policy? Can it change practice? What has to happen with that data and those results for that to happen? Unfortunately, research moves very slowly. And I think I saw I think it was on the copy of your description for your podcast about, a curator will be five years away. I heard that too, right? I was also diagnosed in the 80s and I remember my parents were told it'll be five years, right? so now we veer away from that, but we, there's a reason why it takes so long. That knowledge has to be packaged up and delivered to different audiences in a way that works for that audience. So that's really what it's about, mobilizing and sharing knowledge. And so do you do some, do you do some of translating for the general public knowledge, like taking your research so that the general public can understand it, or is it working primarily with different medical researchers, scientists, groups? Yeah, great question. It's a little bit of everything. So it's partly for the type one diabetes. Community, whether that's families of those affected with type one, whether it's adults, it's also for, federal, provincial, in the U. S. is based in New York City. They do a lot of knowledge mobilization to work with government, right? To push advocacy efforts, for example. and then, like you said, it's really about the impact that the research is having. There's a lot of knowledge mobilization amongst researchers, right? We know that research is a collaborative space, and so you don't want the research to happen in silos at academic level, right? Institutions you want it to be shared. so that hopefully things can advance faster, right? Yeah. So what's well, let's just go ahead and jump into connected emotion. So connected emotion has upcoming conference It's a virtual conference, which is great because then I can attend it without living in South Carolina. And you're doing two different presentations. One is about pregnancy. One is about women and aging, and we would love to talk to you about both, but Liz and I are particularly interested in all things aging and women. So here. Can you give us like some highlights? What are you going to talk about? So they, connected motion and putting together, like you said, there's a virtual slipstream. One of their, groupings of talks is all about aging. So they'll have different speakers come in to talk about different topics. And for me, what's important is, you don't really see it shared as much. Maybe partly because children are often diagnosed. There's a lot of attention on kind of the family space, which, there should be right attention placed there, but not so much on all of us, all people who live with type one who are aging. I'm focusing mainly on health. So the research that is being done around, cardiovascular health, bone health, when it comes to like just female hormones, premenopause, menopause, right? Like we know, for example, that women with type one. often will start menstruation a little bit later, and they'll have premenopause and menopause a little bit, sorry, start later, yes, and have menopause and premenopause a little bit earlier, right? So how does that affect, your aging? we know that the architecture, the microarchitecture of the bones, is a bit different just by being someone with type one diabetes, right? So what I'm going to do is really look at what can we, what do we know about the space when it comes to research, what can we do? there's a gap when it comes to research in the space, because a lot of it is on type two diabetes. If there are any drugs or medications, like you probably have heard or know that, statins. are often given. The research is mainly in the type two space, right? And so often things are off label. Patients, individuals with type one aren't feeling super confident to take something that maybe wasn't really studied specifically in a type one cohort and type one group of individuals. a little bit of sharing research about what's happening. what we want to do in the future as well to be able to really decide what should we do to live healthier, better lives. The life expectancy now with type one is it's really not that much shorter, right? And often those numbers are gathered from Both developed and, underdeveloped countries. So it's not really quality data. but I think there's a big need to understand, aging when it comes to women specifically, like I said, bone health, just female hormones. I remember not even being told in my clinic, anything about like menstruation and female hormones and how that will affect my blood sugars. I have to figure it out on my own. I'm like, why am I going, why is my blood sugar going high every month? Like I just didn't put two and two together. So I think there's a lot that can be shared, about both aging and women's aging specifically that I think, people who joined that talk will really appreciate. That's great. I find that there's, probably just because of my age, and just having been in practice for two decades, that I think that space is just rich for opportunity to look at outcomes. the menopausal transition is just like such a gray zone for so many women. And it's just really hard to give. Really good answers with a lot of confidence, about, and, it's again, in very individualized. So it's hard to know everyone's experience or what their experience will be as they go through menopause. But it's, it's just, I think, it used to be, we never lived long enough to sort of. because menopause is so different for some, it seems to be so individualized. One person can have a terrible time. Another person can be completely symptom free. So that adds an extra challenge to. understanding and sharing information. Yes, of course. and that's, that's a good point. That's with anything with type one diabetes, right? Yeah. there's just your life and your health. And then there's how does type one diabetes actually play into that? at the end of the day for me, I think living a healthy active life. irregardless of your diabetes, if you're, somewhat, taking care of your blood sugars and whatnot, living that healthy active life, it's probably way more important for your longevity and your quality of life than, being super finicky about a blood sugar, right? there is some, of course, research about, like I said, like the changes that are unfortunately, specific to type one diabetes, but I think as a whole, if we can get individuals just living healthy lives, then that's a huge one for sure. and this is probably not a short answer question, but just, I'm trying to be short. Is there, I'm, I am maybe in perimenopause. I haven't had menopause yet, but, just hormones. Is there any difference? Like I've read a lot about taking hormones. Is there any difference between someone with type one taking hormones during menopause and someone who's not type one? Like in terms of hormone therapy, you mean? Yeah. I am. I'm not. I'm not certain if there are specific studies, I would have to, that's actually a good point. And I will look that up for my talk. but I do know that in general, any, anytime you will be adding hormones, you will have more of insulin resistance, right? Like it will be harder on the body. and I know that happens similarly with, IVF and whatnot, some individuals that I know who have type one, who've gone through any sort of hormone therapy, it does make it difficult, And it is individual, but generally speaking, that resistance does happen. but yeah, great question. And I'll make sure to look into it. Yeah. I think that detail. Yeah. I think the estrogen question is just really interesting. Cause I think there's a lot that's extrapolated between type one and type two. And there's a lot of anxiety that giving women with type one diabetes, estrogen is going to have because of the women's health initiative, there's going to be cardiovascular outcomes and all that kind of stuff. And we just don't know. We don't know. As a person who went through menopause, estrogen is like no joke. it's like a godsend. Yeah. Yeah. cause you talk about the effect on blood sugars, but man, if you're not sleeping cause of hot flashes, look also. So yeah. Yeah. And how would that if we have estrogen anyway and we're losing it, so then you take hormones to recover some of that, you know, like, so I would think it you're balancing it out. It's not like you're going from zero. Yeah. Yeah. It's just a balancing. Yeah, and it's consistent, right? Cause you're not like doing like birth control pills where you're cycling or having different doses, which we tend not to do, but just the consistency of it really helps with stability. But yeah, it's great that you're going to be talking about that. Cause I think it's just a, an interesting, just aging. Yeah, And there's not, there are not enough articles, not enough books, not enough speakers. So thank you. Which is really surprising, right? Yeah. There should be more out there. Yeah. Yeah. So we're glad that you're, we're glad you're available and doing what you're doing. So thank you. Yeah. Yeah. Yeah. yeah. And so we're probably getting close to time, but yeah. We always like to end with, looking ahead. So what's beyond your conference next weekend? What are you looking forward to in the next 6 months? The next year with work or family or what's on the horizon for you? Oh, that's yeah, that's always a good question. I'm definitely a forward looking person. I. I have when it, in terms of diabetes, I think I've told myself that I wanted to start looping, which I waited for my pregnancies to be over and I haven't done that yet. I'm still just on the Omnipod. We don't have the Omnipod flies yet, in, in Canada. So I'm thinking of looping, which will be exciting. and then my sport goal is I've gotten back to running postpartum. Running is logistically a lot easier than triathlon, as you can imagine with young kids. so I would love to, I'm not, It's going to take me a few years. I would love to qualify for the Boston marathon. That's my big bucket goal. giving myself five years. I think it's doable in five years. I've learned over the years that it always takes longer than you think, but you can always get there when it comes to some of these athletic goals. and then I think just, day to day, I think what's nice now post COVID is just like, even if this is a virtual meeting, just interacting, being out more, Connecting with the community, right? Like I've definitely missed that. with COVID and with having young children, it becomes difficult. So whether it's going to conferences or traveling, I'm just, looking forward to getting out of the house more. Yeah, that's good. Sounds great. does JDRF have a group that runs in the Boston Marathon or is it just, I know they do it in New York. yes, I think they do. I think they do. I should know that. I know they do New York. I believe they have done Boston in the past, whether they do it every year. I don't know. the older I get, the more time I get to qualify. So now that I just turned 40, I'll be like, I'll be in the next kind of age group, which is always nice. You get an extra five minutes. I'll take it. I'll take it. Yeah. yeah. that's great. I look forward to hearing about your progress and we'll stay in touch and follow up with you. Yeah, I would love that. Thank you. Thanks for taking the time to meet with us. And, and I'll look forward to seeing you next weekend on the perfect. Yeah. Thank you so much. And you're very welcome. Take care.

Amy: 22:04

Thank you for listening to this episode of embracing diabetes with your podcast hosts, Dr. Liz Stevens. And myself, Amy Stockwell. And music by Noah Mortola. We hope you enjoyed the conversation. And maybe felt​inspired or informed or less alone or all of the above. Please follow embracing diabetes on all major podcast platforms. And leave a comment question or review. Thanks again. We hope you'll come back for more.