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Scott Benner 0:00
Hello friends and welcome back to another episode of The juicebox podcast.

Jenny's back, and we're going to do another defining diabetes episode today. Today's topic is frozen shoulder. Nothing you hear on the juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com up into the menu and click on defining diabetes to find the series that will tell you what all of those words mean, short, fun and informative that's defining diabetes. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juicebox at checkout. That's juicebox at checkout to save 40 percent@cozyearth.com if you're a US resident who has type one, or is the caregiver of someone with type one, you can write from your right, from your couch, right from your phone. You can add your help to type one diabetes research by completing the survey AT t1 dxchange.org/juicebox this episode of The juicebox podcast is sponsored by Medtronic diabetes, and later in this episode, we're going to be speaking with Heather, who will talk about the importance of education and understanding the impacts of hyperglycemia, Medtronic diabetes.com/hyper, Jenny, I'd like to define, I don't Is it frozen shoulder when it's related to T, to T, 1d or is it? It is? It's still called that. Okay.

Jennifer Smith, CDE 1:55
Well, it is. Yeah, same thing.

Scott Benner 1:58
What is it? How do you see it like clinically?

Unknown Speaker 2:03
So it's, it's not an it's

Jennifer Smith, CDE 2:07
not an injury, right? This is something that can develop, again, from an inflammatory nature, which we know that type one diabetes especially calls to a lot of different inflammatory types of things, especially depending on what blood sugar levels look like. Frozen Shoulder isn't something that you know within six months of having type one or a diabetes diagnosis that you're going to all of a sudden have. It is something that develops kind of over over time, right? Another name for it is adhesive capsulitis, yeah, and like, there's another word beside capsulitis. It's a heat adhesive. Capsulitis is another term which you might hear from the doctor, again, similar that you may not understand what it means. They're referring to frozen shoulder. That's what it's talking about. And it's the shoulder joint like that, that area that is supposed to give you fluid range of motion. It's sort of supposed to move around like a ball joint, almost. Ball Joint kind of moves your shoulder forward and up and down and back and forth. You don't have just one motion like you do with your fingers, right? Yeah. And that inflammation kind of in that area gets worse and worse and worse over time, and it impacts the movement. And remember, all of our joints also have sort of fluid in between them, and that fluid starts to get kind of, I guess, gummed up, so to speak, along with the inflammation. And so it the inflammation gets, over time, worse and worse, and then your shoulder starts to have loss of loss of range of motion. Essentially, I

Scott Benner 3:43
have here a condition characterized by stiffness and pain in the shoulder joint typically develops gradually and can progress through three stages. The first stage is the freezing stage. During that stage, any movement of the shoulder causes pain, and the range of motion starts to become limited. The stage can last from six weeks to nine months, the age two frozen stage, pain may begin to diminish during this stage, but the shoulder becomes stiffer and the range of motion significantly decreases. This stage can last from four to 12 months, and then the thawing stage. During the final stage, the shoulder's range of motion begins to improve, and this stage can last from six months to two years. It says the exact cause of frozen shoulder is not well understood, right? But it's more common with people and with diabetes and other systemic conditions like hypo and hyperthyroidism. It could also occur after a shoulder injury or surgery, so the treatment for it is, I've only ever heard of people going to doctor's offices and they very painfully move the shoulder around. Is that horrible? Like, what is have you ever heard of people going through that and then that's not the right thing to do or something? But like, treatment of frozen shoulder typically involves physical therapy to improve range of. Pain Management and medications of cortico steroid injections, surgical intervention to release the tight capsule surrounding the shoulder joint in trying to reduce function. But I've heard people, I don't want to say exactly, but I've heard people tell stories of like they go to the doctor, and the doctors like they they're moving the shoulder, and they describe it as very painful.

Jennifer Smith, CDE 5:21
It is very painful. I mean, usually, this

Scott Benner 5:25
episode is sponsored by Medtronic diabetes. Learn more about hyperglycemia at Medtronic diabetes.com/hyper

Speaker 1 5:34
Well, Hi, I'm Heather lackey. I am a wife and mom. I have two children that are seniors in high school, and I've had type one diabetes for 34 years, and I'm a dietitian and a diabetes educator. You know, I'm the Director of Global Medical Education. I lead a team of clinicians that are developing content. How do

Scott Benner 5:57
you feel when your blood sugar's high? Irritable,

Speaker 1 5:59
thirsty, hungry.

Scott Benner 6:03
What do you enjoy most about your job? See

Speaker 1 6:05
education, working. See people thriving. That's kind of the fuel that feeds, you know, my fire.

Scott Benner 6:13
What would you like to see community members talk about more hyperglycemia

Speaker 1 6:16
is the critical thing, right? That leads to short term and long term complications. Hyperglycemia is the greatest unmet need in the treatment of diabetes currently, and I think that that's where technology can help if you're having

Scott Benner 6:32
trouble with hyperglycemia. And would like to talk to other people in the diabetes community, check out the Medtronic champions hashtag, or go to Medtronic diabetes.com/hyper,

Jennifer Smith, CDE 6:44
initially, they start with a lot more conservative treatment, right rest it use some, sometimes pain medications to kind of help ease some of the pain symptoms. Some treatments actually don't recommend many pain medications because they think that they may be counter to the actual healing process, but a lot of it often decreases your ability to do the normal exercises that you may have been doing right which, in terms of diabetes management, may be a shift, then to your insulin sensitivity and how your blood sugars are managed, and All of those things. Do

Scott Benner 7:21
you see it with older type ones who've maybe lived through management situations that aren't as good as what is like? This is a thing we should see less of moving forward, if we're lucky, or is there no way to

Jennifer Smith, CDE 7:34
expect? Quite honestly, again, it's usually, I don't know if your resource references like an age or a number of years in terms of just diabetes, but it does tend to be people who had diabetes for a longer period of time, which is, you know why I said you wouldn't necessarily see this within six months of a diagnosis with with diabetes overall, I know that they don't typically like to do surgery. But sometimes that's a kind of a last resort, from what I understand. Yeah,

Scott Benner 8:08
I asked what the pathway to frozen shoulder is for a type one, and it says chronic hyperglycemia, inflammation, microvascular changes, neuropathy, other autoimmune factors reduce physical activity and comorbidities, such as thyroid or cardiovascular okay,

Jennifer Smith, CDE 8:26
it's very painful. Yeah, yeah,

Scott Benner 8:29
that's what I've heard. I mean, the people have explained it to me. It's just no joke, and it's constant. And, you know, another one of those things that makes you feel like, Oh, I'm never gonna get past this idea. But,

Jennifer Smith, CDE 8:41
well, I think what goes along with that truly is that you don't think too much like who thinks about the movement that their hands do all day long to do the baseline of just your daily activities, right the shoulder is involved in a lot of that, any carrying or moving or just doing, you know, making yourself a sandwich could be reaching to a certain place in the refrigerator or on the cupboard, or reaching for a glass, and if every movement is pain,

Scott Benner 9:07
yeah, even just holding the weight of your arm up is hanging from your shoulder, right? There's just, it's tough. Okay, I just wanted to cover it so people understood what it was. And we, we do have a couple of minutes here, so I'm gonna say that you know prolonged high blood sugars, the chronic low grade inflammation that can come with type one diabetes. Diabetes can change the small blood vessels, reducing blood flow to connective tissues, where blood flow can impair the healing and maintenance of these tissues, contributing to stiffness and fibrosis, which is thickening and scarring, neuropathy, nerve damage caused by diabetes, uncontrolled blood sugars, not just, not just having diabetes, other autoimmune factors that actually, oh, also target connective tissues in the shoulder, contributing to the inflammation. And let's see, reduce, of course, if you can't exercise. Then you're not using it as much. And then, like I said, other comorbidities, like thyroid and and cardiovascular, it lists here so,

Unknown Speaker 10:08
you know,

Scott Benner 10:10
stable blood sugars, yeah, yeah, don't stare at

Jennifer Smith, CDE 10:14
which is, right? I mean, those are all the things that people are like, Well, gosh, I already do that, right? Well, okay, then move your body, stay active, keep your blood sugars well managed. Those are the goals in terms of preventative and that's kind of as much as anybody can really do.

Scott Benner 10:32
Yeah. So what kind of a doctor do you see for this, if you have it now,

Jennifer Smith, CDE 10:36
I would expect it's an orthopedic type of doctor that you would see if there are some strengthening types of exercises, probably PT or even OT, maybe therapy services that you end up using in order to find, you know, OT, especially for finding ways around doing things the way that you were normally doing them, until things are healed and PT may be giving you some of the strengthening exercises once you're able to get back to some light movement, using that, you know, to keep strengthening. And I mean, a big piece of this is also circulation, yeah, so keeping blood circulating and flowing kind of starting to rebuild any muscle in the area that's kind of started to, I hate the word, because it sounds almost like you're dying, but atrophy, so, right? Like muscle needs to be used in order to stay healthy, and so anytime you've got a period of inactive muscle, you have to do some light things to get it back up to par. Okay,

Scott Benner 11:35
yeah. Also, it says rheumatologist might be helpful. You could be in a position where you need a pain management specialist, but generally speaking, you know, it's suggesting an endocrinologist to help you get your blood sugars in line, an orthopedic, a physical therapist, rheumatologist and pain management so there. Well, I hope none of you have that. If you do, I hope you can get treatment for it. Because, like I said, every every description of it has never been good when I've heard it. So thank you. I appreciate it. Of course,

prolonged hyperglycemia can lead to serious health problems and long term complications. Learn more at Medtronic diabetes.com/hyper this episode of the podcast was sponsored by Medtronic diabetes, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the juicebox podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to juicebox podcast.com and click on bold beginnings in the menu. Hey, you listened all the way to the end. You might want to know more about the juicebox podcast. If you do go to juicebox podcast.com scroll down to the bottom and subscribe to the juicebox podcast newsletter. Each week, you'll get a rundown of the shows from the past week, just in case you missed something and you think, Oh, I would have loved that now I know. Thank you so much for listening. I'll be back very soon with another episode of The juicebox podcast. If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcasts and set it up so that it downloads all new episodes. I'll be your best friend. The episode you just heard was professionally edited by wrong way recording, wrongwayrecording.com. You.