Dr. Elizabeth Sellers

This podcast was recorded on the ancestral lands on Treaty One territory, the traditional territory of the Anishnawbe, Cree, Oji Cree, Dakota, and the Dene peoples, and on the homeland of the Métis nation.

This is Humans, On Rights. A podcast advocating for the education of human rights.

Here's your host Stuart Murray.

My guest today on humans on rights is Dr Elizabeth Sellers.

Dr. Elizabeth Sellers is a professor in the Department of Paediatrics and Child Health at Winnipeg Children's Health Sciences Centre, University of Manitoba.

She is a scientist at the Children's Hospital Research Institute of Manitoba, and Dr Sellers is the editor in chief of the Canadian Journal of Diabetes.

I'm always interested to find out how people like you go through schooling.

You live a life, and then you find yourself as we're going to talk about being highly, highly educated and highly highly determined to do some amazing things around diabetes.

But before we get there, tell us a little bit about where you went to school and how you spent your summer holidays.

And who is Liz Sellers?

Well, I'm first and foremost a very privileged and lucky person who have had the opportunities to do many fun and exciting things.

I was born in Saskatoon but moved to Ottawa, sort of in my grade school years.

So grew up mostly in Ottawa, but spent all of my summers and three months like the whole summer long in northwestern Ontario, because I'm privileged enough to have a family cottage that's been in the family since the thirties.

And that area is a long way from Ottawa.

24 hours drive is what everybody in my family considers home.

So though I grew up in Ottawa and love that region, I spent a lot of time in northwestern Ontario.

In fact, that's part of what attracted us to Winnipeg.

As a family, I was incredibly lucky to win a spot at the United World College of the Atlantic to finish up my high school, which is an international the last two years of high school.

It's an international college that you must go to on scholarship to try to even out those with means and those without.

It brings together young people from around the world, really, so we can understand our differences, understand our similarities and accept both those differences and similarities So that was a life changing opportunity for me in the last two years of high school, which really has changed how I look at the world.

Where did you find out about this schooling?

Where is it?

How does it that this came to be something that you were interested in?

It's funny.

I remember there used to be an insert in the newspaper The Ottawa Citizen on the weekend, so sort of a weekend magazine, and they had a story about the United World colleges at the time.

There were three around the world.

There's about 12 now, and I remember talking to my mom brought it to my attention that what an interesting idea this was to bring together young people from around the world not only to learn but to give service to the community that they were living in and wondered if I would be interested.

My parents were both educators, though physicians but physician educators, and really valued the opportunities that were perhaps maybe a little bit outside the box.

And I remember applying almost as a bit of a lark because, you know, you've got to be lucky enough to have the right interview and get in, but was fortunate enough to go.

And the United World College that I went to was in southern Wales, and I spent two years there living with young people.

Well, there were.

There were 62 countries represented when I was there.

Well, anybody else to Canada, by the way.

Yes, it's a two year course, and there were probably five Canadians in each year.

There was someone from Western Canada.

There was an Ontario person on Eastern Person Quebec.

So I think there was 8 to 10 of us in total over the two years.

Amazing.

Are you thinking about medicine at this point list?

I think I was.

But perhaps denying it so integral to the United World colleges is the concept of community service.

And in fact, it was a very academic school.

Formal academics were in the morning, and the entire afternoon was committed to community service.

And whether you are visiting an old folks home are working on the Coast Guard.

It was the concept of doing something that made a difference.

So that was part of it.

As you know, Stuart, I grew up in a home where there was a very privileged home where my parents were both physicians.

So I guess I've had a little insight into what it actually was.

I think at that age I said no because I wasn't going to do what my parents did, but came to realise I would have the opportunity to do something that would have direct impact, which is satisfying as an individual.

It also gave me the opportunity to do kind of my other career.

I toyed with, which is teaching and teaching is ingrained in medicine.

Whether you're working with a family or whether you're teaching, formerly in terms of students are lecturing at the university.

It's really very much part of medicine.

So I was a little older when I really I was thinking about it early on, but I was actually had finished my undergraduate degree before I was really had made the decision that it's what I wanted to do.

Let me come back to this piece.

I mean, there you're in males and what I loved about what you're talking about.

Liz, is there something so practical about winding academia into a practical day?

In other words, as you say, do some academics in the morning and then something community given back, Really, At the end of the day, that's developing citizens, you know, citizens of the world.

And we need more of that.

I think, and you know, that's a whole other discussion.

But I just look at that and how you share that and see how that has helped you as a human being, as I know you as a person, as a professional, they couldn't have got a better person to be a part of that than you.

I guess I'd rephrase that Stewart and they helped form who I was.

The community of the United World colleges helped form who I was, as did my parents instil in me the importance of contributing to the community of which you're a part, whether that's at a very local level or at a broader level.

Those contributions are important regardless of what level they're at.

Good point.

Where do you decide you're going to go to university?

I mean, you've got the world in front of you, and I made it what some people think was an unusual choice.

But it was a great choice for me.

I came back to Canada and I went to Trent University in Peterborough, Ontario, very specifically because it was a small, undergraduate focused university, remembering that I was coming out of this very intimate small experience of living with a small group of people.

And I knew that I was probably best for me not to suddenly being big.

Waters and Trent also had an international programme that was not academic.

It was led by a Jack Matthews who was actually the first headmaster of the United World College of the Pacific in Canada.

So he had very much a similar experience of living in an international group, and I wanted to go to a small university.

I wanted to live in a smaller town, and Trent gave me all of those advantages.

And I was part of an ongoing sort of international programme that wasn't tied to what I did at university, but attracted a really large group of young people from around the world.

What did you major in at Trent University of us?

Besides fun?

I did biology, which a trend is very ecologically based biology, for sure, but from an ecological point of view.

But it was it was a fantastic experience.

And so again, you're starting to get closer to looking at medicine.

I mean, you're looking at that as part of your you know where you want to go.

Did you get that at Trent, or did you from Trench?

Where did you go?

As I was finishing my work at Trent, I think I was really starting to think that medicine is what I want to do, which is part of the reason my peers perhaps thought I was crazy because Trent does not have a medical school.

But in fact, I think that was really good for me because, as some of the listeners may know, that, you know, getting into medical school is competitive.

Maybe not in such a good way and going to a school where people weren't.

You know, the Med Keener's who was going to get in who was not was actually a good thing for me.

But I didn't go directly.

I didn't actually apply.

After my fourth year, I worked at camp.

I had worked at a summer camp for years in the Rockies, UNESCO outdoor school run by the Rocky Mountain Y M.

C.

A.

Runs a year round well run summer camp in the summer but has a year round environmental education programme that they ran with the Calgary Board of Education and I stayed and worked springs there and been involved in those school programmes.

But then after I finished my undergraduate degree and I stayed for a year and worked with the school programmes and I'll tell you to this day the experiences I had there have carried me far.

I think we worked with 4000 grade sixes.

They'd come for a week at a time with their teachers and you know, I sometimes I'm in our northern communities here and they asked me to go to the school, and I'm quite comfortable leading a song or playing a game with Grade six is because I did it full time for a while.

So I was at the Rocky Mountain y for many, many summers and springs, but full time the year of the Calgary Olympics, which was also just serendipitously the right place to be because I was in the middle of that excitement.

These create Sixers Liz.

Would they be sort of like local like Albertans, British Columbians?

Or was it broader than that or who would be the people who would attend a camp?

They were mostly during the school programmes during the non summer.

Like during the school year.

They were mostly from Alberta, the majority from the Calgary board, because the Calgary Board of Education actually helped form this outdoor school, though we did have kids from rural communities in the summer, camp Chief Hector is the Rocky Mountain wise summer camp and has been around for Oh my goodness, we just had an anniversary, and I'm trying to remember whether it was the 95th or but attracts quite an international crowd, actually.

Majority from BC Alberta.

But lots of kids from Ontario and a good handful from overseas who are just looking for a different experience.

I loved my time at the United World colleges and at Trent, but I was at Hector.

I don't know.

I guess I was 23 24 25.

Those friends I worked and lived with their remain my crazy camp friends and with a lot of those people working at that camp Liz, whether the Canadians or would they have an international flavour also pretty mixed the majority, I would say we're Canadians, but many had had world adventures because they just attracted the people who were interested in that sort of thing.

But perhaps the less of an international flavour than some of my previous experiences.

So now you're Rocky Mountains, you're going to get that medical bug.

Well, I think I had it at that point, but I'm glad I had that experience of working with people while I was at camp she Factor of the Rocky Mountain.

Why that I applied to medical school, I suspect, to my father's delight, because I think he thought I'd thrown my life away and was living at camp forever.

But I applied from there and lucky enough to get some interviews.

And I remember leaving camp where, you know, you spend your life in grey fuzzy wool socks and Birkenstocks and suddenly realising I had to go be interviewed, had to go get a haircut.

It was during that year that I decided for sure it's what I wanted to do and applied and then started the year after that, not a delayed route to medical school, but perhaps not the fastest either.

And I sure don't regret it because It gave me more experiences with different people.

That helps.

I think it helped me when I'm working with families now.

Part of it is when you get into medicine or medical research or whatever area.

Maybe there are some that prefer to work in an office with a computer doing great work.

There are others suspect This is you because I know your personality.

You are as much interested as the person as you are about anything that might be on the research side.

I mean, it's all about human beings.

It's that aspect of medicine that poses the questions that I have made.

Part of my clinical research career is questions that come from the clinic or from people that sort of inform where my research career has evolved Very much starts with the individual or the family or the problem that they have, and we don't have answers.

So let's go and look.

Let's let's kind of gently more far way in.

If I could use that expression to talk about what you're currently studying now and the reason that I asked you to come on to this podcast, Liz is to talk a little bit about what you're doing around diabetes and perhaps just give us a little bit of a grounding on.

I know there's a couple of types of diabetes talking about the types there are what the differences between type one type two I pre diabetes is something I've learned a little bit about.

Share a little bit of background on sort of the different types of diabetes.

And then I'd love to find out a little bit more specifically about the area that you are are researching or involved personally.

Sure so Type one diabetes used to be called insulin dependent diabetes or childhood onset diabetes.

Juvenile diabetes.

Those are all older terms for what we now call Type one diabetes and Type one diabetes occurs when the cells in our pancreas, which is an organ that kind of is tucked in behind our stomach.

The cells that produce insulin that are in the pancreas are destroyed so the body no longer makes any insulin.

So it is absolutely imperative to take insulin for survival, which is why it used to be called insulin dependent.

Type one diabetes when I trained and it's rapidly changing was the most common type of diabetes in young people under the age of 20.

If you were diagnosed with diabetes, it was most likely Type one where the immune system, the body's own immune system, makes a little mistake and recognises the insulin producing cells as though they weren't part of the body as though they were foreign and attacks them and destroys their function.

If you look at all diabetes, about 10% of people who live with diabetes live with type one diabetes, so let's just quickly on that.

How would I know her?

How it if I know if I got a child, I got somebody?

Is there a sign that would say to me, Okay, my child or this person?

This youth has an issue and looks like it could have something to do with diabetes.

Sure, so the symptoms of diabetes are actually the symptoms of Type one.

Diabetes are the same symptoms you see with any type of diabetes, and those are being thirstier than usual, using the bathroom, peeing more than usual, getting up at night to use the bathroom or to drink.

So being and drinking a lot younger kids and even older kids might have accidents at night because they're making so much urine and losing weight rapidly without trying like the weight just comes off you.

And those are classic symptoms of diabetes.

In Type one diabetes.

It's often quite acute, you know, go from one day and then over a course of a week, you know you're using the bathroom every hour and you've lost £20.

That can also happen in other types of diabetes.

It's just usually a little more dramatic and type one diabetes.

But those signs and symptoms are the signs and symptoms of all types of diabetes.

So Type one diabetes, the cells that make insulin, have been destroyed.

We have to give insulin back for survival.

That used to be what we considered the type of diabetes kids got.

That's no longer true.

Type two diabetes is quite a different disorder.

They both result in high blood sugars.

But that's kind of the similarity in Type two diabetes, which used to be called adult onset diabetes or non insulin dependent diabetes.

We've gotten away from those terms for a couple reasons.

For an individual with Type two diabetes, insulin might be a good choice for them, so it got confusing.

Are they insulin dependent, are they not?

And we no longer call it adult onset diabetes because we now see Type two diabetes in Children and adolescents, and that's in the last 20 or 30 years.

In Type two diabetes.

The body makes insulin, but our body cells don't respond to it.

It's like we're resistant to the action.

If that happens, if the body can respond by making more and more insulin to overcome that resistance, all is good.

So in Type two diabetes, you have two problems.

Your body doesn't respond to insulin very well, and while you make insulin, you can't make enough to overcome that.

So for any one individual individual, a might have a big problem with resistance and a little problem with making insulin.

But another individual individual be with Type two.

Diabetes might have a little bit of a problem with resistance, but a big problem with making insulin.

So it's a bit of a mixed bag, to be honest.

And Type two diabetes accounts for about 90% of all diabetes in Canada, so it is much more common than type one, and again it used to be considered.

If you were 40 you had type two diabetes.

If you were eight, you had type one.

Unfortunately, that is no longer true.

We now understand that it is possible for anyone to develop Type one diabetes, though it is more common to develop it before you're 20 but you can develop it at 30 40.

You can develop it at 50 or 60.

It just becomes uncommon.

Type two diabetes is absolutely more common in older people, but unfortunately we now see it in well, I used to say adolescents, but I have to say Children and adolescents now.

And Manitoba, unfortunately has amongst, if not the highest rates of Type two diabetes and Children reported in the world.

And we're going to talk about that list.

I think that, you know, I think that's one of the things you're studying around with indigenous peoples and Children and that sort of thing just before we get there, Liz and we will, because I'd like to spend the bulk of our conversation there.

But is there other types of diabetes you park over type one type two.

Is there anything else that we should cover off?

So there is something called pre diabetes, which means pre diabetes related to type two diabetes.

So those are people who again have some of that resistance to how well their body responds to insulin.

They're not making quite enough.

The sugars aren't quite normal, but they're not high enough to say diabetes.

They're kind of in that in between state.

And the importance of that is that we know that if you are in that in between state or pre diabetes, you're at really high risk for developing Type two diabetes.

And we also importantly no, at least in adults, because I'll be honest.

We don't know in Children yet in adults, we know there are some things that can decrease that risk of progressing to Type two diabetes.

So there's Type one diabetes type two diabetes, pre diabetes.

There's also something called gestational diabetes, which is a high blood sugars that occur only in pregnancy and as a paediatrician.

I try not to deal with that at all.

There is actually even more types of diabetes.

Stewart.

I don't want to confuse you, but there's a handful of other rare types of diabetes, some very specific genetic diabetes.

We see Children who have diabetes related to medications they're on.

So, for example, Children who've had a kidney transplant in order for the body to not reject that kidney, they have to take all sorts of medications, including medications that cause insulin resistance and medications that decrease the amount of insulin you can secrete.

And so some of those kids end up with high blood sugars or diabetes that it's a medication induced.

And there is another type of diabetes called CF related diabetes that people who live with cystic fibrosis develop.

And it's a very unique type of diabetes related to CF.

The common thread is they all have blood sugars that are higher than they should be.

So this let me just come back to one thing, because it's interesting.

When you talk about some of these, they're not as well known as sort of types of diabetes.

If you have to have, say, a transplant and you know that you're going to get that organ, are you aware at that point that some of the medication that you're going to be taking will in fact make you a candidate to be a patient of being diabetic?

So, Stuart, I'm going to say Yes, I am not a transplant physician, but I am pretty confident that the teams of health professionals that deal with folks who are having a transplant or going to be taking medications that are potentially producing diabetes, that that's discussed with families and Children beforehand.

Life's always a trade off, right?

You need that kidney.

You need that kidney.

So let me just, you know, kind of my My basic research has showed that there's 11 million Canadians that are living with diabetes or prediabetes.

Obviously that you know, we know somebody.

Which, of course, we all do in our families and our relatives.

Seems to me that there's about one in four people in Canada that are touched.

You mentioned earlier about the fact that Manitoba has some of the highest cases of diabetes well in Canada.

In terms of Type one diabetes, we are amongst the highest rates in the world.

Type one diabetes.

The rates are highest in people of northern European background, so the Caucasian Canadian population, Australia's in their northern European Finland across Scandinavia have the highest rates.

So we're not particularly high in Manitoba compared to other Canadian provinces.

But we are relatively high around the world.

About one in 500 young people under the age of 15 in Manitoba lives with Type one diabetes.

That's pretty common.

This in my local high school, is about 1500 young people.

You'd expect there to be three or four young people living with Type one, and there are in terms of Type two diabetes.

Manitoba does stand out.

Stuart.

I'm going to speak primarily to what I know best, which is in young people.

So Type two diabetes in Manitoba is one of the first places in the world.

It was described.

And that was in the late eighties by my colleague Dr Heather Dean, who has been a lifelong mentor and also a lover of northwestern Ontario.

As I met her in northwestern Ontario as a child before I worked with her, she first was one of the first people to recognise that what she was seeing in young people from northeastern Manitoba, young indigenous kids was Type two diabetes, not type one diabetes, so Manitoba was one of the first places to recognise it.

It's now being seen around the world, but our history is sort of 30 years here and it's been recognised around the world, perhaps the last 20 years.

It can affect any young person.

But unfortunately, Children with indigenous background around the world doesn't matter whether you're from New Zealand or Australia.

American Indian Children, Indigenous Children have a higher rate than any other population of Children.

But that doesn't mean that other Children are immune.

Anyone can develop it.

So in Manitoba, we, unfortunately have well the highest reported rate, which is 150 almost 160 Children for every 100,000.

1st Nation Children has Type two diabetes under the age of 18, and those are kind of funny numbers to talk about because most of us don't know 100,000 Children.

But if I put that into context in Manitoba, remembering that in Canada we have pretty high rates of type 1.

25 Children per every 100,000 Children are diagnosed with type one diabetes six times.

That is the rate for First nation Children to be diagnosed with Type two diabetes and Liz, are those sort of those equations, if you will, would that be the same as you made mention about indigenous Children around the world?

Are those numbers the same?

Or do they differentiate?

No, they're not.

Actually, though indigenous Children around the world have higher rates than non indigenous Children.

So the Mari Children or the Australian Aboriginal Children, American Indian Children.

So if we speak to the U.

S.

American Indian Children have been shown to have about three times the rate of what they call non Hispanic white in the United States, meaning a child of northern European background about three times the rate.

But there's no where's near the rate that we're seeing in our first nation Children, so we are still very much higher.

You're going to ask me why, and I wish I had the answer to that.

And that is a major part of what we are trying to understand.

And it is not as simple as diet and exercise.

It is absolutely not as simple as that, for sure, access to healthy foods, access to clean water, access to opportunities to be physically active or important.

But it's not as simple as that, and we're trying to understand why a young person whose family is first nation bears such a high risk, we think, and the research team that I work with, which includes youth and families with Type two, because they help inform what we do.

One of the things that we are learning is if what we call exposure in utero when a baby is developing inside the mom's womb.

If the mum has Type two diabetes before she is pregnant, that child is at very high risk of developing Type two diabetes themselves at a younger age.

What I've learned from some elders is that the ideas of what your great, great seven generations, what your great great great great grandmother was exposed to will affect the next generation and the next generation and the next generation.

And I think that's what we're seeing in terms of our escalating rates of Type two diabetes.

You know, the notion that you're finding out all this information?

It's important to find out kind of why, which is what you know, the question I was going to ask you.

As you say, that's what you're trying to discover.

But as you're on this journey of trying to discover why and you say it's not a diet and exercise, which I think probably was a myth, you know that, you know, that was one of the clear elements that was a major cause of diabetes was the kind of diet you had and the lack of good quality of food that you're eating.

And I think a lot of people would just jump to the conclusion that up North it's so hard to get fresh produce fresh this and fresh that.

So it's nice to I'm not saying that it's not definitely a part of it, but that's not a direct relation to it.

Is there something that you're starting to find, or are you anywhere close to saying it's not about finding a cure?

It's about how do you manage it?

How do you sort of manage that through the process so that you're not definitely going to be just a candidate?

And if you are a candidate, how do I manage this?

Well, I think part of the journey to that Stewart is actually understanding what's going on because if you can understand what is putting an individual at risk, then you've given them the information or the ability to target whatever that is.

And I don't mean to say that healthy food and exercise is not good for all of us, but it's not as simple as that.

We think that our best chances from what we understand so far is actually to target the health of mums as young women before they're pregnant so that they can have healthy pregnancies.

We know that things like stress in pregnancy affect babies outcomes, including potentially risk for developed diabetes.

So making sure that that environment is healthy and, when I say healthy yes, access to healthy food, clean drinking water.

But a healthy environment where that individual isn't worried about personal safety isn't worried about feeding Children.

We think those things are actually going to make a difference in the long run.

One of the things that has been shown to decrease the rate of type two diabetes and young people is breastfeeding, so we've shown that here, and it's now been shown in other populations around the world.

We don't know the direct cause, and I think that's important.

But we know that breastfeeding clearly reduces the rate of overweight in Children, and it reduces the rate.

So if you compare even siblings where the child was breast fed versus not the child who is breast fed is at lower risk for developing Type two diabetes as a child.

And that's something perhaps we could make a big difference in, even if the mother at that point is there a correlation between a mother who might have Type two diabetes?

Is there an insular or protection for the child through breast feeding?

Yes, absolutely, regardless of whether the mum has Type two diabetes herself or not.

But what we don't know, and that's an area of people are looking at.

Is there something in the breast milk itself, or is it an association?

Whereas if you're getting milk or being breast fed, you are being nurtured?

We know that Mother's touch is important in terms of how a child develops, and perhaps it also means that they're not getting higher sugared substances if they're being breast fed.

So we don't know exactly what it is, but we do know it makes a difference.

We also know that breastfeeding has many, many, many other health benefits for Children.

Breastfeeding is in our northern first nation communities is done at fairly low rates, and I think that I'll be honest here, and I'm only giving an opinion here from talking and listening to elders.

I think that that is in part a consequence of the residential school system.

So as a older mother myself, who really wanted to breastfeed, it was not easy.

But my mother had breast fed and she came and helped me with the residential schools.

We now have many generations who weren't at home watching all of the other young moms breastfeed being nurtured by the aunties and their grandmothers who were there to help them.

And it is not easy.

So right now what happens to many of our young mums from northern First Nations communities is first of all, they are forced to deliver their babies many hundreds of kilometres away from home without their mom and their anti and their older sister there to help them.

And that first week is really important in terms of initiating breastfeeding.

And then they go home where there isn't the experience around them because their mom didn't their mom and their grandmother, we're at residential school didn't grow up in an environment where you learned by watching.

So I think it is one of those sort of not so obvious consequences of the residential schools.

But I think a consequence of it.

And I mean there's just so many elements that are sort of tied into the horror that we are now discovering around residential schools.

This is just kind of another extension, and it totally makes sense.

There's appreciate it's your opinion, but what you've been doing with your life and your career is trying to find answers to these things.

So the fact that you're in this conversation, I think is very, very, very helpful.

There is one thing we think is specific to Manitoba Stewart, and I'm always very cautious when we talk about it.

There is some issues related to the way somebody is made to genetics, and there is a very specific difference in one very specific gene in some of our northern populations that appears to make it easier for them to develop Type two diabetes.

And what we're learning about that is it probably was a gene that gave them more resilience when food was scarce.

We have some work we're doing now shows that if you have this little difference and that's all it is, like jeans come in different forms.

Clearly there's a one gene for eye colour, but it comes in different forms.

There is a form of one gene that some of the First Nations peoples have that makes it easier for them developed diabetes.

But what we're learning is it probably was a resilience gene in the past, because in the past, when food was maybe not abundant all the time, it appears that this little difference when food is available makes you store it really efficiently.

Well, that's a resilience gene.

And if we can understand that and understand differences in food composition, maybe that will actually help those people who have that difference.

Because if it was a resilience gene when the diet was very heavy and fat and protein and less in carb, then maybe that's a diet that would help that individual.

So I don't want to get too complex, and I don't ever want to send the message that there's a problem with the genes.

It's not a problem, but the environment has changed so quickly.

That's something that might have been really a resilience.

Gene may cause some difficulties now, and if we understand that people can use it in a positive fashion, I mean The environment you talk about is on many levels, one of them coming back to the whole residential school environment.

I mean, that's just a change of trying to drive a culture out of our first people.

So I find that the work you're doing, which is, I mean, it's incredible to hear what you're up to.

I want to just get a sense.

You know, I talked to you before the podcast about diabetes and human rights, and I know we're doing a lot of amazing work.

You are doing a lot of amazing work here in Manitoba, around diabetes.

From a research standpoint, the scientific side just share your thoughts a little bit about kind of the human rights that go along with the issues around diabetes.

Before I do that, I don't want to correct you.

But when you say you or me an amazing work, I think it's really important to acknowledge that I am lucky enough to be part of a really big team of clinical people of families are young adults who actually are part of our advisory group, basic scientists who are working together to come, so it's not me, that's a great correction.

Thank you for that.

I just know that you're a key key player, So tie in a little bit about this notion about human rights and diabetes.

This is true of Type one or Type two diabetes, the two major types of diabetes on an international scale.

Not everyone has access to life saving medications, and that is a huge issue in Type one diabetes and has been addressed by some groups, including something called the Right to Life, which is trying to make sure that Children with Type one diabetes have access to insulin.

Because while we celebrate the 100th anniversary of insulin, a Canadian discovery, there are still many places in the world where there is no access to insulin, which, if you live with type one diabetes, means you don't survive in terms of Type two diabetes and access to regular medical care.

But I want to turn my attention to Type two diabetes because population, so I'm not really talking about an individual person, but populations who are at risk for childhood onset Type two diabetes, whether you're in the United States or pick another country, have a lot of similarities, and that many people who are at risk for youth onset type two diabetes live in poverty who don't have access to recreational activities who don't have access to clean drinking water.

And while those are not direct causes, we know that those characteristics cluster with risk for Type two diabetes and the fact that that continues to occur in Canada.

Most of my kids, friends from River Heights don't realise that in our own province there's families growing up without heating without fresh drinking water.

And I think that's really important to acknowledge and, yes, access to the health care system and surveillance or supports for people living with diabetes is also not equitable in our own country, much less across the world.

But it is not equitable within our own province.

If you live 1000 kilometres from Winnipeg, in order for your child to have access to a specialty team that a child living down the road would have, you're out of the community for at least three days.

Your child's missing three days of school.

You're missing three days of work.

Who's caring for the other kids, so health care access is not equitable even in our own country.

Our own province and the other issue that I think is really important and what we have learned from the youth.

We work with youth.

We work within clinic and families.

But also use on our parent and patient advisory committee is they feel an extraordinary amount of stigma related to their diagnosis.

Everybody should have the right to not feel inferior because of a medical issue, something that's outside of their control and the kids talk about blame and shame.

And I guess I wasn't really surprised when they told us about that in the medical world.

But they told us that that's how they feel in their own communities, in their schools with their peers.

And correct me if I'm wrong because you're more of an expert in the big world of human rights.

But to me it is.

Nobody should ever feel that way about a bad set of cards that they've been dealt because it will impede their ability to care for yourself, too.

Yeah.

I mean, it's the fundamental we're all born equal, you know?

What does that mean?

Like, what does that mean?

So, you know, I appreciate that.

I just wanted to maybe sort of end our conversation around two points and one is diabetes.

Is it something that is there a cure or as diabetes?

Just something that we're trying to figure out, how we can manage better and better and better to deal with some of the issues you talked about from a human rights perspective.

So, Stuart, when you say diabetes, we actually need to be specific because the answer might be different.

In Type one diabetes there is in 2021.

There is no cure.

It is something the individual and their families need to learn to live with.

Can we be hopeful?

There is much work going on looking at a cure, but we are not there yet.

It is something that you learn to live with in Type two diabetes.

That actually is an issue that remains debated at many conferences and meetings.

It is possible when you live with Type two diabetes to for some individuals to get their blood sugars in the completely normal range without the use of medications.

I do not believe that is possible for every individual, but it is possible for some individuals to get their blood sugars normal in the non diabetic range without using pills or insulin.

So do you say that they're cured?

I'm not sure that I do.

And this is a personal opinion, because they will always have to work extremely hard above and beyond what other people might have to do to keep those blood sugars in the normal range.

In terms of being their physical activity levels of their food choices, they will always have to pay attention, perhaps more than other individuals will.

What's being used in the medical world now is remission of Type two diabetes as opposed to cure.

I love the answer.

You know, just exploring the opportunity because it's such a big issue and the fact that there's so much work and it's getting so specific and more specific and more specific than that.

As you're sort of diving down into finding out these different genes and some of the stuff you're doing or your team is also doing list, it's quite incredible.

Let me just ask you this last question before I I thank you so much for your time.

If there was one thing that you wanted to let the public know about diabetes, that you maybe you found through conversations with people like me or other people on the street or you've been talking and you find that it's there's a kind of a myth or a misnomer about diabetes, and you say no, I find I'm always correcting people about this.

Is there something that you want to share that is, and maybe it's more than just one, but certainly is there something you want to share and it's and it's over to you.

This is not very scientific, but I think it is for either Type one or Type two diabetes.

Our families carry the burden of reactions that say it's their fault, whether it's type one diabetes or Type two diabetes.

I've had mothers of Children with type one diabetes.

Tell me that you know they're at a school function and someone says you can't give your child that treat well, that's their choice as a parent, and they know what they're doing.

Or that if they had only not fed their child desert, they wouldn't have developed Type one diabetes.

It has nothing to do with it.

And in type two diabetes, it is true that many people who live with type two diabetes carry extra weight, but not everyone.

But it's a very complex issue.

It is not an individual's fault that they developed Type one diabetes.

And when you talk to people who live with any sort of diabetes, I'm always amazed at how often when you ask them, what do you struggle with most?

And I think they're going to say insulin injections or and they say it's feeling like it's my fault and it is not so well said, a great way to sort of end this conversation.

Liz, I can't thank you enough for taking some time to have this conversation.

I can't thank you and your team, and I want to be very clear.

Thanks for the correction.

You and your team, the work you're doing.

The fact that Type two has a home here in Manitoba is one of those elements.

That again, I think, is something just to talk a bit about, because it's not only that, it was sort of discovered if I could use that term here, but there's so many people across the world that are working on it.

But it's something that I think is Manito bins again.

It shows you some of the elements that we've done around research.

I just want you to know that, you know, as a citizen, I want you to know, and as a friend, thank you for all the work that you and your team are doing.

And I look forward to more conversations with you as you proceed down this journey of educating people around the research and some of the issues around diabetes.

Well, listen, Stuart, I really appreciate the invitation and look forward to ongoing conversations.

Humans on Rights is recorded and hosted by Stuart Murray.

Social Media Marketing by the Creative Team at Full current and Winnipeg Thanks also to Trixie.

Maybe you in Music by Doug Edmund For more go to human rights hub dot c A produced and distributed by the Sound Off Media Company.

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