Dr. Korey Hood is a clinical health psychologist and Professor of Pediatrics and of Psychiatry and Behavioral Sciences at Stanford University. He directs NIH- and foundation-funded clinical research to improve the health and quality of life of people with diabetes. He designs programs that (1) address barriers to managing type 1 diabetes, and (2) optimize the use of diabetes devices and technologies to improve outcomes. He also coordinates the Human Factors assessments in national and international closed loop trials. Last, but not least, Dr. Hood is married to Dr. Diana Naranjo. Like Dr. Hood, Dr. Naranjo is a clinical health psychologist. She is an Associate Professor of Psychiatry and Behavioral Sciences and Child and Adolescent Psychiatry at Stanford University and has a private practice working with families with diabetes. Much of her work involves training community mental health professionals about diabetes as a way to reach and support people with diabetes nationally. She's studied individual, family, and digital factors affecting the management of type 1 diabetes, and, with Dr. Hood, published a review on how psychological factors affect diabetes technology use. Drs. Hood and Naranjo met six years ago at a Behavioral Research in Diabetes Group Exchange (BRIDGE) meeting. They've been married for almost four years. Diabetes brought them together. It is the focus of their work. Diabetes is also a part of their home life because Korey has diabetes. I recently caught up with Korey and Diana at BRIDGE. We chatted about their work/life diabetes dance. Here's how that went down...
Diabetes is a huge part of your professional and personal lives. What does that look like day-to-day?
Diana: Korey and I talk about diabetes A LOT together. We talk about his diabetes, all diabetes, about research, about cases, about new ideas. We are super collaborative in both life and work.
Tell me about your diabetes diagnosis and what helps you manage it.
Korey: Six months into working on a PhD focused on the behavioral and psychological health of people with type 1 diabetes, I was diagnosed with type 1 diabetes. That was 17 years ago. I manage a lot on my own, and I don't need handholding or guidance. I definitely don't want a lot of advice.
Diana: Any advice. (laughter…)
Korey: Help with the things I need, occasionally, is helpful. I get a lot of emotional support from being around other adults with type 1, or even couples. We know other couples where one person has type 1. Most of the teens with diabetes I see in clinic want peers with diabetes they can talk to. They don't want to talk about diabetes, per se. I'm the same way many times. I don't need to talk about my diabetes with people with diabetes. Just being around other people with this shared experience is helpful. It's because they get it. My professional life is all about diabetes. Many times it's complete diabetes overload. It's less about the personal stuff. It's more the professional side - being in diabetes all the time. I notice when I have breaks from work, even for 4-5 days, I've thought less about diabetes. And, that's refreshing. I have to find those times when I can step away. It helps in my own management. I'm on autopilot when I'm busy, and tons of things are going on with me professionally.
Has being married to someone with type 1 diabetes shaped your work in diabetes?
Diana: It gives me street cred. I study diabetes, counsel people with diabetes, but I live in a household with diabetes. I see the daily tasks, the difficulties, the triumphs — all of it. If it's in your life, you have a different understanding of it than if you only see it in your office. That being said, I don't understand it to the level Korey understands it because it's not mine.
How does Korey's diabetes affect you?
Diana: Living closer to diabetes has changed my attitude towards diabetes technologies and devices. There are a lot of pros, but a lot of cons. The CGM alarm is loud and goes off all night, all the time. It vibrates. It repeats. It's irritating. It can be stressful when I know he's making choices that are going to affect my sleep. He'll get a craving for cereal before bed, and I know what's coming because cereal always elevates blood sugars overnight. It's a delicate balance. I want him to feel like he can do whatever he wants to do, but his decisions also affect me. The cereal scenario is an example of a short term issue, but longterm complications worry me most. My life is connected to his life. I feel like I have a right for him to be as healthy as possible, so we can experience this life together. So, I take some ownership of that. That can be complicated because it's not my body. It's not my diabetes. It's not my food choices. It's not our exercise routines. But, it's our collective life.
Korey: There are many times I don't want to validate those worries or concerns, especially in the moment. But, she has to put it out there, and then it takes me some time to think through it. If, at the same time, she is saying I'm concerned about this and worried about that, she is also saying I'd like you to do this… it doesn't go well. Instead, if I have time to process her worries, I can think through ways to change that are good for my health and validate her concerns.
How do you help Korey?
Diana: In specific ways. If Korey's gone down to the kitchen three times for low supplies in the middle of the night, I'll go down even though I don't want to get out of bed. Or, when there's a site he can't reach, I'll help push it in. I've gone to a few doctors appointments. I'll send him articles about new drugs or devices, but he's usually seen them already. I'm also a buffer between Korey and his family. Korey's parents are on the Dexcom share. So when the alarm goes off, they call and text me in the middle of the night, asking, “Is he doing ok? Has he taken juice?” I'm the one telling them he's ok.
How do you like being the buffer?
Diana: Sometimes it's a little overwhelming. I'm already getting woken up from the alarms. I'm already worried and trying to take action, and then I'm trying to take care of them too.
Korey: For people doing Dexcom share or any other kind of remote monitoring, you have to have rules of engagement. Otherwise, it can be counterproductive. Sometimes I turn off the share function, and other people talk about this as well, because I already know something's up. I don't need to hear it from anyone else.
What additional advice do you have for couples or family members with diabetes in the mix?
Korey: Advice I often give couples or parents or teens, is to ask the person with diabetes, “What can I do to help?” Find out the kind of support they want. Like me, occasionally, I need someone to bring me juice. I don't need someone to prime my pump. But, there are plenty of couples we know that the person with diabetes let's the partner give insulin in the middle of the night if there's a high blood sugar. It's not that I don't trust Diana to do that. It's just I would rather do it.
Diana: Take the lead from the person with diabetes. I could easily have jumped in and said, “I know all about support, coping, and destressing.” But that's not what he's looking for. I try not to say things in the moment because it never goes well. Instead, I try to wait, collect some data and present it in a way that's cohesive and curious “Hey, so for the past month it seems like your mood has been a bit low, and your sugars have been kind of high. Just wondering what you think about that?” He'll weigh in, or I'll ask, “Is there anything I can do to help?” Often there's not much I can do to help. Though, sometimes he'll ask for specific things. And, I'm happy to do them.