Why You Hold Your Breath Every Time You Check Your Blood Sugar with Sam Tullman

[00:00:00] Rob Howe: Hey everyone, welcome back to the show. We're continuing this series of Living Well with Diabetes, and in the four pillars, the second one is mental health. And I am going to be participating in a Diabetes Sangha retreat. My guest is one of the co-founders and facilitators of Diabetes Sangha. He's been on the podcast before, Sam Tullman, and he is going to sit with us and talk a little bit about mindfulness and mental health around your diabetes. Sam is a dedicated student of Rinzai Zen, and he is now the record holder for Zen references and stories on the podcast with four. And he and I have become good friends in our time together, and I'm really looking forward to sitting with him and the rest of Diabetes Sangha in Washington very soon. The importance of mental health cannot be overstated, and I think if you are really looking to try to get out of a mental rut with diabetes, give this one a chance. It's light, it's interesting, and it helps us to reframe our diabetes and look at our glucose and look at our life with diabetes without judgment. I hope you enjoy it as much as I did. Guys, who was MVP of the chat? Rob Powell! Rob Freakow! What were you on? We need more of that. Sam Tullman, welcome back to Diabetics Doing Things. Been a couple of years. I've fortunately got to meet you in person since the time that you were previously on the show. You are still living with type 1 diabetes, as are we both. And it's my pleasure to have you back here today. And welcome back to the show.

[00:01:30] Sam Tullman: Rob, it's a pleasure to be back, man. It's great to see you. And yeah, just thankful for your work in the community. Thankful you're still doing this. I think it's a benefit to all of us. So good to be back here.

[00:01:40] Rob Howe: Well, thank you. And likewise, at the time this will be published, I think I will probably be on a retreat with Diabetes Sangha. So I'll get to see you and the rest of the crew on my first in-person retreat with you guys. So I want to give that back to you. Thank you guys for all the work that you guys collectively do for so many people.

[00:01:57] Sam Tullman: Absolutely. Yeah. We're all doing our part.

[00:01:59] Rob Howe: And even better if it can come from the heart, as I think it does for you.

[00:02:03] Sam Tullman: Yeah.

[00:02:03] Rob Howe: So let's talk about the heart today. Because we, you know, I'm taking this approach this year for this idea of living well with diabetes, which at the core, whether you are a patient or you are a caregiver or a parent of someone with diabetes, I think is a universal thing we share is that we want to be able to live well. And that, you know, whether we have complications associated with diabetes or no matter how we were diagnosed, we want this idea to hope to live well with diabetes. And there's a lot that goes into that. And one of the things that continually shows up for me and others is this idea of mental health. And so I'd like to have a little bit more of a free-flowing discussion because you are a great interview, as is now a fellow podcaster yourself, to talk about the head and the heart and mindfulness and consciousness and meditation and things that are sort of these high-level concepts in many ways. But we can sort of distill down to what someone with diabetes might be experiencing. And so I'd love to start there of like mental health is often, I mean, we have to label it, right? It needs to have a label. but it's often discussed as this separate thing. And, you know, the head and the brain and the heart, for that matter, are part of our body. Like we are one thing and part of our consciousness of just sort of being alive. So I'd love to just see how that lands for you of, you know, this idea of mental health and diabetes and how it all works together.

[00:03:29] Sam Tullman: Yeah. I mean, there's so much there. I think we'll probably be orbiting around that topic for the whole time today.

[00:03:35] Rob Howe: I hope we do.

[00:03:36] Sam Tullman: You know, there's two things that immediately come to mind and maybe we can riff on this a little bit. The first one is kind of meeting us where most of us are at, which is that what's going on in the mind, which is heavily related to what's going on in the brain, but we can even broaden it beyond that, is hugely impactful of what's going on with our body. And so if we're focused on just getting good blood sugars or managing diabetes well, quote unquote, whatever that means for you, the mind is critical and we so often leave it out. There's a couple of different pieces of this, right? So like an easy place that we can talk about this is just the way that our bodies respond to insulin, right? There's so many mediating factors, but two big ones, stress and sleep. Stress directly related to what's going on in the mind. And sleep, one of the biggest issues with getting to sleep is stress and other things that happen. And quieting the mind in some ways, right? Exactly. Exactly. And so, you know, when those two things aren't, you know, aligned or harmonious or aren't being cared for or taken care of, that creates problems for our insulin sensitivity, which makes it much more difficult to manage this condition. That is just like tip of the iceberg in terms of influences of the mind on the body. And then you think about also decision-making, right? Like we don't think of type 1 diabetes as having a behavioral health component. We know that it's much more likely to have a depression or anxiety if you have type 1 diabetes. And so I think that's widely known and appreciated now. And fortunately, there's more and more resources. I think both of us would like to see more resources around that, but they're increasing. We don't think about the actual day-to-day management of type 1 diabetes being a huge behavioral health, mental health matter, right? The example that I always love to give here is rage bullising. So, you know, rage bullising, you know, for those who aren't familiar with the term, probably most people are. And if you're not, you could also just look it up right now. But you can imagine a situation where your blood sugars have been high and maybe stubborn. They're not coming down. You're trying all the stuff and you just feel bad. You're getting more and more frustrated. Probably part of your frustration, by the way, is the fact that you're getting signals from your body related to your blood sugar that is actually telling you that you're uncomfortable. You're anxious, you're stressed, you're annoyed because high blood sugar can actually feel like that. Whatever is going on actually in your mind, your body is telling you, well, you must be annoyed, right? Your heart rate is a little bit faster or it'll find you're headed or whatever the symptoms that you're feeling. your body's telling you that you're not safe and you're not comfortable and you get a little more annoyed and frustrated that way. So anyways, as a result of, you know, this kind of this spiraling situation where you're getting more and more frustrated, you make an aggressive decision, which you give substantially too much insulin and you end up with a low blood sugar. Maybe then you end up with a little bit of a roller coaster up and down. Chasing the highs and lows and treating and such. Right. Very relatable. And everybody does it, including me. Like I'm, You know, I've been meditating for 10 years and I still do this. And I've had diabetes for 23 years now. So it still happens. The point is not that it doesn't happen. But the point is that every time we're making a decision about our blood sugars, that decision is hugely impacted by our state of mind. How aggressive we are, how patient we are, how much we're able to see a bigger picture, a little bit more perspective, get creative about solutions, understand a little bit what's going on. or even if we don't understand to not overreact. Those are all qualities of the mind that directly impact our physical health.

[00:07:16] Rob Howe: Well, I think your first response to this question earlier was that we're going to orbit this for the entire conversation. And now I feel we could do another hour just on that because it's also sort of a loop. I'll give an example from today, which I noticed, and I was happy that I noticed because I knew we were going to have this conversation. But I was feeling, use the term spiraling, that felt right. I was kind of annoyed. I was making a mountain out of a molehill, which is, I think, a key factor for me when something's kind of going on with my body. It's not right. And I was like, well, I don't quite feel like I'm having a hypoglycemic incident yet, but let me just look at my CGM. And I was like 71 milligrams per deciliter. So, you know, not urgently low, but we're floating around there and obviously possibly could be a little bit lower or higher depending on, you know, actual blood glucose versus the CGM. And I thought for just a second, I was like, I wonder if this way that I'm feeling is actually not how I really feel, but is just a side effect of my body giving me some sort of signal that something is not right. And can I take an action now to sort of quiet this part of my mind that has really nothing to do with my mind, but everything to do with it in that it's part of my body and there's something going on with my body that's outside of the range that it wants to be in. And it doesn't feel safe, to your point earlier. My body doesn't feel safe, so of course my mind doesn't feel safe. And in that way, I was like, oh, well, this makes a lot of sense. Let me go have a couple of glucose tabs here and see how we feel after that. And you know what? I hadn't thought down that same frame of mind I was in since that happened today.

[00:08:56] Sam Tullman: This just really gets into there's a whole area of neuroscience, which is kind of one of the more broadly accepted theories or understandings of the brain right now, which is called predictive processing or predictive coding theory. And I'm going to like, you know, simplify it and dumb it down a lot. But if you want to dive into this topic more, one of the kind of pioneering researchers in this area, her name is Lisa Feldman Barrett, Dr. Lisa Feldman Barrett. And she has a great book, which is pretty comprehensible, even if you don't have a science background. It's called How Emotions Are Made. And it's right to the topic that we're speaking to. It's to the heart of predictive coding or predictive processing theory. The idea is exactly what we're saying, right? So there's signals coming from your body. They're going up to your brain. Your brain has to interpret them. There's also signals coming from the outside, right? So your body is one source. Your eyes are another source. Your ears are another source, et cetera, et cetera. it's taking all of this raw information way more information than we could ever be consciously aware of and it has to make a decision about what the heck is going on literally like making statistical inferences it's like the most it's the original machine learning ai model right not all of them dumb it down our brains and our our bodies and minds are much more than just ai but the incredible capacity to take all of this information and then to come up with a best guess. That's all our consciousness or our brain is ever doing. It's just a best guess of what's going on, right? Like out of the corner of my eye, I know that there's flowers on the other side of the screen, but I'm not actually seeing flowers. That is my best guess. I'm seeing a little splotch of red, a little splotch of yellow. And because my brain has a previous experience with this room recently, knows there's flowers there. And so it's best guess is I'm looking at flowers, but I might look up and it's like a clown face or something, you know, it could be something completely different. So predictive processing theory basically says we're getting this information from our bodies, like information from a low blood sugar or a high blood sugar. And naturally, these are things that there's a lot of, I'm going to use another kind of neuroscience-y word, interoception, which is our ability to feel what's going on internally in our body. The internal signals, not like the external signals, like touch, but some of the internal information from our organs and our blood. like our blood sugar. And blood sugar is like a huge potential warning signal for our brain, right? Blood sugar is off. That is a big problem. It wants to get that handled right away. And so we're taking that information and our brain is going to immediately understand that as there's a threat. And it's going to start looking for threats of different kinds and different ways based on the information it's getting from the body. She tells an amazing story, Lisa Feldman Barrett, about there's this one coworker that I think, you know, I don't know if this coworker had asked her out before or you know just kind of given her some clear vibes that that he was interested and you know she was clearly not not interested not interested um and then at some point he asked her out and she was like wanting to be polite and so she said sure you know i'll go out with you and so they're out at this meal and she's sitting there at this meal and she's like oh my god what's what's going on here do i have butterflies in my stomach or something like am I really like this guy? Like, I really didn't expect this. And it's just like, I have this magical experience. And then goes home and realizes that she has food poisoning and was sick for like two days, right? So she's totally misinterpreted. Her mind has misinterpreted the situation based on the best information it has. It's coming to a conclusion and I guess. How interesting. And we do this all the time. We have no idea because 95% of the time, And it works out just fine. There are flowers there, right? I can be sure. I want to pull a flower for you to see so you know I'm not just making this up, right? There is really are. But we're not aware of the 5% to 10% of the time, or maybe it's much larger, that this doesn't work at all. Like, we've totally made stuff up and we've come. We're like, I'm mad at this person. It's like, no, you're not mad at that person. It's like the Snickers commercial, you know? You're not you when you're hungry. You're hungry, you know? Like, you're not really mad at that person.

[00:13:03] Rob Howe: And, you know, I think there are people in the diabetes community who will recognize like, I'm sorry for what I said when my blood sugar was high or low, like the T-shirts or the stickers. And I think we laugh about those. But you bringing up interoception made me think of something back to the point earlier about like the cognitive load or the behavioral aspects of life with diabetes. And it brought up something interesting to me because as people with diabetes, as we are onboarded to the knowledge that we live with diabetes and our glucose is no longer automatically managed by our body, we then kind of add a skill set of noticing how we feel based on what our blood glucose is, right? we all know at a certain point, obviously there are exceptions. And the longer you live with diabetes, it can be a little difficult sometimes. Things like hypo unawareness, hyper unawareness. But we learn what a low blood glucose feels like, what a high feels like. And that's information that a person without diabetes maybe knows, but not truly, like acutely aware and making decisions of I need to take an action on this and my body is sending me a signal that I'm in trouble and I need to move on this. And that's something I hadn't really thought of. I think I've said on record in the past, like I do feel grateful for the connection to my body that I have as a result of type 1 diabetes and being able to trust how I feel and knowing that there was something wrong with me at the time of diagnosis, that it wasn't just in my head, so to speak. But there's already so much cognitive load in a life in 2026. There's a lot of, I got my phone right here. It's designed to distract me and, you know, exploit all of my qualities to the maximum level to be focused on it. And there's diabetes as a part of that and just life in general. So feeling that sense of overwhelm and like it's no wonder that we're three times as likely to be anxious or to suffer from some sort of depression because of the increased cognitive load brought on by our body.

[00:15:02] Sam Tullman: Yeah, absolutely. Absolutely. Well, I love that what you've highlighted there, though, because it really is a strength and a curse. It's a strength and it's a weakness, both. It is an additional burden and there's an opportunity there. And so I love one of the things that you said was that you're grateful to diabetes for the increased connection to your body. And I know it's been my experience, and I am always saying this in our community. I speak to others about diabetes and meditation, that we really do have a kind of a leg up as people with diabetes of understanding our mind and developing a different relationship with our mind. There's some additional complexities, but because of this increased interoception, right, we know what these highs and lows feel like. We have this very embodied understanding of constant change because our blood sugars are constantly changing. So there's a real embodied sense of that and a real embodied sense of how the mind changes with different blood sugars. And I remember this was kind of one of my early realizations. You know, I was diagnosed when I was eight years old. So, you know, probably by the time I was 10 or 11, I was starting to notice these things. Like, oh, this is changing the way that I feel. That changes like how my conversations go or how I'm doing in school. And so there's a real opportunity there to develop a different relationship. Now, the additional challenge is that there's difficulty there, too. And there's a lot of frustration. So sometimes the relationship that we develop that increased awareness or capacity is we develop an aversion to it. And we're like, this feels bad. I don't, I'm going to push this away or I'm going to ignore it. So then, you know, you increase this kind of inability to sense lows and highs or I'm going to act out in a certain way or I'm just going to, even if I can feel it, I'm going to avoid it in a different way and not treat it. Or you get a different kind of aversion where you're like, I'm going to avoid this happening at any cost and you'll end up living a very small kind of boxed in life. And so that's the additional challenge, right? We have this increased awareness, but sometimes we're not ready with the kind of equanimity and compassion to match being more aware of all of this difficulty. But if we can work within that a little bit and soften things up a little bit, the opportunity is huge because that then translates to the rest of life. There's nothing that diabetes is teaching us that life isn't also teaching us. Diabetes is still like a crash course in it.

[00:17:23] Rob Howe: I really like the way you frame that. I think the thing about where I, and you and I are about the same age, or I think you're a little younger than I am, but it's so interesting how, I think I've said this before, I'm sure you feel the same way, like being diagnosed when you're eight years old, you're forced really quickly to grow up in a mature way of like, you're very aware of your own mortality at a, at a very young age. and also you become more independent as a result. Many, many people, some others, I think, take a little longer or whatever the case may be. But I think at that point now, as I'm in my late 30s, I'm starting to think of like, oh, like all these life lessons or the wisdom that I've acquired from living this long, as they say, any fool can learn from experience and I'm no different. I've learned so much of that from diabetes as well. And at the same time, something that came up for me while you were talking is the idea of holding something in both hands, where acknowledging the devastating, annoying, never-ending effects of diabetes and the emotions that come up, pain, anger, sadness, and also being able to be grateful, being able to be curious, being able to say, yeah, you know what? I learned this lesson a long time ago. I don't have to learn it again because I have type 1 diabetes. And so I always am prepared for the worst outcome. I'm more tuned into my body. And I think for me, if we're going to shift this into what's a practical application that somebody could take away from this conversation in a way to improve their mental health is maybe to talk about when you're noticing a low blood sugar or a high blood sugar, maybe even without looking at your technology or just confirming it in that way, you're really meditating in a way. You have a curiosity about why you're feeling a certain way. And I think, you know, that was something for me that, you know, meditation, and I'd like to talk about it with you. It's a practice that I think many people with diabetes, if they haven't tried it, could benefit from just from the idea of being able to allow thoughts into their mind, notice them and continue moving forward and have a curiosity about what that's like. This is just a practice that may solve a bunch of problems.

[00:19:25] Sam Tullman: Well, yeah. So we're always practicing. And I love that you brought that in. Like, you know, when you check your blood sugar, you're practicing it. And that's true. No matter what, we're practicing something. And I think that's an important starting place, an important perspective, because it begs the question, what am I practicing right now? So when you're checking your blood sugar, you are certainly, or you're noticing your blood sugar, right? As you mentioned, you're practicing awareness for sure, right? You have to be aware of your body. It's kind of, there was some cue for you to check, or maybe you're aware of time. There's a certain time you're going to check out. So it is a practice of awareness. But if you look at most of the definitions of mindfulness. And I think there's lots of different ways that you can put words to it. Important is to experience what that means for you. But there's a lot of different words that people put to it. And so often there's a kind of framing like it's a nonjudgmental moment to moment awareness. And so as people with diabetes, we are kind of, I don't want to say forced, but we're pushed into a moment to moment awareness. And maybe we don't always have that true moment to moment awareness that you're really working on if you're sitting in meditation, but we're probably, we've got a little bit more of that than most people do. And we've got more frequent little blips of awareness. So we've got a little bit more of that awareness part. We don't have the non-judgmental part. And nobody does.

[00:20:43] Rob Howe: We're sort of like, we're sort of conditioned to like be very judgmental.

[00:20:46] Sam Tullman: Well, that's right. That's right. But everybody is. So I don't think that we're disadvantaged in that sense. Actually, I think we have an advantage in the moment to moment awareness. And then I think in the non-judgmental part, we're just the same as everybody else, which is that we judge everything. And especially we judge things that feel threatening or feel really important or scary in some way. So with a blood sugar, especially, we jump to conclusions. I would make a little tweak on what you said. We are always practicing, but we're practicing mindfulness when we check our blood sugar if at that moment that we're noticing, we can bring a little bit of ease. We will often notice that there's some tightness associated. Even if I'm not even looking at my blood sugar monitor. I have it on my watch. So I can look at my watch. So often, and I invite everybody to experiment with this themselves, when you look at your blood sugar, you'll end up holding your breath. So you'll inhale and you'll be holding your breath. And so it's a practice just to keep breathing or even to try to exhale slowly as you're looking and let your body be relaxed. That helps this nonjudgmental piece. Relaxation and being nonjudgmental, not exactly the same, but it really helps being non-judgmental if you're relaxed. And so I think it's a good starting

[00:21:59] Rob Howe: place to say, let's relax into this. And now we're exactly where I wanted this conversation to go, which is like something that you couldn't plan for, right? Something that I could have sent you an agenda. We maybe would have gotten there, but I like that we've improvised our way here, which is the sort of fight or flight mentality that diabetes puts you in, right? Whereas, I mean, in some ways it's an acute condition that requires immediate action. The awareness too of like, well, I'm recognizing I'm holding my breath when I check my glucose because I'm bracing myself for impact. I'm trying to protect myself. Right. And your body is signaling that like something may be dangerous is coming up. Right. It's a chronic stress, but it is your body signaling to you that you need to protect yourself. And I think that there is and I'd just be curious to your thought on this, because you talked earlier about stress we know impacts our glucose. Like it's physiological. It happens to our brothers and sisters who don't have diabetes as well. They just have a pancreas that can adjust. And at the same time, we're not taught to practice, hey, let's work on noticing our relationship to when we're in that mode where we just have to rage bolus. We're emotionally tied up. Our knuckles are white from all the stress. We've maybe been sitting down after lunch, after a long day of calls. That's kind of my, if I'm feeling a little bit upset or a little bit angry in the afternoon. It's because I ate lunch and then immediately sat down for two hours and haven't had any water and I haven't been outside and I haven't moved. And it's of course my sugars are high and I'm in this like fight or flight mode. And what we know about not just diabetes, but just as a person and a mind and a body, you know, living in a fight or flight mode all the time, it is not sustainable and causes, you know, downstream effects that are really challenging. So I guess like showing up and thinking about like how to notice and be mindful of those times where maybe you're in a fight or flight response around something like just checking your sugars or if you have an out of range glucose, you know, excursion or one direction or another, like how do you notice that without

[00:24:04] Sam Tullman: judgment? How do you bring and coach that nonjudgmental state of mind? It's a muscle. It's a muscle and we need to work it. I'll start by just saying that it takes time and it takes practice and there's lots of ways to practice but you know my my preferred way is mindfulness meditation and other forms of meditation practice but actually i want to take this back to what i was starting to say at the beginning and we kind of got off a tangent this is the perfect full circle here um at the very beginning we were talking about the mind and the body and diabetes and how sometimes we kind of put the mind over here but it really is part of the body and it's part of our diabetes experience. And I gave some examples about how relating to the mind skillfully is helpful for managing one's diabetes. And I gave a few examples of that. But I didn't get to say this kind of whole other arm, which for me is the foundation that answers the question of how do we start practicing less judgment? How do we start practicing more ease with diabetes? And the foundation has to be this. Let me actually just ask you this question. And if you're in the audience, you can pause and see what your answer is to. So here's the question. What is your goal in living with diabetes? So you had to name a goal. What's your goal?

[00:25:21] Rob Howe: I think what comes up for me first is I'd like to live long. I'd like to, you know, I'd like for my life to not be cut short, you know, by the diabetes, to have a chance to experience a long life. Yeah. Yeah. I mean, I think I could probably go a dozen other things, but like that, I wanted to be true to what came up first for me, which is like, and that's, I think what it is, is like to have a chance to live a long time. Yeah.

[00:25:45] Sam Tullman: And I think that's so important. Like, and I think that actually relates in a beautiful way to everything else we're talking about. But what comes up for me with this question, I used to work at this retreat center. It was my first job out of college. I worked at a retreat center. At that retreat center, I met a dear friend and mentor of mine by the name of Brad Liechtenstein, Dr. Brad Liechtenstein. I invite you to look him up. He's still doing great work. He's an expert on the breath, not diabetes specific, but he does work with people with chronic conditions. And he would always challenge people. People would come into this retreat setting. and they would come in and they would kind of, he would invite intentions and people would have intentions and they have goals of what they want. And he would say, but why? And they would say, well, I want that because then, you know, I want to make a million dollars because then, you know, I can have financial security and I could be healthy and yada, yada. And he would say, okay, but why? Why do you want financial security and why do you want to be healthy? And then they would go another layer or whatever it is. But why? But why? At the base of all of this is that we want to be happy. We want to be happy as people. And so for me, I think something that so often gets lost and why this kind of mind-body piece is so important, we lose the point of living with diabetes. It's to live well. It's to live a good life, to have a happy life. That for me is what I want more than anything. And I also hope it's a long life. But I don't want a long, miserable life.

[00:27:13] Rob Howe: I agree. And I'm not saying that's what you're saying, but but just to put that forward as a kind of the priority of the conversation I want to bring.

[00:27:23] Sam Tullman: When we make the focus at all times, I want to live a good life with diabetes or I just I want to live a good life and I have diabetes. If it puts everything into balance in a different way, right? Because difficult to live a good, happy life if you are really not taking care of your blood sugars at all. Like if your blood sugars are really a mess, it is going to be difficult to live happy and at ease because your body is constantly giving you these emergency signals. And so, so many of the different things that they say like, oh, well, this is important. You know, an endocrinologist will focus on the blood sugars and naturally that's their job. But the real focus, I feel very strongly, should be how do I live a good life with diabetes? Because again, if I have perfect blood sugar management and I'm totally miserable, and by the way, I have met those people. There are people who have incredible, much better than me and my blood sugar management is quite good. I feel impressed by it and my endo likes it and that's great. but there are people that have much better blood sugar management than me and they live really small restricted lives and you know i can't measure it quantitatively but my sense of them is that they're not actually that happy or satisfied with their life so living in a little box and that to me is not the goal the goal is how can i live a happy life while i'm doing this and if we put that forward everything else comes a little bit more into perspective right if i'm testing and my blood sugar is high and I get really upset about it, my focus and that moment is on having perfect blood sugars, most likely not on living a happy life. Now, I might still be frustrated when I test and have a high blood sugar because it doesn't feel good and it's hard to reflect on, hey, you know, having a lot of these high blood sugars is going to impact my long term health. And maybe this high blood sugar means that I have to wait to eat a meal. And that's kind of restrictive. So I might still be upset and sad, but it kind of stabilized, brings things into range a little bit more. So the highs aren't so high emotionally and the lows aren't so low emotionally. Brings us a little bit more balance and ease of, okay, the point here is to live a happy life. What's my best option? And then we constantly take the next best option. I am a huge proponent of meditation practice, mindfulness practice. And I think there's two ways that we can think of meditation practice. And it's been this way for millennia. People have thought about these in both ways. And both are complementary. They're not at odds with each other. One is as a source of relief, right? So in the moment, I might be struggling and it's helpful for me to have some relief from the more difficult experiences that I'm having. Stress, anxiety, can't sleep, fear, all of these things. So in the moment, a little bit more of that ease. And it doesn't just impact us in that moment, right? It impacts us later in the day and maybe in the next day. So it has a little bit of an afterglow as well. But we think about this kind of more relief-focused effort of meditation. That is real. And that has been studied. The results are really impressive, right? You can look. There's a lot of research on MBSR, which is Mindfulness-Based Stress Reduction. So you can even hear it in there, right? It's about relief. It's about stress reduction. Very, very impactful. Done research in diabetes for this as well. decreases diabetes distress. They've done research in anxiety. It's as effective. There was a large randomized control trial that consistent in-depth mindfulness practice was as effective as anxiolytics, this kind of anxiety medication. So we know that the impact is large of really, really doing this practice and diving in. There's a whole other strand though. So that's the relief side. The other side is this long-term change and learning and growth. And that is, as mentioned, long-term. It takes time and it's cyclical. You go through periods where you're really having a lot more perspective and then you go through periods where it's, you know, much less perspective and it's more difficult to access. That is the other piece of this. And we can develop these two together. We can develop our ability to be at ease with ourselves, to settle our minds and our insight or our wisdom into the nature of our minds and our body and our experience and our reality. Both are so, so important. And you can expect that one of them, these big changes, takes time and time measured in, you know, five, 10 more years to really see some of these changes. But also these have been research and there's really, really cool research around them.

[00:31:50] Rob Howe: I'd love to dig deep into a lot of that. I was jotting down a few things that I wanted to talk about along the way. And I think the first is to give some folks some grace if they feel like they've been trying. And like you said, it's a long term. You got to zoom way out and look at the growth trajectory of someone and the impact on your life. I have to credit my old therapist on this because I was having some friction in my personal life where I was finding that relationships were changing with some people around me after I had been doing a lot of work on myself and my mindfulness and, you know, years of it. And my therapist made me kind of see it in a way that she said, well, if Rob, if you were putting as much time and energy towards almost any other skill or a physical practice of some kind, like if you were lifting weights or you were training or you were learning to be a carpenter or an artist or something, you wouldn't be surprised that you were making progress over the long period of time. So it makes sense then that some of the things that used to make sense to you don't make sense anymore or some of the relationships don't fit anymore. Just like if you were, you know, growing muscles, maybe you wouldn't fit in the same shirt size anymore. It just those those things no longer serve you. And and I found that and you're a tall guy as well. So maybe this will resonate with you more than even other people is like growth is not comfortable. I remember being, you know, 12, 11, 13 years old and like waking up in pain because I grew overnight, you know, and like my knees hurt and I was unfamiliar in my body. And I think we look at as adults, maybe growth in the form of financial or business, or it makes it seem that growth is always good, but growth is challenging. And that includes growth that you can't see and that's hard to track and that's going on internally. So I'd like to encourage people who have run into that resistance. On the other side, I do find it really like, A, the research also that Diabetes Sangha has championed and been part of, I want to really applaud. I've seen Brooke and Peter presented at conferences. And I'm a big believer in mindset. You know, the main thing is, if you can't believe that it's going to be possible, nobody else will. And I think Henry Ford maybe said, like, whether you believe you can or you can't, you're right. And I try not to. I know there are many other social determinants of health that come into play with diabetes. But I think that mindset, mindfulness and approach to self-belief and is something that is critical to living well. And I think, again, the question is like, what am I optimizing for? Is the 2026 version of what is your goal? And I think you're exactly right. There are a lot of people with amazing A1Cs and amazing time and range who are unhappy because they've, you know, I love the way that you frame it as like living a small life. And again, like I hope that people in those situations, maybe to them that life is full. And like, that's the thing about life is that everybody gets to choose, right? And decide what's right for them. That's not my choice. But it also reminded me just overall of the approach. An Olympian, Alysa Liu, I believe is her name, is a figure skater. She had taken some time off. She was an Olympian previously as a child, like dedicated her entire life to being a top performance figure skater and had to take some time away for mental health and came back under the pretense that she would need to be able to determine her own training and wasn't going to be fit into a program that she didn't sign off on. And she, of course, came back and won a gold medal and, you know, had this incredible success. And in the post-Olympic press conferences, people were asking her about this difficult journey and like coming back. And her response has gone viral many times over. It was basically, I don't think things are going to be hard from the outset. Like, I'm just going to pursue joy. I'm going to be an artist. I'm going to explore the ends of my capacity in a creative way. And I just thought that that was so impactful because, you know, again, back to the Henry Ford quote, like whether you can or you can't, you're right. Whether you believe you can or you can't, you're right. And like, OK, like we all have with diabetes a task in front of us of whether it's a pizza party or a birthday party where there's cake and unknown ingredients. So like that's going to be something in front of you. And so you have a choice as you walk into that. Oh, am I stressed out? Am I in fight or flight? Am I on defense trying to make my way through this? Or can I accept it as it comes without judgment and enjoy this experience?

[00:36:17] Sam Tullman: There's a great story that this reminds me of, and this has really gone to heart. It's a story of an old Zen master. I believe he was around in the 17th and 18th centuries. Zen master Hakuin. And, you know, had this big kind of following and became, you know, very renowned throughout the country. at some point he is you know giving some kind of lecturer a lesson and somebody barges in and says hey you are such a scoundrel i can't even believe you you're like supposed to be celibate and you know you're a monk and you got my daughter pregnant and he doesn't try to argue or say anything you know he didn't first of all i mean i think that's an important part of the story he didn't and we'll find that but in that moment in front of all these people he just said is that so and so you know then just kind of like a lot of people leave him and they're like hey he's kind of disgraced um and they're like what's what's the deal with this guy he was like kind of totally a phony this whole time and then the baby is born and this family doesn't have a lot of means and so they give it to him they're like hey you have resources you have means take care of this child he's your child and he just said is that so and so he takes the child and he cares for this child like it's his own child for over a year and you know has gone from this famous zen master to now probably still has a modest following but kind of disgraced and then about a year year and a half later the uh guy who was actually the father kind of came forward and was embarrassed and like wanted to see his child and was like hey actually it was me like i'm really sorry but i didn't say anything until now and so they went back to him and said hey we should actually give this child to his father and make him take care of it and you know bring it in back into the family and you know he's taking care of this child like his own for a year and a half two years he said is that so he gives the child back and you know the story goes on but the idea here is if we can just walk into situations with, we don't have to like it, we don't have to dislike it, no doubt there were parts that he liked and disliked in that story. But if we can just say, curious, okay, what do we do now? And now what? Notice the reaction that's coming up and then step into it. I think if we can find a way to bring ease to our inner experience, whatever the outer experience is, then that option becomes available to us. It's easier said than done, but we really need to practice bringing ease to our internal experience, even in difficult external experiences.

[00:39:00] Rob Howe: You know, you and I don't know each other that well, but I think you probably know that. And I love a good Zen master story. And so that was incredible. And I also think really relevant for people with diabetes who are living their lives outwardly with their diabetes, whether it's sharing on social media or wearing their devices in public for strangers to see and sometimes comment on. Because as we know, you know, being different is difficult and people are often willing to voice things and say sometimes mean or wrong things to people. And I love that idea of saying, is that so? You mentioned it, but I imagine, you know, that didn't feel good to be to lose credibility over something that was untrue. Those things going away, like it probably felt really bad to lose, you know, and obviously like monks, they're not in a similar like financial situation. probably like and again a lot of that is because of the dedication and the work that went before that to even have the capacity to see that oh it doesn't matter if this is true or not i'm just going to be curious about it and see how it goes and i find like that that's a good signal for me to have work to do i put myself in that situation and i'm like oh i probably wouldn't have reacted

[00:40:11] Sam Tullman: the same way it would have felt a little bit more defensive my old zen teacher used to say like he couldn't stand this story. It just drove him nuts. He was like, I just can't step into that. I would have to say something like, this really wasn't me. I shouldn't take care of this child. But that's why 400 years later, we're still telling this story, you know? Exactly. It's an inspiration for us.

[00:40:33] Rob Howe: Yeah. I think, again, living well with diabetes does not mean that there won't be obstacles. It It doesn't mean that it'll all be frictionless. And I think you have done a great job of mentioning a lot of great teachers. Dr. Jack Kornfield is one that comes to mind for me. He has this great, I guess it's an essay or a lecture really of after ecstasy, the laundry. And it's just like even after we have had the best meditation session or the most transformative experience, there's still laundry to do. And something that's come up for me over the past few years, but more recently as a result of this talk, is I'm changing my site. I'm changing my CGM. It's a sign I'm alive. It's a sign that I'm getting what I want, which is to live well with diabetes, to live long and have a chance to do that. And while it is annoying and it does cause pain short term, long term, what a privilege it is to get to be able to do that. And it's even changed my relationship with the dishes. You can ask my wife. I'm doing better about the dishes now because dishes are just a sign that I'm living. And I'm still here, baby. And, you know, while I can choose to be, I hate dishes. I don't want to do them. They're gross. They're not fun. But when I use it as an option to celebrate that I'm still here, it changes that relationship a little bit. And actually, they don't take that long to do. Yeah.

[00:41:51] Sam Tullman: Yeah. And you can find ways to enjoy almost whatever you're doing. You can make different things a game or a mindfulness practice or fun, you know, dishes. I love dishes, actually. You get a little warm water going and you get the satisfaction of, okay, this is completed. If that's done, then it gets to dry now. And I didn't used to love doing dishes growing up. It's not like a longstanding thing for me, but it's become part of my practice. Or, you know, my old Zen teacher would always give the example of like picking up dog poop, right? You know, he has a dog and he has to pick up his dog's poop. And how can you make, how can you weave that into your good life? This isn't just a side thing that's like, oh, I have to do this and then I'll get back to my good life. It's like, no, this is part of my good life. I'm picking up this dog's food.

[00:42:35] Rob Howe: I had to, this is very relevant for me. The other day we were on a walk. My wife and I and our dog Enzo, and he did what he does on walks and he pooped. And so I cleaned it up. The bag that I had brought was like ripped. You know, yeah, fuck. It was just like, all right, here we are. Well, I used it and then I just had to carry his poop in my hand for the rest of the walk. And I just had to laugh about it because you know what? Like here we are. It was a beautiful day, a beautiful day. We were in our neighborhood. The flowers were out. We were done working. And I was like, you know what? I'm not going to let this shit ruin my walk. And so I told Enzo, I was like, hey, man, you better know I love you because here I am carrying your poop in my hand. And I love it. So, OK, we're riffing on Zen stories.

[00:43:19] Sam Tullman: Another really famous is actually a koan, but it's used as a story as well. Very, very famous Zen master in, I guess it would have been medieval China at that point. Zen master, the Japanese call him Ummon. Zen master Ummon, you know, people would go up to him all the time and ask him these kind of classic questions of the time about Buddhism. And one classic is, what is Buddha nature? Kind of an enigmatic question, but it's also kind of getting to like, what is the essence of reality? What is this thing that somehow we all share? What is the fabric of the universe? So somebody comes up to him and says, what is the essence of Buddha nature? Or what is Buddha nature? And he says, a shit stick, which is basically like their form of toilet paper at that time, right? He's basically saying, it's like toilet paper, you know, you're like, it's what you clean your ass with. And it's just getting to, I mean, there's lots of different angles of explaining this or understanding this. But one angle is it's part of the fabric of this good life. dog poop that I'm holding is part of this great, beautiful world that I'm in. And does it smell bad? Does it make me gag? Is it kind of warm in an unpleasant way? Yes! To all of the above. And that is also part of the fabric of this beautiful life that I'm living. I'm alive so I can smell this horrible thing. Yeah! Part of it.

[00:44:44] Rob Howe: We talked about Rage Bullets And I know we've definitely gone down the rabbit trail and I'm so happy that we did. We talked about rage bolusing earlier. Something that over the past couple of years, I was in a, you know, my mental health was in a difficult place. I was searching, kind of yearning and really, you know, something for me, like I know I'm not in a good place when I'm like grabbing the bull by the horns too hard. I'm trying to control every variable and I'm not in control of those things. And a thing that really helped me, very similar to rage bolusing is rage gratitude. And I think I maybe, I don't know what resistance I was giving to just being grateful or a gratitude practice. You know, I had done years of transcendental meditation and, you know, mindfulness work, but gratitude had kind of escaped me. And I never really, for one reason or another, I was on a different journey. And I sat down because I had this day where this little thing just caused me like to totally spiral. And I was actually in a basketball gym, which is like my favorite place on earth, you know, and like, why am I letting this ruin this? And so maybe that was one of the reasons that I had this, you know, realization. And I realized that like, oh, man, I think I was I don't think I've been grateful today at all. Like, so maybe that's why I'm I'm so, you know, turned up over like just really messed up and upside down over this very simple situation. And so I got home and I decided like, all right, well, I got to think of things to be grateful for. I'm just going to start with I'm grateful on the page and just go from there. And I think I did like 30 or 35 lines of I'm grateful for X, Y, Z. Really simple, sometimes trite, sometimes like really like not things that are very obvious. And at the end of it, I was like sweating. I felt so good. And and so I've I've just made that so much of a part of my daily practice now, because at the end of the day, I know no matter what has happened, that that I started my day with being grateful. And that has made my life with diabetes, my life with other people, my life with myself so much improved. And it's so simple. And like I laugh sometimes I go back and I look at the things that I was grateful for because they're dumb and they're not profound. And that makes me like them even more. And that's something I think for those out there listening who are either curious or have tried other, you know, certain forms of meditation or mindfulness practice and it hasn't worked. Just keep searching. I think that there's something there for everybody and it doesn't have to be profound. And, you know, I'm leaving it open. I would love to one day, you know, levitate off the floor and transcend. But if it never happens, like it's fine.

[00:47:17] Sam Tullman: That's really beautifully said. There are so many different styles. I try to remind people in the sangha of this all the time. I think there's a big focus on breath-based meditation. And for good reason. I think it's a lovely way to practice and it's often how I practice. But that is just one way, right? There's also mantra meditation, like a TM will be a mantra style of meditation. Meditating on sounds. There's meditating on the body in other ways that's not the breath. You can even do visually focused meditations as well. And so there's so many different ways. and then, you know, get even more specific of like gratitude practice or loving kindness practice. And something can click. You find the right thing and it kind of clicks for you. Like this, I can find a little bit more ease this way. This helps me access it. And then I have this bigger perspective and you can do a lot from that. You can learn a lot from that.

[00:48:13] Rob Howe: Well, you certainly can. And I think this is a great plug. I'm nothing if not a podcaster ready to plug a product or a service or a community. And I'd love for if this conversation has reached you in a way that's exciting or you have curiosity, I'd encourage you to visit diabetes sangha.org. There's lots of weekly meditations. There's newsletters. There's events. There's an entire very supportive, really amazing community of people who all sign off on. So if nothing else, you could trust my recos there. Anything specific that you'd like to talk about within the sangha as we close?

[00:48:46] Sam Tullman: No, I appreciate the plug. Thanks. Peter would have killed me if I didn't somehow get that in but you did it for me so fantastic you know got this retreat coming up but it's full and by the time this comes out we'll probably be in it so I'm excited to be meditating with you soon we'll have another retreat in the fall which we haven't announced the dates yet but probably in October we'll have another three four day retreat and then stay tuned we always have programming we have kind of our regular weekly stuff and then we have special events from time to time so would love to see you and engage with you and any of those and i'll include a link in the show notes for everybody listening to this they can easily go and click through and learn more about that but

[00:49:27] Rob Howe: sam well you're right at the time of publishing we'll probably be sitting down to to meditate at the retreat i'm looking forward to seeing you again and thank you so much for your time and your wisdom and i think the most zen stories per in a single diabetes episode to date so you're at the top of the mountain now

[00:49:46] Sam Tullman: it's great to be there we'll see you soon appreciate you