#1191 Canadian Dinner Rolls

Bonnie is 57 and was diagnosed with type 1 diabetes at 18 years old.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to episode 1191 of the Juicebox Podcast

Bonnie is a 57 year old architect who has had type one diabetes since she was 18 years old. She's got a couple of things going on. I don't want to ruin all the fun for you but there's frozen shoulder a skin condition and much more. While you're listening today, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always please, please Always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juicebox help out with type one diabetes research by going to T one D exchange.org/jukebox. and completing the survey. It's all you have to do you need to be a US resident who has type one or is the caregiver of someone with type one takes you 10 minutes your answers to simple questions will help move type one diabetes research forward. And don't forget to check out the private Facebook group Juicebox Podcast type one diabetes with 50,000 members there is very likely someone in there you're gonna like someone's gonna have answers you need. Someone will be funny, thoughtful, kind nice. We got so much in there go check it out. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven made for all types of diabetes Dexcom G seven can be used to manage type one, type two, and gestational diabetes, you're going to see the speed, direction and number of your blood sugar right on your receiver or smartphone device. dexcom.com/juice Box. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jaylen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juice box or search the hashtag Medtronic champion on your favorite social media platform. This episode of The Juicebox Podcast is sponsored by cozy earth.com Cozy Earth is where I get my clothing, linens and towels from their incredibly comfortable and temperate. I love them. I really do love them. And I love that I can give you an offer code that will save you 40% off of your entire order. Just use the offer code juice box at checkout and you will save 40% at cosy earth.com I

Bonnie 2:59
also think that you get a lot of visual cues when you talk to people such that if suddenly you want to speak and your mouth is hanging open. I can't tell if I don't see you.

Scott Benner 3:08
I have made nearly 1300 episodes of this podcast you telling me I've been doing it wrong. Oh no, not at all. Do I get to see you or you just get to see me.

Bonnie 3:19
Oh no, you get to see me too. Absolutely. Hey, hey, also,

Scott Benner 3:24
you're gonna get to hear me. I'm gonna test my blood sugar. So while we're getting set up here, I'm recording you chat normally wouldn't do this early in the call, but I'm wearing a CGM. Very cool.

Bonnie 3:39
While you're doing that, I'll I'll do that I'm I'm at 150. So

Scott Benner 3:43
I just got out of the shower. And it's telling me I'm low. And I don't imagine that's true, although I have not eaten in a long time. So I'm going to test myself here with the contour next gen blood glucose meter contour next.com/juice box. Let's say I have struck my finger. blood is rushing to the area not really rushing. I'm getting it. Actually this meter doesn't need a lot of blood. So not a big deal. You know, maybe it would help if I put my glasses on. Old. Oh, yeah, damn thing. Okay, there's my little blood drop. And let's see what we got here for my blood sugar. What do we got? Survey says 54321 95. I knew my blood sugar wasn't well. When

Bonnie 4:32
you started counting down and you said five. I thought that was your blood sugar. I thought well, that's perfect.

Scott Benner 4:38
What do you from Canada? i Oh, no. Okay.

Bonnie 4:40
I'm bilingual when it comes to blood sugars. Oh, excellent.

Scott Benner 4:45
Yeah, so I'm looking here. So I went in the shower and it took a dip. I don't know why. I'm gonna calibrate because I don't want to hear it beep at me while you're doing this. When I say 95 You did?

Bonnie 5:00
Did silence my phone.

Scott Benner 5:01
Do that to a minute ago? It says I'm 70 now. It's like a little. I don't know. Interesting. It's been really interesting to watch because last night, I on purpose ate pizza and Chinese food. And my blood sugar like didn't move. And in the past that would have, but I'm using we go V now. So basically it's, I mean, basically it says Empik. It's the same molecule. Of course, of course. And I just don't seem like my blood sugar just won't spike anymore. Like I don't I want to be clear, I don't have diabetes. I'm not pre diabetic, or anything like that. But if I would have eaten a couple of slices of pizza and some Chinese food, some rice, I would have seen a 150 Maybe 140. So like, nothing went up to like 95. It stayed there for a couple of hours went right back down in the mid 80s. was pretty good.

Bonnie 5:51
You exercise exercise yesterday.

Scott Benner 5:53
I try not to exercise at all, so I didn't do it yesterday, either. Okay, so we're doing this, what I guess they would call bass ackwards. Because I would normally tell you all the stuff before we started recording that I'm going to tell you now, so everybody's gonna get to hear what I say to people. Before we're recording. I don't care what you say, I am not going to stop you from saying anything. If you go in a really crazy, weird direction, I'm gonna go with you. If you use people's names, please be comfortable that you can, the worst thing that could happen is that you get to the end and say, like I said, my uncle's name five times I need you to go take it out. It creates an editing nightmare. And other than that, I wouldn't be overly specific about where you live. And that's pretty much it. So usually now I say do you have any questions or concerns? Oh, no, no, not at all. Okay,

Bonnie 6:49
I'm nervous. You're nervous energy? nervous energy. Can

Scott Benner 6:53
you push your hair back away from that microphone for me? Thank you. Don't worry about being nervous. I'll make you comfortable. And if I don't, I felt so it's on me, not you. What I'll say is last thing. Don't need to use your last name in a second. Just kind of take a deep breath. Introduce yourself. Give me a couple of sentences about who you are. We'll start talking hour from now it'll be over. Well, this episode of The Juicebox Podcast is sponsored by cozy Earth. And right now I'm looking at cozy earth.com to see what's going on. I got Oh, look at this bamboo pajama set for ladies. That jogger pants for ladies looks like plush lounge socks. That's one of Oprah's Favorite Things. There's the bath collection. We love the waffle towels. But there's also premium plush bath towels. Everything that you see here can be had for 40% off with the offer code juice box at checkout. Even the sheets. Now we use the bamboo sheets, you may choose different linens, I don't know what you're going to love when you get to cozier.com. But we sleep on bamboo sheets from cozy Earth, they are incredibly comfortable. And I bought them myself with my own money using my own offer code. juice box at checkout. 40% off is what I saved. You can as well at cozy earth.com.

Bonnie 8:16
My name is Bonnie and I live in the Midwest originally from Canada. And if I tell you my profession, probably everyone will know who I am. Because it's a small world of my profession. But I'm not hiding. I'm an architect. So saying

Scott Benner 8:33
that your Barney, an architect from the Midwest is going to tell people who you are. At least Oh, you're in the midwest of Canada?

Bonnie 8:42
No, I'm I live in the United States now.

Scott Benner 8:46
Oh, you live in the United States now. Okay, because I was like in Canada, there must only be one architect. That's not what we're talking about. Right? No. Okay. Well, I'll tell you what, if you get a call from somebody who's like, I heard you on a podcast, please email me immediately because I will be. I'll be baffled that that happened. Because you're I think I would be baffled as well. I think if I went on another podcast and said, my name is Scott, I make a podcast called The Juicebox Podcast. I still don't think anybody would know who the hell I was. So I'd be I wouldn't be thrilled if somebody knows you from that.

Bonnie 9:19
Okay. I mean, if I got very specific and said, I'm from, you know, this portion of this

Scott Benner 9:24
state, okay. All right. You didn't build like a really famous building or something. Did you design something really famous? Reasonably

Bonnie 9:31
famous? Yes. In the state of Michigan? Yes. Interesting. I won a competition to design a memorial for law enforcement officers who died in the line of duty. Wow,

Scott Benner 9:44
that's amazing. And I thought you're gonna say lawn furniture.

Bonnie 9:50
I was like, I don't, I don't design lawn furniture. But I know architects architects do design furniture.

Scott Benner 9:56
I thought you were gonna say designed to building About lawn furniture. And I was like, This doesn't make any sense at all. I don't think she's as famous as she thinks she is.

Bonnie 10:05
I'm not that I'm not that famous.

Scott Benner 10:09
How did you? Is that something you always wanted to do? Is it something you thought of as a child? Or do you pick it up in college, I

Bonnie 10:14
always wanted to be an architect. My father was an engineer, and I just got that way of thinking in my head, I inherited that way of thinking. I

Scott Benner 10:24
always wanted to be an architect. Do you have that engineers mind? I think so. Yeah.

Bonnie 10:30
Very linear way of thinking, a very mathematical way of thinking. One plus one always equals two type of thing, which, you know, leads me to the My frustration of diabetes having diabetes. But,

Scott Benner 10:43
yes, do you have that sort of social awkwardness that sometimes engineers have? I'm

Bonnie 10:49
not an overly social person. I'm a very visual person. I'm the type of person who likes to sort of watch, sit back and watch.

Scott Benner 10:59
Interesting, you know, you said that you were a little nervous. I don't normally do the podcast with video on. And we have it on today, right? And I've lost so much weight over the last nine months. My brain doesn't always remember if that makes sense. So I'm sitting here, I spent the first couple of moments we were talking, trying not to obsess on whether or not my stomach look big in the video. I don't

Bonnie 11:26
know why I'm not watching your stomach.

Scott Benner 11:28
But you're looking at me now. Do I look heavy in the front? Not at all. No, you know, I think I do. Oh, I'm wired from having been overweight a lot of my life. So just see this line on my shirt? Oh, yeah. Yeah. It's apropos of nothing. It's just the way my shirts hanging. But I think it's showing you a delineation of where my stomach starts and stops.

Bonnie 11:52
Well, we all we all have a stomach. So

Scott Benner 11:56
if I stay on, we go be much longer. I'm going to be a skeleton, and then I won't have a look at.

Bonnie 12:00
That's not good, either. I mean,

Scott Benner 12:02
I'm not gonna go that far. But no, I just I wanted to let you I actually the people in listening to in on that, like, there's just a wrinkle in my shirt that my brain is telling me. Hey, that makes you look fat. Adjust yourself. Not crazy.

Bonnie 12:18
I think we are all very self conscious people. Yeah. Yeah.

Scott Benner 12:22
It's really something anyway, I just, you know, it's a podcast, if I don't share these things, then that it's not a podcast anymore. It's just, yeah,

Bonnie 12:30
I mean, we don't get the visual when we listen to you. So we have to kind of make up what we think you're doing where you're sitting. At least I do.

Scott Benner 12:38
Yeah. That whiteboard behind me has the secrets of the podcast for the next five years on it. So all the things I'm going to do like literally 123 new series, a bunch of different topics we haven't gotten to yet. There's a note over there for me to pay my taxes. Do I want to get the book rights back to my book? Which by the way I do, but I don't want to do it badly enough to put any effort into it. In case you're wondering. It's all the list of advertisers. Actually, there's new advertisers out there that people don't know about yet. And then there's this tree art in Germany, it says big ideas. And then each leaf has a different little like idea about things I should maybe think about during the podcast.

Bonnie 13:20
That's an interesting mnemonic. Yes. Yeah. So

Scott Benner 13:23
art enjoyed from the last time she was she also wrote the date on it. And she says, every day, change the date, it's good for you. And I was like, Yeah, I'm probably not going to do that. It said, it said July for a really long time. And then I changed it. I thought recently, and I just looked at it since November 3, it's the 17th. So apparently, I'm not on top of that. Anyway, what made you want to come on the podcast? I

Bonnie 13:47
think a lot of different reasons. But you know, I used to think of myself as just sort of an ordinary person dealing with diabetes, and I just wanted to come on the podcast and say that, you know, we're all kind of dealing with it every day. 24/7 nonstop. And yeah, just sort of get that out there and get it out there that frustrations with it. That sort of thing I've been dealing with it for Oh my goodness. 39 years, really? So yeah. How

Scott Benner 14:21
old are you? Can I ask? 57 Oh, wow, you look terrific. Oh, thank

Bonnie 14:26
you. It's a good good hair jeans.

Scott Benner 14:31
You know, Bonnie, you and I have a lot in common. I am steadfastly believe I look younger than I am because my hair is nice and dark. Exactly. It really is the whole thing until you're if you get pale and then the and then the lines right around your eyes. Yeah, the worst part. Yeah. Okay, so

Bonnie 14:48
the problem you're gonna have as you lose weight, you're gonna start to wrinkle you know, I mean as as we get older and you know, our faces stay nice and plump you don't see as many wrinkles

Scott Benner 15:01
I'm very near you in New York. I'll get Joan Rivers doctor to pull me back. There you go. They eventually killed her at night. Nevermind. I'm

Bonnie 15:08
just gonna use some drafting dots. Do you know what drafting dots? I do?

Scott Benner 15:11
Yeah. Just like in a sci fi movie, they'll actually be things on my face pulling my face backwards. It's not a bad. That's hilarious. Do you know they killed Joan Rivers. This episode is sponsored by Medtronic. diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion. Jalen.

Speaker 1 15:33
I was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went, I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was, my hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 16:07
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 16:12
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it. Did you

Scott Benner 16:27
eventually find people in real life that you could confide in,

Speaker 1 16:31
I never really got the experience until after getting to college. And then once I graduated college, it's all I see, you know, you can easily search Medtronic champions, you see people that pop up, and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to take when diabetes. To

Scott Benner 16:52
hear Jay Lin's entire conversation stay till the very end, Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community. The Dexcom g7 is sponsoring this episode of The Juicebox Podcast and it features a lightning fast 30 minute warmup time, that's right from the time you put on the Dexcom g7. Till the time you're getting readings, 30 minutes, that's pretty great. It also has a 12 hour grace period. So you can swap your sensor when it's convenient for you all know that on top of it being small, accurate, incredibly wearable, and light. These things, in my opinion, make the Dexcom g7. a no brainer. The Dexcom g7 comes with way more than just this. Up to 10. People can follow you, you can use it with type one, type two, or gestational diabetes, it's covered by all sorts of insurances. And this might be the best part, it might be the best part alerts and alarms that are customizable, so that you can be alerted at the levels that makes sense to you. dexcom.com/juicebox links in the show notes links at juicebox podcast.com to Dexcom. And all the sponsors, when you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful.

Bonnie 18:13
What do you mean they killed?

Scott Benner 18:15
I don't think it was a like a vast conspiracy. But she was getting, you know, plastic surgery pretty, pretty constantly. And she was in a surgery center. And she I don't know what happened. She She threw a clot or had a like a heart attack or something. But the surgery center was not prepared to handle that level of a medical issue. Wow. There are people who think that if she was in a hospital, that they probably could have stopped it. Oh, that's interesting. That's interesting. So when I went and had my toe I surgery on my toe this year, and it was like, you know, a half an hour, they cut it open, they cleaned it out. I get drilled a bunch of holes in the bone and my toe or whatever, which by the way, seems like it's working. As they were like doing the pre op stuff. The nurse comes over. And I said, How are you set up for? You know, heart issues. And she goes, we don't handle heart things here. And I'm like, no, no, no, I'm sorry. I misunderstood. I'm like, what if I have a heart attack? You? Yeah, you got like a like clear. You got one of those things. Do you guys know what you're doing? Is there like a girl here who really gets it? And she goes, that's not gonna happen. I went, That's what Joan Rivers thought, Oh, God. She goes, what? And I said, Joan Rivers died in a surgery center like this. And she goes, No, she and I was like, Well, yes, she did. And I was like, so if I like, are you gonna be able to help? And she said, Oh, yeah, it's fine. By the way. I did not believe her.

Bonnie 19:36
Of course, she's gonna tell you it's fine. Like,

Scott Benner 19:38
don't worry, we'll just call 911. I was like, again. That's what they told Joan. Anyway, she really didn't believe me. I went in I got the surgery. I woke up like, you know, you wake up. You're like parked like used cars with a bunch of other people. I'm like coming to I barely have my focus. And this girl is like at the foot of my bed and she goes, Oh my god. You weren't kidding. Joan Rivers did die in a surgery. had heard I was like, Is that what you guys have been talking about while I was getting my toe fixed? And she goes, yeah, and then we just, I woke up and we started chatting about it. But anyway, I don't know. But yeah, anyway, but But yeah, my eyes, it's really around your eyes. If I could just have my eyes just came up a little bit, it would like change everything it really would. About how I look. Yeah. Anyway, I'm not gonna do anything about it. Can you imagine? How much would you be willing to spend? I mean, obviously, you're a very famous architect $5 million. But um,

Bonnie 20:32
I don't practice architecture to make money.

Scott Benner 20:37
I'm so sorry to hear that. But I always like think like, how much like, what percentage of your yearly income? Would you be willing to give away like, if you could, to making a major change to your physical appearance? You don't I mean, like, well, how much would seem like too much? Oh,

Bonnie 20:58
I could not tell you as a percentage. I think the bigger sacrifice for me would be sort of the time and effort and the recovery and just getting potentially major surgery, like I was a wreck when I had to have a colonoscopy when I turned 50. You know, I mean, I had a commission for days. No, it was kind of I was still on sliding scale MDI. And I'm kind of like, How the hell am I gonna do this?

Scott Benner 21:22
Well, you were doing sliding scale, like seven years ago. Oh, yeah. Okay, why don't we talk about your diabetes? How old were you when you were diagnosed?

Bonnie 21:30
I was 18 and a half. Okay. Still in Canada? Oh, yes.

Scott Benner 21:35
So they gave you NPH and regular? Absolutely.

Bonnie 21:37
drawing up a ticket twice a day, I used to have to draw up the regular the clearer than the cloudy because in case I accidentally injected the clear into the cloudy bottle, it wouldn't ruin the bottle. But if I accidentally injected the custom cloudy into the clear, it would ruin the clear bottle. That's

Scott Benner 21:56
what you were thinking about. What province were you in when this happened? Ontario. All right. They are a little different. I know that

Bonnie 22:06
I was 18 and a half. I was in my last year of high school because at that time, we used to go to high school for five years. So that was the equivalent of grade 13. We say grade 13. Not 13th grade. We don't use orden. We didn't use ordinals. In Canada,

Scott Benner 22:26
you're trying to use fancy words. Do you know I don't know what an ordinal is?

Bonnie 22:30
I wouldn't ordinals like first second third as opposed to 1230.

Scott Benner 22:36
Anyway, word for word. No, no, no, don't don't say anyway. I'm interested as service. Short for ordinal number ordinal number. Oh, look at that. defining things position in a series first, second, third. I look at you smarty. Okay, whatever.

Bonnie 22:56
I will tell you, I'm a real detail person. And I will go off on a tangent as well you so we could go off on some interesting tangents.

Scott Benner 23:06
I'm recording three times today. So one thing you can be sure of is I'm going to be a little more focused today. Although it's been 18 minutes, so maybe not but but your regular mph. You're still in school, even though you're you're almost 19 I'm sorry, keep going.

Bonnie 23:22
Yes, I am almost 19 it was timber such that I just finish started my final grade of high school. It was September when I got sick. I was hospitalized for 10 days. And basically, in terms of my diagnosis, I started to lose weight. So I'm five foot four and a half I weigh 120s and the 120s. And I was down to 95 pounds at the time, which meant I was looking pretty skeletal Yeah. And I remember being thirsty all the time. And I had a wicked when I say wicked. That was an understatement. I had a wicked yeast infection. And my mom took me to her gynecologist, and he took one look at me and said you're going for a glucose tolerance test. And that afternoon, you know, I drank like 12 or 16 ounces of pure sugar and felt like absolute crap afterwards. And I think my blood sugar was over 30 which would have been in like five 540 ish.

Scott Benner 24:39
Is there other diabetes in your family any chance? Nothing, nothing. Okay, no autoimmune. Nothing. You know, if you don't say something incredibly interesting in the next 45 minutes you're episodes called wicked yeast infection, right?

Bonnie 24:53
I hope to

Scott Benner 24:58
do your best Okay

Bonnie 25:02
because I will not want to be known.

Scott Benner 25:05
Okay, you might have trouble them

Did they give you I mean put you on insulin, they mentioned the hospital all that stuff happens.

Bonnie 25:18
Absolutely. I was admitted to the hospital almost immediately for 10 days and they started to put me on insulin almost immediately monitor my blood sugar, which meant not fingerprints because at the time, there was no such thing as a as a glucometer. We called it you know, I used to do urine testing. And the way they took blood, my blood sugar was they would actually take venous blood, which means they were poking my arms at least four times a day. I think I counted in 10 days I was there. I had blood taken out of my arms. I look like a druggie with all the tracks, you know, with track marks up and down my arm so they were taking blood at least four times a day, sometimes more. How

Scott Benner 26:03
long did it take for the dinner rolls to stop falling out of your pants? Isn't that interesting?

Bonnie 26:08
Oh, okay.

Scott Benner 26:10
I love your I love your I love your like, I watched her. I watched her little like mathematical mind go those words don't have anything to do with what we're talking about. That was very interesting. Did the yeast infection clear up pretty quickly?

Bonnie 26:20
Oh, absolutely. Yeah, okay, got that. We're speaking metaphors.

Scott Benner 26:28
I don't really know how to speak clearly. So we're gonna have to go that way. So that clear up very quickly with the introduction of the insulin. Absolutely.

Bonnie 26:37
I will say as I once told my husband, which could be the title of this show, metaphors are not my cup of tea. So

Scott Benner 26:46
funny. Okay, that's fine. I gotcha.

Bonnie 26:49
I am very, I mean, I think abstractly, spatially, but I don't think abstractly when we speak. I'm a very literal person. And so

Scott Benner 26:58
no, I know, I could see the look on your face. You were lost. You were like, how is this guy talking about you listen to this podcast, right? Oh, absolutely. You didn't you still weren't falling. You're just like, I'm done. Don't know what we're talking about. Okay, so.

Bonnie 27:12
So I'm hospitalized for 10 days. Yep. They put me on did not start on beef and pork insulin at that time, this would have been 1984. I made notes. And I was on what they called human insulin or recombinant DNA. And I guess I did pretty well on that. And, you know, and stayed on that for a long, long time. I could not tell you when I went on to MDI. But I know I started Lantis and Kuma blog, I'm gonna guess right after whenever lent as soon came out. Okay. And was on a sliding scale,

Scott Benner 27:53
sort of like the late 80s 89. And their summer.

Bonnie 27:57
Well, I it was, I want to guess it was after I moved to this country, which would have been in 90, yes.

Scott Benner 28:04
Oh, so they didn't Oh, you left Canada. That's how you upgraded your insulin, because they would have kept me on that regular and mph forever. Probably. Quite likely,

Bonnie 28:11
because things get tend to get approved there much later than they do

Scott Benner 28:17
here. Right. Right. Okay. So, what did you move for was for school? Yeah. Graduate School. Okay. Not a boy. Oh, good for you. Not yet. Oh, there's a move in here somewhere that involves the boy.

Bonnie 28:31
Oh, no, no, no, no, it's just yeah. met met him in graduate school. But yes, scotch? Oh,

Scott Benner 28:35
not yet for him. So you moved from Canada to what was the thing you noticed? You remember, going from regular and mph to just MB, you know, to Lantis and Humalog? Or something like

Bonnie 28:46
that? I don't remember. But it was more shots per day, because the regular you know, mph, you know, was only a twice a day thing. Yeah. Do

Scott Benner 28:55
you recall if that seemed like bothersome work? At all? No, no, it

Bonnie 29:00
was funny, because, I mean, so I became diabetic at 18 and a half. And I was telling a friend of mine, a gentleman I know who is a type two researcher here at the big university in my town. And I was telling him the story. And he said, when I said I became diabetic at 18 and a half, he said, Oh, what a great age to become diabetic. I'm like,

Scott Benner 29:24
okay, usually the argument I get is everyone says the opposite of their thing. So if they're young people go, Oh, it's terrible to be diagnosed. When you're young, it'd be better if you were older, you'd have more time to live without it. Bah, bah, bah, you go find an older person that was diagnosed when they're 40. And they go ah, you know, being diagnosed when you're older is terrible. Because you you know, this life without diabetes and life would have been much better if I was diagnosed when I was young. Everyone thinks the opposite of what happened to them would be better. So that's course

Bonnie 29:51
yeah. So yeah, being diagnosed 18 and a half and he said, What a great age to become diabetic. I think he was just thinking King in terms of not going through the teenage years of rebellion?

Scott Benner 30:03
was my thought it's a valid observation for sure. Not arguing with him. Yeah.

Bonnie 30:10
So for the most part, at least, when I was in the hospital, I remember meeting with a dietician, you know, my mom and I, and I was still living at home, obviously, I was in high school at 18 and a half, you know, and my mom did the cooking. And so we met with a dietician who sort of organized, you know, my life and my day and what I would eat. I mean, it wasn't a matter of telling me what I needed to eat, it was more of a matter of, what do you eat? And how can we kind of tailor that based on your insulin? You know, every meal was kind of like, you know, one, one carb, you know, one serving of bread, two servings of fruit, and told me all the sort of free veggies I could eat, which were green leafy vegetables and broccoli. And my mum said to my mum said to her, Well, what if we all ate this way, and we were never bad, poor ears, just saying, my mum asked her what if we all ate this way, and she said, you'd all be very healthy people, and

Scott Benner 31:09
go for that, then you left the country to get away from it. You're like, I'm getting out of here, all this.

Bonnie 31:14
So, you know, my mom, and I get this from my mom, my mom and I are really, you know, rule followers, right? And so it became my way of life. And I never, I was never the type of person to love, like giant, sort of pieces of cake with icing that's two inches thick. I was just never that type of person. And my mother always used to say, you know, thank goodness, she wasn't that type of person. Because, you know, according to her, she couldn't eat it now. You know. And, you know, according to my mother, I would rather which is true for me. Of course, I would rather eat a piece of pound cake than a piece of cake with a ton of icing, you know, regardless of the density of pound cake. No, no, I

Scott Benner 31:57
understand. I absolutely understand. I prefer, and I have like a sweet tooth when I get involved in that stuff. Like I can avoid it forever. But if you said to me, I think Oh, pancake. That's good. But I think of pancake is having icing on it. So I I don't Yeah, and you don't that's it's very interesting. Honestly, some people just have that, like, you get lit up by sugar. And so I think some people like almost have the opposite to it. It puts them

Bonnie 32:22
off. Oh, sure. You know, I won't pass up a piece of dark chocolate if you gave it to me. But small quantity, it's not like I will eat a whole chocolate bar of it. Yeah. All right. Candy Bar, as you call it. In this country, we call them chocolate. We used to call them chocolate bars. So I

Scott Benner 32:40
got overwhelmed by a pound of fudge recently, was brought in to the house. Then eventually, when it was gone, my wife goes where the hell's that fudge? I was like, you shouldn't have left it here. And she was where I'm like, in the house. Like, it's, it's not here anymore. But it was having like a little piece of it every once in a while. And then I looked back over, like the two weeks that it took to eat. And I was like, every once in a while, man. Anytime I walked through the first floor of the house. I was like, Oh, look, the fudge. Yeah, well, good. You're not You're not burdened. So no big deal. Did you make the big switch in your eating?

Bonnie 33:16
I did, you know, I kind of cut out, you know, a lot of fat in, you know, I used to sort of butter my bread. And I cut that out. You know, I mean, I learned that, you know, protein and fat can slow down the absorption. I mean, I have to say I was pretty, I thought reasonably educated until I listened to your podcast. No.

Scott Benner 33:36
So how long does that go for? Your living? Like sort of the way you just described? Oh, currently as well. Forever. When did you find the podcast? During COVID? Oh, just

Bonnie 33:48
a couple of years ago? Oh, yeah. Probably only two, two or three years ago. Alright. So

Scott Benner 33:53
you were MDI for a while eventually need to get to a pump. only like two years ago. Oh, okay. So you were MDI the entire time we were using Lantus and human log the whole time? Absolutely.

Bonnie 34:03
Through two pregnancies. Wow. You have

Scott Benner 34:07
to How are your kids? 18 and 2525. Oh, that's pretty close to mind. What was your control? Like through that time? No CGM, by the way.

Bonnie 34:17
No. Okay, so I've only been wearing a CGM, probably for five years. Okay.

Scott Benner 34:24
So what were your A onesies like? 18 years old till a few years

Bonnie 34:28
ago? Five years? Okay. 18 years old? I have no idea because I not pay attention. Well, who the hell could look up their medical record when when you're 18 years old? Oh, yeah.

Scott Benner 34:40
So it's like you're alright or you're not alright. When you go to the doctor's, it's either like, everything's fine. Or,

Bonnie 34:46
I mean, now they do a fingerprint when I go to the doctor, and they test my agency, and they come back and tell me, you know, 10 No, and that's only been in the last five or seven years when they can do an agency in the office. Before I would get a blood draw, never look up my medical record until I have no access to it on my phone before that I had no idea what my a one C was. Okay, that said, I, you know, as a rule follower, you know, I have to think I was in pretty good control. So up until the last five years, I mean, my a one CD was probably in the 60s low 70s.

Scott Benner 35:21
That's a guess you really don't know. Oh, no, I

Bonnie 35:24
looked at my age. Okay for you in 2019. And I had an A one C of 6.6. Okay, great. That's terrific. And then 6.8 7.2 and 2020. I was hitting 6.1 So it's always been in the sixes. And then I went on a pump

Scott Benner 35:42
are all those a onesies with a CGM? Yes. So you don't know what it was prior to the CGM, though. Okay. No, gotcha. You don't have any complications. Well, that's

Bonnie 35:54
a that's a sort of another story. I have other issues. Yes.

Scott Benner 35:59
diabetes related.

Bonnie 36:00
I would like to think, why would you?

Scott Benner 36:04
Why do you want to thank you.

Bonnie 36:05
I think I've had issues that are more prevalent in diabetics, but not an exact result of diabetes like solar or isn't shoulder

Scott Benner 36:15
see the cameras on I saw you reach up towards your shoulder so I know you're gonna say touch

Bonnie 36:19
my shoulders. Yeah. skin condition called granuloma. And you larae The

Scott Benner 36:26
dark spots, little rough patches of skin. Are they dark, their

Bonnie 36:33
little red, bumpy patches. It kind of looks like someone once said to me, oh, it looks like you because I had it on me on my legs, a few spots on my legs. So it looks like you've gotten to the poison ivy, it just looks like red, little bumpy, bumpy patches

Scott Benner 36:48
granuloma. annulare is a benign skin condition characterized by small raised bumps that form a ring with a normal or sunken center. The cause of granuloma annulare is unknown and is found in patients of all ages, condition tends to be seen in otherwise healthy people. Alright, I'm gonna go to the pictures.

Bonnie 37:08
Oh, that's interesting. It's amazingly innocuous. Like it doesn't bother me in any way except it just little rough patches of skin that for the most part are on my abdomen that I can hide. So

Scott Benner 37:21
it's not constant, though. Is that correct? I

Bonnie 37:24
have had spots of it for months at a time. And then they'll kind of fade away and reappear in other places.

Scott Benner 37:34
Do you do anything to them? Cortisol and cortisone or something like that?

Bonnie 37:41
Nothing. They don't itch sometimes, though. Ah, but really? Absolutely. Nothing. super interesting. Yeah. Okay. Okay.

Scott Benner 37:49
But you think it's, but I don't see anything here about it being diabetes related.

Bonnie 37:53
Okay, then maybe it isn't.

Scott Benner 37:56
I mean, I gotta be honest with you. There's no reason. If you're taking a picture of an old person's skin condition on their arm, there's no reason their bare breasts needs to be in it, too. I just want to tell that to Google right now. Little TMI. There's significant change. Like some people have it everywhere. And then some people don't. It's just like little patches. It's interesting.

Bonnie 38:20
Which is what I have. I have small patches here and there. Okay. Okay. Randomly located.

Scott Benner 38:25
Your kids have it? No. Okay. Would they tell you if they did as an adult? I always wonder that like, you know, you spend so much time connected with your children. Then they get older. Like, if something happened, they're not going to call you and be like, Yo, guess what? Like you stop learning about it. You know what I mean? Oh,

Bonnie 38:41
absolutely. Oh, I think my daughter at 18 She would probably still tell me things.

Scott Benner 38:47
Yeah. Okay. I gotta get rid of this elderly breast. Excuse me. All right. Yeah. That was enough of that. That made me feel older.

Bonnie 38:57
I've had Oh, yeah. Well, welcome to my world. Yes.

Scott Benner 39:00
That's not how I remember.

Bonnie 39:05
My endocrinologist has said, oh, yeah, like I've had other issues with I've had conditions with my eyes, which was not for the squeamish. But

Scott Benner 39:15
did you have to get the needles? No,

Bonnie 39:17
I had something really bad done to my eyes, which I have. I shouldn't say have Thank goodness. Touchwood I had a condition called Map dot fingerprint dystrophy.

Scott Benner 39:30
What the hell I'm gonna keep my browser open. If you're gonna keep talking. I'm gonna that's fine map dot dot fingerprint door it came right up. Not a lot of things. Is it serious typically, will flare up occasionally for a few years and then go away on its own with no lasting loss of vision. How does it appear?

Bonnie 39:51
incredible pain in your eyes because basically what happens is your cornea is made up of a series of layers and the outer Most Leia kind of comes away from the surface. And my ophthalmologists told me oh yeah, your your cornea is like a rug on a hardwood floor, flipping around, and I had a condition. So I had that condition. I was in extreme pain, I could not tolerate light, I had to wear dark glasses sit in dark rooms, until I had what's called a super k in both eyes, which is a super keratectomy,

Scott Benner 40:33
which, you know, offers procedure to remove the FFP meal and any redundant tissue.

Bonnie 40:42
So basically, they take a Dremel move, okay, and this is where if you're squeamish, just stop listening. They basically take a Dremel like instrument and remove the outer layer of the cornea of my eye,

Scott Benner 40:58
they grind your eye down a little bit,

Bonnie 41:01
which you don't feel okay. They gave me they gave me some valium for it. And then they put a bandage contact lens over your eye to kind of protect it and you regrow that outer layer in about two days. However, it's two days of like it in your

Scott Benner 41:20
high as a kite, right? It was like, hey, I'll just stay alive and not feel this. Ooh, I'm sorry, I need a second. That's terrible. It really took me like the Dremel thing. Like, I know what a Dremel is. But I was wondering if people didn't know what they were thinking but like, just like a, like a rotary sander, almost Yeah. Do you get to see it? Or is it healed? But

Bonnie 41:44
I it's just blurry.

Scott Benner 41:46
I mean, that by the time they uncovered, is it healed? Or do you see it like bloody or weird or anything?

Bonnie 41:51
It's, it's not bloody at all. Okay? I mean, it's basically a five minute procedure in the ophthalmology sort of center, and I go home, and I then take Viking in for two days. Because if you've ever gotten a scratch on your cornea, sure, and you know, the pain that that causes, imagine this pain and multiply it by about 1000.

Scott Benner 42:13
Every after you your eyeball just got tattooed. You know what I keep thinking, who thought of this? Like, who was the first physician who said, you know, we can do for people with this condition? Why don't we grind a layer of their cornea off? Somebody else went, Oh, what a wonderful idea. Let's do that. Like, seriously? Who's the because it helps you? Right? Oh, oh, yeah. Who thought of that? That's genius.

Bonnie 42:38
I mean, there was one point when I was in so much pain before I had the procedure done. I was like standing in my living room that night. And I said to myself, I was in so much pain. I said to myself, if I throw myself through this plate glass window, okay, I didn't want to kill myself. And I said, if I throw myself through this plate glass window and cut myself with these shards of glass that might take my mind off the pain I'm having in my eye. Geez,

Scott Benner 43:07
I can't imagine that. But that's not necessarily from diabetes, either. Is it?

Bonnie 43:13
I don't think so. I know my my ophthalmologist says, Oh, this is really common. I'm like, oh, common in your profession. Yeah, but not for the rest

Scott Benner 43:22
of us. The rest of us don't find this common at all. No, not at all. Okay, she gets a little skin thing. You got the eye thing. You got the diabetes. What else?

Bonnie 43:30
frozen shoulder shoulder? Yeah, I mean, that's probably about it right? At this stage of my life.

Scott Benner 43:37
Almost said right now. Oh, it's interesting. Because you're in a really, you're in a really kind of flux place. Because the way you stayed so long, and that Humalog Lantis. No CGM thing was and then you're saying the podcast made you? Did you get the podcast before the CGM or the CGM before the podcast?

Bonnie 43:56
CGM. I was on the FreeStyle Libre before the podcast. Yes.

Scott Benner 44:02
And when you got that was it to you just merely like, oh, I don't have to, like poke my fingers anymore? Or did you see the bigger picture?

Bonnie 44:09
It was mind blowing. Because I was, you know, I was on MDI for four shots a day, sometimes five, because just to maintain better control. And it was mind blowing that I could see my blood sugar constantly. It was

Scott Benner 44:29
so you liked the numbers. Obviously, you've brought this up already. So what what did having the data do for you?

Bonnie 44:35
It just brought me in better control. I mean, it just, you really added another layer to to my my ability to control things.

Scott Benner 44:45
It's funny because I asked that question to see if someone will pop up and be like this exact thing happened and this is what led to this, but it really isn't. It's just seeing it and then being able to see cause and effect more visually. Right and Don't you just start making different decisions because you know what's gonna happen? Exactly.

Bonnie 45:04
I mean, the amazing thing is your podcast. Oh my goodness. Now that I'm 57 and no longer sort of, you know, at the control of my being affected by hormones.

Scott Benner 45:19
Oh, okay. That part's over now. Oh,

Bonnie 45:23
yeah. No one ever told me that hormones could affect my blood sugar. Nobody ever told me you lived

Scott Benner 45:31
all that time not knowing what all that fluctuation was correct. How did you manage through pregnancy then? Because insulin needs really racking Oh, they don't even know. I guess then. Well,

Bonnie 45:42
I yeah, I didn't have a CGM, then I had really good. Lots of dogs, you know, because I was in a high risk clinic, not just with my son who was born when I was 32. So I was at a high risk clinic with him. And then when my daughter was born, I was 39. So I was sort of hit the

Scott Benner 46:01
were they turning your insulin up during the pregnancy? Oh, absolutely. Okay, but they were just doing it based on bloodwork.

Bonnie 46:08
Based on my little form, you know, my little blood glucose thing book I would fill out. Oh,

Scott Benner 46:16
oh, okay. So you were you were testing with a meter writing down your book, and then they were they it was as simple as these numbers are a little high, we're going to give you more insulin. That's all it was. Kids came out, okay. Were they real big or anything?

Bonnie 46:31
Um, my son was the size of a two month old.

Scott Benner 46:36
That's pretty common, especially back then for people with diabetes.

Bonnie 46:39
He was and you know, they were not alarmed by it. He was 10 pounds. 15 ounces. Okay. Yeah. And so they said, you know, he'll be fine that he was in the PICU for the first 24 hours because they wanted to watch his blood sugar's. And they said, you know, he will gain weight, like every baby does. But at a slower pace. All the other babies will catch up to him pretty quickly. Yeah, right. Exactly. And my daughter was not that big. And yeah, I mean, basically, my doctors told me, and then they took pretty good care of me, except for my endocrinologist went on vacation, and I had some other someone else, you know,

Scott Benner 47:15
bye, bye, I'm leaving.

Bonnie 47:18
On vacation, he went on vacation for a week or two. And someone else had to fill in for him during one of my visits, and I would go see a doctor, like every week, if not two weeks, you know, every week or two. And I was in a case. So he went on vacation, and someone else was filling in and he said, Oh, yeah, we're gonna change your insulin. And we're gonna do this, this, this, this and this. And I looked at him and said, No, you're no

Scott Benner 47:42
wait for the guy to come back. Don't worry. Where do people vacation from the Midwest? Would you go to a lake or something?

Bonnie 47:47
I suppose you could you go south where it's warm. I was gonna say, because

Scott Benner 47:51
you don't have access to the, to the beaches and like, or you got to go on long flights to get to water.

Bonnie 47:59
We have the Great Lakes. You

Scott Benner 48:01
don't know. It's not the same thing. It's like I had a little. I had a little girl from Canada told me about a bagel she was eating. And I was like, Have you ever been in New York? And she goes, No, I'm like, you've never had a bagel. You never know what you're talking about. Seriously? You don't know if you haven't in New York bagel is a different thing.

Bonnie 48:13
It's like a mantra. It's like a Montreal bagel.

Scott Benner 48:16
Yeah, well, we'll say. But I'm saying like, when you're on the coasts, people vacation generally speaking on islands and at the beach and things like that, because that's the kind of like, it's close. And it's accessible. Every time I've met somebody who's coming from the Midwest, the first thing they were like is, can we see the ocean? And I'm like, Yeah, me if you want to. It's only going to be exciting for 20 seconds. So

Bonnie 48:40
yeah, for the most part, we do vacation by airplane.

Scott Benner 48:44
You have to write like, you can't like just drive somewhere. So anyway, it's not the lakes

Bonnie 48:48
up there in COVID. So we did vacation, a little Airbnb, just to get away. Just to get away, which was like 20 minutes from here on the lake. Let's

Scott Benner 48:57
drive to a different house and sit inside of that one for a while. Okay,

Bonnie 49:00
well, those are the lakes.

Scott Benner 49:03
So okay, so you're using a CGM, things are coming together for you. But you're not making any big leaps. Right? Like

Bonnie 49:10
not huge, significant. Yeah, my blood sugar mighty onesies are probably down in the sixes.

Scott Benner 49:15
Yes. That's amazing. That's really fantastic. But are you still a good eater all these years later? Oh, hell yeah. Yeah. Then stuck. That stuck with you that one conversation with that doctor? Absolutely. And did your mom changed the whole family over like she talked about?

Bonnie 49:30
Oh, yeah. Oh, it wasn't like she was gonna cook for me separately.

Scott Benner 49:33
There's no special chef coming in and handling the different. Oh, no, no. Okay. So you find the, I guess, you say because of COVID. You found the pockets. You're just bored.

Bonnie 49:44
I do like to exercise and I'll go for long walks. And I used to go for walks while watching you know, shows on streaming services. I don't know if I'm allowed to say whatever. They're good. You know, Netflix.

Scott Benner 49:59
I'm sorry. I didn't realize Go ahead. I got you know, yeah, I

Bonnie 50:01
would watch a show while I walked outside. And then I realized, yeah, this is a little dangerous when I'm walking on streets. And so I decided I need to find podcasts to listen to so I'm not impacted visually as

Scott Benner 50:16
a person walking along watching television on your phone in front of your face. Did you ever walk into anything? No. Ever get hit by a car or close? No, I

Bonnie 50:24
mean, you know, I had a few mishaps on sidewalk, you know, on curbs and sidewalks.

Scott Benner 50:31
Midwest could have been a tractor. Who knows? It's so Okay, so you you look for Park is it? Is that thing that I hear people say that that happened? You were they go? It just hits them one day they go, oh, there's podcasts about everything. I bet you there's one about diabetes. Finger. Yeah. That's how it happens. Right? That crazy.

Bonnie 50:48
Finger. And so you know, my search for that then led me to, you know, the Facebook search and this group on Facebook, the private group on Facebook. And it's absolutely amazing. So yeah, so through this podcast, you know, learning about pumps, and I'm like, oh, pump. Oh,

Scott Benner 51:07
no idea. Interesting. Yeah. Which pump do you have now?

Bonnie 51:10
I use Omnipod. Okay. Yeah, five.

Scott Benner 51:15
So I saw I basically I sold that to you. So if they're listening right now, they should keep buying their ads. Yeah. Right. But But yeah, that's amazing. So because because you're so I mean, so many decades into it. Right? It seems uncommon that you would have made like the modernization happen. But what happened? You heard people talking about it, and you were just like, why am I not doing this? Or?

Bonnie 51:38
Yeah, and I'm a real researcher before I do something, so I have to do a lot of research, which means internet research prior to doing something but at the same time, you know, I love to exercise and I used to, you know, currently I will walk four or five miles a day, every day. That's my, those are my off days was that take an hour and 10 minutes ish. And which is a perfect amount of time to listen to your podcast, and that's on my off days and on my on days, I will bike ride, I will row I will cross country ski. I used to be really avid rower until I had hip flexion hip flexor issues. I can go off on a whole tangent about rowing. But you know, I used to, and I still do. I used to always hit lows. Well, I would do intense exercise, I would always go low. Okay. My endocrinologist said to me, she said, you know, we can help that and I'm like how she said, a pump. I'm like, Okay, so after her telling me that for a couple visits in a row, I finally decided, okay, let's do a pump.

Scott Benner 52:51
Go for it. Wow. Let's do you think you'll do an algorithm ever? I do. Oh, wait, you're doing Omnipod? Five Omnipod? Five. Oh, not that the sun. Okay. I'm sorry. And that is helping you with your exercise? To a degree. Yeah, it's tough. Even if you do if you do a really vigorous exercise, there's still things you need to do. Yes. Listen, Arden got low last night packing her room up to leave college. All she was doing his packing bags, like doing dishes, loading her car. And she's like, Dad, I got low overnight. And she's like, it was hard to get it back up. And I said no, I I thought so I said we probably should have done something little restriction of your insulin. And she's like, didn't the algorithm and because she's using Iaps right now. And I looked and it had been taking her it was taking her Basal away for ever. And still the exercise like, you know, got got to her got her like to like a 55 blood sugar at some point. Oh, yeah,

Bonnie 53:49
absolutely. Like me washing my car or doing yard work. I will always go low. Okay, that said, I love to run low. Hello. I mean, I love to run low. I love to run in, you know, the 90s. I mean, I don't run as in go running. I love to stay low. But for me, too. And I will go into the 60s almost every day, once, at least once a day. Because for me, it's easier to control blood sugar in the 60s and just nudge it back up, then for me to deal with high blood sugar and bring it back down.

Scott Benner 54:22
So it's something you learned on your own or something you heard from the podcast,

Bonnie 54:26
for the most part learned on my own. I was doing that. Sorry. No, no, no, I

Scott Benner 54:30
don't I mean, that you. My expectation is that in 30 years, you would have figured that out. Yeah, you know what I mean? Yeah, by the way, I'd like to be really clear about something in case I haven't been. I'm not saying anything magical in the podcast. It's just that kind of common sense stuff about insulin management that people don't talk about, so nobody hears about it. So the next thing you know, it's 30 years later, and they, you know, been just been doing it like this forever. That's what you

Bonnie 54:57
are saying. Things that like I said Add things my doctor never told me, right? Yeah, like, here's another example Pre-Bolus I

Scott Benner 55:06
am always stunned by how few people have ever thought about timing their meal and so

Bonnie 55:12
39 Well, I've been Pre-Bolus thing for a while now. Okay, so let's say, I've been Pre-Bolus thing for two years. Seven years, no one ever told me to Pre-Bolus

Scott Benner 55:24
just match up your insulin a little bit over the phone. What I meant was that it's not like, it's not like I got on the podcast, I'm like, Alright, everybody, listen, I'm going to tell you how to jump from universe to universe. It's, you know, like, I mean, it's not, it's not crazy, like, Oh, my God, only this one guy knows these things, like people, people, the problem I found with the diabetes space, is that people come in, obviously, they don't know anything. They're mostly left to figure stuff out on their own, some do, and go their own way. And some don't and live in a struggle. Neither of those two people are telling everyone else, Hey, have you considered Pre-Bolus And your meals, like you either don't know when you're gone, or you, you know, figured it out, and you're back to your life, and it's not your job to tell other people. I just was in candor, I was just one of the first people with a wide audience who was willing to say, this is how insulin works, you should probably understand this, you know, and nobody else would say, by the way, I knew people who understood it, people who had diabetes, who were in the diabetes space and writing blogs, and like making money and doing all the things, but they would never tell people how they manage their blood sugar, and they would hide behind. Well, everybody's different. You know, and I'm like, That's not why you don't want to take responsibility for saying this out loud. That's what this is, you know, just like through the same goddamn reason some doctors won't tell you and they know. Well, yeah, it's

Bonnie 56:48
the same reason I don't go on a job site and tell tell a contractor, they're not OSHA compliant. You know, I don't want the responsibility of it. Just

Scott Benner 56:55
look the other way.

Bonnie 56:56
It's fine. No, no, basically, no, serious. No, I

Scott Benner 57:00
understand. Yeah. No,

Bonnie 57:02
I mean, I don't want the liability. I mean, there's actual liability.

Scott Benner 57:06
Yeah, one of the things that actually, you know, I say sometimes some of the little things you'll never realize that help people with diabetes through me, cell phones, cell phones, were a big deal, because I can now talk into this microphone, and you can hear the thing without too much trouble or expense, like so having cell phones, proliferates, podcasts that ends up helping people with diabetes, being podcast becoming something that people are like, understand now and their normal allows me to say nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And then we're all kinda like, like, in this day and age, we're all good with that. We all have agreed as a society, we know what this means. There is, you know, maybe no shortage of 10s of 1000s of podcasts telling people how to manage their health. And at some point, during each one of them, somebody goes, Hey, this isn't advice. I'm just telling you what I do. But 20 years ago, if you would have written a blog, and said, Hey, here's how you're Pre-Bolus, someone would have come along and said, You can't give medical advice to people. And if you would have said, I'm just sharing my experiences, they would have said, No, you're giving people medical advice, because society hadn't gotten to this point yet. So it's one of those simple ways that I now get, I mean, uncountable numbers of messages, emails, and you know, whatnot about people are like, Oh, my God, look, my one see a six one, like, so cool. Like, I've never in my life, I didn't expect to hear you saved my life 1000s of times. Because, I mean, who knew that was gonna happen? But on the other side of it, I don't feel like I did. I feel like I just pointed when you should know about that, you know, so. And,

Bonnie 58:50
yeah, and It shocks me that the that my doctors, I mean, I haven't had a huge number of doctors not tell me this. And I don't mean to diss my doctors either. Don't, don't get me wrong. Yeah, I

Scott Benner 59:02
want to say I don't take you that way. And I also hope that doctors don't take it that way. Then Jenny and I are recording a series right now. We're pretty far into the recording of it. It'll come out next year. I'm going to actually tell you how far we are into it right now. It's in this folder here. And then this but there's a lot of folder so that all these folders, I actually have a folder that's called needs organizing. Do you think that's good news? It's not it's bad news. Jenny and I have now 1234 We've now recorded five episodes of something that we're going to call Grand Rounds, which is just talking to physicians about what people with diabetes need from them. And we don't imagine that every you know, we're going to be able to attract all the doctors, but some will. And the conversations are set up so that they're talking to To the doctor about like, Hey, this is what you should be expecting, and what you should be doing and what these people deserve. But at the same time, if you listen from a patient's perspective, what you're hearing is, this is what I deserve. This is what I should be asking for. This is what I should be expecting. And, you know, Jenny gets fired up, like for people who've only only, like, heard her like, in, like pro tips or bold beginnings, and she's all like, you know, Wisconsin and like, Oh, it's okay. Like, like it all sweet and everything, you shouldn't see how upset she gets when she thinks about people with diabetes not being given reasonable information. And as we're having this conversation, it's ringing in my head, are we going to turn doctors off to this? And what I eventually figured was, they need to, like, take their part of this responsibility here, like I can't hold their hand and tell them they're doing a great job, because a lot of them just aren't. And if hopefully, some of them will hear it is, you know, my expectation. Yeah.

Bonnie 1:00:57
You know, I mean, I don't know how open doctors are to critique. And as architects, we are always open to critique. But yeah, I mean, I haven't gone through this for 39 years, I'm amazed at what my doctors haven't told me. But by the same token, I understand that, you know, they're looking for like, you know, they're looking, I want to say for big picture, serious things like, Have I lost circulation my feet, I mean, you know, yeah, no issue, then, by

Scott Benner 1:01:27
the way, you might not lose the circulation your feet, if you tell me how to Pre-Bolus My friggin meal. Like, it's and that's the thing we talked about this series is how, thank you how they're so willing to see you in a in an emergency room situation and go, oh, this person, man got a high once he blood sugars all replaced, they don't know what they're doing. They gave up they don't even understand like they're willing to talk about people like that. But they're not willing to take responsibility for not putting the person on the right path. 20 years before they ended up in the emergency room. Being proactive. Yeah, it's your fault, not their fault. Anyway, that's what that series is going to be like, and she gets, I think it's, sometimes we're all upset. We like stop the recording, we sit back, like, Oh, my God.

Bonnie 1:02:08
I remember when I was pregnant, and they said, you know, it's critical that you check your blood sugar two hours after a meal, and that it'd be within normal range, like around, you know, 90 to 110 or something like that. And I'm like, okay, but you haven't told me how to do that. Oh,

Scott Benner 1:02:23
I do that. Yeah. Thank you. Is there a way you would say that would work for that? Because I've had diabetes a while and it's never gone that

Bonnie 1:02:31
way. Right? And so yeah, let's, you know, tell me means and methods. And I'll, I'll give you an outcome, right? Yeah.

Scott Benner 1:02:38
i It's all I say, it's all I'm saying, by the way, and I'm not. You know, it's funny, as we talked about how, how the Internet matured society about their expectations about what was being said to them, you things change. I would say as recently as four years ago, I would be told by doctors that I was Doctor bashing. Oh, and I guess that would have actually, there's a great episode called listen to the doctor where an endo comes on, and admits to listening, lovely woman comes on to tell me how she started to listen to the podcast and was like, Oh, my God, this guy's Doctor bashing, and then kept listening. And eventually says in the episode, you know, a large part of how I now treat my patients with diabetes is from you in this podcast. And I was like, that's so cool. But anyway, that nobody tells me I'm Doctor bashing anymore. Because society's moving forward, like all of a sudden, you know, back then it was like you're complaining, you're blaming us? And I'm like, seems like you have some responsibility in this. And only four or five years later, people don't think like that anymore. Now they're like, Yeah, I deserve for someone to give me good information. I'm dragging people's expectations into the future is what I'm what I'm trying to do like, like you should expect better than what you're getting. Yes, you have to put the work in, but to your point, which you've made like six times now, if I don't know the tools, I can't write, I can't do the work, you know, right. That's it super simple. It's all very simple. People would just listen to you and be fine. But no, one of my house listens to me. Anyway, I can't wait to put this series out and hear through the grapevine. How I'm making fun of doctors, but

Bonnie 1:04:21
I think people need to understand that, you know, people are critiqued at least, you know, as architects, we critique each other. We go through school getting critiqued, and, you know, critique is not necessarily positive or negative. It's just here's, here's an analysis. Yeah, this is

Scott Benner 1:04:43
my perspective of what you're doing the thing you're doing. I listen, I gotta tell you for any doctors listening. I don't mean to curse because you've been so nice lately, but I take it pretty frequently from people are like this podcast. He doesn't do this right. He doesn't do that. Right. Why does he talk so much? How come you won't Let them talk. I'm like, yeah, I gotta hear you gotta hear it. How's that?

Bonnie 1:05:08
I can. I can be salty if you really want me.

Scott Benner 1:05:11
You're a Canadian in the beginning. So I know you guys are savvy, you don't shoot people. You like to curse. That's pretty much what I know about Canadians

Bonnie 1:05:18
I can I can get pretty salty when I'm coxing races.

Scott Benner 1:05:22
You have to hear the episode that came out today. It's called Canadian clown car. It's nine year old little girl. So her mom sets up the recording like it's for her. And you I mean, you've now been through this with me. I don't put almost any effort into making sure you're here. So it's really on you to show up, you know? And so the microphone comes on. I go Hello. And it's this little girl's voice. And I was like, I'm like, going through my notes real quick. I'm like, I'm online. Talking to a little kid on that like, what's going on? I think the mom just set me up like she just booked for herself and then stuck the kid on the show. This conversation it's a really great actually with this like nine year old little girl. But she's Canadian. And you know, I do all my like better Canadian humor. Whether I was like, you know, dog sleds, that's how you get things places. They don't grow apples in Canada, do they? She's like, Yeah, I've been to an orchard. I'm like, they're no orchards and Katelyn. She's like, it's their arm, like, I don't understand. I'm like, Can let's just a big piece of snow. And I was like, I don't even know how you're on this call with me. You live in an igloo. And you know, like, that kind of stuff. And I was like, at one point, I go, and I was like, oh, wait a minute. I'm like, your Santa lives. She goes, No, that's the North Pole. And I'm like, those aren't the same place. And she's like, here's what we're doing all that. And at some point, she says something about the cars in America. And I said, How do you know there are cars in America? And she goes, Well, there are and I was like, if you ever been here and she goes, No one I'm like, Are you sure? And I got down to like an existential moment with a nine year old where she goes, Yeah, I guess I'm not sure that there are cars in Canada. And I was like, right? As like, for instance, are you in a room right now? And she goes, yes. I said, is the door closed? And she goes, yeah. And I said, Is there a clown on the other side of the door? Oh, boy. And she goes, You should hear she goes, No.

Bonnie 1:07:15
She's, she's had nightmares. There

Scott Benner 1:07:18
might be and I was like, right. Anyway, I love Canadians. Alright, so I am on a super tight schedule today. So I wouldn't I need to ask you the question a little earlier than I normally would. What we haven't talked about that we should have. Oh, no,

Bonnie 1:07:34
I think I think we hit everything we did. Okay. 10, tangents and otherwise, three words. I

Scott Benner 1:07:41
don't know. I didn't write them down. Because I didn't want to be like, did you say starkly? At some? No, not starkly. extact? What did you say at 1.0? I

Bonnie 1:07:49
can't remember all tangents. Is

Scott Benner 1:07:51
that what you did? I know. That was insulting. Like, she's like, Oh, does he not know tangent? Okay, you're

Bonnie 1:08:01
asking me to recall. You don't have to, I'll go back that I learned, you know, orally and I'm a visual learner. So I have to think now.

Scott Benner 1:08:12
I just thought of the worst joke that I'm not gonna say. Maybe just horrifying. I'm not gonna say I'll tell you when we're done recording. So, but yeah, we haven't missed anything big picture stuff like, like, you know, it's funny. I meant to say this earlier. I asked you why you wanted to come on the podcast. And really your answer was, I've just had experiences I'd like people to know about them. I think that would help them. Yeah, I always think someone's gonna say something like, super specific. And they never really do. It's always just like, I think if people listened to what happened to me, it might help them. And which I think is lovely. You know? Yeah, yeah. Here's some free advice for other podcasts. I think were some other podcasts go wrong is they decide this episodes about this specific thing. And then they try to talk about this one idea for an hour. And I'm like, that's like four minutes A Conversation. You know what I mean? Like, you can't, you can't break this thing down that far. Like it just it's boring. Oh,

Bonnie 1:09:09
I know, I know what I wanted. That when I first went on the pump, I was on dash. Because the Omnipod five algorithm was out. And I was shocked beyond belief that my blood sugar could be straight lines.

Scott Benner 1:09:27
The first time it happens, it throws people off.

Bonnie 1:09:32
Loop shock. I mean, quite literally, you could have picked my jaw up off the floor. I

Scott Benner 1:09:41
have a graph, a graphic when I speak in person and I go, Hey, here's a graph, 24 hour graph and this little girl, and it's pretty choppy, like really choppy kind of all over the place. And I said I spoke to her mother privately and we fixed her Basal insulin and then the next graph comes up and I go in, that's her blood sugar. Next 24 hours. And they are people are just like, wait, what? And I was like, yeah, so it's bowls them over when they first see it. It's all about timing and amount. So, absolutely.

Bonnie 1:10:10
I could not believe I could ever have blood sugars like that.

Scott Benner 1:10:15
Yeah, it's not that difficult to accomplish once you know how to do it, have a couple tools and get me takes time. Don't get me wrong, it's not easy. It takes time. And

Bonnie 1:10:23
you know, my, my endocrinologist is really good at sort of really sort of on a granular level really dialing up and down my Basal at least at the time when I was not on an algorithm, really dialing my basil up and down to get me that straight line. utterly shocked. Yeah, so yeah, so the people that insolate I have to say and other pump makers. I applaud you that said, you know, don't you know, when I go low, don't take away my basil forever and ever. Well, don't you know, it's frustrating because I'm on so little insulin a day, I probably take on average, like 22 units a day total insulin. And so when I go low, you take away my basil, but I don't need the basil. Now when I'm low. I need it like in an hour, and you've taken away all my basil and I'm like, Oh, I'm gonna It's too it's

Scott Benner 1:11:15
too late now. Yeah, yeah. Well, the algorithm Listen, first go round for these algorithms. I can't wait to see them in a few more years, sir. So

Bonnie 1:11:23
absolutely. So the low life intern who's sitting and listening to all your podcasts?

Scott Benner 1:11:28
Make a person listen. Also, don't call them a low life. I know some of them. They're lovely.

Bonnie 1:11:34
I'm sure they are. I'll say I'll say the love. Yes, exactly. I'm sorry.

Scott Benner 1:11:41
So you believe that in every company by the way, this is true. I know this is true. But in every company for people who've never thought about this, there's somebody whose task it is to listen to this podcast. Oh, yeah. Yeah, that happens. And then they talk about it in meetings and, and stuff like that. I have a great story. I wonder if I'll ever be able to tell it about how Medtronic became an advertiser. I don't know off to see if I can tell that stuff to think about. All right. Thank you so much to go. Hold on one second for me.

Jalen is an incredible example of what's so many experience living with diabetes. You show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story visit Medtronic diabetes.com/juicebox And look out online for the hashtag Medtronic champion. Thank you so much for listening. I hope you enjoy my full conversation with Jalen coming up in just a moment. A huge thanks to Dexcom for supporting the podcast and for sponsoring this episode dexcom.com/juicebox Go get yourself a Dexcom g7 right now using my link. I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juicebox at checkout will save you 40% off of your entire order at cozy or.com. That's the sheets, the towels, the clothing, anything available on the website. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made the finding diabetes, go to juicebox podcast.com up into the menu and click on defining diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Thanks for hanging out until the end. Now you're gonna hear my entire conversation with Jalen don't forget Medtronic diabetes.com/juice box or the hashtag Medtronic champion on your favorite social media platform. My

Speaker 1 1:14:25
name is Jalen Mayfield. I am 29 years old. I live in Milwaukee, Wisconsin, where I am originally from Waynesboro, Mississippi. So I've kind of traveled all over. I've just landed here in the Midwest and haven't left since ice.

Scott Benner 1:14:40
How old were you when you were diagnosed with type one diabetes?

Speaker 1 1:14:43
I was 14 years old when I was diagnosed with type one diabetes 15 years

Scott Benner 1:14:47
ago. Wow. Yes. Okay. 14 years old. What do you like? Do you remember what grade you were in?

Speaker 1 1:14:52
I actually do because we we have like an eighth grade promotion. So I had just had a great promotion. So I was going straight into high school. So it was this Summer, heading into high school

Scott Benner 1:15:01
was that particularly difficult going into high school with this new thing? I

Speaker 1 1:15:05
was unimaginable. You know, I missed my entire summer. So I went to I was going to a brand new school with, you know, our community, we brought three different schools together. So I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was,

Scott Benner 1:15:25
did you even know? Or were you just learning at the same time, I

Speaker 1 1:15:29
honestly was learning at the same time, my hometown did not have an endocrinologist. So I was traveling almost over an hour to the nearest, you know, pediatrician, like endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown. Was

Scott Benner 1:15:46
there any expectation of diabetes? Is somebody else in your family have type one? No, I

Unknown Speaker 1:15:51
was the first one to have type one in my family.

Scott Benner 1:15:52
And do you have children? Now? I do not know. Do you think you will one day filled, you're

Speaker 1 1:15:58
gonna validate. But right now, I've just been traveling books at all my career myself. So

Scott Benner 1:16:02
what do you do? What's your career? Yeah, so

Speaker 1 1:16:05
I am a marketing leasing specialist for student housing companies. So we oversee about 90 properties throughout the US. So I've been working for them for about eight years now. And you get to travel a lot in that job. Yes, I experience a lot of travel. It's fun, but also difficult, especially with all your type one diabetes supplies, and all your electronics. So it's a bit of a hassle sometimes.

Scott Benner 1:16:27
What do you find that you absolutely need with you while you're traveling? diabetes wise,

Speaker 1 1:16:32
I have learned my biggest thing I need is some type of glucose. I have experienced lows, whether that's on a flight traveling, walking through the airport, and I used to always experience just being nervous to ask for some type of snack or anything. So I just felt, I felt like I needed to always have something on me. And that has made it my travel a lot easier.

Scott Benner 1:16:53
So growing up in the small town, what was your initial challenge during diagnosis? And what other challenges did you find along the way?

Speaker 1 1:17:03
Yeah, I think the initial one, I felt isolated, I had no one to talk to that it was experiencing what I was going through, you know, they were people would say, Oh, I know, this is like hard for you. But I was like, you really don't like I, I just felt lonely. I didn't know you know, people were watching everything I did. He was like, You can't eat this, you can't eat that. I felt like all of my childhood had been, you know, I don't even remember what it was like for life before diabetes at this point, because I felt like that's the only thing I could focus on was trying to do a life with type one diabetes,

Scott Benner 1:17:38
when you found yourself misunderstood? Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 1:17:45
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just, you know, kept it to myself didn't really talk about it when I absolutely had to,

Scott Benner 1:18:03
did you eventually find people in real life that you could confide in?

Speaker 1 1:18:07
I think I never really got the experience until after getting to college. And then once I graduated college, and moving to an even bigger town, that's what I finally found that was people were I was like, Okay, there's a lot of other people that have type one diabetes. And you know, there's a community out there, which I had never experienced before,

Scott Benner 1:18:28
is college where you met somebody with diabetes for the first time or just where you met more people with different ways of thinking. So

Speaker 1 1:18:35
I met my first person with diabetes, actually, my freshman year of high school, there was only one other person. And he had had it since he was a kid, like y'all once this was like, maybe born, or like right after that timeframe. So that was the only other person I knew until I got to college. And I started meeting other people. I was a member of the band, and I was an RA. So I was like, Okay, there's, you know, there's a small handful of people also at my university. But then, once I moved to, I moved to St. Louis. And a lot of my friends I met were like med students, and they were young professionals. And that's where I started really getting involved with one of my really close friends this day. He was also a type one diabetic. And I was like, that's who introduced me to all these different types of communities and technologies, and which is really what helped jumpstart my learning more and with type one diabetes.

Scott Benner 1:19:26
Do you think I mean, there was that one person in high school, but you were young? Do you really think you were ready to build a relationship and around diabetes? Or did you even know the reason why that would be important at the time? I

Speaker 1 1:19:37
didn't know you know, I honestly didn't think about it. I just was i Oh, there's another person in my class that's kind of going through the same thing as I am but they've also had it a lot longer than I have. So they kind of got it down. They don't really talk about it. And I was like, Well, I don't really have much to like connect with them. So sorry. Connect with them all.

Scott Benner 1:19:57
Yeah, no. So now once your world expands as far as their From people, different backgrounds, different places in college, you see the need to connect in real life, but there's still only a few people, but there's still value in that. Right?

Unknown Speaker 1:20:09
Correct.

Scott Benner 1:20:10
What do you think that value was at the time?

Speaker 1 1:20:12
I think it was just what making me feel like I was just a normal person. I just wanted that. And I just, I needed to know that like, you know, there was other people out there with type one diabetes experiencing the same type of, you know, thoughts that I was having.

Scott Benner 1:20:27
When were you first introduced to the Medtronic champions community? Yeah,

Speaker 1 1:20:32
so about two years ago, I was, you know, becoming more I was looking around and I noticed, stumbled upon the Medtronic community. And I was like, this is something I really, really, I kind of need, you know, I said, I, all throughout these years, I was, you know, afraid to show my pump. You couldn't, I would wear long sleeves, like, didn't want people to see my CGM, because I didn't want people to ask me questions. And you know, I just felt so uncomfortable. And then I noticed seeing these people really, in the Medtronic community just they embraced it, you could see them, they weren't afraid to show it. And that was something I was really looking forward to. How is

Scott Benner 1:21:08
it knowing that your diabetes technology is such an important part of your health in your care? And having to hide it? What did it feel like to have to hide that diabetes technology? And how did it feel to be able to kind of let it go, I

Speaker 1 1:21:21
will refuse to go anywhere, like, Hey, I would run to the bathroom, I just didn't want to do it in public, because I felt like people were watching me. And that was just one of the hardest things I was trying to overcome. You know, I was fresh out of college, going into a young professional world. So you know, going out on work events and things like that. I just, I just didn't think I just didn't think to have it out. Because I was so afraid. But then, once I did start, you know, embracing it and showing it that's when the curiosity came and it was actually genuine questions and people wanting to know more about the equipment that I'm on, and how does this work? And what does this mean? And things like that, which made it kind of inspired me? Because I was like, Okay, people actually do want to understand what I'm experiencing with type one diabetes.

Scott Benner 1:22:06
What did you experience when, when the internet came into play? And now suddenly as easy as a hashtag, and you can meet all these other people who are living with diabetes as well? Can you tell me how that is? Either different or valuable? I guess, compared to meeting a few people in real life? Absolutely.

Speaker 1 1:22:23
I think if you look back from when I was first diagnosed to now, you, I would have never thought of like, you know, searching anything for someone with, you know, type one diabetes. And now it's like, it's all I see, you know, you can easily search Medtronic champions, and you see people that pop up, and you're like, wow, look at all this content. And I think that's something that that kind of just motivates me, and which is how I've kind of came out of my shell and started embracing more and posting more on my social media with about, you know, how I'm able to type one diabetes. And I think that's something that I hope can inspire everyone else.

Scott Benner 1:22:57
What was it like having more personal intimate relationships in college with type one?

Speaker 1 1:23:02
I think it was kind of hard to explain, you know, just, for example, like, no one really knows, it understands like what alo is. And I think that was a very hard thing for me to explain, like I, you know, it can happen in any moment. And I'm sweating. I'm just really like, not all there. And I'm trying to explain, like, Hey, this is what's going on. I need your help. And I think that was something that was hard for me to, you know, I did talk to people about it. So when this happened, they were like, oh, you know, what's going on with you? I'm like, I'm actually a type one diabetic. This is what's going on, I need your help. What about

Scott Benner 1:23:40
once you've had an experience like that in front of someone? Was it always bonding? Or did it ever have people kind of step back and be maybe more leery of your relationship? After

Speaker 1 1:23:53
I would tell someone I had type one diabetes after subtype of Evander endemic, they were kind of more upset with me that I didn't tell them up front. Because they were like, you know, I care about you, as a person I would have loved to knowing this about you. It's not anything you should have to hide from me. And that was a lot of the realization that I was going through with a lot of people.

Scott Benner 1:24:09
Okay, let me ask you this. So now we talked about what it was like to be low, and to have that more kind of emergent situation. But what about when your blood sugar has been high or stubborn? And you're not thinking correctly, but it's not as obvious maybe to you or to them? Yeah.

Speaker 1 1:24:24
So I also I go through my same experiences when I have high blood sugars. You know, I can tell like, for my co workers, for example, I didn't really talk to you know, when I go out backtrack, when I visit multiple sites for work, I usually don't announce it. And so sometimes, I'm working throughout the day, I might have snacks, forgot to take some insulin, and my blood sugar is running high and I'm a little bit more irritable, I'm all over the place. And I'm like, let me stop. Hey, guys. I need to like take some insulin and I'm sorry, I'm not I didn't tell you guys. I'm a diabetic. So you may be wondering I'm kind of just a little bit snippy, you know, so I like to make sure I do that now going forward, because that's something I noticed. And it was kind of hindering me in my career because I was, you know, getting irritable, because I'm working nonstop. And I'm forgetting to take a step back and focus on my diabetes,

Scott Benner 1:25:15
right? Hey, with the advent of new technologies, like Medtronic, CGM and other diabetes technology, can you tell me how that's improved your life and those interactions with people? Yeah,

Speaker 1 1:25:26
I can. I feel confident knowing that it's working in the background, as someone and I always at least said it, I have been showing that's really bad with counting my carbs. So sometimes I kind of undershoot it, because I'm scared. But it allows me to just know that, hey, it's going, it's got my back if I forget something, and I think that allows me to have a quick, have a quick lunch. And then I'm able to get back into the work day because it's such a fast paced industry that I work in. So sometimes it is easy to forget. And so I love that I have that system that's keeping track of everything for me.

Scott Benner 1:25:59
Let me ask you one last question. When you have interactions online with other people who have type one diabetes, what social media do you find the most valuable for you personally? Like? What platforms do you see the most people and have the most good interactions on?

Speaker 1 1:26:16
Yeah, I've honestly, I've had tremendous interactions on Instagram. That's where I've kind of seen a lot of other diabetics reach out to me and ask me questions, or comment and be like, Hey, you're experiencing this too. But I've recently also have been seeing tic TOCs. And, you know, finding on that side of it, I didn't, you know, see the videos and upload videos. And I'm like, I would love to do stuff like that. But I just never had the courage. So I'm seeing people make like just the fun engagement videos now, which I love, you know, really bringing that awareness to diabetes.

Scott Benner 1:26:45
Isn't it interesting? Maybe you don't know this, but there's some sort of an age cutoff somewhere where there is an entire world of people with type one diabetes existing on Facebook, that don't go into Tik Tok or Instagram and vice versa. Yeah. And I do think it's pretty broken down by, you know, when that platform was most popular for those people by age, but your younger people, I'm acting like, I'm 100 years old, but younger people seem to enjoy video more.

Speaker 1 1:27:12
Yes, I think it's just because it's something you see. And so it's like, and I think that one thing, and obviously, it's a big stereotype of our diabetes is you don't like you have diabetes. And that's something I always face. And so when I see other people that are just, you know, normal, everyday people, and I'm like, they have type one diabetes, just like me, they're literally living their life having fun. That's just something you'd want to see it because you don't get to see people living their everyday lives with diabetes. And I think that's something I've really enjoyed.

Scott Benner 1:27:41
What are your health goals? When you go to the endocrinologist, and you make a plan for the next few months? What are you hoping to achieve? And where do you struggle? And where do you see your successes,

Speaker 1 1:27:52
I'll be honest, I was not someone who is, you know, involved with my diabetes, I wasn't really focused on my health. And that was something that, you know, you go into an endocrinologist and you get these results back. And it's not what you want to hear. It gets, it makes you nervous, it makes you scare and so I have personally for myself, you know, I was like, This is my chance, this is my chance to change. I know there's people that are living just like me, everyday lives, and they can keep their agencies and their blood sugar's under control. How can I do this? So I go in with, you know, I would like to see it down a certain number of points each time I would love for my doctor to be like, Hey, I see you're entering your carbs, I see your, you know, you're not having lows. You're not running high, too often. That's my goal. And I've been seeing that. And that's what motivates me, every time I go to the endocrinologist where I don't dread going. It's like an exciting visit for me. So you'd

Scott Benner 1:28:40
like to set a goal for yourself. And then for someone to acknowledge it to give you kind of that energy to keep going for the next goal.

Speaker 1 1:28:48
Yeah, I feel as a type one diabetic for me, and it's just a lot to balance. It's a hard our journey. And so I want someone when I go in, I want to be able to know like, Hey, I see what you're doing. Let's work together to do this. Let's you don't want to be put down like you know, you're doing horrible you're doing it's just, it's not going to motivate you because it's you're already fighting a tough battle. So just having that motivation and acknowledging the goods and also how we can improve. That's what really has been the game changer for me in the past two years.

Scott Benner 1:29:25
John, I appreciate you spending this time with me. This was terrific. Thank you very much.

Unknown Speaker 1:29:28
Absolutely. Thank you.

Scott Benner 1:29:30
If you enjoy Jalen story, check out Medtronic diabetes.com/juice box. I appreciate you listening all the way to the end. So this little bit is just for you. Hello, friends. Hello friends. Hold on. I'm getting there.

Alright, let's try this again Hello friends and Hello friends. No hello hello friends Hello friends and welcome to episode 1191 of the Juicebox Podcast.

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#1193 Two Wheelin'

Brandy and Lisa are a delightful mother daughter pair.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to episode 1193 of the Juicebox Podcast.

Today I'm joined by Brandy. She's 40 years old, she's had type one diabetes since she was a sophomore in college. And brandy brought a little bit of a surprise with her. You'll find out about that in just a minute. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink ag one.com/juice box you know I'm talking to you right now into your ears and I'm saying to you go to T one D exchange.org/juice box and complete the survey. They're looking for type ones and the caregivers of type ones who are US residents to complete a short survey. That's all they ask. He will in the exchange.org/juice box you will help type one diabetes research move forward and you may just help yourself. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org and find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. The free tickets for their annual conference just became available today. Go to touch by type one.org then click on programs and then annual conference and register for free. I will see you on September 14 in Orlando, Florida. This episode of The Juicebox Podcast is sponsored by the ever since CGM. And sure all CGM systems use Transcutaneous sensors that are inserted into the skin and lasts seven to 14 days. But the Eversense sensor is inserted completely under the skin lasting six months ever since cgm.com/juice box. This episode of The Juicebox Podcast is sponsored by the Omni pod five, Omni pod.com/juice box. My daughter Arden has been wearing an omni pod every day since 2006. And it has been a constant friend in her life with diabetes, consistent tubeless and worryfree Omni pod.com/juice box IO

Brandy 2:52
My name is Brandy. I am a type one diabetic. This is my 20th year dealing with this lovely, lovely disease. And I just wanted to come on here and tell a little bit about my story.

Scott Benner 3:06
Randy, how old were you when you were diagnosed?

Brandy 3:08
I was 20.

Scott Benner 3:10
So you're 40 now? Oh, you're at that interesting split time. You've now had diabetes for as long as you didn't have it.

Brandy 3:17
Yes, exactly. Which is a little surreal,

Scott Benner 3:21
I would imagine. And we are actually joined today by your mother Lisa.

Speaker 1 3:27
Yes. Hi, this is Lisa. I'm brandies mom and honored to be on this podcast with brandy to again, share our story in hopes that perhaps something we might say or that we've been through would be of help to others.

Scott Benner 3:45
That's wonderful. That is exactly why I started making my my blog all those years ago. Please. I won't ask you how old you are. I assume you're also 40. So

Unknown Speaker 3:54
older than dirt.

Brandy 3:57
Oh, there you go twin, but

Scott Benner 3:58
yeah, right. I just I just assume that's how it went. So I guess I'd like to start by asking, yeah, I think this is what I want to do. Brady, what do you remember about being diagnosed? Well, it's

Brandy 4:10
I mean, it's very, most things are very vivid. There's a few things I think now like looking back on it. It's a little hazy. But I remember I was in college. So it was my second year in college. I was about two and a half hours away from home. Well, I have family close to the area that is extended family. And I remember just not feeling the best kind of rundown, tired. I was thirsty all the time. And the college that I went to is a very, very, very tiny college like, I could call my professor on the phone and not identify myself and he recognized my voice. So we didn't have like a medical clinic. It was only a couple of days a week. I knew I needed to be seen. So I kind of do just went and saw the nurse one day and was like, Hey, I don't think I think something's wrong. And she was like, Okay, well go get you a big breakfast. She's like, the doctor will be in at nine. And I was like, Well, I had to teach a class that morning as well. So I went and got breakfast, taught the class, I let everybody go early, and then went back. And I was the first one to be seen by the doctor. And I just remember, I told her kind of what was going on about how I lost 15 pounds in one week, thirsty all the time getting sick on my stomach. She said, Here, go pee in a cup, came back and she's like, Hey, sweetie, I don't know how to tell you this, but you have diabetes. And I'm like, No, you you can't tell that I just peed in a cup. That was a she's like, who can you call? I'm calling an ambulance. We're gonna we're gonna take you to the hospital. And so you know, it kind of started from there. And I still at that moment, like it hadn't registered. And so like I called my mom who was at work. And I started to tell her and I was like, Mom, I have diabetes. And like, I just started sobbing. And the doctor just took the phone out of my hand and then talk to my mom. So

Scott Benner 6:14
hey, what was your last? What was your last meal? Do you remember? Wait, was it Hardys? Did you say

Brandy 6:21
already breakfast? I went into like, go to a very small school. We have one cafeteria and we had one fast food restaurant and it was hearty. So I got like a sausage biscuit. You

Scott Benner 6:32
got cut rate fast food? Yes. You didn't even like go to one of the big ones.

Brandy 6:39
We don't have. We didn't have big ones that literally Hardee's is the only fast food restaurant in town. Okay,

Scott Benner 6:44
when you get on the phone with your mom all those years ago, like, Were you being brave, right up until that moment?

Brandy 6:51
I don't think I was being brave. Up until that moment. I think I just I didn't understand what was going on. in shock.

Scott Benner 6:57
Yeah, Lisa, what did it feel like when she? Do you remember that phone call? Every day all over my private Facebook group? I see people talking about their love for Omni pod five. Have you seen people out in the community talking about Omni pod five and thought, Oh, I wish I could have that experience with an insulin pump too. Well, guess what? If you've answered yes to that question, you may be experiencing FOMO fear of missing out on Omni pod. Symptoms of flu may include but are not limited to fantasizing about jumping into a swimming pool without disconnecting from your pump first, dreaming about walking past doorknobs without getting your tubing caught? Oh, I bet you've been wishing you could wear your outfits that don't have pockets? Well, there's good news for you. You don't have to suffer from flu any longer. You can see what you're missing by just trying the on the pod five for yourself. Visit my link Omni pod.com/juicebox To learn more, and get started today. Let's get rid of that fear of missing out on Omni pod and get you going on life.

Speaker 1 8:05
Oh, I'll never forget. I'm sitting here at work and, you know, hear answer. And then I can hear immediately in her voice that, you know, she's on the verge of tears. And then the doctor gets on the phone and introduces herself. And you know, this is a small town college with an infirmary and she says, you know, don't panic that you need to come up here immediately have called an ambulance for your daughter. She has type one diabetes, her blood sugar's were, you know, through the roof. And my initial thought is, well, you know, lady, I'm not sure who you are, you're in a little small town, college infirmary. And, you know, diabetes, which I was totally ignorant of no one in our family has diabetes, even type two, I see them thinking, you know, there's got to be all sorts of tests that have to be run, which you're obviously not capable of doing. So I was in shock and denial, both but you know, knew that I had to get there as soon as possible and just found out a hospital they were sending her to and drove like a bat to meet her there. You know, just couldn't get there fast enough. And that that day is just scorched into my memory. And I'm, I'm hoping that over the last 20 years, there have been changes in improvements and with with teaching and all the information and instructions that can be given but years

Scott Benner 9:44
ago, Lisa there hasn't been don't worry

Speaker 1 9:48
about that. That's that's my biggest beef of the staff and they are the endocrinologist. They were all fabulous but the lack of education In and really enlightenment, to this life changing disease that you've now got that can kill you if it's not treated properly, that can't be stressed enough. And we did not get that we got a pink panther coloring book literally never even happened that riding on it that we went through pretty much on our own. And that was just an innate even after the initial week in the hospital. You know, it wasn't near what we needed and and we were fumbling you know, in the dark trying to figure this out. And then, you know, I have to come back home and leave my daughter two and a half hours away to fend for herself. And we still didn't understand the enormity of this at that time.

Scott Benner 10:54
No, I guess you also you know, Brandi, do you have kids now?

Brandy 10:59
I do not know.

Scott Benner 11:00
So your mom and I know something that that other parents know. And people who don't have kids know is that every time your kids text or call or anything, there's this your your heart, like takes half a beat. And you're like, like you just you're waiting for somebody to say something bad. And I think that people could think oh, that's you being I don't know, like dramatic. Or you know, you don't need to be that way, Scott. But I swear to you, every time I get calls, I think I hope they're okay. And then when they're okay, then you think oh, I hope they're happy. And then when you think that, you know, then you're like I hope people are being kind to them. Like the things you worry about constantly for your children are are insane. So when the call comes, and you're like, Oh, I hope this is okay. And then it's no, this is happening. Your mom, I like your mom going like I don't know who you are, you might not know what you're talking about. But at the same time, I'm incredibly impressed at how well that clinic diagnosed you.

Brandy 11:57
Oh, me too. I was I was shocked. You know, and again, I had no idea. Well, I am also very, extremely stubborn. I'm sure it has nothing to do with being an only child. But she told me EMS was coming. And I was like, No, I can have a friend dragged me to the hospital. And she's like, I don't think you understand how sick you are. And I'm like, I am walking and I'm talking and I came to you. And so she was like, they're gonna come in and take you out on a stretcher. And I'm like, I am a sophomore in college, and you want to put me on a stretcher in front of everyone. No, we're not doing this. And so we negotiated for a few minutes. And finally it was I was able to walk out on my own with one EMS person in front of me and one behind me and get into the ambulance. But you know, the load the closest hospital is about 35 minutes away. So I had that fun ride.

Scott Benner 12:53
Did you guys stop at the Hardy so the EMS guys could get some lunch? Yeah, I

Brandy 12:57
mean, I should have asked them if they wanted something

Scott Benner 13:01
that you know, 15 pounds in a week. Yeah, so

Brandy 13:05
and I know it specifically because I, the guy I was dating at the time, we had gone for some reason. We've gone to his family's house twice, like back to back weekends, which were normally alternated. But I weighed on his mom's scale. And when I weighed the Sunday before I was at one way and the next Sunday, I lost 15 pounds. And on the way back driving back to campus, my vision just completely almost went I've worn glasses and contacts since I was in seventh grade. At this point in time, I took my contacts out and I could see just fine. So it was almost like, I got a little excited at first I was like oh my gosh, my vision just automatically correct.

Scott Benner 13:50
turning into a sexy spider that can see well.

Brandy 13:58
And then, you know they burst my bubble in the hospital. They're like, Oh, no, no, it'll it'll correct itself back and I was like, was

Scott Benner 14:05
15 pounds a big percentage of your body weight?

Speaker 1 14:09
At the time? Yes. Yeah. And she had told me that she was not feeling well and that she was tired. And I'm thinking out, okay, you know, most college kids are tired. I knew her schedule, her workload teaching classes as well, being an RA just always overachieving. But when she told me about the weight loss, again, I had no light bulb that went off because I knew nothing of diabetes. But that was enough of a concern that made her promise she would go to the infirmary the next morning, which which she did know, but never expecting the diagnosis

Scott Benner 14:47
or rapid weight loss makes me think cancer right away. Bleeding and rapid weight loss, put my head to cancer. And so yeah, and yeah, hey, you know, you kept saying you don't know anything about diabetes. Is there any They're auto immune in your family like, Lisa like celiac, or do you have a bipolar uncle or anything going on at all?

Speaker 1 15:08
Yes and no in that, again, no other diabetes, as far as the auto immune Hindsight is wonderful. When Brandi was younger, in the I believe it was this seventh or eighth grade brandy, when you started having when the passing out, and they diagnosed you with that was one of the two. I

Brandy 15:31
think it was eighth grade.

Unknown Speaker 15:33
I think it was eighth grade, it

Scott Benner 15:34
was the diagnosis.

Brandy 15:37
That vasovagal syncope. They

Scott Benner 15:39
don't know why they didn't call it they didn't they didn't talk about pots back then. Has anybody said that to you since then, or has that gone away? No,

Brandy 15:47
no, and it's gone away? And they said I might outgrow it. But no, I mean it. You know, we didn't have the that wasn't pots wasn't a thing back

Scott Benner 15:57
then nobody would have talked about that. How about like thyroid stuff? Lisa? Anybody with a thyroid? No,

Speaker 1 16:02
no, no. I have a nephew who had thyroid cancer a couple of like hypothyroidism or or something. Yeah. No, but but the auto immune issue with vasovagal syncope, you know, that was often wonder, could that have been some sort of initial something? Because it was vase, you know, the auto immune with her that it kind of changed her life for a year? A good year? Yeah.

Unknown Speaker 16:32
I don't know

Speaker 1 16:33
went away. But she's, you know, again, with the the diabetes, the doctors, or the endocrinologist actually said that they thought she had meningitis right before the onset of this and they thought that that could have been a trigger for the onset and just, you know, her pancreas dying. Yeah,

Scott Benner 16:57
I mean, it to be perfectly honest, like, that would be the first time anyone's ever brought that up to me as as connection. But I think that what can happen often is that when this stuff happens, and you can't point to a reason why think we keep looking for a reason why. And then you start saying like stuff like, Oh, she passed out when she was eight, like, you know what I mean? Like, who knows, right? Like, it sucks. But we said, Were you sick before that? Did you have any kind of a virus and illness? I? Well, I mean, I'm sorry, I misspoke, Brandi.

Brandy 17:29
I got diagnosed in February, in July, before I had meningitis. I had my cousin had meningitis. And of course, passed it to me, because I guess we just like to do things as a family. And so I had meningitis, and was very, very sick with that. And then I you know, looking back on things, there were a few signs, I think that my pancreas was starting to kind of go kaput, because I remember going out to eat with my dad in January. And like we went to a Japanese steakhouse, and we ate and I immediately got sick and had to run to the bathroom at the restaurant and throw up. And that happened to other times, with meals with certain meals. Were kind of in that january MONTH, where I would eat something and immediately get

Scott Benner 18:20
Lisa Lisa meningitis is a viral infection. And if I had $50 to bet with you, I'd bet that that's what happened. So Exactly, yeah.

Speaker 1 18:29
That's what the doctor was leaning towards me a trick or, but, you know, once we got the diagnosis and knew that this was for real, you know, we've been just trying to educate ourselves since on, on how to how do you live with it? How do you how do you control it? And we've come so far, and I'm so grateful. You mentioned earlier about, you know, when something's wrong with your child, you're just you inhale and you don't breathe and you wait to exhale to know everything's okay. And brandy having the continuous glucose monitor. And the dex comm app where we can, she can share with me to where I don't have to bug her 50 times a day to see what her blood sugar's are that was a life changing thing for us in that I can look at it and know that she's okay. Or if it's low, I can just send her and we have a we have an unspoken rule when it gets low. I don't even have to text her. She sends me a text and says a meeting you know,

Scott Benner 19:34
so you don't feel like you're bugging her all the time. And she doesn't feel like you're watching her. Yeah. Hey, yes, yeah, Brandi. How long have you had a CGM? today's podcast is sponsored by the ever since CGM. Boasting a six month sensor. The ever sent CGM offers you these key advantages distinct on body vibe alerts when higher low, a consistent and exceptional accuracy over a six month period. And you only need two sensors per year. No longer will you have to carry your CGM supplies with you. You won't have to be concerned about your adhesive not lasting, accidentally knocking off a sensor or wasting a sensor when you have to replace your transmitter. That's right. There's no more weekly or bi weekly hassles of sensor changes. Not the ever sent CGM. It's implantable and it's accurate ever since cgm.com/juicebox. The ever since CGM is the first and only long term CGM ever since sits comfortably right under the skin and your upper arm and it lasts way longer than any other CGM sensor. Never again will you have to worry about your sensor falling off before the end of its life. So if you want an incredibly accurate CGM that can't get knocked off and won't fall off. You're looking for the ever since CGM. Ever since cgm.com/juicebox.

Brandy 20:59
So often on I, my first one I got when I went back to school, I went back to school and got a second master's degree. And when I was there, I did an internship in an endocrinology office, a pediatric endocrinology office and the Dexcom rep there hooked me up because I had zero insurance. And I had never had a CGM before and that was a My first one was

Scott Benner 21:30
the four you had the g4.

Brandy 21:32
Oh, no, no, no, no, no, I'm sorry. It was good. G five, five.

Scott Benner 21:36
And Lisa, did you Did you hear her humble brag that she has two master's degrees?

Unknown Speaker 21:41
I'm glad she did you hear?

Scott Benner 21:43
Did you hear her slip that in? She's like, Yeah,

Unknown Speaker 21:46
I'm glad. Glad.

Scott Benner 21:48
So So you've had one for? I mean, a while now six years?

Brandy 21:53
Yeah, about six years. Yeah, I'm at now. I did take a year long break. But no, I I've had one for about six years now. And it honestly is really helped. Because, you know, my mom would irritate the crap out of me like, asking how are you doing? How's your blood sugar's? How are you feeling? You know? And then it would kind of sometimes if that would tell her what the number is, you know, then she'd be like, Well, why is it that like, did you do this? Did you do that? And I'm just like, You know what, I have been doing this on my own for how many years? I'm good. I got it. And so now her being able to follow, and then we have that little unspoken. If it's high, or if it's low, don't ask me about it. I'll tell you that, um, I can be a mean person when it's out of range.

Scott Benner 22:42
Lisa, I'll tell you how interested I am in this that you're 20 years into this, she's 40 years old, you worry about her every day.

Speaker 1 22:52
Every day it your children are always your children. Doesn't matter the age, that will never change, you know, so she can be 60. And I'll still worry about her health and her happiness and her well being Yes. Ready?

Scott Benner 23:10
Can I ask you how it makes you feel to hear that?

Brandy 23:14
Oh, already? I mean, I already know that my mom and I have a very, very, very close relationship.

Scott Benner 23:19
Are you yelling at this poor lady than when she's checking on you what's going on?

Brandy 23:24
Because as I have posted on the podcast on the Facebook group, when we have high blood sugars, and we have low blood sugars, I am already I'm I'm a perfectionist already a little bit. And so I'm already irritated. I'm already upset at myself because I'm low or high frustrated, because something is I did something wrong or whatever. So I don't want anybody else like pointing out that flaw.

Scott Benner 23:50
I have an episode with Jenny called altered minds that goes over how people's brains change when their blood sugars are high and low and how that comes across. But Lisa, you know that right? Like, you know, she's altered when she's higher. She's low.

Speaker 1 24:06
Yes, absolutely. But it still doesn't, you know, change the fact that you're going to check on them? No,

Scott Benner 24:12
of course, but does it? Does it make you I can explain it for me. So you've been a mom of a person with type one for 20 years. I've been the father of somebody with type one for 718 17 years. So you and I are pretty much like we're in the same game pretty much. And it took me a while to let art and be upset and me just sit there and just breathe through it. Like when her blood sugar is high. And I'm like, Hey, you got to do something at first. It's like, Hey, I'm trying to help you. And then you realize like, this is not the response I would get from her for blood sugar wasn't high. It's not her fault. Her blood sugar's high, but it's hard right to like to just sit there like a punching bag and take it

Speaker 1 24:56
totally, totally it is. But and that's one reason why I think our unspoken rule works is because she knows that I know when it's low or when it's real high. So thankfully, she is considerate enough, even in her irritation, that it's going crazy for whatever reason, which often there is no reason, you know, it's a Wednesday at four, and it decided to drop to 35, she will send me that just a text I'm eating, you know, if it's 3am, I'm eating, you know, because the lows really are the scary horse. So that that and me having, again, the Dexcom app to where I can see and I get an alert, and I can see your trends. All of that has, has eased that to where I'm not having to constantly bug her about it, and may be an irritation on top of her trying to deal with this mess that she was given. But it also, you know, by her knowing that I can see that, she just sends me a text, and I trust that she is taking care of it. And that's one thing that I've been very fortunate is that Brandy is she could be a poster child for type one diabetes. She's one of these type of people she is a little on the perfectionist side, she has educated herself she has gone above and beyond, you know what the ADA says and all of this trying to really understand and help her sail to where the fact that I know that I know that she is extremely responsible, and is going to to address any situation that comes up. And in a few conversations I've had with other folks, parents as well. You know, especially if it's a young child who doesn't know who can't, you know, they really can't be responsible for themselves so to speak. It's very difficult. You know, when some some kids don't take care of themselves like they should, they don't, you know, give themselves their insulin when they should or just just different scenarios. That would make me crazy if I was in that. So I count myself lucky that you know, Brandi is as responsible as she is in that we do have the pump, that we have that CGM in the app to where we can share information without being you know, irritants to each other. And just making a situation worse, because stress alone, you know, wreaks havoc.

Scott Benner 27:47
I want to say to Brandi I mean I agree with your mom, but at the same time, I'm impressed that you're doing this even as an adult, like just having the the courtesy if nothing else to say, I know you're worried about me, I'm handling it. Like it's a it's a big deal, because my daughter's 19. And there are still times where I'm like, Hey, are you aware of this? She's like, I know I'm handling it. And I'm like, I know, just please LIKE if you just let me know that or even just like put a checkmark or a thumbs up or something on something. So I know you're like, like moving into anemia, like it's, uh, it's, it's scary, you know?

Speaker 1 28:25
Exactly. Well, Scott, I will say this, I did want to touch on this while we were talking because to me outside of the diagnosis, it's the second biggest thing that Brandi and I went through, and I think perhaps having experienced that is one reason why she is as considerate as she is, even though I mean she was before. But, you know, again, Brandy has done everything perfectly. I'm not just bragging on her because she's my child. She's just done all this additional research and, you know, she keeps her blood sugar's in tighter range. In fact, brandies a one c this past checkup was what Brandi?

Brandy 29:11
I found like, six. So my, my, my goal is to do it.

Scott Benner 29:18
That's amazing. Also, I love how your mom just set you up to that like you were 12 years old and you were at like a dinner party. She's like, go ahead honey, tell us about your dance award. Do it tell him no

Speaker 1 29:30
I didn't want to misspeak the number but I mean for for Title markable. So I just I just say that to to kind of confirm, you know what I'm saying as far as how tight she tries to keep her blood sugars and all. So with that preface, Brandy got sick and I don't even think I have purged it from my memory the year how many years ago it was it seems like it was about

Brandy 29:58
it was January 2012. Okay,

Speaker 1 30:00
that sounds we were 10 years into the diabetes and thought we were knew what we were doing and in doing everything, right, and brandy got sick. She knew the Sick Day protocols.

Brandy 30:19
Actually, actually, actually, I pulled out the paint, paint their book to double check. couldn't remember because I found the book. And I have had this update protocols pulled out to make sure are doing everything right. But go ahead.

Speaker 1 30:39
I even took her she was living in an apartment here in town. I went and picked her up and took her to we went to an urgent care because by the time I got her, everything was closed and her endocrinologist was still up in. She loves him so that two and a half hours away, she was still going to see him, you know, for her checkups every few months. So I take her to urgent care. All right. So doctors see her we tell them she's type one diabetic, she tells him what she had been doing. They gave her fluids to do all this stuff. So I'm exhaling now because medical professionals are taking care of my sick daughter. We're okay. And she wants to go back home. And this little voice, you know, in the back of your head says no. And so I'm like, No, I picked you up and you're coming home with me. And she's a grown woman with her. house. Yes. So, but I took her home. And by the grace of God, she's with us today because I did. And unbeknownst to us, you know, and I'm checking on her. She's running a high fever scale, no light bulbs going off, because well, the doctor just saw her so I know she's gonna be okay. And around midnight, when I went in to check on her. The she somehow from the depths of her soul was able to whisper rocks got right in my face. And she grabbed my arm and she said, Please help me. And her face was right in front of mine in the fruitiness of her breath about knock me down. And somehow in that little thimble of training, we had that, that triggered me to say, Oh, my God, and threw her in the car and two wheeled into the emergency room. And she was in full blown DKA. And, you know, it looked like some scene out of off of an emergency room TV show with, you know, I'm standing in the corner trying not to freak out or scream, I think I probably even have my hand over my mouth. And there's nurses and two doctors in there. And they're working from both sides and trying to get IVs. And I remember the doctor turning around and giving me this death stare saying How long has she been in DKA? And it couldn't even register with me. I'm like, what what? You know, and he later apologized for that. But, you know, she was in ICU for three days and fortunately recovered from that. From that time on. We are very sensitive to

Scott Benner 33:31
illnesses being sick. You got yourself a nice nursing home. Like setup. She can't she can't bail on you now. Right? This girl's yours. You're stuck. You're stuck. Also, I don't know, Brandy, if you realize that your mom named the episode. Oh, and what is I mean, for certain we're calling it to wield it.

Brandy 33:51
I think that's accurate, because at this point, she has to wield it twice.

Scott Benner 33:57
to have you here, I just love it. I'm going with that. He's gonna have to say something pretty amazing to get me off of that. So

Speaker 1 34:05
I just I want to emphasize you know, if there's any advocacy to be done, it is that initial education and you know, someone needs to be standing over you making you memorize the signs and symptoms of DKA and sick day rules because you can't it you can't emphasize the importance and the severity of of that and that wasn't done with us. Again, you know, referring back to the Pink Panther coloring book, that's what we

Scott Benner 34:41
magazine didn't help you. But listen, that is honestly the distribution of of information back then, like what did they have? They're gonna put it in a book. Like I always laugh when people say not laugh, but people say to me, sometimes you should write a book about this. And I'm like, you don't think this is a much easier way of getting this information out? out here recording your voice and making it all available for everyone that owns a cell phone. Like I think that's better than putting it in a book and hoping someone finds it buys it and actually reads it. You know, Britney, I want to get back in a second. I have one more question for your mom first. Lisa, Lisa, what got you into her room at midnight.

Speaker 1 35:19
Just checking on her every hour to just to check and make sure that she was you know, was okay, because her fever was so high. And I was hoping that the you know, medicine would break it and I was wanting to make sure she wasn't getting sick on her stomach. You know, that sort of thing. And I had just gone in to make sure that she was alright and then realize that that she was not and you know, would would the light bulb have gone off? Had she not been able to

Scott Benner 35:48
move? She's that she dies? She dies overnight if she doesn't get to that and if you don't if you don't go in there. Oh my god, Brenda, you can't there's no home even you're gonna have to let her move in with you. This well.

Brandy 35:58
It's funny that you say that. I just moved to a new place two weeks ago. So we we got 21 acres. So there's we've already said there's plenty of room for

Scott Benner 36:10
her kids because you're busy being like making money is that what's going on? Like I don't have time for kids? I'm I'm piling up wealth and property. Thank you.

Brandy 36:23
Well, we want to start a homestead. So yeah, we're gonna have lots and lots of little furry animals around here get to

Speaker 1 36:31
that's wonderful. And a tiny house for mom overwhelmed back north for the in the colon.

Scott Benner 36:36
I was gonna say yeah, she she earned it. Honestly, Lisa, you shouldn't you're not working. Are you?

Speaker 1 36:42
Yeah, I'm at my place of employment. Now with the Do Not Disturb sign. Oh, my God,

Scott Benner 36:47
this is shameful. That lady saved your life. 10 years.

Brandy 36:52
I know. I know. Well, it's funny. She actually though. I started. I was apparently talking gibberish. Also for a while that mom, she thought I was completely crazy and talking out of my head. And I remember saying, talking about some. I think I was watching like a gangland episode or something on True Crime TV or something like that. And I was telling her about it. And she was like, none of what you said made any sense. Yeah, none of it. I have no idea where you're going with that. And I was like,

Scott Benner 37:23
by the way, just so you know how my brain works. Had you said speaking tongues you would have gotten the new episode title. But you said speaking, B said talking gibberish. So I'm sticking with my first thought. So So brandy, listen, I want to know about I know it feels like we're moving forward and moving backwards. But just think of this as Pulp Fiction. We're just jumping into the future. And then all of a sudden, John Travolta is alive again. Perfect. I want to know about that first week in college, trying to figure out how to take care of yourself by yourself with what I assume is needles, insulin and a meter.

Brandy 37:57
Yes, right. So I first app I will say, I was very ignorant. And I didn't know what I didn't know. So I didn't know that I needed to be concerned or worried or scared. I just I followed the instructions. Now I will say first of all, my endocrinologist that I had was the most amazing, kind hearted man ever. He was a straight shooter. He was like, I'm gonna go ahead and tell you this right now. You're a type one diabetic. All the money is in type two diabetes. So I am so sorry. But just you're not going to learn a lot. And I'm like, Well, this.

Scott Benner 38:42
Thanks, but okay. 20 years old, you're still a sophomore, right? Yeah, I

Brandy 38:46
had no idea what's going on. But he's like, the first thing I want to do is get you on a pump. And I'm like, Okay, I don't even know what that means. But yeah, so that for the first three months, I was on insulin injections. I just made my lunch. Like I would pack like a sandwich and some chips. And I remember writing like the card counts on the baggies. Now, obviously, I would eat, eat, then take my insulin because there was, at least in my world, there was no never any discussion of Pre-Bolus thing or you know, anything like that. So it was eat, count the carbs then Bolus so obviously I was going up to probably, you know, 350 or something every day with meals, but that was it. Like there was never Yeah, it was very kind of rudimentary to

Scott Benner 39:33
kind of fascinating that coming from like, regular mph cloudy, like that whole time of insulin. The whole the whole idea was shoot it early so that it's working when you eat and then they got to, you know, I don't know, they moved up to human log. And they, like the entire profession forgot about that.

Brandy 39:55
Exactly, exactly.

Scott Benner 39:56
They're just like, Oh no, it's faster acting insulin now. So you don't need to that those Jenny talks I don't know if you how much of the podcast to listen to but but Jenny is so if you if I asked her right now What irritates you about diabetes in her top 10 She'd say that they call it rapid insulin, but it pisses her off. Because it gives people the idea that it works rapidly and so it'll just work real quick when you put it in. And you know, it's just it maybe it's bad branding or maybe it's just like, sometimes I think it's just the case of the doctors being so impressed with how much faster it works than what they were accustomed to coming from regular etcetera, that they're, they just forgot about that whole aspect of the timing the insulin Yeah,

Brandy 40:39
I was gonna say I, in all the doctors that I've seen over the years and that sort of thing, like it's always been referred to as your fast acting insulin. And I don't ever remember a single doctor saying, it takes 30 minutes for it to start working in your body. Like that was never even mentioned. Of course not. I had to bring it up. Actually, whenever I was like, hey, there's newer influence out now can I get on the Gosper? You know, can I get on something that's a little bit better?

Scott Benner 41:09
Do you have any idea how many people think I'm a genius for saying to Pre-Bolus I'm like, I'm not a genius. I just this is pretty freakin common sense. He right here, you know? Because, well, but it's because of the time that they spent not living like that. And then when when somebody finally says it to them, and they see the impact of just balancing, like making the timing of the insulin line up with the action of the carbs. Like they're just like, Oh, my God is amazing. And I actually no lie. I have a thank you online this morning. It's actually still in front of me. I can't believe you said this. This lady named Sandy sent me a note and said, Honestly, this podcast is more important to me than seeing my Endo, you have helped me tremendously. I was given minimal information by my doctor didn't even know to Bolus before eating after being a type one for 10 years, I was still seeing an endo, who I was seeing an endo who is a type one who now tells me that my control is better than his. And so that's the Lisa's point earlier. Least I didn't want to break your heart in the first five minutes. When you were like, you know, I hope that the education is better now. But I'm currently recording a series of episodes, that will come out in 2024. And I'm calling them whistleblower. And they are healthcare professionals whose voices are going to be altered so they can talk about their jobs openly. And each conversation is more depressing than the next one. Just so you know.

Speaker 1 42:38
I could I could lend comments to that series well, with other things I've been through myself, where there's just no education, even in the medical profession that they should know better. If this is your job, it's your responsibility to stay cutting edge and to educate your patients about so yes. And I'm sad to hear that that's still so often the case and and I think it would be good brandy, if you even mentioned, some of the things that you've done that have enabled you to tighten the control on your a one see, like you have the additional stuff that you

Scott Benner 43:23
look at, maybe let's do that it's Christmas, your mom has gathered up your aunts and uncles and it's time for you to tell them about your report card. Okay, but before you do that, I love you guys together. But before you do that, like let me let me finish this this thought and then brandy, we'll jump right to that. It's a great idea. an ER nurse, who I spoke to anonymously just yesterday recorded with her just yesterday, I asked her the question. In the hospital you work, what percentage of people? Would you be comfortable? And before I could finish the question, she said, I don't trust anyone here to help me with my diabetes. She was talking about in the 1,000th person. I agree with that.

Speaker 1 43:58
Yeah, absolutely. And Scott that that was one of the other incidents after the dka episode, when Brandi got sick, and I again had to take her to the emergency room. We knew that's what she needed. We couldn't fool around with urgent care. They literally took her us into a room. They started they were hanging What was it like two bags, their insulin brandy, they were pumping it way too fast.

Brandy 44:27
They they did. I had some ketones. I needed to get flushed. And at that point in time, I didn't have an an EMT friend that could come to my house to do it. So I went there and told the doctor what I needed, because he was just very flippant, like you're not in DKA. And I was like I know I'm trying to prevent that. It's called preventative medicine. Come on, let's go. So he gave me a shot at he started an IV gave me a shot of insulin hung two bags of saline turned on wide open. They walked out of the room and shut the It

Speaker 1 45:01
literally shut the door and never came back to check.

Scott Benner 45:04
Does that make your blood sugar crash eventually? Oh, yeah.

Brandy 45:08
I mean, it was like maybe 30 minutes or so. And I just looked at my mom and I said, Hey, did you do you have snacks in your bag? And she was like, Yeah, and I said, well go ahead and give me a pack of crackers. Now. I'm gonna crash diluting

Scott Benner 45:21
my blood and my blood sugar is gonna crash. Yeah, yeah. Yeah. Lisa, my daughter had to be in the emergency room for some like belly pain while she was away at college, maybe a month ago, and she ended up there twice. So she spent two separate times 12 hours apiece in the ER 36 hours apart by herself with a roommate. They were scared and she's in pain. They loaded her on morphine, and then never once checked her blood sugar ever again, ever. While she was there, both times no one ever looked at her blood sugar. Doesn't that infuriates? Yeah, the second time I flew to where she was, when I sent her back to the hospital, like the first time after it happened, and I got her out of there. And I was like, Okay, I basically managed her blood sugar from a distance through a proxy, which was her roommate. And that's how I got her through the first 12 hours because she was out of it. And then as soon as I sent her back to the hospital, I literally sent her to the hospital, sat at my computer, bought a plane ticket at two in the morning, drove across New Jersey, to an airport, got on a plane flew to her. And I was in Georgia by 10am. And she was in she was still in the hospital. And they were not helping her still. Like I had to get there and forced them to do what they needed to do. And

Brandy 46:35
I think that's the biggest thing like, I am 40 years old, it does not matter if I get sick. And for whatever reason, I need an emergency room, I will always have somebody with I refuse to go by myself because I know what will happen or what can happen. And I need somebody else who was going to fight for me, you know, and one of the biggest things now is fighting to be able to keep, you know, my CGM and my pump and all this stuff on me. And educate that

Scott Benner 47:05
I asked that ER nurse when I was recording yesterday, what's your best piece of advice? And she said, Don't go to the hospital by yourself. Exactly. That was her biggest piece of advice. So okay, so you're doing I mean, you just pull a five, six a one C, that's pretty terrific. What have your a one C has been like throughout the 20 years? And what improvements did you make along that time to make this number better and better and get you where you want to be?

Brandy 47:30
Honestly, technology was the biggest thing. But you know, I started off I would say, in the between, like in the high seven, for the first few years with, you know, and fallen and just a meter and just trying to figure it out. And honestly being really bad at carb counting because they don't really like they, I remember they handed me a printout of like common foods. And we're like here, this is this is kind of what the carbs are. Like, you know, there was never any discussion of weighing food or doing this or that. So it was, you know, the diabetes education that I received was, you know, when I went in, she was already ready to go to tell me that I needed to change my diet. And then when she asked me what I ate, she was like, Oh, you eat really well. And I'm like, yeah, and then you know, she's like, well, the only thing is you can't have as much fruit as what you normally eat. Which that was that was probably the worst day

Scott Benner 48:28
you enjoy for? Yeah,

Brandy 48:30
I was the one again small town college, I had to drive 20 minutes to the grocery store. And so I was the one at like, three o'clock in the morning, we get a fruit craving and we drive 20 minutes to the grocery store to get, you know, whatever. But anyway, so yeah, so I started off kind of high sevens. And I started on decks calm. And I was able to kind of see patterns more I was able to really kind of dial in insulin better and understand how it works in my body better. And so at that point, then I got down to the six.

Scott Benner 49:02
Let me cut you off for one second. You think you were the sevens for the first 14 years? Yeah,

Brandy 49:06
okay. 100

Speaker 1 49:07
There was some eight. Lowly. Yeah, very well could have been. I

Scott Benner 49:12
gotta be plus, no, I don't remember it that way. I think it was. Yeah. The teachers wrote a note and said you weren't trying hard enough brandy.

Brandy 49:22
And actually, you know what's funny? I don't know if anybody else is like this. I feel like there's probably parents who are like the two numbers are hard. Because we got to deal with numbers all the time. If you ask me. Hey, what's your blood sugar, I will read I will rattle off whatever a number is, but it may not be what my last one was because I'm just so used to looking at the numbers. All the time that I start getting them kind of mixed up.

Scott Benner 49:48
I love this. This little product called glucose. It's this. The I don't know if you know what it is. But it's this little orb. It's just you plug it into the wall. You set it up. It Parris the your Dexcom account, and then basically you tell it in what range it should be green. And it just it at least it's just this little, like, little bigger than baseball sized thing that goes on your desk, and it just glows. Green when you're in range red as you get higher or lower, it flashes. If you get too low, it turns different colors as you get high. And so it doesn't beep doesn't do anything like that. I have one on my desk right now. And to brandies point. The numbers are just they're constant. Like I mean, I don't know what Arden's blood sugar is right? I gotta be perfectly honest with you. It's 11 o'clock in the morning, Arden's home from college right now she's still sleeping. And I haven't looked at her blood sugar once today. But when I woke up in the morning, there was a little green globe on my bureau, and I was like, Oh, her blood sugar is in the range that I set. And then I got a shower. I've done a bunch of things. I came in here and sit down. And this the globe that's on my desk is green. And it's just it's it is such a lovely thing. Sounds

Unknown Speaker 50:59
like a good Christmas.

Scott Benner 51:01
I'll tell you for you. Brandy, you're gonna have to set it up if you got it for ya, Brady, you're gonna have to set it up. Okay, but that's I heard Yeah. I mean, listen, it's cheaper than a house. So I would do it if I would do. But it's just kind of wonderful. Because even in the middle of the night, like, you know, you wake up, you roll over, you crack your eye open. Green light, good. Red light. Alright, I'll pick up my phone and see what's going on. It's it's beautiful. Right,

Speaker 1 51:28
right. Well, and brandy keeps her she keeps her blood sugar's lower than what you like. Well, what the ADA says is in normal range. I think my my range should be this. And so, you know, the the fall too low, is a lot closer. But because of that, but she's obviously doing something, right, because her a one C is so daggone. Good. I mean, it's almost normal. So I don't fuss about that. It's just that it takes her less time to get to 35 then it would somebody that was keeping their, you know, low range at 100 or above ready?

Scott Benner 52:12
Are you getting a 35? Or is this an old like fear from your mom?

Brandy 52:16
Old fear for my mom? I don't I don't get to 35 very often now. I mean, you know, every once in a while, I'll make a horrible mistake. Like last last Friday. I had, I was having a bad day, you know, you have those days that are just horrible. And I accidentally first of all, I have my glasses on, which is probably part of it. So I wasn't seeing very well, I dosed 20 units of insulin instead of 20 grams of carbs. And so yeah, yeah. But I knew what I recognized my mistake right away. And so I just had some orange juice and was sipping on it. Right. But, you know, for the most part, I know, I don't I don't get that low. Yeah, I keep

Scott Benner 52:57
thinking like, this is her these are her fears from when you were younger. And big? Well, it's not

Speaker 1 53:02
been that many years. I mean, we have many, when the Dexcom when the Dexcom just only reads low. In the last number you see is like 42. And then it's just arrows down red and says low because this can't read it. That's not been that many years ago. But I will say that since she has been doing the additional stuff, she's doing the Pre-Bolus thing and keeping a tighter, she's staying within her range for I would say the last year or two that you've really been in that that's not been the case, you know, because she is doing what she needs to do when it's getting into the 50s or upper 40s. But there are still times but of course like I say the lows are what what alarm you and just the fact that because she is keeping such a tight control and keeping it a little bit low where she doesn't have a lot of wiggle room there. Yeah,

Scott Benner 54:02
so a couple things first of all, brand new your mom loves you a lot you know that right? Yeah. Okay. And this is this is my doing isn't it? Brandy is this my fault that your is this is a from listening to the podcast, or it's just an idea that you came to on your own like, I'm gonna I'm gonna go lower and more stable and use less insulin, so I don't get as low and as high like, is that? Where did you get all that from?

Brandy 54:24
Yeah, so Well, I started off. Gosh, I went to my first kind of interaction with this idea was Dr. Bernstein. Oh, sure. And then after that, I found the podcast and I don't remember how I came across. I really don't remember how I came across the podcast. But But no, I mean, that was one of the things i i noticed immediately whenever I was, you know when I'm 85 I feel my best. You know, I'm not crabby. I'm not whatever. And it's easier to kind of stay at 85 Yeah, with my I'm on the tandem T slim control in So

Scott Benner 55:00
I feel like you're you're using? Yes,

Brandy 55:02
yes, I use Control IQ and absolutely love it. And so, because of that, I learned very quickly, I will not treat a low unless I'm under 60. Because it cuts off my basil. And if I just give it 15 minutes, it's going to come back up like it's, you're gonna have a nice little rebound into the 80s. And it's great. So I don't treat a low unless I'm under 60, which does make my mom a little bit nervous. But part of it is because the technology is so new to us. I mean, I waited a long time to get on this because I was so anal about like, control and giving up control to algorithm was like it scared the crap out of me. But

Scott Benner 55:48
I got well, let's go. I just looked at going so well just looked at artists blood sugar, because we're talking and I pulled up our 12 hour graph. Arden hasn't been below 85 or over 116 and 12 hours.

Brandy 55:59
See it? I'm telling you the algorithms,

Scott Benner 56:02
the straightest line that you can imagine we are you low carb or No,

Brandy 56:07
no, I'm not. I've gone back and forth. But honestly, if I do really low carb, I have to sell Bolus for protein. Of course, I can hit me harder. Yeah. So I kind of go back and forth. But I'm, I'm high fruit.

Scott Benner 56:24
But you mentioned Bernstein. So like, when you said what happened? Like, were you looking for an answer, found people talking about low carb and then took something from it, but not a low carb lifestyle? Is that about how that half Correct? Yeah.

Brandy 56:38
Yeah, yeah. I mean, well, I started, I did start doing some lower carb. I mean, I guess, I guess, in theory, according to I guess, whatever the people say about what's considered low carb, I guess I am considered low carb. Because I think I'm maybe eat, I don't know, anywhere between 45 and 60 grams of carbs a day. But to me, that's not really, you know, I'm not trying to beat

Scott Benner 57:07
low I don't think a low carb, a person who was eating low carb would consider 60 low. I just I don't think that Well, yeah.

Brandy 57:14
That's what Yeah, but I mean, you know, I see people post about it sometimes to talking about under like, 100 carbs a day under 100 carbs a day is is low. And I'm like, Okay,

Scott Benner 57:23
well, it's just, it's just personal, like, like experiment preference and stuff like that. I you know, it's funny. He's you sit and talk about on a on a normal day. I don't know how many carbs I eat, to be perfectly honest. Maybe. I mean, if I ate on a day when I ate exactly the way I meant to, which I'll take yesterday, as an example, I had a coconut milk yogurt in the morning, which is probably like nine carbs, or maybe 12. I had a couple of eggs. You know, there might be two carbs and eggs, but probably not. And I had some chicken later in the day. It had hot sauce, but not sugary sauce on it. I might not have had very many carbs yesterday. If I'm thinking about it, but Arden had nachos last night. Well, Lisa, does that freak you out? My daughter had nachos for dinner last night and her blood sugar has been at five to 116 for the last 12

Speaker 1 58:13
hours? No, no, not at all. It does not I mean, and that's the brandy eats pretty much what she wants. You know, and she knows that how to manage Bolus has been wonderful, because that has stopped, you know, the roller coaster spikes and all of that. And I know at one time she was you know, looking into the glycemic indexes and different stuff, you know, just trying to understand the different types of carbs and understand how, which carbs affected her body the most. Because you know, that you could be two things with the same amount of carbs, but one would spike her sugar and the other one would not. So those type things are what I was referring to as far as just trying to, again, empower herself with knowledge, to be able to control the blood sugar more and be as healthy as she possibly can. And, you know, in hopes that anybody out there that listens to this, you know, it might prompt them if they have had no more education from the folks that are supposed to be experts on this that perhaps they can do a little on their own and and you know, if they don't have a CGM get that just be able to follow some of these things that have helped her so you

Scott Benner 59:40
know that one of the I think the greatest things that's come out of this this conversation so far is that your mom Brandy is growing along with you and her diabetes like so often when I do talk to older parents of adults who have had type one for a while. They'll say stuff like Well, I haven't really known much about it since they were thistle. order this whole, but even your mom started when you were in college like it would have been, it would not have been crazy to me if you said it at least if you ended up saying to me, I don't really know anything about diabetes, because Brandi was diagnosed in college, and she's been taking care of it on her own. But instead you, you went right through the whole struggle with her in the beginning, you understood the management back, then you understand how it's been changing for and not just like brandy has been trying harder, like you're talking about things like, no, she was looking at the glycemic load index of foods. So she would know how to Bolus for like, you really understand what she's been doing. Yeah,

Speaker 1 1:00:33
what she's, again, taking it upon herself, seeing that she wasn't getting the help that you would think would be forthcoming that they would make sure that you understood as a diabetic. So she had the initiative to do that. And because we are as close as we are for she shares, you know that with me, and it just it, it helps me to, to feel more reassured in knowing that she's continuing to, to educate herself, and to try to keep this as under control as you possibly can, knowing that there's all these scenarios and factors that affect the blood sugar that you have zero control over at all. And that's, you know, if she's monitoring and managing it, as close as she is, and doing all that she can do, then it makes those times when it falls out of range a little bit easier to swallow and handle. Yeah.

Scott Benner 1:01:36
And Brandy is this is a collection of reasons, right? You guys have good communication, you're willing to tell her stuff she's willing to ask, she's not judging you. She's not pushing you. You set boundaries, she follows them. Like it's working for all of those reasons. Is that right?

Brandy 1:01:54
Yeah, absolutely. You know, I mean, it's, it's one of those things where, you know, too, she understands that it's, it's, I mean, as much as I don't want to ever be like, Oh, hey, my name is Brandi, I have type one diabetes, it's one of those things where it, it is a part of my daily life, every single day, as much as I don't want to identify as that it still is very front and center. And so she gets that and she understands like, you know, it doesn't define you, but it is a very large part of your life. And so, you know, when I go to the doctor, I'm like, Hey, this is what was said, and, you know, this is what we talked about. And, you know, this is, this is how things are going. You know, recently, I actually have fired my Endo, and getting a new one. And so, you know, it's it's that whole, the struggles of going through, you know, with help getting help and needing you know, someone to listen. And so she 100% understands that and so we have kind of that open communication around everything, just like you know, I find protein noodles are better like I had alfredo pasta last night that I made, and I spiked my highest was 140. So you know, she she gets it?

Scott Benner 1:03:16
Is does this just apply to the diabetes? Or is this your entire relationship? Like, are you guys like at each other's throats over different things, but on this you're simpatico? Or is this just how your relationship works? And how much of this do you think has to do with you being an only child?

Brandy 1:03:30
This is 100% Our relationship just with everything. And so like I said, we I just moved two weeks ago, yes

Scott Benner 1:03:39
to your palatial estate I heard go ahead with your two masters degrees.

Brandy 1:03:46
have moved, like many, many times, I am a terrible, terrible person when it comes to moving. I don't know how to pack correctly. Like my mom over the years, has really had my back. Well, she wasn't able to really help with like, me packing or getting the house together this time. And she she felt bad about it. She was just like, I am so sorry. I had no one to be there. Well, Monday night before we moved, she came over to my house. She packed a bag. And so she stayed with me that Monday nights. And then she didn't leave until last Wednesday before Thanksgiving. So she was there for a week and a half through the move. We got every single box and pack and everything put away, though. No, this is this is our normal relationship. And yeah, it's 100% because I'm an only child and you know, that's, that's always been our relationship

Scott Benner 1:04:40
at least Are you married?

Speaker 1 1:04:43
Yes. So, yes, I have. I have two stepsons, 30 and 26. Wow. Two boys. Yeah, one still at home

Scott Benner 1:04:52
with us. At least I didn't ask but I'm gonna ask now. How old are you? Six.

Speaker 1 1:04:56
I just turned 64 last week. gratulations

Scott Benner 1:05:02
Oh, well, this is terrific. And Lisa, you're married. It sounds like

Unknown Speaker 1:05:06
yes, yes. Oh,

Scott Benner 1:05:07
I'm sorry. I meant brandy brandy. You're married?

Brandy 1:05:09
No. Well,

Scott Benner 1:05:11
you said we, I was gonna say You said we are gonna do a thing. Okay, so you guys, yeah. The guy who doesn't owe you money if he bails?

Brandy 1:05:22
Well, our both of our names are on, on the deed. So

Scott Benner 1:05:27
yeah, I don't know how many boys you've met. But you might want to like legal this up a little bit. Like,

Brandy 1:05:32
well, actually, it's more him. I think, honestly, he is a former professional basketball player that has retired and decided that he wants to have a homestead and he has zero experience whatsoever with farm animals. I'm the one that has the experience with farm animals. So it's about to be really,

Scott Benner 1:05:53
I don't know if everybody heard brandies. Next, humble brag that she she pulled a former NBA player but like,

Brandy 1:06:00
he's not NBA, not basketball.

Scott Benner 1:06:03
I don't care. He's still athletic and muscular, right. I hear you, I know what you're doing.

Brandy 1:06:15
He's goofy and in the anime, so I don't really know that.

Speaker 1 1:06:20
He's, uh, he's, he's a wonderful man. And just what Brandi needs, she was talking earlier about not being able to pack brandy can be described as a collage, you know, that's kind of been her lifestyle, kind of a collage, you know, something, I'm go, I'm over here. And this bright, shiny thing catches my eye. And now I'm over here. That's a part of her personality. So, you know, the whole diabetes and her attention to it and the detail and the, everything she's put into it has kind of been an exact opposite of what is her natural inclination. So that's, that's been interesting in of itself, but it's because of the severity of the whole situation. You know, she's learned that she has to be pretty rigid where that's concerned. And then she can just be more freestyle. With the rest of her life. The fella in her life is a wonderful man who helps helps keep her grounded. So it's been a good thing. Maybe you're not, or you're not, and I'm blessed to have have had the relationship with her. Oh, yeah, we do have Oh,

Scott Benner 1:07:35
it sounds like it. No doubt. Brady, are you not in the private Facebook group? I am you are. It's a different last name, though. Yes.

Brandy 1:07:43
I was gonna say actually, I think it's hilarious that my mom described ADHD as a collage.

Scott Benner 1:07:52
So you have ADHD.

Brandy 1:07:54
Okay, I've never been formally diagnosed. But I mean, I'm a licensed clinical social worker. And I see all of I tick all the boxes.

Scott Benner 1:08:02
Right? Okay, I tick all the boxes, I'm pretty sure. Okay, all right. So I think I understand everything I got, I got a pretty full picture, or is there anything that we haven't talked about that we should have? You know,

Brandy 1:08:15
I mean, originally, like, I had reached out to you about coming on here. Because, you know, there's so I see so many people in the Facebook group, parents with their oh my gosh, my kids going off to college, and, you know, so concerned and worried, and I totally get it, but I just wanted to kind of, you know, share an experience of I was diagnosed at college a way and you know, had zero idea of what I was even dealing with, and we made it through.

Scott Benner 1:08:47
No, I mean, you've done we've done astonishingly well, especially because that that diagnosis that moment of you're in school, you know, I mean, I've helped Arden through some medical things while she's away at college. And it's, you know, it's not easy. And we have CGM SMS, and text messaging, and you know, like a lot of things you didn't have 20 years ago. So and your mom, I mean, we didn't even talk about No, like, if 20 years ago, your mom had a 10 year old car, right? Even the idea of hopping in the car and driving two and a half hours somewhere. I don't think people now in a modern time realized how crappy cars used to be. Great, Lisa, it was a big deal to go on a long car journey.

Brandy 1:09:27
You know, it's really funny that you say that. My mom is laughing because my mom has a 1999 Toyota Camry.

Speaker 1 1:09:34
I'm still driving the same car that I was when she was diagnosed she

Scott Benner 1:09:39
didn't get she didn't get into her like computer on wheels that doesn't let in road noise and doesn't shake and go zero to 60 in five seconds. Like she can do a car and she's like, I hope this thing can gets there. And like, exactly right. And so it's even those little things like I went and picked up food last night for Arden And I went in, I paid with my phone at the, you know, the place. And I watched these three young girls just think nothing of the fact that she said, how do you want to pay and I pulled out my phone held up to my face and held it out with my hand over top of another piece of plastic to transfer $60 to her. And I said to the girls, I'm like, This is not remarkable to you at all, is it? And they were like, what old person? And I, I said, I just took a magic box out of my pocket and gave the owners of this establishment $60 Like, and the one girl goes, I know what you're saying. And I was like, right, I was like you guys don't know. And the one girl looked at me like, You got to shut up, man. My dad says this to me at home too. And I was like, But you like it. We live in such a weird inflection point in time, that there are still people alive, who remember like before cell phones and the internet and cars were not a thing you just have has no one noticed that over the last 20 years, you don't see cars broken down on the side of the road anymore. But when I grew up, the roads were littered with broken down cars. It happened all the time. And now even like they figured out how to stop that from happening with as much frequency. And anyway, I'm holding my phone up and these girls are like, you should just take this food and leave. Like, please leave. i

Brandy 1:11:21
The broken down car thing though. I think that's just the northern versus southern thing, because you guys deal with snow. And you have to have stuff clear. If you are down here in the south, there are still cars quite often on the side of the

Scott Benner 1:11:37
road. Okay, well then buy new cars. But I mean, that might be but actually that might be a financial thing more than a weather thing. Because maybe I just live in a place where people own more newer automobiles, which is possible. I live in New Jersey, it's the home of banks and pharma company. So people are out here doing okay. But it really is. It's just an interesting like technology event. Like, here's my point on cars, you can go by still today, you could go lease a car for $80 a month that will go for 100,000 miles and generally speaking not cost you a ton to keep it up. Like that's insane. You don't I mean? Like it just it really is. I don't know. Anyway, these girls were looking through me like, oh my god, this old fat guy wants to talk about my phone via magic. I just want to stare at the wall. And I walked outside my daughter goes what took longer. And she goes what happened in there. And I said I was trying to explain to the girls how the phones she's like that just leave them alone. I was like what they don't know. And she goes, they also don't care. And that was like that. That part? Yeah. Anyway, you guys were terrific. I really appreciate you doing this. Thank you so much. Thank you. It was a pleasure. It really was Hold on one second for me. Okay. Okay.

Come meet me live in Orlando, Florida, September 14 2020. Ford go to touched by type one.org. Go to their programs tab, click on annual event. And right there, you'll get your absolutely free tickets, all you have to do is register. And we can take a picture together or I'll talk about diabetes stuff or something like that will happen in Orlando. And if I suck, who cares? You'll be in Orlando. It's fantastic. They're very sorry, very nice. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever since cgm.com/juicebox, to learn more about this terrific device. You can head over now and just absorb everything that the website has to offer. And that way you'll know if ever sense feels right for you. Ever since cgm.com/juicebox. Get rid of that fu mu baby get rid of it. By getting yourself a beautiful on the pod five on the pod.com/juice box. There's no reason for you to be wanting and wishing and hoping when there's a link that all you have to do is click on Omni pod.com/juice box go to Bliss get rid of that foo if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietitian and a type one for over 35 years. And in the bowl beginning series Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698 In your podcast player, or you can go to juicebox podcast.com and click on bold beginnings in the menu. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. So thank you so much for listening I'll be back very soon with another episode of The Juicebox Podcast the episode you just heard was professionally edited by wrong way recording wrong way recording.com

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#1192 Grand Rounds: Dr. Marwa

Dr. Marwa is a pediatric endocrinologist.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android  -  Radio Public, Amazon Alexa or wherever they get audio.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 1192 of the Juicebox Podcast.

Today, Dr. Marwan joins the Grand Rounds series. He's a pediatric endocrinologist who also teaches medical students from both Johns Hopkins and Washington University School of Medicine. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about. Travel and exercise the hydration and even trampolines juicebox podcast.com Go up in the menu and click on diabetes variables. Are you a US resident who has type one diabetes, or is the caregiver of someone with type one and you'd like to help? You can do a lot right from your sofa with your phone in your hand, go to T one D exchange.org/juicebox. and complete their survey when you do that. Your answers to simple questions will help to move type one diabetes research forward. T one D exchange.org/juicebox.

podcast this episode of The Juicebox Podcast is sponsored by the only implantable sensor rated for long term where up to six months. The ever since CGM ever since cgm.com/juice Box. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox.

Dr. Marwa 2:16
Hey, thanks for having me. I'm Dr. Bara Marwan I'm a pediatric endocrinologist at Sinai Hospital in Baltimore. I also teach medical students from Johns Hopkins University and George Washington University School of Medicine.

Scott Benner 2:30
Wow. How did we get in contact? Okay, so

Dr. Marwa 2:34
it's through a patient of mine who actually follows you or podcast. She said Dr. Moore, what you need to meet Scott, you need to be in that podcast. So I thank them for that introduction.

Scott Benner 2:49
Oh, that's nice. Okay, so let's go over a couple of things about you. How long have you been a pediatric Endo? Alright, so

Dr. Marwa 2:55
I started fellowship back in 2018, and July, and so been in the field for now almost six years, then and quote unquote, gainful employment since July 2021. So almost three years as an independent practitioner, but six years almost integral taking care of kids with diabetes. I like to start that my my initial training experience was in camp Sweeney. They threw us for a few weeks at camp with the campers suddenly the camp doctor that I have to prescribe and adjust insulin doses. And I was like, Oh my gosh, that's so complicated. How can I even do something like this. So that really was a very good eye opener for me to not just look at it from a medical standpoint, because as a pediatric resident, my exposure to diabetes was mostly through sick kids in the hospital, or just a few brief clinic appointments, but their one on one contact in the camp just helped me really realize what kids with diabetes have to go through every single day. So kind of gave was a real eye opener when I started fellowships six years ago, that's

Scott Benner 4:08
something they do with everyone, or were you just lucky to have that opportunity?

Dr. Marwa 4:12
I think it's common practice for programs to send their fellows, at least in my program at UT Southwestern, this is considered work so we actually do work hours at camp, but I'm not sure how other programs have it. But it's, it's typically a an opportunity that a lot of fellows like to kind of get themselves into,

Scott Benner 4:36
you know, it's interesting, you think about it, the people who you were helping, were probably thinking, Oh, this guy, he knows what he's doing. And you were thinking, Oh, how do I do this?

Dr. Marwa 4:45
Right? And I was like, Oh my gosh, it's so like, I don't know those devices. Can you please teach me what this guy does? what this button does, like I understand basics of what I mean, they all need insulin, but it's like how we're how we're operating it with so many new devices. So many new tools, that was the first time I actually got introduced to like a continuous glucose monitor, for example. So by that, at that point, it still required a lot of calibration and a lot of work, but it was still a very, very fruitful experience, I would say,

Scott Benner 5:17
when you start off, so let's kind of step through this, you leave high school, you go to college, when you're an undergrad, you know, you want to be a doctor. Alright,

Dr. Marwa 5:25
I'm an international graduate. So I, the way we do it in Saudi where I went to medical school is we do a high school and then directly into medical school, and that's called a Bachelors of medicine. It is equivalent to an MD, it's a longer program. So it's six years of medical school and a year of internship. So it's different from the way it's done typically in the United States and Canada where typically you do undergrad and then you do the MCAT. And then you decide to become a doctor and to become an MD and that's like a postgraduate not just straight from high school.

Scott Benner 6:04
So when you pick the you know, when you pick endocrinology, is there a reason that you chose endocrinology is something that interested you about it something you were good at or had a personal connection to, if you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself and certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G voc hypo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk For safety information.

Dr. Marwa 7:28
Big question. So zero personal connections at that point. So I was in the middle of pediatric residency. So basically graduated medical school applied for residency and matched to a US hospital in New York where I was doing pediatrics. But throughout those three years of training, it prepares me to become a general pediatrician. And then I have the opportunity to do three additional years of training in whatever field that I'm interested in. So whether it's being like a heart doctor, a cardiologist or an endocrinologist that comes in, after we do those three years of general, whether it's internal medicine, if you want to be an adult endocrinologist or pediatrics, if you want to do a pediatric endocrinologist. Okay, so my first year in and like as a pediatric resident, I was like, I know that I don't want to do general pediatrics, I think yes, I love taking care of patients in a Well Child setting. But I do like to take care of kids who have chronic diseases. And so whether it's being an asthma doctor or like a, like rheumatoid doctor or a heart doctor, or like I wanted to take it a step further. And so, at that time, I was also doing my master's in public health. And I had, at that point, wanted to be involved in some kind of research. And during that time, the fellows who were in my program wanted a statistician to help them run those numbers and analysis. So I kind of find myself really, with the people with the group of endocrine fellows and the endocrine attendings who were amazing. And they got me involved into the diabetes research. And I was like, You know what, I actually liked that, but I did not know how much I would love it. I was like, Okay, I don't mind being an endo or an asthma doctor. But now it's like, looking back. I don't want to do anything about diabetes and Endocrinology. So I'm glad that it's kind of the stars aligned this way for me. Yeah.

Scott Benner 9:36
What about it captured your imagination.

Dr. Marwa 9:39
I knew I love working with numbers and I'm a caring person. So I think I found that kind of right mix within paediatric endocrinology. But at that point, I was like, Okay, I like to get results right away. So I was thinking maybe I can do a hospitalist job where I can just take care of very sick kids in the house. Fill er the ICU or neonatology. But then, like, I love to also have a work life balance and spend the nights really at home with my family and not really have to spend so many nights of my adult career in the hospital. So that's where a subspecialty like endocrinology came in as a natural fit. It's

Scott Benner 10:22
interesting how many little variables go into your course.

Dr. Marwa 10:26
Right? Yeah,

Scott Benner 10:27
really, it is really something. So once you decide that you're going to, you're going to help kids, you know, in a clinical setting, what do you know about diabetes, I guess, in the beginning, and how do you learn what you know now? Because it's not from medical, because people would be keen to believe that go you go to medical school. So now you understand diabetes? That's not really how it works. So what's the pathway to to really becoming proficient?

Dr. Marwa 10:55
Right. So honestly, if without having a one on one, diabetes training, I don't know how I would have been one because yes, we do study how insulin works. That's something that they teach us in medical school, they we study the different kinds of insulin we study, there is a pump, we study about DKA. They teach us in the hospital, of course, in the emergency room, how to take care of a sick child, but they don't really teach us what goes into the day to day management of diabetes. This is not a common thing that a general doctor, I mean, yes, they know that the kid needs insulin, but that's pretty much where it ends in terms of what they teach us in pediatric training. Not every pediatrician does endocrinology. So yes, a lot of my trainees currently in the hospital, where I'm at, they just see kids with diabetes in the hospital, they never really have that connection with kids who never landed the hospitals to begin with. So I think, again, if somebody wants to really get into diabetes, they need to actually experience then just deal with people who live with it.

Scott Benner 12:03
Okay. Yeah. So it's just the experience just having conversations, watching people struggle or succeed and taking information from that building on top of it. Absolutely,

Dr. Marwa 12:13
yes. And again, staying. I was very, very lucky to have very good mentors in Dallas, where I did my a year of fellowship. I mean, we just was excellent, 16 endocrinologist and I was the only fellow that years. So again, I felt that there's a lot of responsibility, but at the same time, it's that joy of learning something new, and really being able to slowly understand how those doctors think about going about medically making the right decisions. But then after that, I realized there is a there is very limited that doctors do in clinic appointments. And it's like, and this is always a question that I asked myself, like, what's my job as a diabetes doctor? What's my role? I mean, at this point, at least when I was in Dallas, the nurses would pre charge prepare all the prescriptions for diabetes, there is a protocol for when to do the labs and when to do that blood sugar checks. And even in terms of trend management, giving more or less carb ratios are long acting or just making a pump change. Again, that's also mostly handled by our nursing and diabetes educator team. So it's kind of like that struggle is like diabetes is like no other disease is. It's not just that you need the medicine. Pretty much everyone universally, Nellis you need insulin for type one diabetes, but it's more of how can you tailor that treatment to that individual in front of you?

Scott Benner 13:46
What did you decide your job was?

Dr. Marwa 13:49
At that point in Dallas, it was a much more structured way where we had diabetes educators routinely go in with a doctor's for a visit, that all changed. When I actually started here working at Sinai was COVID. Most people were remote. And we were just starting to get people back to the office. And I found myself basically doing it alone. It's like an old man. Like it's an it's a one man show, for the most part for the diabetes care and follow up where I had maybe three or four people helped me in my visit, I kind of took a different approach to what other doctors might do. It was more of a concierge, so to speak, kind of practice in a community hospital, where I, I personally again, it was like, okay, somebody needs to provide that education. If I don't have the nursing Task Force. I don't have that skeleton. Hey, I mean, I still want my kids to get the best care possible. And I'll just go ahead and do my own education. So I was very, very fortunate to have that capacity. It's like yes, we are a smaller house. spittle, and we have lots of hospitals in the area in Baltimore. It's not a big patient load, we get around maybe one new diabetic every single week. That's different from Dallas, for example, when I used to get a diabetic every single day, the the load there was much bigger. So with having a diabetic every week, it was more of a process of how can I make sure that my patients are up to speed with that education process. So for me, my goal was mostly an educator. And I'm like a teacher. And basically having a little curriculum in my mind, even though it's an unwritten curriculum about, okay, this is what you need to learn when you first leave the hospital. This is what you leave, leave to learn, like, a month or two, down the line. Of course, we all are different in how fast we learn. But at least understanding the basics, the concepts, I would like all my patients to learn how to do trade management, of course, not everybody is able to do so. But it's mostly structuring the education. So I think founding my role as a physician educator was very, very fulfilling, I then decided, okay, you know, what I put in all those hours, I was able to put in my diabetes educator exam, I'm now very one of the very few doctors who are certified diabetes educators, and also board certified in advanced diabetes management. So basically, it's just from an A to Z kind of standpoint where I could just cover not just the doctor, yes, I know how to look at prescriptions and look at trends and make those adjustments, but also educate and empower my patients to be able to really achieve what they need. By the time I see them. The next time, of course, what do I use to measure? what's the, what's the variable that I'm tracking? It's like, of course, I track their time and range, and they're a one see that everybody does, but of course, it's not just a one. See, that happens in three months, I always ask myself, there is a lot of room as a window for opportunity between those visits that we could probably work on.

Scott Benner 17:06
What do you feel like a newly diagnosed person needs to understand? First, it feels like you have it broken into steps, right? What are the steps? diabetes

Dr. Marwa 17:16
is a life changing diagnosis, there's a lot of stress. But then at that point, families are very eager to learn. And I found it that really what we teach in that first week, or that first few weeks, really stick with them for a very long period of time. And it's kind of like this is the unshakable truth. So I think the most important things I teach or focus on, I think everyone can learn eventually how to check a sugar level, or how to give insulin injection, this is not my point of focus, our nurses in the hospital can even they're not diabetes educators, they can also teach those basic mechanical skills, what I focus on is the understanding of diabetes targets as like, Okay, this is a prediction game. Even if you're off by a point, upper or lower, you have the numbers to track and to kind of teach a good target, I always say I want to make diabetes, invisible disease. And so I give Dexcom during that first admission, or like any other as mostly Dexcom. To allow for monitoring, I've got I've given some Libras to my type twos, basically a continuous glucose monitor, so that we can continuously monitor and when they can reach out the first few days after because I'm having a patient a week or so I try to not just say, make this change, but explain why I'm making those changes. So it's kind of like slow learning process that hey, this is a an imperfect disease, we do our best we try to come up with a certain dose. But if it doesn't work out, doesn't mean that you're doing anything wrong. This is the nature of diabetes, and let's try to kind of work on improving all the time.

Scott Benner 18:58
You're teaching them the way you learned from your fellows. Correct. Okay, and you're taking the experience that you had at diabetes camp, right for yourself, remembering that you didn't know anything, and you had to go over and over and over again until it started to make sense to you. You're just doing what worked for you. For them. Yes.

Dr. Marwa 19:15
I was like, Okay, it's they're very worried initially about a high number. I always say it was much higher just a week or two ago when it was running at a super high levels. We did not know it. diabetes was a thing. But now we know it, we can see it, we can act we have the tools to respond to it. And so yes, it's always those kind of questions. Can we have a snack after we had a meal or they like we always try to not give concrete answers, but always try to reference Hey, oh, my gauge is your numbers. And this is what I want to try to kind of perfect and so my focus is yes, you need to learn how to perform those skills how to use The Corporate shell. But eventually, if we do the math, and the numbers are not where they need to be, we need to think about how can we make it better the next day. So kind of make it like a process. And not you do this, and we'll fix that kind of thing.

Scott Benner 20:14
I think that one of the nicest things I heard you say, Was that what you tell them in the beginning becomes this unshakable truth. So then, you know, to that if you lead them in the wrong way, in the beginning, it's hard to break them free from that as well. Right? And

Dr. Marwa 20:29
I look at it just like I'm building a house, I need to set up a solid foundation. Yeah. Yeah. And how do I mean, again, it's this is what makes the diabetes doctor different from like, say, hematol, like an oncology Doctor, where you're setting up all the plans, for example, for treatment of a tumor, mostly in the hospital. I mean, what our job is, is to empower people to do the tasks of diabetes at home. And that's what makes our job much more again, demand. And what we're asking for is something that is very demanding 24/7 365 kinds of jobs. So it's this is I think, what makes it all a it's also very

Scott Benner 21:10
uncommon in health care. Far too often, we accept the blood glucose meter that someone hands to us, the doctor reaches into a drawer and goes here, take this one. That is that is the one you want. Is that accurate, you have no way of knowing. But if you want accuracy, and you want to be confident in the blood glucose readings that you're getting from your meter, you want that contour next gen. It's incredibly easy to get the same meter that Arden uses, just go to contour next one.com/juicebox That's all you have to do. The contour next gen is easy to use and highly accurate. It features a smart light that provides a simple understanding of your blood glucose levels. And of course, Second Chance sampling technology that can help you to save money with fewer wasted strips. Contour next one.com/juicebox This episode of The Juicebox Podcast is sponsored by the ever since CGM ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever since CGM. Ever since cgm.com/juicebox, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with. If you're tired of things falling off and not sticking or sticking too much, or having to carry around a whole bunch of extra supplies in case something does fall off. Then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link, you're supporting the production of the podcast and helping to keep it free and plentiful. Ever since cgm.com/juice. box right? Because you usually things are measured, take the pill at one o'clock take it at five o'clock, I want you to do the albuterol before you have this hat like like it's all very structured diabetes isn't like that at all. diabetes it is but it doesn't feel like it, it feels like it feels like it's always flowing and moving and changing. And I need you to do this all at home and make changes to that. So how long until you empower them to make dosing decisions that are different from what you've written down? Oh,

Dr. Marwa 23:56
it's like a few weeks down the line. Okay, so I think because I'm with them pretty much every day or every other day when they leave the hospital. And so it's a lot of hand holding initially, but then slowly they realize what I would do. And then I start to ask questions in the Socratic manner be like, okay, they would reach out we're having lows when we're intrigued that honeymoon phase and it's like, okay, you see those lows? What do you think caused that? And what insolent change do you want to do? And I always say, this is purely educational. If you don't know the answer, or if you ask the wrong question is okay, and I'll then put in my recommendation myself, or if I see that they put in a recommendation and it really is what I would suggest and I was like okay, yes, this is what I want.

Scott Benner 24:41
This is how I do it online. I when I talk to people I almost always say to them some version of what do you think, you know, where you ask them a question to get them to think in a direction that they're you don't know to go into? Have you ever done that kind of leap like little carrot and stick lead them towards it?

Dr. Marwa 24:58
Oh, yes, absolutely. You I slowly and sometimes I say, Okay, I usually go down. I mean, sometimes I just when I see somebody is just really stuck and frustrated, I'll say, Okay, we'll do a 20% decrease, what do you think that will do? So at least I'll make them do one task out of the process. Yeah. So at least getting them engaged in there. It's more of where's the center of control, I wanted to be with the families, I want them to feel that they're under control of their disease, yes, they get their prescriptions and the guidance from the doctor's office, but it's mostly I want to empower them to really be able to be independent in taking care of that disease. So they don't need a doctor's input, Allah down the line,

Scott Benner 25:41
it becomes crippling if you infantilize them, and don't let them make decisions, then down the road, when you're not as connected any longer. They don't know what to do. And then they just start taking those outcomes as this is how it's supposed to be. And so they don't even reach for more at that point. They just accept it.

Dr. Marwa 25:58
Right? Yeah. And honestly, I feel that my personal anecdotal experience in my practice or care model, is that I really, really value starting a sensor they won and having that hand holding process throughout, because it's a very critical moment. This is when they're very eager to learn. And this is when I can really get somebody to get a buy in with me teaching versus somebody who's had diabetes for five or six years, I might use the exact same skills, it might not stick, because this is not what they've been used to. It's very hard to change someone's behavior once we get to that level. Yeah. So

Scott Benner 26:39
that's insurance, though, right? If they have insurance, then they get one if they you know, but are there people who you want to put on them? You can't get them for? Pretty

Dr. Marwa 26:48
much, at least in Maryland, I know other states might have it differently. But in Maryland, it's universally covered for anyone who needs insulin four times a day. Oh, wow. So I have samples in my office that I give at the hospital. And so the first one is just a free sample. And that buys me 1014 days until I figured out a prescription and prior auth pretty much they're getting continuous numbers since they are in the hospital for that first appointment.

Scott Benner 27:15
Do you see people becoming overloaded with data? Or do they handle it? Well,

Dr. Marwa 27:20
people handle it differently. But I feel that I want them to be overloaded with data. That's the whole point is to make them to let them know diabetes is messy. And let's try to solve this together and trying to just walk them through my thought process about making it less of a messy disease, so to speak. I

Scott Benner 27:42
appreciate that attitude. I really do because I think that everyone should leave the hospital with a CGM, right? Yeah, after diagnosis, it's just so valuable. And you learn so much about how food and insulin impacts things. It makes you just Ultra aware of all the things that would look completely invisible and unknowable if you didn't see the data. Correct? Yeah. So fantastic.

Dr. Marwa 28:05
I honestly, again, it's this so this is kind of the I'm sure that down the line, we'll have more studies to support that. But I think at this point, even without a study, I think I already know that this is the route that probably the future we'll see this model get more generalizable. Right now I have a very busy clinic, a clinics a week, they really don't have time to kind of sit down for academia and research. And then important topics to kind of just review, evaluate, not in terms of control because I think if we resist studying control in a month or two, I don't think that's a good outcome. Because I think eventually mother nature allows honeymoon to kick in and everybody gets a good, relatively good a one see in like few weeks, a few months down the line,

Scott Benner 28:52
some stability happens. And yeah, a year down

Dr. Marwa 28:56
the line or two years down the line, the understanding the level of being able to handle the burden of diabetes. Initially, I had a mom who was very, very worried about how discrepant the numbers are between the Dexcom and the glucose levels. And she was almost going to write off Dexcom in the hospital. But then I was like, Okay, we need to be patient with this. This is a tool. So it was more of that explanation. But eventually now she's like talking about Well, thank you so much for walking us through it because otherwise we might have not even started it. And I've had it here now where I have a patient who was seven years into their diagnosis, they are still refusing to wear a CGM because they had one bad experience. So I think if we just say that this is the way this is the standard of care is to take care of diabetes with a CGM, despite its limitations, and let's walk through it and let's teach you a sugar stick as a backup. I think this is the message that I want us I want them to stick with and not the fact that oh I can take care of Diabetes with finger pricks? Yes, you can, but you're not gonna get the good control that you would get otherwise with a continuous glucose monitor. What

Scott Benner 30:07
do you think about the algorithms? Do you put algorithms on people? So

Dr. Marwa 30:11
algorithms? Do you mean DIY systems?

Scott Benner 30:15
No, we're all them. Omnipod five control IQ, Medtronic 780 G like, do you? Do you give those to people?

Dr. Marwa 30:22
Oh, absolutely, yes. Yeah, that's what I do most of my day is I look at my most of my day is it tech support, so to speak, because hey, somebody just we need to connect them and we need to get their numbers, the algorithms I day one, I tell them, we have this is Basal Bolus. This is how we can do it at the hospital is a backup system, but yet you need to learn. But I always introduce to families that, listen, it's just a transient phase, but most of my kids will need to transition to a pump process of some sort, to get the good control. So I always say this is just the stage to learn, I kind of try to give the analogy of a elementary school student we don't we don't give them calculators until they have mastered how to do addition and subtraction on paper. So like, I always put them in the mindset that this disease requires technology to fix it at this point, we can only do so much with shots, eventually, the goal is to transition them to a pump of some sort of a closed loop system. So you're

Scott Benner 31:29
of the opinion that they should know how to use a manual pump first,

Dr. Marwa 31:32
that manual pump but at least know how to master injections. First, a lot of families asked me in the hospital, can you get a pump right now? And I was like, No, it's mostly educational. I mean, if they already had another sibling on a pump and family has gone through the process training, then yes, I don't mind a week one or two after diagnosis.

Scott Benner 31:52
I was gonna ask you, can you dig down into that a little bit for me, tell me what the benefits are that you see coming from being MDI for a while? Oh,

Dr. Marwa 32:00
so I think understanding the process, diabetes, understanding the relationship between insulin and food, yes, we can also get that in a pump. But I think with shots, it will make more of a physical, like you are actually getting that insulin to see the effect of food. But then eventually, I think, with any pump, there is a chance of technology failure. So I do want them to be very overwhelmed when technology fails, and we have to resort to some sort of either manual mode or MDI. I

Scott Benner 32:43
say, if you could be certain that there wouldn't be any bad sites or mechanical like, I don't know, hiccups, then would you have any trouble with them starting on a pump, then?

Dr. Marwa 32:56
The family knows how to revert to MDI. I wouldn't mind that, okay. Meaning the family should be very well versed with MDI, they should not I mean, it's not like, oh, we just learned about it for a day in a hospital. No, they should have really a full understanding of it. This is how you do the long lasting, this is how you do your rapid and this is how we calculate the doses manually. It will help them understand how we think about insulin doses. Yes, I do prescribe the bionic pancreas against prescribing it that first week of diagnosis, I think it's important to understand how insulin works, and to see okay, what does five units mean to my child to my meal and what it does and how different doses deal with like, again, how do how they affect insulin levels, like just make it more of a an understanding and break the barrier of Oh, diabetes is difficult. And then I want them to feel that, oh, diabetes is not too difficult. And we really know and it's only repetitive and I think this is when somebody's ready for a for an upgrade. And this is why it's like at least I give them a few weeks of MDI.

Scott Benner 34:07
Give an example of something that you've seen go wrong when someone starts off without that understanding.

Dr. Marwa 34:12
I started like I've had that Pharaoh who was so much into technology. And they requested a an ink pen and ink pen is a smart pen that would have a Bolus calculator and would tell me, Okay, how much you program the current ratio is the correction factor. And the pen will calculate is an onboard pretty much like a very old school Bolus wizard, right and we'll log in the insulin doses. So I had it been who requested that they wanted to hospital and I was I was able to actually provide an NPN as part of their discharge prescriptions. I think the problems that happened is that they became I'm so dependent on that recommendation of the pen thinking that this is an absolute recommendation. And it kind of made them not think about how good is this those working? Or is it time for me to make a dose change. And so they would be like, Okay, that's what the pump recommended. Sorry. That's what the pen recommended. That's why we gave it and not really there. Okay, now, this is something that's manmade, that we came up with those programming settings, and we need to continue changing it kind of thing. So

Scott Benner 35:28
is this a situation where month it's given over to the pump, that if they see it, I don't know, if they see a situation that doesn't react the way they expect it to. They don't think about it any more deeply, because they believe that the pump has told them the right thing to do. Happens

Dr. Marwa 35:46
all the time. Yet, I say, this is where I would like people to think beyond just what's happened. And unfortunately, that might sometimes lead to DKA. Because hey, the pumps told us to not give anything when the pump was actually kinked or something. And someone might try pushing an insulin and despite you reading a chai for many, many, many hours, and then the kids just have comes to the to the emergency room with a DKA diagnosis I so so I try to kind of prevent that reliance on technology. And I try to say it's not like it's not a foolproof thing you foolproof is you need to know how to do the shots, right? I need you to know how to give insulin manually, and how to be able to just put a pause on diabetes technology if you need to. Okay,

Scott Benner 36:30
very nice. I appreciate you explaining all that. Oh, of course. Yeah. No, it's fascinating. So I guess my question is, you said you also you teach people how to do their jobs now, like So you've now become a person who, who helps younger doctors learn what to do and what to expect. Right? What do you think are some of the most important lessons that they can learn when they're younger? Those doctors, right.

Dr. Marwa 36:55
So I think just being humbled to diabetes and learn from your patients, because my patients teach me something every single day. Like it's always a new trick, or hack that I did not know about whether it's in technology and how they do things, I've found, really, yes, I learned a lot from my teachers and my mentors and my professors, but my patients, I really, I'm very, very grateful for all the discussions and the interactions we've had together. I think that's the number one thing is be humble and understand that what it is that we're dealing with every day, what we study in textbook is really nowhere close to what this again, what what people would diabetes in their families have to deal with every day. And again, I think my other advice would be to not prejudge a patient or a family. I think a lot of doctors fall into the trap of the judge a diabetic based on their agency or their race of admission for DKA. I think sometimes we as doctors need to step back and look at the full, holistic picture of what's happening. What are the barriers to care, don't look at it as sometimes people used to us from the doctors world, labeled patients as non compliant and just call it a day. And I think this is the easy, lazy way to do things. I would say they are not adhering to the plan of care. What are the barriers and let's break down those barriers. And so this is the process that I try to teach all my training doctors who come here to like, okay, their agency is high this time, what are the barriers and let's try to kind of break them one by one and try to hopefully work on making it better the next time. Whether it is an educational barrier, or the technology barriers supply barrier insurance barrier, no matter what barriers there are, I always say hey, mother, nature's plan for this kid is to have the agency as 17% or higher. So whatever number that's lower, there is some work that had been done and it always celebrate the successes and try to kind of work on improving it the next time. That's

Scott Benner 39:04
excellent. What percentage of the students do you think, learn those lessons? How many out of 10 do we send off into the world to be good, thoughtful, quality endocrinologist, and how many of them just end up writing down noncompliant if they don't get the result they want back?

Dr. Marwa 39:20
So right now in my capacity, I'm training general pediatricians. So I'll be very honest. I'm not training actual endocrinology fellows who are about to be in the chronologist. But I'm trying to teach your pediatricians if they have if they see their kids with diabetes, whether in the emergency room or hospital or their outpatient clinics, kind of what to look for and kind of how to approach a high agency in that scenario.

Scott Benner 39:44
So that's not a fair question for you then on that form, but let me ask you this then, how do we get the overall quality that people see like him? This is happening at your hospital and you know, at your facility, but that doesn't mean it happens everywhere. Like, how do you think we can turn endocrinology into something for type ones that is very specific to them instead of you know, what often happens to adults, for example, is that they end up at an endo that handles mostly type two, and they don't know anything about type one. And they get no direction whatsoever. Like, like, I know, what's the thing you have to learn? And I know, it's not the same as being other kinds of doctors, where there's just rules or, you know, when we take the medication, or when we put in the implant or something like that. Have you thought about that? Have you thought about ways to spread good care to type ones?

Dr. Marwa 40:34
That's a very good question. Because honestly, even my care model, I could not even I will say, share it among peer endocrinologist in just again, in my surroundings. So not everybody is hardwired to kind of function this way, so to speak, because endocrinology is very algorithmic, so to speak, I mean, you have low levels of thyroid, you give thyroid medicines, you check labs in two months. So I think if we put diabetes into the umbrella, this is where a wrong thing happened. And this is where it's very, very hard, because we're all doctors are humans at the end of the day, and we are just as varied as again, the variation of human nature. I mean, some people are more patient than others, some people are more rushed than others. And people like to rush through things. But I think if we were looking at it from a systematic standpoint, then yes, we do have a lot of potential in terms of educating an endocrinologist about type one diabetes when they're in their fellowship. But also, actually, I think, and this is what I always tell my families is that they can share some information with their own doctors about, hey, this is something that I'm interested in. And the doctor needs to also explore those things and needs to be very honest, if that's something that they do everyday or not. And I'll be very honest, not every industry knowledge is fit to kind of tap on diabetes. Again, some people it's that's not their thing, and they shouldn't be forced into that field. I mean, you should have a passion for a topic if you really would like to take care of it. Right? I find it hard to answer that question. Because, again, it's goes into a lot of political. No,

Scott Benner 42:12
no, I expected your answer. I just wanted to just say it, that's all. Because because it is random, like there are people who will just luck of the draw, get get you. And there are people who luck of the draw will get somebody who's not well suited for it. And and then their health follows that path. And they don't even know like, that's the part that's that I think heartbreaking to me is that, you know, I could have got you but I got somebody else. And now my eight one C is seven instead of five. And I'll never know that my whole life. I'll just think that I went to the doctor, they told me the right thing, and a seven is what I'm able to accomplish. And, you know, it makes me wonder so much if we're not going to see a significant change in this through I don't know AI, honestly, over the next 10 years, like how soon until AI is connected to your CGM data, and it knows how many carbs you've taken. And then it starts making suggestions to you about, hey, I think we should change the carb ratio to this or I think we should change your insulin sensitivity to that, like that stuff can't be that far off.

Dr. Marwa 43:18
Right. And I think it's already you're already in the bionic pancreas. Sarah, just to give you as little perspective, I mean, I've had a lot of patients who had, everyone was like, okay, my normal agency is 910. And I was like, This is not normal. I mean, and so, especially in lower like underprivileged communities, and this is most of the kids that I serve here are from underprivileged community, Medicaid, mostly government insurance population and for pediatrics. And like you said, they don't know any better about, oh, really, there is a pump that can do that. And so a lot of doctors would put themselves as basically the judges of how good someone is, and they would think of a pump as a price as like, no, it's a tool I would give a for my criteria to start a pump are very, very low, meaning you just have to have type one diabetes, and you have to care a little bit about getting it better. I mean, it's like you need to charge any pump, you need to keep it on your skin, you cannot just disconnect it, you need to be to have somewhat of a caring thing about your pump. So not your question about AI and technologies. So I always think about that every single day is like, When can I play offense and not defense to diabetes? If I see somebody in the hospital in DKA, or and they're wearing a Dexcom, you don't know how many times I looked at a Dexcom where it was reading 383 90 for like many days, and we are looking at that data. Of course nobody alerted us to look at it otherwise we would have guided the families on what they need to do. But we wait until they land in our emergency room when they are very sick, when we could have kind of picked on those early signs of a deteriorating disease early on, I think it would be interesting to see what the future would hold in terms of not just the corporations, I think this is a very advanced thing, but at least there's something going off and you're spending time before hundreds, maybe it's time to alert the doctor, we don't even have that as an option in most of those data analytics software's that we currently utilize. So there is no way for me to soar with skills, so to speak, I need my help. And unfortunately, some kids go into a mental health crisis. And then diabetes control goes south. And I wouldn't know and this would be the kids that I would expect to control from them the least because they it's again, typically it's something outside of medicine, it's not that they do have a medication, it's mostly something social that impacted their diabetes management.

Scott Benner 45:57
How often do you see people with a three ad for days that they don't do anything about and what do you what do you think that causes them not to react?

Dr. Marwa 46:06
People just become numb to just hey, we were used to being numbers, like the numbers, this highs, like and this is what I mean, like people were not taught the targets they want, they don't know what to expect. And some people just treat diabetes symptomatically I don't feel bad. I feel okay. I don't care what the numbers are. This is the struggle that I always try to make them care. I always say I need to make the height or painless, but I need to make it painful. I need to make them feel that this is not right for my body. And so I think a lot of times there is a fear of dropping low there is like okay, there, we're not even checking. They're not having the alarm set, or nobody's actually looking at that data until they see me in clinic.

Scott Benner 46:46
Right. So for the group of people who are not scared of being alone, they're just not motivated. Right? Do you think they don't understand the impacts on their health? Do you think they don't care? From my perspective, as a person who sees a 135 blood sugar and things? I think we could bring that down? I don't understand staring at a 380 for days, but I'm trying to put myself into the mindset of a person, because it's not just apathy. Right? It's not that they don't care. Like there's other things at play. Right.

Dr. Marwa 47:15
And I think it's that invisibility, feeling that, okay, you know what I mean? Nothing is gonna happen to me, even if I go into DKA, I know that the doctors will fix that for me, kind of thing. So it's especially I mean, again, I'm a pediatric person. So I deal with a lot of children and young adults, I mean, adult children don't think the way we think of things like I wouldn't expect a 16 year old to think about a 401 K. So right, but

Scott Benner 47:40
their parents don't get involved either. Did they do that thing? Or they're like I tried, I told them, but they don't listen.

Dr. Marwa 47:46
Yes, all the time. Again, it's more of we give them the tools we bring into the doctor's appointments. We try we best, but we also have to work three kinds of jobs. And I cannot be there with it to baby my child anymore. Yeah,

Scott Benner 47:58
I see the problem. Okay.

Dr. Marwa 48:00
So this is kind of the struggle that I have to kind of deal with. And this is where I think AI, like on the spa. And this is where honestly, again, sometimes even an Omnipod five algorithm might really not work for that person. So I honestly took a lot of people out of Omnipod, five into some other pumps and vice versa, taking some people to the Omnipod five, some people would do better with a tube, some people would do better without a tube, some people would really like that a we did something different about what we were dealing with every day. And I mean, I've had a kid who really did not pay attention to the Omnipod five, and then the Omnipod five will go into manual mode because it's reached its automated delivery settings, I switch them to bionic pancreas. And today, I saw not great results because the kid was not connected to that to their pump most of the night. So again, it's this is the kind of chart I think, yes, there is a role for technology. But I think we are at a decent stage. from a technology standpoint, it's more the psychology and having the buy in from the people living with diabetes to say, No, I really want to feel better. I really want to make sure that my my numbers are better. I mean, that might sound like common sense to us adults, but for a lot of my kids it's not and some kids do, but some some kids are some of the lessons they just it is a struggle for them dealing with the DS they'd rather not think about it or just take as long as I'm okay I'm not in the hospital I did. I reach my goal. So I tried to be patient try to take it step by step I tried to kind of go focus on little goals and actionable things that they can do to try to kind of prevent a, so to speak of like a major relapse in diabetes, like like a DKA admission, but also to really make sure that we're back to the process of hey, you need to see too You see 100 Most of the time and not 250. And you feel that this is okay. And so trying to change that mindset is a hard thing. I think, again, I am not a behavioral person myself, but my wife does a lot of work with applied behavioral analysis. My parent, my father is a psychiatrist. So again, I was surrounded by a lot of mental health experts in my home. So I got a lot of training there about maybe a behavior prescription so to speak, which so I think is helpful.

Scott Benner 50:34
Yeah, no, I would imagine it would be greatly valuable. Can I ask you, so I find myself like wondering out loud about the eyelet pump, the BT bionics pump. And I think, well, if somebody's not going to do anything, at least if you put them on that they maybe could get an A one C and the sevens with it. But you're telling me that you might be intersecting people who won't put the pump on even? Right?

Dr. Marwa 50:54
Yes, I mean, not put up on par for quite some time. And again, of course, the huge wall, I'm not getting my shipment from my supplier. It's like the usual frustration, and then okay, we don't know what to do as a backup, because we and then our numbers are just running very, very high. So I think, again, until there is a biologic fix to type one diabetes, which I'm hoping for will happen in the next half decade or two, but And so until we're there, I don't think technology by itself, can everybody fix diabetes, I think there should be also a lot of work on the psychology and the social work services that we provide, and not social work in terms of I don't want someone holding a stick, what am I called a social worker, and told the mother, if you don't follow this plan will take the child away from you. I mean, it should not be confrontational, some social workers just don't understand the complexities of this disease, and they want to try to get a black and white answer. And there are lots of shades of grey, and there are some there. Again, there's this difference between somebody who's just overwhelmed, frustrated, diabetes, fatigue, versus somebody who truly is completely completely negligent of their child. And that's, that's a fine line. And I always find myself thinking about those things. But at least, if I have somebody who reaches out to me, when they have trouble, then we have that open line of communication. And we're able to do really, again, it's a partnership, it's like trying to get to a place where they're in harmony with their disease. And what I mean by Harmony is that they're doing what there's something that they're comfortable doing, and they're seeing the results that they're seeing. I mean, you will be surprised how many times I would be somebody with an agency of 12 per sentence as how things are going, and they feel like things are okay, yeah. But in my mind, things are not okay, we need to fix things.

Scott Benner 52:53
You're dealing with so many different types of people. And yes, and situations on top of that, anywhere from someone who's very interested and able, for a number of reasons, and is probably keeping an agency in the fives to somebody who you're just like, Look, you have to put the pump on or you're gonna end up in the hospital, right? And everywhere in between and parents that can be involved in parents that can't be involved in kids that do care and ones that don't care. That's exhausting. No,

Dr. Marwa 53:21
it is very exhausting. Yes, yeah. I love the experience of it all. Whether it's somebody that I was able to, again, at least move the needle in the right direction, and trying to at least make them leave the office with a positive attitude about Yes, I can handle this. Yes, I can. This is something that I learned from the doctor, I can totally make this better the next time and just celebrate the little victories as we go.

Scott Benner 53:44
Do you have any luck explaining to people that high blood sugars lead to cloudy thinking that they are sluggish and, and generally less healthy, and they wouldn't even know it at this point, they don't care. So

Dr. Marwa 53:56
I deal a lot with kids who are taken care of by caregivers. And so a lot of times I tell the parents, please, for the next few weeks, you need to take away all their independence privileges, and you need to be on charge. Not all your life, but give me a week of very solid control, otherwise, your kid will land at the hospital. Right? So I mean, at least I tried to make such an advice very, like very indirect, but at the same time very actionable to say, Hey, listen, it's like they're sick, and they don't understand that they're sick. Like we need to do ABCD you need to follow it as a protocol. And just remember the day you left the hospital, you were calling us every day or every two days, we have to kind of push a hard reset button on diabetes and get it there. Otherwise, I'll have to do this for you in a hospital setting. And so a lot of times, I was able to call, so to speak, press a hard reset on diabetes.

Scott Benner 54:53
How often do you experience someone who has struggled like this, but eventually just breaks it? out of it. Like, do you see them come around eventually?

Dr. Marwa 55:03
Yes, all the time. And this is what makes it very, very fruitful. I mean, I've had people both type one and type two who had very difficult diseases. Sometimes it's just giving them the right tool. And sometimes just listening to them. Sometimes it's empowering them and seen a lot of people who just again, previous endocrinologist would always be like, okay, noncompliant, you stuck in the 10 11% a one sees, but I think I see a nice slow decline, because, like, they feel that they are now empowered to really do this. And they find that, okay, it's not that bad to follow the doctor's advice. I don't have to be defined as a teenager, I, the doctors might say something that's going to help me. And so trying to kind of work with them, and not to kind of be their dictator, kind of like, I'm not mandating you to do this. But hey, why don't we do this and try to make it something that, like, I use a lot of salesperson tactic. Let me put it this way. And I try to not celebrate victories very early, because a lot of times I see a sharp decline, but then things might go south socially, and then I might see a spike back up. So there is no finish line and diabetes is always how can I make it better, so that the following time we can continue? Where we are. So even for my kids who have very good control? My appointments are still very long, because I like them to stay in that range and not really rebound.

Scott Benner 56:26
Yeah, not to feel like, Oh, I did it. Now I can stop doing it. Right, right. How often do you find yourself without hope for somebody?

Dr. Marwa 56:34
I mean, I think when I feel that the person is not connecting with me, I tell them, Listen, maybe I'm not the right fit for you. Maybe you need another endocrinologist. I mean, I can't force people to like me, or I mean, it's just, but if I feel that I cannot partner with someone, when I feel that there are barriers to I mean, I take a lot of no shows people can sometimes not show up to an appointment, it's fine, I'll try to accommodate another time. But if somebody has not seen me for a year and a half, I put a hard stop and say you need to see a doctor or otherwise I cannot keep on being your insulin dispensing machine. So. So that was my heart stop. But otherwise, pretty much I tried to not give up on someone. Because if I do that, I know that knowing my colleagues in the field, I don't know if someone else will be able to provide them the care and just the hand holding that I might be able to provide. But again, I would like to give them the option and eventually to really be able to self manage, so they don't need the doctor. So yes, I have patients that I need to see every two weeks or every week, two patients that I can see every six months, and I had somebody who canceled that six month appointment, and a year later that he was still 6%. So back to my questions like what's the role of a doctor? It's like, yes, we are the educators, we are the coaches, we are the guides, but we are basically the captains of the chef's we need to make sure that things are getting in the right direction.

Scott Benner 58:03
Have you imagined a magic wand fix for problems like this yet? Like is there? Do you look at people and think if I could just make them believe? Do I feel something that this would all go the right way? Like do you know the path and you just can't get them on it, or you're not certain of what the path is at times as well.

Dr. Marwa 58:22
Sometimes not because especially if it's a complex social disease. So say if somebody is struggling with major depression and diabetes, it's very hard for me to fix that without to Central Health help. And I don't have a psychologist or social worker in my office. So I try to be the social worker, even though I'm not a trained social worker, I tried to be the psychologist even though I'm not a psychologist, I tried to not at psychology in a professional setting, but in a way so to speak good heart, somebody who listens to them and try to acknowledge what they're going through and try to at least in a way, be neutral through what they're going through and be a, so to speak diabetes mechanic. My focus here is diabetes and not a mental health professional. Right? My focus here is, hey, yes, you're going through a lot. But can we? What are the things that you can do for your diabetes so that as a diabetes guard, your diabetes is not going out of nowhere? I mean, whether you're having a good day or a bad day, you number should not have a bad day. That's my mantra there. It's like, it's I would like to make a good day for diabetes, no matter what the psychology is. And this is where technology really helps in that regard. If somebody's into that habit into that routine, then the better what life brings good days or bad days, we'll have a good control of their diabetes. So

Scott Benner 59:44
yes, we can see people being like, I guess, emotionally overmatched by how often do you see people who are intellectually overmatched by it and what do you do about that?

Dr. Marwa 59:54
So is it more that they feel that they're defeated by their numbers and diabetes? Since then it's hard for them to kind of predict what's going to happen.

Scott Benner 1:00:03
I mean, I'm saying, Are there people who just IQ wise just can't keep up with what's going on, they can't juggle all the balls and understand the math. Yeah, I've

Dr. Marwa 1:00:12
had a few families. And again, this is where there is no magic wand, you have to take it step by step and focus on one tool and work with it. I mean, we have had a toddler with diabetes recently. And it was a very big shock for them to have to deal with diabetes every day. Initially, I because the kid was not eating solids. So I did not need to teach carb counting initially, I needed to this this, this is how much you're feeding. This is how much insulin you need to give for that amount of milk, because having and then slowly introduced card counting slowly introduced ratios. And so I'm thinking maybe if it's good, I'll put it on a bionic pancreas. Because I don't know if they'll grasp insulin in a toddler. But again, I want them to understand that any device can fail or cannot give insulin, if the numbers are high, we need to do something about it. Unfortunately, this kid is averaging 350. And they're very sensitive to insulin. And if they get insulin, they get very low. So it's a very, very hard balance.

Scott Benner 1:01:19
Well, it's just a terrible thing to have to deal with. For sure. Yeah. Yeah. So my gosh, well, I'm going to put this episode in with my series called Grand Rounds that I've been making this year, where myself and a CDE, who has had type one diabetes for 35 years, we took people's feedback listeners feedback about what they wish their doctors would understand. And we did episodes about that. And now I'm adding on conversations with doctors about how they work in endocrinology. So I can't tell you how grateful I am for you taking the time to do this.

Dr. Marwa 1:01:54
Oh, of course. No, thank you so much for giving me that part in that platform. Because yes, I I heard about the Juicebox Podcast, I think I've listened to one or two a few years ago. But I am very, very grateful to be here today.

Scott Benner 1:02:08
No, I am. I'm very grateful for you taking the time because I'm very interested in this entire dynamic about, you know, different people, different scenarios, different variables, different doctors, and how do we get as many people as possible to lower stable a one sees that allow them to go live their life and not think about diabetes quite so much. You know, if you listen to some people, they'll just say, my doctor socks, and I'm sure some of them do. But I also think that there's I don't want to say culpability, but there's responsibility on both sides. Right. And oftentimes, the doctors don't know when they're falling short. And the patients don't know when they're falling short. And they're very apt to blame each other in that scenario. And I don't think it's that simple.

Dr. Marwa 1:02:55
And this is where I feel that hey, I mean, if it doesn't work out by somebody else, maybe it's not a good fit. I mean, I've had some some of my colleagues who are very, I would say robotic, and the way they approach diabetes, where it's just numbers. I mean, some people just want that kind of doctor, you know, if it's like, make sure that my numbers and my pumps are okay, and I will take care of the rest. And these are typically parents who or families who are already pharmacist or medical professionals or highly educated people. But that's not that does not capture that majority of people who's living with type one diabetes every day. How

Scott Benner 1:03:31
progressive? Are you with other things? Do you aggressively manage people's thyroids for example?

Dr. Marwa 1:03:38
Oh, yes, absolutely. Yeah. I mean, I think once I have a problem I try. It's all in our lap. That's, that's my style. You

Scott Benner 1:03:46
medicate symptoms? Not numbers? Pretty

Dr. Marwa 1:03:48
much. Yes. I, I take numbers into context for sure. Sure. And of course, our numbers. I mean, if numbers don't make sense, or if I feel that medication, won't really hell, then I

Scott Benner 1:04:01
use it just to use I'm not going to use it right. But if you're symptomatic and you have a three TSH, then you're getting Synthroid, for example,

Dr. Marwa 1:04:07
I don't think so. No, I think at least a higher number. So depending on what we, again, I try to be logical and try to see hey, I'm I always tell my families I'm like a hormone judge. Is the thyroid guilty or not guilty? Is the pancreas guilty or not guilty? And then I have to kind of give back whatever hormones the body's missing.

Scott Benner 1:04:31
Once you're confident that it's thyroid, what are your TSH goals?

Dr. Marwa 1:04:36
Oh, just in the target goal. So say if it's if it's in the reference range for a lab, then I'll take it but of course, if somebody is symptomatic and there is room to increase the dose, I don't mind giving up on the deals and give a keeping a trial and error. But I mean, typically teaching is TSH of 10 or higher is what you treat. If somebody who's not known to have died disease. However, I've had someone that I treated as seven or eight because they had some symptoms. And I thought, You know what, it's very plausible that those symptoms might be contributing. Let's give it a try. It kind of helped the symptoms, the constipation, but it now made the kids now irritable. So I'm not sure what tease apart. So I think it's not, it's not a straightforward trade line of thinking. It's more of it's a tool. I mean, medications hormones are out, there are tools for us. And if we could utilize them to really improve someone's health,

Scott Benner 1:05:35
then do so yeah. Yeah,

Dr. Marwa 1:05:37
let's let's do it. Yeah.

Scott Benner 1:05:38
Can I ask you, when you do blood work for people? Do you look at their iron ferritin levels, things like that? Not

Dr. Marwa 1:05:44
typically, for type one, unless if someone has specific like symptoms, or they have anemia, I would okay, but not my typical screening, I typically follow the ADA screening guidelines to the book from that regard.

Scott Benner 1:05:57
I asked, and I wonder because I feel like I see a lot of people with digestion, and then absorption issues. So once you have like, type one, or autoimmune, you can see poor digestion. And a lot of people like you must have kids or like my stomach always heard stuff like that. And then, you know, we've been having a lot of conversations on the podcast, people using different aids like digestive enzymes and things like that, that have been taking away a lot of that pain, where their endocrinologist will sometimes tell them, Well, you just you have gastroparesis. And it turns out that maybe they've just needed some help with the digestion process. And when that digestion gets messed up, oftentimes nutrition uptake gets messed up along with it. And then I'm seeing a lot of people with low ferritin issues, who have type one, I see a lot of different interesting connections, having so many conversations, I have over 1200 episodes that I've recorded over the years, and for instance, to talk to people and say, you know, hey, you know, what other autoimmune do you have in your family? And as I'm asking them, I'll always say, How about bipolar? Do you see a lot of bipolar? And you'd be surprised how many people have a bipolar relative, when there's autoimmune or type one in their family? Little stuff you would never see connection to if you didn't have the opportunity to ask so many different people. Right?

Dr. Marwa 1:07:17
So no, I mean, very, very grateful for all those things. Again, this is kind of I think, this is how science, this is what sparked science and scientific research is like, Okay, you, you look at a connection. And then we kind of put it to the test with a with a scientific research question. And I think there's a lot to be understood, there's a lot we need to learn about what causes type one diabetes, what might be a link with other digestive or autoimmune disorders, and I'm sure there are a lot of unanswered questions that will continue learning. I mean, we already have achieved a lot, but there's still a lot to learn about diabetes. And what's happening. I'm excited

Scott Benner 1:07:55
that people like you were involved. Can I ask a question? Of course, what do you think? Or have you thought about where we're going to see GLP medication to use with type ones in the future?

Dr. Marwa 1:08:07
So I am a very aggressive users of GLP. And type one, probably more than my other colleagues in the field. I feel that if someone has signs of insulin resistance and their insulin daily requirements are much higher, and there is their family history of type two diabetes, I think they have two diseases, they have both type one and type two diabetes for the same person. I have specially for my kids who have type one diabetes and who are overweight and who needs for example, 150 units a day, should I just give you more insulin? Yes, I need to give you more insulin. But I always ask myself, why do you need 150 units a day? And these are the kids who end up typically getting a GLP one prescription along with their insulin type one treatment therapies. So in terms of I think, the question about a GLP. One for people who don't fit this umbrella for people who were type one, they're not overweight, there is no family history of type two, can we give a low dose of GLP? One to kind of hell, just with some endocrine function. I have brought it up with one or two patients who had like who were in honeymoon and they wanted to think about hey, can we prolong honeymoon this way? I'm not sure if you're aware, but the New England Journal of medicines submitted, there was a research that was published. For small clinical study only 12 participants who had longer honeymoon longer see peptide if they took a small dose of semaglutide much slower even the dose that I would start somebody with type two. So for type one, can I give them a small dose of a GLP one agonists to kind of help preserve some pancreatic function, especially if they're in that honeymoon phase. I Think this is a question for science to answer in a few years, I feel that I look up GLP, one agonist as in a ways, getting the effects of exercise into the blood sugar level, but without actually exercising, it's nice how their insulin requirements would come down. And insulin, diabetes will be an easier disease to manage with those medications, plus also the impact of the effects of appetite and lowering the appetite, it might also impact and improve those, those glucose levels.

Scott Benner 1:10:34
The study you you spoke about Do you happen to know was periactin Dona involved in that one? Let me pull it up really quickly, because I'm about to have him on the show. And I've had a mother of a like a 13 year old child, who's had type one for three years more using 70 units a day, but with a background of the family of PCOS. And they gave the child we go V, and they're down to seven units a day, and they're not even shooting Bolus insulin anymore. Yeah,

Dr. Marwa 1:11:08
I think there is a lot of potential. I think we are going out. I think the biggest barrier for me prescribing it off label a lot is insurance. Take comments. But for example, I think if somebody is overweight, and using a lot of insulin units a day, I have been able to convince insurance to to start them,

Scott Benner 1:11:31
have you. Yeah, that's amazing if you're able to get type ones covered, because I'm right now, my daughter has PCOS, and type one. And I'm having to buy ozempic out of Canada just to give her a non therapeutic dose. And you should see how much it's helping her. It's significant her, her insulin sensitivity went from one unit moves her 43 to one unit moves at 93.

Dr. Marwa 1:11:55
Wow. So yes, this doctor didn't didn't Donna, and Donna and Dr. Choudry.

Scott Benner 1:12:01
Yeah, I'm in contact with him right now setting up having him on the show. Wonderful. Yeah, no, I'm excited.

Dr. Marwa 1:12:07
So I think my trick there, I would mention that this is an element of type two diabetes, and I make it that this is, yes, we have a background of type one. But please look at the data, it is suggestive of type two in the intermix of the picture like this is this is part of what we're seeing right now, really. And so I was able to get insurance buy in and a lot of and once I get approval, it's very hard that they come back and deny it again. After that,

Scott Benner 1:12:36
I have to ask you if, if you have any tips and tricks for that, if you'd email them to me, I'd like to share them with my daughter's endocrinologist. Of course, yes,

Dr. Marwa 1:12:44
I think it's with insurance. It's always a game. That's another side of what we have to do behind the scenes to try to make sure that we can write the right things to convince insurance for what we are doing is really sound and really medically reasonable and makes sense. I think

Scott Benner 1:13:01
there's gonna be a lot of application for it. I really do. And there's other stuff coming too, right? Isn't one of the companies is working on a daily pill instead of a weekly injection? I think there's a lot, right, I have to tell you, I don't have type one. But my daughter does. And I've been using a GLP for a year now. And I would tell you that I lost I've lost 50 pounds in a year. But I was never a poor eater or, or a person who wasn't moving. And if I had one way to characterize what I think is happening to me, it feels like I have a GLP deficiency. Because in the first four days on point two, five of weego V i lost four pounds, my digestion changed like everything. I was a person who would have to get iron infusions all the time, because I wasn't absorbing my nutrients. But now I've been on a GLP for a year, my ferritin levels 188 When it was just tested, I haven't had an infusion in like 18 months.

Dr. Marwa 1:14:02
Wonderful. That's great to hear that crazy. Yeah, it's it's amazing again, how those new medications are out there. I mean, we did not speak about type two, but I also treat our adolescent type two diabetes in my clinic. And we I mean, we see it very, very commonly, much more commonly than when I started like, six, seven years ago, we're seeing an app spike in type two diabetes, right? I think when doctors three type two is type one, this is the wrong thing, because we keep giving them more insulin and we kind of playing catch 22. And so I tried to get them out of the insulin cycle by prescribing a GLP one agonist for a lot of my kids, especially now that we have a pediatric indication for three GLP one agonists and I'm sure that more will have more choices for pediatrics as well. As we progress, yeah,

Scott Benner 1:15:00
they're working on it. And a lot of them even for pregnancy, they're looking at it now like to be able to keep people it's Listen, my brother, I'm adopted, so not by blood, but my brother is type two. And I've seen I talked him into pushing for a GLP. And his a once he went from the sevens into the fives, yeah. So,

Dr. Marwa 1:15:22
and these are people who've had it for four years. So why so even though my training is in pediatric one that was all just pediatric endocrinology. I'm now a board certified in advanced diabetes management, meaning I can still take care of adults or diabetes across the lifespan. So I face it sometimes I do help some parents with their own diabetes when they ask me questions about diabetes. And so there was that that girl who came to see me again, PCOS, insulin resistance type two and severe obesity, the mother had the same problems. But somebody told the mother that she had type one diabetes after she had gestational diabetes, because she she was very hyperglycemic. And this mother to think was under the care of her endocrinologist for, again, more than a decade treated as a type one. But I was I counseled her, even though I at that point, it was a very brief interaction. I strongly suggested that she presses for GLP one, and she went down from dealing 150 units from Protandim to down to like 20 units a day for tandem. That's wonderful,

Scott Benner 1:16:34
isn't it? No. Hey, you're a little go getter. Dr. Morrow, I see all the letters after your name, by the way here. Sorry, I see you out there hustling?

Dr. Marwa 1:16:43
I enjoy taking exams, I don't mind them. Well, I think

Scott Benner 1:16:48
your letters are going to be in a different line if you get a couple more of them. So it's probably

Dr. Marwa 1:16:54
I mean, again, so I get all those emails like hey, come certifies like yeah, you know what, why not? I'll get back now that I think it makes me a better doctor or worse doctor, but I think it just it's nice to have show that hey, I to learn to learn, of course, and also to be able to present that Yes. Now, I'm not just an endocrinologist, I also do care about this disease.

Scott Benner 1:17:14
Yeah. No, I love your energy around this. I really do think I appreciate this very much. I might have to ask you to come back on again. One day. This was wonderful.

Dr. Marwa 1:17:21
Thank you so much. I will probably be moving to Saudi Arabia. Oh, okay. We'll be probably like this summer. So my contract here in Baltimore is terminated like is ending. And so I might be coming closer to family that might be the next personal big news. But of course where I am, wherever I am, I'll have access to zoom. I'll be in touch.

Scott Benner 1:17:42
Well, listen, they need it to you. I have a number of people in my Instagram, DMS from that part of the world and they're struggling pretty mightily to understand their diabetes as well. Right. So your help will definitely be valuable anywhere you go.

Dr. Marwa 1:17:57
Well, thank you so much. I appreciate it. And again, that's that's that's really again, and this is what makes being a doctor really fulfilling you know, it's like you're able to impact lives and try to kind of make try to help improve people's lives.

Scott Benner 1:18:10
Well, I hope other doctors heard you and they can. I hope they try to match your enthusiasm. That I guess that's what I hope that's really fantastic. Thank you so much.

Dr. Marwa 1:18:19
Thank you so much. Thank you, thank you.

Scott Benner 1:18:28
If you're a physician and you'd like to be on the Grand Rounds series, please send me an email through juicebox podcast.com. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast. Learn more about its implantable sensor, smart transmitter and terrific mobile application at ever since cgm.com/juicebox. Get the only implantable sensor for long term wear. Get ever since having an easy to use and accurate blood glucose meter is just one click away. Contour next one.com/juicebox That's right Today's episode is sponsored by the contour next gen blood glucose meter. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. The Juicebox Podcast is full of so many series that you want and need afterdark s gotten Jenny algorithm pumping bold beginnings defining diabetes defining thyroid, the diabetes Pro Tip series for type one diabetes variable series mental wellness type two diabetes protip how we eat oh my goodness, there's so much at juicebox podcast.com head up into that menu and pick around. And if you're in the private Facebook group, just go to the feature tab for lists upon lists of all of the series. always free. Always helpful. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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