Scott Benner 7/5/25 Scott Benner 7/5/25

#1568 Best of Juicebox: Small Sips Tug of War

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Meal bolusing simplified (I'm not kidding)

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Scott Benner 7/4/25 Scott Benner 7/4/25

#1567 Everyone is from Regina

Leah, a Manitoba social worker, navigates her son's type 1 diabetes amid a family history of autoimmune and allergies.

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Scott Benner 0:00
Here we are back together again, friends for another episode of The Juicebox Podcast.

Leah 0:15
Hi there. I'm Leah. We have two boys, a 13 year old and a seven year old and our 13 year old boy was diagnosed with type one diabetes in 2013

Scott Benner 0:34
if your loved one is newly diagnosed with type one diabetes and you're seeking a clear, practical perspective, check out the bold beginning series on the Juicebox Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type one. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one you can start your journey informed and empowered with the Juicebox Podcast, the bold beginning series and all of the collections in the Juicebox Podcast are available in your audio app and at Juicebox podcast.com in the menu. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. The episode you're about to listen to is sponsored by tandem Moby, the impressively small insulin pump. Tandem Moby features tandems newest algorithm control, iq plus technology, it's designed for greater discretion, more freedom and improved time and range. Learn more and get started today at tandem diabetes.com/juicebox us med is sponsoring this episode of The Juicebox Podcast, and we've been getting our diabetes supplies from us med for years. You can as well us. Med, com, slash, Juicebox, or call 888-721-1514, use the link or the number. Get your free benefits, check and get started today with us. Med,

Leah 2:15
Hi there. I'm Leah, my husband and I and our two kids live in Brandon Manitoba, which is in the prairies of Canada. We have two boys, a 13 year old and a seven year old. And our 13 year old boy was diagnosed with type one diabetes in 2013 Nope. That is not right. That's not right. Yeah, no. 2023

Scott Benner 2:48
sorry. You know, you took me by surprise, because I thought, I actually thought that their child was diagnosed more recently, and then I thought, oh, maybe not. So, no, no, wrong year. Okay, that's okay. So tell me again. How old is is his son?

Leah 3:02
Our oldest Cohen is 13. Okay, so he was 11 when he was diagnosed.

Scott Benner 3:08
Okay, so just two years ago, is there type one or other autoimmune in your family?

Leah 3:13
No, there's some type one far enough back that I don't know that it counts for anything in my mom's family, she had a cousin. That cousin son had it okay, my dad had type two, which I know is not related, but there is autoimmune for sure, and particularly from my mom's side of the family. And I struggle with some of that 10 Cohen had before he was diagnosed with type one also. So it's definitely right in my family, we all kind of struggle with some of the same things and some different things.

Scott Benner 3:55
Well, what did Cohen have before his diagnosis? What else did he have going on?

Leah 4:00
As far as autoimmune he had other diagnoses beyond that. He was followed by a allergist for about three years. He had viral induced asthma. It started about when he was three, I think, and the allergist had said that often kids do tend to grow out of that type, and he did eventually grow out of that type. He also has some eczema and psoriasis, so he's also followed by dermatology, which has been kind of that's been ongoing for Cohen. What about you? Well, I have a Fibromyalgia diagnosis that kind of been queried by other physicians, but it is what it is. So I deal with some chronic pain, but I also have some dermatitis type issues. I. I was diagnosed with an eye condition at the age of 20 called posterior scleritis, at which time the ophthalmologist had told me that that's often associated with autoimmune disease. But other than what I've got, I haven't developed anything new as of late.

Scott Benner 5:21
Okay, and then you said there's other stuff, like on your mom's side of the family too. What else?

Leah 5:26
There's thyroid. My sister has thyroid. Both my mom and I and my sister have psoriatic arthritis, and my mom had a cousin with rheumatoid arthritis.

Scott Benner 5:38
Well, guess what? Leah, I'm counting the cousins daughters type one as part of your family line, because that's a fair amount of autoimmune dripped in there. I think. Yeah, anything on your husband's side? No,

Leah 5:52
not that we know of Scott is pretty healthy. He was actually adopted at birth, so we, as we were preparing to get married, had looked into getting some of the medical documentation from his birth, and there was nothing noteworthy in there about anything autoimmune wise.

Scott Benner 6:18
Yeah. How about your other kid? Do your younger one. Did they have anything

Leah 6:22
so far? Just the viral induced asthma. He's got that

Scott Benner 6:26
too. Okay, interesting. So they both have it. And you live pretty rurally. Well, we're

Leah 6:33
in a city. It's the second biggest city in Manitoba, Winnipeg, I want to see it has about 750,000 and Brandon, where we live, has about 45,000

Scott Benner 6:45
so a lot of people I just meant, like, because you called it the prairie, so I wasn't certain if that meant,

Leah 6:50
like, oh yeah, no, there's lots of farmland around here. And you know, we're kind of the armpit of Canada, so to speak.

Scott Benner 7:00
Why are you the armpit of Canada? I don't understand.

Leah 7:04
Well, we're probably the least desired place to come and visit, because I think we're just seen as you know, a lot of snow, cold. We do have beautiful lakes and stuff like that. We really do. And we get hot, hot summers, but comparatively to places like Toronto and Vancouver and all of BC, really, even Alberta and then the east coast were just not the top I got you tourism destination.

Scott Benner 7:34
So it's May. It's beginning of May right now is it still cold there?

Leah 7:38
It's kind of an odd time, because you'll wake up and it'll be like, and I don't know, I only know the Celsius system, but it would be like plus three or four here in the morning right now. But then today, it's supposed to get up, I think, to around 19 degrees so, and then by Sunday, it's supposed to be 30, but we could still see snow at the same time. Okay,

Scott Benner 8:06
so, so for people like it, like a four degree Celsius is like 39 here. So for us, that's about six degrees above freezing, five, six or six, seven degrees above so above freezing, but not a lot. I would call that cold. And it can go to 30 then,

Leah 8:24
well, on Sunday, yeah, it's supposed to be 30 degrees Celsius, okay, but, but we are not unknown to have like, a big snow storm in the middle of in the middle of summer, yeah, in the middle of May. It's not unusual if that happens,

Scott Benner 8:40
wow. So it can go from, like, for people listening, like, from like 36 degrees to like 86 degrees, which is such a huge swing, oh my gosh.

Leah 8:49
All right, and then the other way, we can go, like, to minus 40 degrees Celsius, which is nasty.

Scott Benner 8:58
And tell me why you don't leave.

Leah 9:01
I ask myself that every winter, I guess, because our family is here, and I see myself as a snowbird, once we retire, is

Scott Benner 9:15
your family that great? You need to be that near to them. It's really cold.

Leah 9:19
Well, yeah, it is, I know. And actually, like, one of the biggest things of why we have stayed because I grew up in Saskatchewan, which is the next province over, which is similar to Manitoba, and I had kind of always thought we'd go back there eventually. That's where my family is, and I again, Cohen had some other diagnoses, cognitively and developmentally related as a preschooler. And I'm a social worker, and I'd worked for in the disability field, well at that time, probably for four or five. Five years, I closed that season out, actually, after Cohen got diagnosed in 2011 but because of that, I kind of knew who the players were, as far as supports in the community of where Cohen would need, and who those people were, and so it was a comfortable place for us to be initially. Then he moved over to the school system, and I don't know it's a Brandon is kind of a neat little place. It's like a big, small town, really is what it is. But all right,

Scott Benner 10:41
you like it there? It's fine. I hear you. I'm not gonna argue there. It just sounds very cold to me. It is, yeah, tell me a little bit about your son's diagnosis. How did it come on, and what did you notice first

Leah 10:51
April, I guess, April of 2023, where there was he had shown a symptom, but I didn't, neither Scott or I connected it back to diabetes like it wasn't even on the radar. But we had taken him. We'd gotten a call from the school that Cohen was really complaining that his calves were sore, and so we picked him up and took him to walk in, and, you know, they sent him for an x ray, but thought it's likely just growing pains, that's normal, and so that's where it was led. The X ray was normal, and we didn't think much of it. And then about three weeks later, it was a weekend, and Cohen was and he was playing spring hockey at the time. It was a weekend, and they weren't playing weekends at the time, so we had friends sleep over, and I took them to the movies and the Friday night, and Cohen, partway through the movie, asked me if he could go get a refill on his pop, which is really unusual for him. But I was like, I did again. I didn't think a lot of it. I was like, Sure, go for it. And then he told me when we left the theater he felt just like a little bit funny, but he couldn't really verbalize what that meant, yeah, yes, and probably having more context and maybe some of his other cognitive stuff will help with this at some point, but the next day, like he kind of bounced back that night, his friends left over, went home, he had other friends come. Wanted to go for a bike ride, so he went along. But we were just getting separate ready, and Scott noticed out the front window that Cohen was walking his bike home, and looked wind dead, and so when he got in the house, he was not feeling great. He didn't feel like eating. He was presenting like he had the flu, very tired. And then on the Sunday, we woke him up and we're gonna go to church, and he was like, Mom, I'm just so tired. And so I was like, that's okay, you sleep. We'll just leave you. So we did that. And then I did notice that day that he was going to the bathroom a lot, and but again, I didn't know much about type one diabetes, so I wasn't thinking about thinking, Yeah, I like Scott. And I had already talked about, like, I don't think he's going to school tomorrow, so, but I, you know, we

Scott Benner 13:33
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Leah 16:07
Yeah, and we did decide that we take him to walk in on the following day, the Monday, and that because this was kind of just coming out of COVID and everything. So he neither him or his younger brother had had physicals in the last couple of years. So I said, I think we should get some blood work done, though. And just like, insist for it. Yeah. So we did, and we got a call about 530 that day from the walk in that saw colon. And he just said, You guys gotta get to emerge right away, and the pediatrician is there waiting for you, so, you know. And he said something about his blood sugars being very high. And so, yeah, I kind of panicked, but we got ourselves ready to go to the hospital, and I contacted my sister. She works for two physicians in Saskatchewan, and one of them is a pediatrician. So you know, she had already kind of gotten her in the role of things, of what we should be expecting with this and initially and and thankfully, it was actually Cohen's pediatrician on Call of that night, which was really helpful for him. And I just for comfort, yeah, Brandon, like, they'll do some minor stuff with kids, but they don't like to touch much when it comes to anything complex. So I could tell that they were, I think actually, Dr Nomani had already indicated that she'd been on the phone with the Winnipeg endocrinology department for peds, and they did some blood work, that kind of stuff. And the initial message was that we were gonna have to go by ambulance that night, run home and get your stuff and come back here. So I was gonna do that. And then in the meantime, of course, like Gray was only about four, which wouldn't have probably been a great scene, having to be there with us all week. So my sister in Regina was working in the backgrounds to help find care for him, and they actually drove out here in the end, and but Scott had called me while I was home grabbing stuff to pack, and said they have decided that they think he needs to be airlifted and so you need to get back here like now. Yeah,

Scott Benner 18:39
can I take a moment to thank Canada for naming a place something that sounds like vagina? I think that's really fantastic. And by the way, I'm one Saskatchewan away from my bingo card being filled up on my my my Canadian Provence bingo card for today. You're like, Brandon Saskatchewan, vagina. Oh, my God, we're all over the place. This is awesome. Yeah,

Leah 19:02
yeah, I'm a Regina. And there's lots of good names and not so good names. You just kind of take them in. I don't

Scott Benner 19:13
know why we wouldn't just call this episode Regina in, because that was that, is that? Oh, what are you called? If you're from there, what is

Leah 19:19
it? Say it Say it again? Oh, usually they see, oh, you're from vagina. Yeah, we all are technically, yeah, fair enough. Everyone.

Scott Benner 19:32
Sorry, your your poor son is very sick. Did you take him back to the house when they said, Go grab your stuff? No, no, he stayed at the hospital.

Leah 19:40
He stayed right. Yeah, right. My husband stayed and Gray came back for with me like we still thought we were taking him to Winnipeg at the time, gotcha,

Scott Benner 19:49
passed the other kid off to your sister. You gathered some things, went back to meet them at the hospital.

Leah 19:55
Yes, awesome. So Scott drove into Winnipeg. It's about two hours from here. And I went on the plane with Cohen. And did you say a plane? Yes, they ended up airlifting him because they felt Leah, it

Scott Benner 20:09
was a plane with little pontoons on it that lands in the water. Also,

Leah 20:13
I don't think it was that fancy. It didn't have seats. It had one seat beside the person you like, for one parent or loved one to sit beside. You know, where your child is laying in a steel kind of I

Scott Benner 20:34
yearn for a simpler life where pontoons on a prop plane is considered fancy. I think that's what I want. I'm gonna, I'm moving back to vagina. What do you think of that?

Leah 20:44
It's not so bad. You have some perks here in this area,

Scott Benner 20:48
has a lot of perks, but it also has a lot of downside. So

Leah 20:53
true Winnipeg probably is more. But anyways, we won't, you know, waste our time on that. They're kind of always in rivalry of who has the least murders, who is the least per capita in the air.

Scott Benner 21:07
You always, you always want to strive for, strive for better. Yeah. So wait, so you flew on how? How long were you on the plane? I

Leah 21:15
think it was about like 40 minutes. Tops 35 maybe interesting. I mean, you kind of get lost in time, sure, probably from, like, flying out and then, because an ambulance actually took us to the airport where we took this medical airplane, so probably 40 minutes leaving, like, taking off and landing, and then

Scott Benner 21:40
it, Where's your head? Then at that point, Leo, like, you just went from I think my kid has flu like symptoms, to I'm on an airplane, like, what are you thinking about at that point?

Leah 21:50
Well, I was thinking he was gonna die. And what I understood when the pediatrician talked to me at the hospital was, I thought they were saying that he was had diabetes, type DKA, that's what my understanding of. Okay, yeah, so I was like, but I also wasn't pulling out my phone at that point googling. I was just worried. And it was scary. It was how quickly he got sick and wondering, like, were there other things that we missed in the past? And, like, there probably was, but I think yeah, for us. And it's funny, because, like, the night before, I was Googling on different things, this could be, I said to Scott that type one diabetes came up that I really wasn't thinking, that's what this was.

Scott Benner 22:45
Is chaotic affair. Statement, yeah, yeah. Can you look back on it and tell me, is that someone's fault on the hospital side for not for not sharing it clearly, or were you just so like bumfuzzled that you couldn't hear anything that was happening.

Leah 23:02
I think it was probably a little bit of both. I think in Brandon, they were panicked, just because, again, when you know any child has anything too serious happening, they want to ship them off to Winnipeg right away.

Scott Benner 23:17
So their hustle was, let's get them the hell out of here. Yeah, okay, all right, okay,

Leah 23:22
you know, you're not thinking that at the time. It was like, I think I could have, like, remained, probably not very calm, but a little bit, if they just continued us on the path of the ambulance. But that's not what happened. So were

Scott Benner 23:37
you panicking? Like, outwardly, would people look at you and go, This lady is in a

Leah 23:42
panic. Oh yeah, I was

Scott Benner 23:46
tell me, like, looking backwards. How would you have handled it differently if you got another I don't want you to get another shot at this, but if you get another shot, if you got another shot at this, what would you do differently?

Leah 23:56
Do you think for yourself? I don't even know. Because, like, I guess when you don't have enough information class, you know, like, it's probably, probably also, again, I acknowledged partly it would have been me and my level of understanding around what some of these terms were, and I was just jumbling them all up together. And,

Scott Benner 24:18
yeah, is this common for you. Leah, like were, did the situation knock you off kilter, or would you describe yourself as having trouble in situations like this? Generally, that makes sense.

Leah 24:29
I would Pro I do, but not ever like this before. Like our healthcare system, as you know, runs a little bit differently. And what the one thing I can say in all of this is that experiencing the world of pediatric care for type one diabetes in Canada, or at least in Manitoba, has been amazing, but it's very different navigating our system as an. Adult, and you know, you wait in the hospital or in the emergency room for 20 hours, they they miss lots of things because they're understaffed, and so it is a very broken system, but not for kids. Okay, so I think more my fear around like emergency rooms is some of my own past situations that have happened that I just hate having to be

Scott Benner 25:27
there. Okay, so hospitals in general are not a good place for you, not really, okay. Okay, that makes sense. No, I'm just trying to understand, like the whole pathway, because, you know, most of your and my communication when this was first happening, you would write me very long emails. I'm sorry. Okay, don't be sorry. You're not the only one that does it. So don't worry. Like, I understand what happens when you get into a panic, but your emails are so, like, long and involved. I will tell you something I don't think I've ever I've probably never said this aloud on the podcast before in the last couple of years. When I get emails like that, I actually feed them into a large language model, and I say, what is this person asking me? Because often it becomes like a stream of consciousness, and sometimes people get lost in what they're saying, or they give you so much information, it's like a book report. And when I sit down to do my my email, I'm already answering hundreds of emails, so, like, when I get to one, I'm like, I don't want to miss anything here, and sometimes I don't have the bandwidth for it either. Like, so, but can you tell me what, like, what prompted those emails? Like, were you scared or trying to figure things out? Like, what place were you in at that time? Well,

Leah 26:43
I would say, like, you have some comrades standing beside you with who teased me about my writing and that I could work a little bit on

Scott Benner 26:54
condensing. Are you talking about your husband? Actually,

Leah 26:57
more so my work like I've had for close to 12 years. And he jokes with me about it a lot, but I and I am actively working on it, because I do go back and see sometimes I'm like, okay, Leah, I wasn't at that time, though, definitely

Scott Benner 27:15
Oh no, no, no. You weren't like, like, I 1,000,000% like, if you made me bet as to whether or not, you were mentally ill or not? I would have gone, yes at first. And then I realized you weren't, like the first one. I was like, oh. But then I realized you were just overwhelmed and trying to figure a lot out. Was it all on you? Like, did it feel like I have to get this all figured out

Leah 27:35
now? No, like, Scott, you know, right in the beginning was a part of things. And we, like, we spent almost a week in Winnipeg. They spent about two and a half days, I think, just getting Cohen's body, like, nourished with whatever nutrients that had lost and hydrated. And then, you know, they take you into the three days. We call it like diabetes school. And so we did that. And yeah, both of us, from the beginning, were really committed to doing Yeah, yeah. And I think too, like another aspect of with Cohen that is challenging for us is, you know, he's he's had some hard things like thrown at him through life, through, you know, just since he was a little guy, if you saw him, you wouldn't think he's different, but you can kind of tell once You start talking, he struggles. He's not autistic, but he has like, and actually, there's a psychologist through the diabetes clinic in Winnipeg that we had connected with when we had some behaviors like, I don't know, the first six months to a year with Cohen after diagnosis, and she's been there like we always say, she's the silver lining of all of this, because she's just an amazing human. And I think it's so cool that there are psychologists that specialize not just in like looking at brain and cognitive function, but paired with chronic illness, okay? And so we just feel super blessed, because from the moment she met Cohen, you know, she knew we like, we weren't just dealing like with a kid that was having behaviors, because he was 11, and it's a hard, you know, everybody could argue that when their child got diagnosed is the hardest time, but

Scott Benner 29:45
she saw something about him that was a little deeper. Yeah,

Leah 29:49
she really wanted to understand like because he'd had a couple of psychologists psychological assessments done through the school prior to that he had when I. Honestly, one done in Winnipeg. He was in grade one, and then he had another one in, I think at the end of grade five. I mean, those really look at a lot of the same things, but of course, they're gathering that information to understand corn better from an academic perspective, whereas, like, Dr Jen came in and was also like, she could see and understand all that information. And, you know, she worked with Scott and I for a while to start, and had given us some tips, and we are trialing some things, and we were getting a little bit of success, but it was a lot of so she finally, like a lot of back and forth, and not great strides. And so the last, well, not the last session we had with her, but the one that kind of rounded up that stream of virtual meetings with her counseling Scott and I, she had just said to us, you know, Cohen had a lot more balls in here to juggle than other kids his age, prior to type one, and then he got thrown type one, and now he has more balls to juggle. And she's like, simply put, he's just not coping with it. And so she had, at that time, said, like, I feel like we really understand poem well from a cognitive and academic sense side of things. But she said it would, I would really like to try and understand better how he interacts with his world, how his problem solving is, what his social skills look like, that kind of thing.

Scott Benner 31:42
What is her estimation of his situation? Like you said, like he's he doesn't have autism, but he's struggling a lot. Like, are they giving you some sort of a diagnosis or an understanding of what might be happening to him?

Leah 31:52
Like, when he was a preschooler, he was diagnosed with what they call Global Developmental Delay, which is basically, like, there's five areas of core development that developmental pediatricians and such look at as far as where kids fall. And so he was, if I think, if you fall under, like under the whatever is average on three or more, then that's as a preschooler, the diagnosis you would get. And he is also diagnosed with something called dyspraxia of speech, which is, it's not muscle weakness thing, it's more so like how the brain sends the messages to the mouth to move the muscles at the proper times, if that makes sense. So, like, you know, I remember when he was like, four, we'd go to speech therapy, and she would, and she would do lots of, like, oral strengthening stuff. But you know, she would, if we started with the word pop, and you know, she would be, like, really pronunciating that. And, you know, and, and she would then say pop. And then she'd say, can you say it back to me, Cohen? And he'd be like, ah. And then he keep looking at you, like, I did it, like, can you quit asking me, I'm saying it. How many

Scott Benner 33:17
times can I say pop before you people say it's okay, yeah,

Leah 33:21
and he's grown in all of that like but as they get older, you know, they still kind of follow what's going on for them as far as the outcomes, you know, through school. And we delayed his school entry by a year so he had he didn't start Kinder until six, because you get, I would say, much more frequent and thorough supports through therapy and those different kinds of specialists when they're preschoolers. So we just thought he could benefit from that extra

Scott Benner 34:00
year, did it end up helping? Yeah, okay, yeah, it did,

Leah 34:05
for sure. And of course, when they're little like and he was quiet and shy, I would say even up until grade four or five, he had some stress. Most of his struggles are with ELA, like his language arts and reading and writing and being able to pull information,

Scott Benner 34:27
and are those still a

Leah 34:28
struggle they are. So he like this. Dr, Jen, he does still have a speech therapist involved through the school, and she had done this a speech assessment about three years ago. So Dr Jen repeated that one and he there weren't a lot of changes. There were a few improvements, but he doesn't meet criteria for a language communication disorder, but he's borderline, so his two big. Biggest things are that, like, he has slow processing speed. So you know, the best way to give an example of that is, like, if you're talking to him and you're on sentence three, coin still back on sentence one, figuring out and processing what you're saying from there. I think trying to draw language out, especially spontaneously, for him, is really hard. Again, it would be because of the processing speed, partially and then just, you know, I'm not exactly sure of all the science of it, but no, you know. So now social skills are starting to be like, impacted as he gets older, because it's easier when you're a little kid than you look like you're, you know, but he's starting to like, just make, not intentionally, like, you know, or even the way he communicates with his friends. Sometimes

Scott Benner 36:00
they're moving more quickly than he is. Yeah, is that a thing? Have you seen this with anybody else in your extended family? Or is this completely new for your family?

Leah 36:09
This is new for our family. I just have a sister, and she has four girls, and they're all bright, and Cohen had gone two weeks over term before he came out by C section and there was meconium in his amniotic fluid. Oh, I see which can sometimes they say, I don't know if it's because they might swallow it or what that looks like that can impact be a factor, but they don't know for sure. Can I

Scott Benner 36:44
pivot for a second here and ask you a question? I hope you take this the right way. I really do okay, you speak slowly, like you have a very slow, specific speaking style, and but you write prolifically. And so I want to know, like those long emails. Do they take you long to write? Sometimes, sometimes like I was trying to decide, do you write like that? Because it's a freer way of expression for you,

Leah 37:10
I do write better than I speak. I can speak and but I

Scott Benner 37:18
want to be clear with there's nothing wrong with what you're saying. You're methodical. When you speak like you're slow, you think about your words like that kind of stuff. Like, there's no doubt that if you asked me to retell the same story you were telling, I could get it out in like 45 seconds. And no, no, no, don't apologize. No, no, I'm trying to figure the whole thing out. Hold on a second. No, don't there's nothing to apologize for. There's nothing wrong with speaking slower or faster, or anything like that. I'm just wondering if you're prolific when you write because it felt better for you as a better way of communicating. But that's not the case. You feel completely comfortable in both ways. Is that right?

Leah 37:51
I feel pretty comfortable speaking. I think I'm not always as effective in speaking as I am in writing.

Scott Benner 37:59
That really feels like your genre, then for communication. In a

Leah 38:03
way, writing is kind of like therapeutic for me, to be honest, how so I think it's a way for me to get my thoughts out and process them. You know, I do a lot of that at night, and I suppose I would say it's my way of journaling. I often send them as emails, but I don't send them well, I'm learning, I'm learning that art that's my been my goal of 2025, and I'm doing very well at it.

Scott Benner 38:32
It's awesome. That's really cool. So you're finding a way to, like, get through your thoughts by just writing them down. Do you email them to yourself?

Leah 38:39
Yeah, or I just save them to my draft, because I'm not really a journaler. By, you know, like, that's not my jam. I wish I liked to read more than I do. I used to bet I don't enjoy

Scott Benner 38:52
the reading anymore. Is it because you're busy or because you stopped enjoying it?

Leah 38:56
I think, yeah, it's because I'm busier. And I used to, you know, pre kids, like, get through a book in two days, and now I pick one up and I'm like, What did I even read in this book the last time? I hope to get back to it? Wendy, I

Scott Benner 39:13
lie to myself and say that I hope to read, but I really don't. I don't hope to do it at all. I it's too slow for me, like, as a way to, like, ingest things. Yeah, for sure, I am working more towards, like, books on tape and stuff like that, because it seems like a quicker way for me to get it. But I like that you found a way. What do you end up journaling about personal that you don't want to share? Is it about diabetes or how do you what do you use

Leah 39:34
it for? I think different things. Sometimes it is about advocating for Cohen in the school system could be anything related to just like getting my thoughts out, if it was a difficult day at work, or if it was a difficult day with the kids, just to kind of be able to process through it and put it to bed.

Scott Benner 39:56
It's a great idea. Did you come up? Come up with that? You're on your own. You heard about it so. Where did you come up with doing that?

Leah 40:01
No, I kind of came up with it on my own. I I didn't call it journaling at the time. It was, yeah, I see a counselor, and it was her that was like, well, that's kind of is journaling. Leah, like, you know, if you're not sending it, especially

Scott Benner 40:19
Call it what you want, but you're right. Yeah, right, right. When did you begin seeing the counselor?

Leah 40:23
Just before colon got diagnosed, actually, like a couple of months before. What got you there? Difficult work that I worked for the like a government department called the Department of Families, and I was a social worker in the children's Disability Services Program. And, you know, it just evolved as governments changed and it was, there was toxicity, and it was quite stressful, and I live with some chronic pain, which I managed fairly well, but I probably, if I'm gonna let myself fall apart a little bit, it's gonna be at home. Was just feeling like life was and I was noticing that I was more anxious, and I didn't know why. There wasn't really anything about it that made sense. And so I just decided, and it's not the first time. You know, my doctor said, Well, maybe you should see a counselor. But you know, when you're a social worker, you're like, Well, I know what they're gonna tell me. I I know. I already know what they're gonna ask and what answers they're looking for, so you kind of fight against it, but totally been a

Scott Benner 41:39
blessing. Yeah, is that a interesting situation to be in? Like, professionally, you can assess yourself and say, Oh, I know what my problem is. But personally, that doesn't mean that you'll tackle it. Is that right?

Leah 41:51
Yeah, yeah. And I think the best thing about her has been she just challenges my ways of thinking in very kind ways. That's where it's been most helpful for me, because sometimes we have these notions or beliefs that have followed us since we were really young, and so then sometimes our thoughts and or our behaviors and patterns and habits come from that that's where it's been the most helpful is just her pointing that out to me in a very kind and gentle way. But it's been a really good thing. And I I've said to myself even like when I think I don't need one anymore, I'm just gonna keep going. I'm gonna keep going for life, yeah.

Scott Benner 42:42
What would you tell people, right? Like, you know, if you if you're battling something from your past, it could creep back at you if you don't keep talking about it, right?

Leah 42:51
Yeah, for sure. And I think we think sometimes, as adults, stuff that happened very, very long ago, or whatever, we can bury it in the hatchet, but it's not even necessarily the events, but sometimes the way we respond to things is out of an adopted idea from when we were kids. That's not accurate.

Scott Benner 43:15
Also, if it's something to do with a parent or something like that, like I mean, you have to forgive and let go. But if they don't, it can be hard to completely disconnect from the feeling like, if some you don't mean, like everybody needs to come together, and that can be difficult to get somebody to do. They might not even see it. They're not doing the work you're doing it therapy. Like, you know what I mean? Like, all those things are problems. Yeah, right. I hear what you're saying, alcoholic, no, no, something else you want to tell me or no you don't have to

Leah 43:44
No, no. I actually grew up in a Christian home,

Scott Benner 43:49
a little a little too Christian. What are we saying? Leah, well,

Leah 43:52
I would say middle of the road. I think partially what made my home a little bit more tight around what we were allowed to do as kids is my dad was also in policing. Oh, so he had an overprotectiveness of my sister and I, yeah, yeah. So, I mean, we weren't, but you know, we weren't. Are you

Scott Benner 44:14
afraid? A lot like do things? Does everything scare you? No, I don't

Leah 44:19
think so. I think more it used to more than it does now.

Scott Benner 44:25
It's interesting. It's really interesting because it's, you know, you just get a couple of things piled up on top of each other, and they create a way of life. And you don't know how it's going to impact everybody. It's, it's,

Leah 44:37
yeah, and probably, I think that's, you know, in a way too, with Cohen and me just having started, you know, having a couple months in with her was just so timely, because I honestly that was kind of my tipping point of coping, and I knew something needed to change. And I. She really helped.

Scott Benner 45:01
You're saying it's lucky you got started before the diagnosis.

Leah 45:05
Yeah, I, I'm I feel really blessed about that, because I was still working at my same job. And you know, when you're in the government, you're, it's like, I'm gonna have a pension. And I, I've probably been there around 17 years, and there was a point seven position at a personal care home here, and really that's kind of one of the things that her and I had determined, is that me working less would allow more time to look after myself, but also be more present, you know, and available, especially with new expectations and the responsibility, yeah, with the diabetes. So I never, ever thought that I could do an interview. Yeah, I was, like, my resume was last updated in like, 2007 so, you know, it was on a floppy disk, so, but I, I did it. And for you, my dad is probably rolling over in his grave that I walked from my pension. But at the same time, I, I have too many years put in to, you know, be miserable at a

Scott Benner 46:19
job. Yeah, no, I hear you like, how do you find the podcast?

Leah 46:23
We love it like, and I believe it was off of one of the Facebook groups that I saw it. And then we just tried listening to it on one of our drives somewhere, and very quickly got drawn in, and there's just so much good stuff in it, and I just hope that I can get through it all one day, because it, you know, really, actually for us thought like, I mean, you say it in your own way, and I think A lot of your like parents that you interview from listening to you also have their own way of saying it, but our endos and stuff are helpful on some level. But I think just candidly, like hearing you have these conversations and like talking about doing what makes sense instead of, I guess, getting these guidelines of what you're they want you to do, and not feeling good about it, but not feeling, I think you gave us the confidence to kind of step out more and, you know, with insulin, and we're still working on that Cohen's MDI, which is not where our hope is, city lands forever. We really would love for him to get on a pump, and I believe he'll get there, but that that's part of who Cohen is, too. He when we started the Dexcom. We had about six months of him ripping them off and just really struggling with that. We really felt, though, that that was so imperative to not only just us being able to follow him somewhat like, not somewhat but with him being somewhat vulnerable, and not, you know. And I would still say Cohen's understanding of diabetes is, you know, it's what he understands. And that's where Dr Jen really guides us on that, you know. And at the time, just before he got diagnosed, that we were at the dentist, and they are like, okay, he needs braces, and we had put that off for over a year just based on Dr Jen's recommendation of the he's got way too much going on, and so we did that. He's six months in. I do have faith that he is going to get to the pump. He is going to go to a de camp this summer. We did a family one last year. Okay, so he's going to go to that one that's affiliated with the Manitoba kids, yeah, and I think that will be amazing for him, because it will just be, you know, a place where it's just all kids doing the same thing, but a better than family camp at that age, because he gets to be there without his parents.

Scott Benner 49:34
Yeah, yeah. I know how old he's 13, right? Yes, he's

Leah 49:38
13, and they're in the space socially around 10. Yeah. Dr, Jen, he, he, she's like, honestly, there he is one of the like. She's like, he's my most favorite kid that I've ever assessed and spent time with. And she's like, but he's a really tricky kid, because he doesn't really fall. Into one box. You know, he he has a little bit of the like stuff going on around, like, some rigidity and sensory stuff, but I don't know. These days, they all say we have a bit of the autism in us. So who knows? Everybody's got a little, yeah, but he's like, he's got so much empathy and can be interactive. Where he's going to struggle is socially, because he just coming up with spontaneous conversation and friend groups is just takes him more time, but he's working with him on trying to give Cohen different options. And obviously, our world is completely language based, so for kids like Cohen, it's not the best, but you know, she's trying to because I think it gets him very stressed out. And for example, like he had a medic bracelet, and I bought him, like, one that I thought was the most discreet, like just a silicone band, and he had stopped wearing it. I don't know when, but when we noticed, we talked to him about it, and he freaked out. And he's like, You guys don't understand. Like, I just get asked too many questions, and so we kind of left it, and I talked to Dr Jen about it, and from there, is like he just needs the adult helpers in his life to give him some of the responses that he can give to that and know that he also doesn't have to answer if he doesn't want to, I'm finding a way of saying that you know part of the hard you know, because I would say, Well, you got to read your audience because he thinks it's always coming from a negative place, and reading his audience isn't easy for him. Yeah. What's

Scott Benner 52:00
your assessment of him? Like, you know, you said the, you know, in the beginning, you're like, they it's not autism. It's a little, maybe it is a little like, what do you think is going on? Like, do you have a feeling is there like, something in your mom gut that's telling you is happening?

Leah 52:15
He has, like, he has a like out of the assessments that they do that the school when they come up with their IQ, like, all of the testing put together, and I want to say an average IQ is 100 and Cohen's is about 83 Okay, So he's not super low. Like, you know, he's low enough to have deficits in some of his executive functioning skills. He's is doing regular, like a regular mainstream school programming, but he has adaptations to his plan so things like, you know, he has to do the same outcomes and show that he can do the work that you know. He gets certain exceptions, like, he, you know, getting more time, you know, having the teacher check in more frequently, and breaking down the instructions for him less, questions, that kind of thing. Yeah, yeah. So, you know, we're not too sure. Scott and I try not to go too far ahead in the future, because all of it put together, you know, not sure what that's going to look like. And is he capable of I could totally see him being a kid that you know could go to a trades College, potentially, if he had some help with the school room work type parts of it is he a university kid? No, I already know that. And I think though there's some other things that are just where his friends would be, for example, money, like, you know, coincident allowance, forever and he never asked for it, which is not typical for a 13 year old. It's not that he doesn't want it. I he's just not been motivated, or, I guess, fully understood the value of what it can do for him. He has, like, some really scattered skills, which is what makes him really kind of tricky. But Dr Jen is going to reassess him next year, like before he goes to high school, because she's just feeling like even an update once he's more into pure puberty and just having activity information going to high schools, because it looks so different I see.

Scott Benner 54:51
So you think he'll have he'll have challenges along the way, for sure, you're not certain how they're going to impact him as an adult, and he does seem like maybe he could do a trick. A at some point. Yeah, yeah. And your other child doesn't have any of these issues. Is that, right? Except for the allergy thing, the viral asthma, okay, he's totally opposite. Gotcha? Well, it's a lot to deal with Leah. It just, it really is, you know, it's a lot. Are you getting help, like, beyond, like your cell phone? It sounds like your husband's very involved too, which is awesome. But do you have other support?

Leah 55:24
Well, I would definitely say Dr Jen is our main support through, you know, the diabetes clinic, and we'll have her till he's 18. And of course, like family, my family is in Regina. My husband has just his dad, and he's a couple of hours away, so we have limited natural supports. Yeah, we also have lots of people that love us and love our kids and show up at times where we really need it. Just, we need it. That's awesome. Yeah,

Scott Benner 56:02
that's terrific. I'm happy about that for you, definitely necessary, you know, yeah, yeah, and you find the online thing supportive as well,

Leah 56:10
yes, like, like, your Yeah, work, and absolutely, yeah, we, we both do, and we both listen to a lot of your podcast, and Cohen has heard, heard you many times, and he had said to me a couple of weeks ago that he had Googled you so that he would for sure know what you looked like when he meets you.

Scott Benner 56:37
Helen, I'm much more handsome in person, so it's going to be awesome. He'll be super excited. Yeah, no,

Leah 56:44
that's awesome. But no, the work you're doing is incredible. And thank you. I know that things are different from country to country, but really, like, we're a big community at the end of the day and what supports are available to us, from province to province and state to state may be different, but I really believe that it's the people that have lived this disease that are the ones that know the most. For the most part, I'm not going to say all, because we have some pretty like skilled and gifted physicians and specialists out there, but you know, most people don't know that, and I know that you probably don't live with this as much because, you know, Arden's on a pump and she's older, but Cohen has as many highs as he has lows, and so We're probably at four times a week in the night to for lows, usually to give him what his body needs to get him out of there. And we're

Scott Benner 57:51
just trying to keep up at this point, right? Yes, yeah, yeah. So is your knowledge of diabetes growing, or is there so much else going on that it's hard for you to put the the effort into that completely?

Leah 58:05
No, I think both Scotts and mine continue to grow and we there. There are always times where you feel like you're weighing it and it's like, well, you know, like, I still don't know how to dose for fast acting sugar stuff, so that is, like a hard one for me, and I just take a guess. And now that we're almost two years in, we don't get as stressed about it, like, if we're wrong, yeah, we're wrong, and we really hold on to your motto of like it is so much easier

Scott Benner 58:42
to stop a lower falling blood sugar than to than to beat up a high one.

Leah 58:48
Yeah, yeah, yeah. And some people don't understand that, especially in the pediatric world, they want to keep the number higher, just because it makes them feel safer. But I also think our endos recommend that a lot.

Scott Benner 59:04
Yeah, yeah, I hear what you're saying. I think they do too. It makes it harder when you're talking to them right, because they feel like you're going against their good counsel sometimes. Yeah, have you found that? Have you run into that problem?

Leah 59:18
Yeah, we have it. Initially, we had a nurse educator with us, and there was some things that she would recommend to us that we just didn't feel right about, and there's things we have. Well, one thing we have a regret over is that she thought it would be easy enough to just do the Dexcom training virtually, which for maybe most kids would have been, I don't think it was the right thing to do for Cohen, not her fault. But, you know, looking back, those are some of the things it's like, well, we'll know for next time and be a little bit more careful about and I think that's. Too. Like, we've learned so much about Cohen through all of this. And you know, Dr Jen is really talked to us about, like, it's really important how you use language. Because quick example, I know we probably have to wrap up soon, but he in the beginning, was like, because he comes home after school, and neither of us are home, and we have just said, like, if you want to have a snack, just give us a call and because we need to figure out the insulin. And he was like, I didn't realize this for a long time, but I think he was taking that as I need to phone and ask permission for a snack when it wasn't, it was more like he just doesn't know how to do the carb ratios.

Scott Benner 1:00:48
Oh yeah, you wanted to help him with the buttons, and he thought he was asking for permission just to eat. Yes. Okay, yeah.

Leah 1:00:55
And so when those moments kind of hit you, you're, you know, and I can see how he wasn't completely wrong in those situations. So we're more watchful. And having said that, he's like, entering puberty, and no matter what we say some days, he's

Scott Benner 1:01:13
Yeah, despite all of his problems you can he's still a boy. Is that what you're trying to tell me, yes.

Leah 1:01:18
And Nobody says that. They get, like, super grouchy when they had puberty.

Scott Benner 1:01:24
Nobody told you that one. No. How many things have you learned that if you knew, in hindsight, you might not have had kids, because I have a pretty long list at this point in my life. You know? I'll tell you what. It doesn't stop either, like they'll get older, and you know what I mean, there's still more to do and more to help with, and being a parent is no joke. I'll tell you that much.

Leah 1:01:43
No, and you never really stop, nor do you ever really stop being a kid, right?

Scott Benner 1:01:48
Yeah, no, it's interesting. That's a hell of an insight. You're right. It has been a little bit over an hour now, and I am getting texts from Arden, who is telling me that we have to get moving because I have plans with her this afternoon. So let me just ask if there's anything left that you didn't say that you wanted to say, I don't want to get you out of here without you getting anything out that you that was important to

Leah 1:02:08
No, I just wanted to thank you for the opportunity to come on. And it truly is an honor. Like I tell everybody, you're the guru of type one diabetes podcast, and I don't think I've listened to anything really captivating that you know, from east to west really, as far as different topics you cover, and I think they speak a lot to us in different ways, and so we're grateful that we learned of the resource. And I do apologize about my extremely long text or emails, rather sorry

Scott Benner 1:02:52
emails, direct messages at one point, yeah, like, no, no, it's fine. Don't worry again. I'm being serious when I say this to you, like you're not the only one. Like, it happens. People get overwhelmed. Do you know what I mean? Like, they just do, like, this happens. And and then, you know, at some point you say, you know, I'm on an island here by myself. I, you know, for you and ice float, I don't know what to do. And you feel like, like, oh, this person might know, and it, you know, it's a resource. And you I don't know how you're supposed to stop yourself from asking. I'm glad that people ask. You know, I'm a person too, and like, sometimes, you know, when you start getting into the 1,000th word of something, I'm like, I don't know what's happening anymore.

Leah 1:03:29
No, no, I I know. And you know, probably not every parent looks at it this way, and it's the last thing I'll say, Scott. But you know, for me, and I still sometimes feel like this, that like, essentially, type one diabetes is also it's like organ failure, and that's what people that don't know about it or don't live with it don't understand. Tell me how you mean, I think how intensive the management of various you know, one of the endos said to us early on in the in the journey to us that it's a micromanage disease, and the hope is, is that one day that micromanagement is transferred from the parent to the child. That felt very true for us, just because of the age that Cohen got it, but we know we're not going to be in this place forever, and things that, you know, we've grown in some areas, and it's just one of those non linear things that

Scott Benner 1:04:35
it's an incredibly slow process. It just really, it just really is, and I've seen it move more quickly for some people than for others. It's just not the point, like you have to have these experiences over and over and over again, and then eventually they just start to make sense. And before you know it, you know, you look back one day and you wonder, like, I guess you don't recognize yourself one day. You know, one day you're just like, by. I've got this. I don't know how I got here. I don't know why it is that I feel comfortable all of a sudden. But my opinion is, is that it just it takes however long it takes to go through those experiences until, instead of being surprised by them, you see them coming. I think that's the Yeah. You know what? I mean?

Leah 1:05:17
Yeah. I totally get that. That is such a good way of working. Thank

Scott Benner 1:05:21
you. I have a podcast, so I'm good at talking about stuff like this. Yeah, you were really fantastic. I genuinely appreciate you doing this with me. I've been looking forward to talking to you, actually, for a while because I thought, like, like, what a great opportunity to you know, you have a lot to say, and obviously there's something going on in your life that I think would be really valuable for you to share with others, and I appreciate you

Leah 1:05:42
doing that today. Well, thank you so much. I was pretty certain I was in your grave box or whatever, or maybe it's going to be really entertaining.

Scott Benner 1:05:56
Yeah, no. Leah, you too. You're too Canadian. Because once I was like, at some point I was like, Hey, this is really long. I can't really answer this, and he just synopsize it. You were understanding. Like, it wasn't like, you were like, oh, leave me. Like, what do you mean? Like, you're like, No, I get what you're saying. Like, no, you you're great, you're Don't worry about your fav, you're fantastic. And I love this. I really appreciate your time.

Leah 1:06:14
Thank you Well, and I appreciate you giving me the opportunity. And, yeah, just keep doing what you're doing. Scott is touching families and individuals and research companies all over the world. Oh, you're very kind beyond that. Yeah, you're really

Scott Benner 1:06:31
kind. Thank you so much. All right, hold on one second for me. Okay, okay.

Head now to tandem diabetes.com/juicebox and check out today's sponsor tandem diabetes care. I think you're going to find exactly what you're looking for at that link, including a way to sign up and get started with the tandem Moby system. Arden has been getting her diabetes supplies from us, med, for three years, you can as well us. Med.com/juicebox, or call 888-721-1514, my thanks to us, med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at Juicebox podcast.com. To us, med and all the sponsors. Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app, go to YouTube and follow me or Instagram. Tiktok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please. Do you not know about the private group? You have to join the private group as of this recording, it has 51,000 members in it. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. My grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all available at Juicebox, podcast.com, up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at Juicebox. Podcast.com the episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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Scott Benner 7/3/25 Scott Benner 7/3/25

#1566 Five Ways to Boost Insulin Sensitivity

Jordan Wagner shares five practical strategies—stress management, movement, sleep, nutrition, sunshine—to sharpen insulin sensitivity in diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox Podcast.

Jordan Wagner is back. He is, of course, a nurse, a certified diabetes educator and a person living with type one diabetes, and today, Jordan is going to go over his top five tips for improving your insulin sensitivity. If you're looking for community around type one diabetes, check out the Juicebox Podcast. Private, Facebook group, Juicebox Podcast, type one diabetes, but everybody is welcome type one, type two gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. 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 healthcare plan or becoming bold with insulin.

The show you're about to listen to is sponsored by the Eversense 365 the Eversense 365 has exceptional accuracy over one year, and is the most accurate CGM in the low range that you can get ever since cgm.com/juicebox this episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox You can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com the episode you're about to listen to was sponsored by touched by type one. Go check them out right now on Facebook, Instagram, and, of course, at touched by type one.org check out that Programs tab when you get to the website to see all the great things that they're doing for people living with type one diabetes touched by type one.org

Jordan Wagner 2:26
Hey, Scott, good to be back with you here. So I'm excited for this, you know, third episode here, but in case you guys missed the first two episodes, I want to go check those out. In the first episode, we had a pretty detailed discussion on diabetes and management in the hospital setting, so more of the inpatient setting, what to do, what not to do, how to be successful with that. And then we looked at pump Training Success and CGM success. So you've been diagnosed with diabetes and you want to get an insulin pump. There's definitely some things you should know before you get the pump, so that when you do get to that training, you're prepared and ready to go with all that. And I'm really excited about this third episode here. This is a topic that probably doesn't get as much attention as it should with especially the type one diabetes community, and that is insulin sensitivity. And I think part of that is because, you know, we're all insulin dependent with type one, so thinking about insulin sensitivity is not necessarily something we often do. It's just, I have to get the insulin. It doesn't matter. I have to have it. But there are certainly things that will improve your insulin sensitivity with all types of diabetes, but even with type one diabetes, improving that insulin sensitivity could mean that you're using less insulin, which overall could be a good thing for you, perhaps. So I want to go ahead and dive into that here

Scott Benner 3:43
today. Tell people before you start. Why might it be a good thing to use less insulin? Yeah,

Jordan Wagner 3:49
so that's a good question. So there's, there's multiple multitude of reasons here, but one of them could just be that I often see a lot of people scared of low blood sugars, and so naturally, if you're using less insulin, there's going to be a lower risk of hypoglycemia. So low blood sugars, there two would be insulin, in and of itself, doesn't make you gain weight, but if you have a bunch of insulin floating around in your system, and you have excess calories in your system, that will make you gain weight, you know, using less insulin, having a little lower calorie intake, that could also help with weight loss goals, not, you know, having a lot of excess of weight gain, things like that. You know, I've heard from some people that there's a stigma behind it as well, too. So let's, let's say that you're taking a shot, right? Maybe you're able to reduce your needs down to, let's say, 10 units at this meal, right? Versus, like, 20 units. You know, maybe you're out with friends, and people look at the syringe and go, Oh, wow, look how much you're taking. And so I've heard that from some people, even in the hospital setting, that by getting a little bit more sensitive to insulin, they could take less and they felt less stigma about to. Making insulin Interesting? Yeah, so there's, there's different, different things that could pop up for for different people. I mean, not everyone's gonna share the same sentiment, but it's something that, no, it should be considered.

Scott Benner 5:11
Yeah, it's funny, because I, as you're going over those things, I'm, I'm almost playing devil's advocate in my head on some things, like, I spend a fair amount of time telling people you need the amount of insulin you need, correct? Yeah, and I don't want people running around with high blood sugars because they think, Oh, that's a big number, or I'm definitely going to gain weight if I do that. Because there's, there's a cascading effect that comes off of all of that, right? Like, you know, if you can't figure out a way to use less insulin, and you don't want the big number, it could be an eating disorder. At some point you could stop eating correctly, or you could stop bolusing correctly. Some people do that. Some people under Bolus for their food because they think the Bolus like sounds better at a number, or, you know, somehow impacts the thing you're talking about, right? And I don't

Jordan Wagner 5:56
want that, and I don't want that either. That's right. Hear me when I say I'm not. I'm not telling you to take less insulin so that your sugars run higher. Like, what I want good control blood sugars for everybody. But the point I'm making is like, you can get to a spot where your body is more sensitive to insulin and doesn't require the same amount Exactly. So let's talk about the five things you have listed here that can do. So I'll go ahead and just Yeah, list off what we have, and we have, and then we can go ahead and dive in, jump in. One of the biggest things I see that kills insulin sensitivity is stress. Stress is gonna just the stress hormones. There's a lot that goes into that there. I see also that people are not active enough. Doesn't mean you need to be out running a marathon or doing crazy workouts, but just having activity in your life improving your sleep quality. So sleep is a huge time where where we repair and build back up, and if you're not sleeping well, that's going to definitely impact your sensitivity, your nutrition. That's a huge thing that's going to impact sensitivity. Depending on what types of foods you're eating, you could definitely be hurting your insulin sensitivity in today's world, a lot of us have, you know, maybe a corporate job or a desk job, and we're not getting outside. Getting natural sunlight on your skin is really beneficial, and it does help with your insulin sensitivity. There's many studies to back that. So those are the five topics, just to kind of dive into

Scott Benner 7:17
there. So everybody gets super excited, Jordan's your mom now. She's like, get outside, move around a little bit, yeah. But there's a reason people have been saying stuff like that forever and ever. But let's talk about how it actually impacts your insulin sensitivity. So we'll just start at the top, like you. The first thing you mentioned was stress, right? So hey, everybody, be less stressed there. Next thing, No, exactly,

Jordan Wagner 7:41
yeah. Explain to them how the stress is actually impacting them. For sure, the first thing I like to tell people is, when it comes to stress, it's stress hormones. Those are the big things we talk about. So cortisol, epinephrine, that's adrenaline, norepinephrine, things like that. Glucagon can play a role in that as well, but those same hormones will be high in your blood if you are getting chased by a bear in the woods, or if you're chronically stressed out driving home from work, those are two different situations, but your body is going to respond in a similar response with stress hormones. Why do we want those stress hormones? Well, we do want some stress hormones because it's promoting glycogen breakdown and gluconeogenesis, which basically means creating glucose from a non glucose source that is important in times that you need energy. So again, with that bear example, if you're in the woods trying to run away, you need extra energy to either run away or to fight that thing off. That's that fight or flight response. But if you have type one diabetes, or you have type two diabetes, or some form of diabetes where there's some sort of dysregulation going on through insulin, you're not going to be able to respond to that, those excess stress hormones and to increase the glucose there,

Scott Benner 8:56
you won't actually use the glucose either, right? Like in the you won't in the example of the bear, you're gonna burn it off really quickly, running away from the bear, but Correct? Yeah, sitting around worrying about something, it raises all of this up. But then your body doesn't use it,

Jordan Wagner 9:11
correct? And then you have a high blood sugar, okay, right? And so, you know, insulin is like the key. It's the key that unlocks the cells, gets the glucose inside, lets you use it for energy. But if you're you know, chronically, you chronically having these high stress hormones, here it like desensitizes the cells, the insulin. So if you, if you take example of someone with like type two diabetes, that's primarily insulin resistance, the response to that situation, of that chronic stress is that the pancreas is going to make more insulin. So oftentimes with type two diabetes, we see people have very high insulin levels, very high C peptide levels, because it's trying everything it can to get those glucose levels to come down. But again, over time, your cells just keep getting more and more desensitized.

Scott Benner 9:56
Yeah, in all of these things, like in each of these five examples. Temples, the problems build on themselves big time. Like, yeah, like, you start off, like, healthy, and then you have, like, one moment where you're in the car and you're like, everything sucks, and then all the things that are happening behind the scenes are happening. It's not like you then eventually it's gonna happen again tomorrow and the next day, so your body doesn't even have time to go backwards. And, like, repair what's happened. And then it becomes incrementally more concerning. And then I'm guessing here too. It also, like, if you're stressed, maybe you're also not sleeping well, so you start getting compounding right? It compounds

Jordan Wagner 10:35
right. So like, if you just take a look at improving your sleep quality there, it's interesting, because oftentimes we don't sleep well at night, and what do we all do in the morning? We go and get a big cup of coffee or an energy drink or something like that. But it's interesting because caffeine will bind to those adenosine receptors in your brain, and adenosine basically is building up during the daytime, and by nighttime, it's almost aiding you to feel tired and helping you fall asleep. And so like, I'm guilty of it big time, but you drink coffee too late in the day because you're not sleeping well, or you're stressed, and you feel like it helps well, then you get the bedtime and you're not super tired or you're tossing and turning. And so just improving the sleep quality, that's the time where your body's healing itself, it's repairing itself naturally, you're going to see cortisol levels decrease during sleep and getting good rest. Okay? You know, there's other hormones like ghrelin and leptin, right? So ghrelin is going to be one of the hunger signaling hormones you often see, say you are up late at night, right? And you get really hungry all of a sudden? Well, it's, that's ghrelin, right there. That's telling you go get a snack, right? Leptin, is that satiety or I'm full? Hormone. Now, if you're getting poor sleep quality, ghrelin tends to increase because you're so tired your body needs energy. So it's, it's prompting you to want food, prompting you to want, perhaps even junk food, because that's a quick energy source. It's gonna decrease that leptin level, the I'm full hormone, and so you can see how you know the stress and the poor sleep quality, it starts to dysregulate your hormones. And as we know, like with type one diabetes, right? It's a big thing with insulin and glucagon, right? Those are two big things there, but our bodies aren't. It's not just that, right? Our bodies, it's got so many mechanisms happening all the time in the background. When all of your hormones start getting dysregulated, that's when we start seeing this cascade effect of problems showing up.

Scott Benner 12:36
Yeah, okay, all right, I'm sorry. I think I cut you off before you were done with stress, though, did I Oh, yeah, we can definitely talk about a few things there. But I wanted to lay into people's minds that this stuff's going to start stacking up and that these things impact each other as well. You know, you might be more stressed out because you can flip it around. You could be stressed out because you're not sleeping big time. Yeah, absolutely, yeah. And you could be not sleeping because you're stressed out and etc and so on. And maybe you're not dealing with stress as well because your nutrition is wonky, or, you know, you're not exhausted at the end of the night and sleeping when you should because you're not getting enough activity and getting your body moving like this. All stuff this all fits together. Honestly, it does

Jordan Wagner 13:14
everything here is compounding, like you said, there and there's, there's so many angles to look at and talk about, you know, so like, I'll try to stay focused right now.

Scott Benner 13:26
It's my fault. Go back, go back and finish up on your ideas about stress. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery, and a third of Omnipod five users pay $0 per month. You heard that right? Zero. That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox Omnipod has been an advertiser for a decade, but even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox when you think of a CGM and all the good that it brings in your life, is the first thing you think about. I love that. I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by. The Eversense 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems, the Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox, one year, one CGM,

Jordan Wagner 15:37
for sure. For sure, really. So one thing to think about with stress. Here's the deal. Picture your body as a bucket. Okay, inside that bucket is going to be water. Water is like the mineral balance inside your body. Every time you're stressed out, it's like poking a small hole in that bucket. So if you're chronically stressed, you've got a bunch of little holes. And as you can imagine, that water starts to pour out the sides of the bucket there well, as your mineral balance gets out of whack, your insulin sensitivity also majorly gets out of whack. So not only do we have hormones raising your glucose levels, the minerals in your body that would naturally be there to kind of help with that insulin sensitivity, making those cells receptive to insulin, are now out of whack, so now these cells are not as receptive. So think of that almost like rust building up on a lock, and if insulin is that key, that key is going to have a harder time fitting in a rusty lock compared to a lock that's completely cleaned and and nice looking, right? Yeah. So there's, there's big things there that that stress can really impact.

Scott Benner 16:43
You know, in your professional life, when you talk to somebody about this, do you find that explaining it to them, like, because saying to somebody be less stressed is, yeah, you know, I'm married, that's not a thing I would say out loud. The reason is because it's not a feeling of like, Oh, you're right. I'll just be less stressed. Thanks. Do you get to talk to people about ways to do that, or do you find that your idea is like, let me just give them this idea and hopefully they'll go back into the world and figure out how to accomplish this on their own?

Jordan Wagner 17:13
Yeah. So it depends on the console and depends on the patient I'm talking with, and the reality of being working on the inpatient side of medicine, you're often seeing someone, and you have 30 minutes to an hour basically unload as much information as you can without overwhelming them and hoping that they take some of what you have as the as they're leaving the hospital, essentially, yeah, some people are open, right? They'll, they'll talk about things in their life, like stress and for example, maybe they have no community, right? So then I'll say, okay, maybe you need to find a church community. Maybe you need to go out to a place to where you can go dancing and make some friends, right? Get some community in your life. You know, maybe it's they're struggling with their bills, right? And maybe we can talk briefly about like, Hey, this is how a financial planner could help you with your bills, and, in turn, start lowering your stress. So there are definitely times where, like, I'm able to dive into it a little bit, but this is definitely something that needs to be ongoing. And so I think if your only conversation you're having is with me in the hospital, it's going to be unlikely that you actually start lowering your stress levels. Yeah,

Scott Benner 18:18
it's funny. I find that people like you and Jenny and Erica who like coming on the podcast, I feel like it's because you always, you guys always feel like it's just so difficult to get your message out, and you're just always looking for a way to reach other people, which I love. I think it's

Jordan Wagner 18:33
awesome. Yeah, without a doubt. I mean, because I tell people all the time like I probably get 60 70% of my consults of people who actually don't want to talk to me.

Scott Benner 18:45
They don't, like, come on man. Like, just, let's guy need the insulin,

Jordan Wagner 18:50
yeah? Or, like, I've had diabetes for 40 years. I'm not going to learn anything from you. Just give me your spiels I can get out of here.

Scott Benner 18:56
Jordan told me to go dancing, yeah? But what you're really saying is identify your stresses and ways to try to alleviate them, and without a doubt, because this has look, the truth is, these five things have impacts on people who don't have diabetes,

Jordan Wagner 19:12
without a doubt, I mean, and that's it, like we get so fixated on a number, right, whether it's an insulin dose or our glucose level, but I've always said my whole life, like I am more than a number, and that goes for everyone else with that. With diabetes, you are more than a number, right? Your health is not just a glucose number. You have to look at it holistically and look at everything else going on in your life. If you want to have a healthy, long life.

Scott Benner 19:38
I try really hard to think about it this way, I wish my daughter didn't have diabetes, right? But as long as she does, and I'm being made aware of things, things that maybe I would not otherwise be made aware of because the aging process, you know, in a healthy person, you know a person who doesn't have a chronic illness, or like, you know, other things. Going on. You age slowly, and you, you know, you deteriorate slowly, and you don't see it coming. It's that idea of like, I think the jumping in part is, I've always said this, like type one diabetes. It's because you can get, like, in trouble so quickly, it forces you to pay attention to it. It does, and maybe that's valuable for the rest of your life. There's nobody else sitting around talking about, like, you know, parents, like, go to sleep, you know, like, calm down. Like, you should get out and move around. But they're not talking about the why, right? And they're not going to see the impacts of it. If they're lucky for so long that they'll think, Oh, I just got older,

Jordan Wagner 20:38
for sure. And like, there's a benefit too. Like to even my family and friends knowing that I have diabetes, because it's taught me to care for my body, and I'm very open about that, and right. So then they start thinking about their own lives, of, Wow, I need to look at this, or maybe I do need to get a little more exercise, and so you can have this compounding effect of impacting a lot of different people as you take care of yourself.

Scott Benner 21:02
Yeah, no, 100% okay, activity. Go ahead. Talk people into being more active. I dare you, for sure, for sure.

Jordan Wagner 21:09
Okay, so activity is huge. Not only is that gonna make you feel better in the long term, I know, like, if I go out and take a jog, sometimes it doesn't feel the most fun during the jog, but you finish and you go, Wow, I feel great. You got that, that rush of endorphins there? But ultimately, what's going on is when you are using glucose for energy with exercise, some of that is able to happen with limited insulin use, like your muscles are able to use it without a lot of insulin, okay, and so you're naturally going to lower your blood sugars without having to take a lot of insulin, right? So let's say your blood sugar is 200 and you might be a little afraid of taking a dose to bring that down. Well, it's completely reasonable to say, why don't I go take a little walk, you know, walk around the block, right? I guarantee you that if you're doing that, you will likely see that blood sugar starts to drop a little bit, of course, like if you just ate a candy bar or something, and it's 200 that's different. But that exercise there, that little activity, is going to help there. But one of the ways I like to think about it is through analogies, right? And I already have shared a few analogies, but there are these things called glute, right? So, G, l, U, T, those are all capital letters, and stands for glucose transporters. And there's a bunch of different type of ones there. Think of those as like a taxi cab or like a bus, and they're dropping people off the building. The people in the bus is the glucose, right? And as you're moving around, you're getting more of those glute proteins bringing glucose to the muscles. It's dropping more off there, right? The different types of glute proteins get to the other destinations. You have the insulin as the key opening the door. So the point being here is that the exercise is making your body work the way it should, and we are supposed to work, right? That is using the glucose the way it should, and it's making you more sensitive to your natural insulin without having to take excessive amount more now, there are studies out there that will show that the effects of exercise can last for up to 72 plus hours. So let's say you did do some exercise today, you could be benefiting this for for days, but if benefiting this for days,

Scott Benner 23:24
I have to tell you that I've been exercising more recently, and in this past few days, I've been on a medication. I've been a little sick, I guess, for the past couple of days. And because I had not yet, I don't know how to put this, I had not yet built up a real habit of doing the exercise, but I was doing it like I was a month strong every day doing exactly what I was supposed to be doing. And then I got up one I slept in a little bit because I didn't feel good. And then I got up, and I actually think I thought to myself, I should go do that. And I was like, oh, but the day got messed up. And I was like, I'll do it tomorrow. But then I woke up the next day, I didn't feel well, and four or five days later, end of the day, nine o'clock at night, I was standing in my kitchen. I'm like, why am I so tired? Yeah, no. Lie that during the, like, the month of intent, you know, intensively, making sure that I was doing the exercise every day, not even that it was intensive exercise, because it really wasn't. I would get at the end of the day. And I my thought was, like, I have so much energy, like, I hope I can go to sleep, like it turned on in a week, like it just felt different. And I don't think that's even a thing I would have believed had I not experienced it, I guess,

Jordan Wagner 24:34
for sure. Yeah, and you know, another huge benefit of consistent exercise, and I like that you brought that up the consistency part there, if you're consistently exercising, having increased activity in your life, it will start to get rid of some of that visceral fat around your organs. That is basically the fat that just lines the organs in the body. And when, when you can start getting rid of some of that fat there, your insulin. Sensitivity is going to go up a way to perhaps think of that. And this is not a perfect analogy, but it kind of paints a picture here, a little bit. Picture a snow storm blowing through, like the Midwest, or something like that, and you're trying to get into your house now, before you can even get to your door to unlock it with the key, you're going to have to get rid of that snow, and so if you're shoveling that snow away, you get to the door, you can unlock it. That's that's an analogy to kind of picture that that visceral fat there, right? So the insulin is going to have to work harder to get to that lock, to unlock it there. There's just so many benefits exercise. You're going to feel better. You'll have a better outlook on life. Your glucose levels will be better controlled. It's just a win, win. Truly, to exercise other parts of your health are gonna thank you for that as well.

Scott Benner 25:48
Yeah, yeah. I can't agree more, and I also can absolutely throw in with all the people who hear that and say, like, I don't like exercising. I don't have time for it, or whatever you're gonna say, I said it all. I've thought it all. I've believed it all. And now, like, it's on me, you know, talking about like, ways to, like, reduce your stress, it's on me to find a way to actually bring this to bear every day for the rest of my life. Yeah, this is the part where, like, it's easy to say I'm stressed and there's nothing I can do about it, or I would like to exercise, but I don't have time. Or whatever it is, you're going to tell yourself, like, at some point, you know, you just either you have to do it or you have to live with you,

Jordan Wagner 26:29
and a lot of these things, you do have to take some self responsibility. I understand like it is not ideal that any of us have diabetes, but the reality is, we have diabetes, and so you either come to terms with that and do what you can, or you're going to be constantly blaming people and not doing well. And so when it comes to exercise, you have to take some self responsibility. I firmly believe that anyone can get increased activity into in their life in a pretty easy way. Yeah. I mean, that might even just simply be, you know, every hour you sit down and stand up 1015, times in your office, right? That's something you could do right there. Maybe it's when you're watching TV at night. You grab some exercise bands and just stretch them back and forth a bit. Use those muscles. You know, I was listening to a podcast with Andrew Huberman while back, and he mentioned that just taking, like, 30 Seconds to just run up and down the stairs at your office building, like once or twice a day would be a big deal. Makes a huge deal for, like, your cardiovascular health in the long term, it's not just like you feel good, then it's making long term impact. Yeah, how about when you're

Scott Benner 27:34
sitting at your desk for a while and you feel tired and just getting up and walking around is valuable, without a

Jordan Wagner 27:39
doubt. Yeah, right, or even sitting at your desk. I mean, there's honestly, like, you can't make an excuse, because there you could literally be doing those. They're called soleus push ups, where you basically just sit with your legs at a 90 degree angle and raise your ankles up and down. That soleus muscle is just right there by the calf muscle in the back. It's like a sponge for glucose. So you, I

Scott Benner 28:02
gotta tell you, you're gonna make me admit to something I don't wanna say out loud. All right, go ahead. Hold on a second. How many times am I gonna say this? But, like, don't have a podcast if you don't wanna say stuff like this, listen, it's not the healthiest thing in the world. I'm not gonna lie to you, one way or the other. But throughout the winter this year, art and I have been, like, once a month going to, like, a tanning salon, like, just the like, I don't, well, there's reasons why she wanted to do it that are not frivolous, but never. Nevertheless, she wanted to do it to try something. She wanted to see if it would help her acne. Okay? And I was like, she felt weird about doing I was like, I'll go with you. We're signing up. And the woman's like, are you gonna do it too? And I'm like, Okay, I'm in like, I mean, I'm already getting my eyebrows threaded with Arden. I might as well do this as well, right? So I'm using a stand my god, I'm using a stand up tanning thing. Okay, now keep in mind, you're in there and you're not very dressed, but I'm like, standing there for six minutes and I'm like, What am I doing? I'm like, I'm just standing here. So I instead, I do body weight squats while I'm doing exactly yes, yeah, okay, sorry. I didn't want to say that. I really didn't want to say that. I'm telling you, Scott, like, you you can do whatever you can in life. Like, I've told patients. They're like, I don't have time to do this. I'm like, Well, do you do you cook dinner for people in your house? Like, Well, yeah. I'm like, well, then dance while you're cooking dinner, you know, do some squats, turn some music on, turn it into a little time, like I, I've done that with my boys before. It's like we're cooking dinner, but we're having a blast. We're listening to music, we're moving around. It's, it's just what you're gonna have to I mean, it's easy to say, well, this is the world, the way the world works. Now there's no time for that, but this is the way the world works. Now it's not gonna work differently. You have to find a way to incorporate the things that a human body wants while you're living in the modern world. Absolutely. And listen to me, I don't want to be like, you know, I'm not an alarmist or anything like that, but at the rate AI is picking up, y'all might be on universal income soon. Anyway, you'd be like, Oh, I got I got much better. Or this, and much better that I have nothing to do. No, seriously, Jordan, are you not worried about that? Like, what would you call Yeah, when you when you hear somebody say, jobs might be eliminated, we might have to start paying people right like, and I don't know that that's crazy, that that could end up happening one day, and in your mind, like, I don't know about you, but for me, I think, Oh, it's wonderful to give people an opportunity to express themselves, or paint or do the things they've always wanted to do. But I'm afraid that for some people, they're gonna what they're gonna do is nothing, and then and then this is gonna get worse. You know what? I mean? Like for for some people? I mean, maybe this is an extreme example, but you know that movie wall e Yeah, no, yeah, exactly. I mean, dude riding around in chairs and robots do everything for you, yeah? And then that, and that little robot goes Wally, yeah? And you're like, Oh, I love this movie, yeah. I just, I'm saying is, my real point is that, you know, technology is changing quickly. Life is changing quickly. We are not running from bears, most of us anymore, true, but you're still going to get this stress. You have to find a way to manage it in the world that we actually live in, and you have to find a way to get activity in the world we actually live in. Now, if you're out there listening to this right now, and you know you're you're cutting a sewer pipe, well then you're probably okay, yes, yeah, absolutely right. So also, that's another thing, I guess you could, you could try to get more work that does things for you that I don't know. Like, I'm saying there's a lot of ways to,

Jordan Wagner 31:26
there's a lot of ways it doesn't have to be something. It's that's impossible. I mean, accountability is really big. Like, you know you had mentioned earlier, like, oh, I want to exercise, but I'm gonna, I'm not gonna do it right now, like having accountability is really important too. So like, in the past, I've done, like, through social media, like, you know, challenges, right? I did one where it's, like a push up challenge, and it was like, Okay, I'm gonna do X amount of push ups every day, and then at the end of the month, I gotta post my calendar so everyone can see that I did or did not do it, right? And so there's almost, like, a little bit of a motivation when you have some accountability, or people like, Hey, are you doing this? Are you not

Scott Benner 32:06
a lot of the things that happen on this podcast happen because I'll say them out loud so that I have to do them. That happens to that a lot like a lot of the series you that you might love, that's me going online, going, here's what we're gonna do. Because if I don't say it, then I might not do it right? Jenny and I just recorded earlier today the last episode of a short nutrition series that we did together, awesome. And at the very Yeah, and she's so passionate about it, because it's, it's her background, and it's just something she's actually really passionate about. She related a story at the end where she just said, like, look, my father died in his mid 60s, yeah, and, you know, like, basically what she was saying was, like, I'm taking care of myself, because I don't want my kids to grow up as adults without I miss my dad. I don't want my kids to miss me, right? Like, you know, like, whatever you can find to get yourself going, like, find something that means enough to you that you're willing to put forth the effort and and be consistent with it. Absolutely, yeah, absolutely, right. Where are we at on this? I'm sorry,

Jordan Wagner 33:04
no, we'll jump into some of the the sleep again here. So I know before I mentioned a little bit about, like, the the ghrelin and the leptin and things like that there. But just let's touch on how to promote sleep before going to bed. Because that, again, is going to the insult sensitivity, right? But I would say one of the biggest things is a routine, right? If you're going to bed all different times, like maybe at Monday night, it's 10 o'clock, Tuesday, it's midnight. Wednesday, it's eight o'clock. Thursday, you're at 1am if you're doing stuff like that, you're naturally going to have dysregulated sleep patterns. So you got to have a routine. Try to go to bed as much as you possible at the same time and wake up at similar times every day. I know that's not always possible, but if that is becoming a habit in your life, that will, I think, make some impact eventually there. I'm about to say something that's not gonna be feasible for everybody, but if you're able to getting like a bio sensing ring or like a watch, can really help with the sleep, right? I myself personally wear an aura ring, okay? And it tracks your sleep very well. It tells you when you're hitting all the points of your sleep, if you're aligned with your your your sleep type.

Scott Benner 34:14
What do you do with that information once you have it?

Jordan Wagner 34:16
So right now, not a whole lot, because I'm up with a newborn and a two year old almost every night. So you can't really do a whole lot with that, but in the past, if I could see like I'm having these issues here, I would try things like not drinking the caffeine closer to bedtime, I would say like, Okay, I clearly am having a hard time unwinding at night, so maybe I read a book instead of watching TV. I drink some chamomile tea before bed, something like that to relax me. Jordan, you

Scott Benner 34:44
have four kids. I think I know how you relax before you go to bed.

Jordan Wagner 34:49
Yeah, I just honestly hit the sheet sometimes and I'm like, holy cow, yeah.

Scott Benner 34:53
I meant two things there you. Laughed about one of them. I know what you mean. We got a. Lovely you are. You tried to pivot to like, I'm very busy chasing those four kids around. I was like, Hey, you're very busy making those four kids. That's what I'm saying. That's funny. No, no, listen. I don't want to put it on you, but if you listen to you know some of the data that's floating around now as a society, apparently we have sex less now, yeah, and I don't know nothing puts me to sleep better than that, so, but I think we're in a situation where the speed of life, I think it just sped up before we could adapt to it. Yeah. Does that make sense? Like, I don't think we're adapting as well as we used to, because things are changing so quickly. And

Jordan Wagner 35:38
so, yeah, and then, or I think everyone's, I mean, not to touch on these things too, too much. But like, I believe in, like, gender roles, right? And so, like, I think we're getting away from that kind of stuff a lot, right? And so everyone's chasing the bigger, better next thing, right? So it's a hookup culture, and I think that's promoting people not having good marriages. And there's a cascade effect, like we talked about from the very beginning, right? And so like my wife and I have tried really hard to have have a good marriage, you know, have a good intimate life and things like that, and that's paid dividends to the way our family is, and even things like improving sleep quality,

Scott Benner 36:17
yeah, in so you found a way to make a cohesive life together, and it's impacting other things in positive ways, stuff that you didn't plan at the time. Like, you probably listen, you probably just started off, like, with some, you know, like, either, like, cultural, religious or family values that said to you, like, this is how we're going to shape our family, right? And you didn't do that, and say, Hey, we're going to get married, and then, you know, we'll have some kids. You'll stay with the kids, I'll go work, and that'll definitely make it so that we sleep better one day. You weren't thinking that, right? Absolutely not just in the same way I believe that someone's not sitting at home thinking like, you know, I work really long, and I still want to play Call of Duty, so I'm gonna do it at 1130 like they're not thinking. And then I'll ruin my sleep with that, and then my visceral fat will go up and my insulin sensitivity will get worse. Like, no one's thinking, right? Yeah, they're just like, I just want to play this game, or I just want to do this. People, most of the time, are just trying to find a way to unwind at night, get ready for bed. And so, you know, even with that example, there of Call of Duty, or, like, watching a TV show, there are certainly things you can do to make sure you're not destroying your sleep, right? Have some maturity, right? Maybe you play Call of Duty, and you, you know, you stop yourself, you play it for an hour or so, and then you're like, that's it. I'm done for tonight. I know when I was gaming back in like, high school and stuff, I had zero self control a couple games, and then it's like, oh my gosh, it's 4am yeah. And if I just win five more of these games of Madden, I'll be able to draft better next year, and then I'll be like, yeah. Like, no, listen, it's another like, you know, look, I I'm not gonna, like, beat a drum, but, you know, there are a lot of things in your life that are driving up that dopamine for you, and especially in a modern digital world, and I feel very strongly about good sleep, like I harp on it in my family. It's a losing battle. I'm not going to tell you otherwise, you know, I'm not going to tell you that last night, I didn't wake up in the middle of the night and see a light on, and I thought like, Oh, let me go shut this light off. But it was hard. And she was still awake, and she was talking to her. You know, they're in a spring break at college. They're talking to her boyfriend, and I'm like, I'm like, I walked in. I was like, everyone go to sleep. Like, talk, during the talk, when the sun is up, right? Like, right? I try hard to, like, just follow that simple idea of, like, follow the sun. Like, get up with the sun, try to start shutting down when the sun goes down. I'm not all the way. Yeah, I'm not Amish. Like, I don't go to sleep when the sun goes down, like, you know, but like, I'm not trying to, like, stay up super late anymore, like I used to when I was young, and then, like, I was forced to, before algorithms existed and my kid had diabetes. Like, I value sleep. And at the same time, I'll say this, like, because I just shared this with my wife recently, we got in bed, and I was like, I'm so tired. Like, I want, you know, I'm excited to go to sleep. But at the same time, I said to her, like, I'm starting, as I get older, to get mad at have about having to sleep, like, and she's like, What do you first of all, she doesn't want to talk to me when she's tired, like, but because she's like, Oh, good, now he's gonna have like, some existential conversation with me. He just said he was tired. I'm tired. Blah blah. I said, like, I don't know. I just, I feel like my life is winding down, and there are things I want to do, and some days it pisses me off. I have to go to sleep, you know? And I I wonder if that's like, a real feeling I'm having, or if it's a feeling I'm getting from like, some unnatural acceleration that I feel from the work.

Jordan Wagner 39:44
No, that like my wife's grandfather, and he ended up passing away a few years ago, but he always said to white my wife, if he could have a superpower, it would be that he didn't have to sleep like if you I like dream. And stuff like that, right? So if you could sleep, but you didn't have to, that would be kind of cool. Yeah,

Scott Benner 40:06
no, I hear you, I really do. But my point is this is that if you sleep well when the sun's down, then you can pack more in to your life while the sun is up, and you're going to improve your overall health and everything else. Let's move on to do nutrition, because I gonna start sounding like a hippie in a second. I don't like that vibe. Well, Scott, I am a bit of a hippie, so that's okay. Oh no, I imagine you living in a yurt, just in case you're wondering.

Jordan Wagner 40:30
Oh, that's exactly right. But yeah. Anyways, yeah, nutrition. And I'll preface this to saying like, I'm not like a nutrition expert, but these are things that I have seen that have have impacted patients. I'm sure Jenny might be able to speak better to some of these things here, but the idea that I want to get across is that somebody can eat literally terribly and still have good blood sugars. But that doesn't mean that like you're in a good spot with your health, and that that gets back to what we touched on earlier. Of you could look at just the blood sugars and think you're doing great, but health is a lot more than just your blood glucose there. So we'll just start with that there. But I think one of the big things to think about with nutrition and insulin sensitivity is as much as possible avoiding Ultra processed foods, right? So that's going to be things like fast food, or that's going to be things like frozen meals at the grocery store, or, like a lot of packaged goods, things like that. The reason you want to avoid a lot of those, aside from the fact that a lot of them are really, really high in carbohydrate, there's there's trans fats, and a lot of those, and those are, those are known to cause insulin resistance,

Scott Benner 41:42
yeah. I always tell people, if you're looking for a reason not to have some of those oils that are available in so much of our food. Yeah, one of them was developed as a lubricant, exactly, right, yeah. And then they realized, like, Yo, you could eat this. They changed it a little bit, and they took machine grease and turned it into food, and now you make cake with it. So

Jordan Wagner 42:03
Correct, correct. And then that. Those are some of the seed oils that you're referencing there. And this is a hot topic, so we don't need to dive in this one too, too extensively, but the idea just think about this. Okay, if you were to eat, let's say, a peanut, you chew it in your mouth, and a little bit of oil comes out of it because you're naturally just chewing it. That is so much different than having, like, a refined peanut oil coming in out of a plastic bottle, right? So like, for example, those oils there, a lot of them are called PUFA, is polyunsaturated fatty acids. They're often touted as the healthier oil choice, which, again, without getting too, too much into it, I think there's some problems there. But what you often see is that the the Omega six to Omega three ratio is, like, completely unbalanced. It should be somewhere along the lines of like four to one of omega six to Omega three. And these unrefined ones, I'm sorry, these refined ones are closer to, like, 20 to one. Yeah, additionally, they're, they're also, like, stripping these things, not like, intentionally, but you go through this processing, it's getting stripped of all that's natural vitamin E. And vitamin E is, it's a really powerful antioxidant, and so that's why I think it's healthier to just eat, like the nut or the seed, right? Compared to having some of these oils. So not to sound like a hippie again, but like my wife and I will sometimes carry around little vitamin E capsules. And so if we go eat, like at In and Out Burger or something like that, you you pop a few vitamin E's before you eat it, just to help with the antioxidant and all that stuff. I'm

Scott Benner 43:40
going to tell you something like, If you I say this all the time, if you guys knew me, like, 35 years ago, you'd be like, I can't believe that's the guy that's talking to me right now. But I went through a whole renaissance of understanding oils a few years ago, and Jenny and I, by the way, Jenny and I, like I mentioned, we made a series on nutrition. It's out now. It's called Smart bites. I think it's maybe six episodes long, you'll you'll find it. But Jenny is a nutritionist, like by trade, like by by her education, who is also a CDE, and she's incredibly passionate about this. I told her years ago I was like, I think I'm gonna stop eating like oil, like I had like canola oil, which I grew up being told, was like, a healthier oil. But like, now I think of it as, like, healthier a healthier oil is like saying, like, let me find a better way to punch myself in the face. I'm still not doing a good thing for myself. Like, is it as bad as had I hit myself with two hands? No, but it's still not something I'm looking for. We cut all those out. The only oil that's in the house right now is coconut, and we only use it to make popcorn, okay. And other than that, there's a olive oil, but it's used really sparingly, and only cold pressed olive oil, because, like, Good, yeah, because the way Jordan talked about the way they process it sometimes either strip. Sort of the only nutrients you were gonna get out of it, or, believe it or not, heating up olive oil to process it is actually making it processed food, and processing it cold without heat takes longer, so you have to pay more money for it, correct? Yeah. And not to mention, even with olive oil, it has a lower smoke point, right? So using olive oil as a primary cooking oil, you could actually make that olive oil go rancid from over cooking it. And so, yeah, it's, I love what you said, the cold press. That's a very, that's a very important thing with, you know, oils, but especially with olive oil, I have to tell you, cold pressed olive oil might be the only reason I have a Costco card. So that's hilarious, yeah, because they make really great cold pressed olive oil. Yeah, yeah. So that kind of stuff, like, you know, taking vitamins, like this, the thing I've added to my life, like they're right here, like I'm not lying, like they're on my desk, so that I don't forget to take them every day. Yep, yep. I found that if I put them in the kitchen or somewhere near food, eventually somebody puts them away and takes that out of my mind. And so instead, it's just, it's in front of me on my desk, and every day I and by the way, it's not one of them. You have to read the label. You're supposed to take more than that of the one I have like, so I make sure to take more, you know, right, right? Oh yeah, that's funny. If you really want somebody who understands nutrition, who isn't going to talk down to you, but is going to be honest with you. I say go check out the smart Bites series with Jenny. That's awesome. She did such a great job of putting together these different modules to speak about, and we just literally, just literally finished recording it today. So that's so cool. And like, I truly believe that if people want to eat Twinkies and hot dogs and hamburgers all day long, they should be able to but they should also have the information to kind of know what potential consequences could be coming their way. Well, that's where I'm at, Jordan. Let me, let me. I'll finish nutrition, and we can move on to getting outside and get out of here. But, like, everything's a process, right? Like, everything starts one place with one idea, and if you get to keep it going long enough, you watch it grow and it morph. When I started making this podcast, I was in a place where I said, I know how to use insulin, which was revolutionary to me at that time, because I spent so many years with my daughter not understanding how to use it, right? I said to my wife, I'm going to start a podcast and tell people about how we do things, because I think they might find it valuable, and that's come to pass, like the Pro Tip series and the bull beginnings and those things are, I think they're seminal in this space, and people know about them far and wide, and they've helped a lot of people understand how to use their insulin. So when I start talking about that, I am immediately met with the idea that some people are going to eat really poorly, and I can't stop them from doing that right. And if I say, here's the ideas I have about how to use insulin, by the way, eat right and like and start scolding them, because that's how it's going to feel to them, this information is not going to get anywhere. So I started with a very basic idea of you need as much insulin as you need, and you need it where you need it and you should use it, yep. And it took a long time and a lot of years to build up a following that can be disseminated and people share it, and to the point where, like, you know, I mean, you see the Facebook group is huge, right? And people come in, and most of what they say is, my doctor told me about this. Yep, exactly. Mostly how people get into the group. So now, like, we've, you know, we've got this reach. We've taught people how to use their insulin, and there's a resource there for new people to learn how to use it. And I'm saying, in all of it, Bolus, what you need. But at some point. I'm not saying go live unhealthily, right? My concern was, if people don't use the amount of insulin they're supposed to use, it's either going to, like I said earlier, lead to some sort of an eating disorder, or it's going to lead to elevated blood sugars. Exactly. I thought, let's eliminate those two things first, right? Teach them how to use insulin so that they feel free to eat, so that they don't get involved in an eating disorder. Teach them how to use insulin so they're not running around with nine and 10 and 11. A, one, Season Eight, a, one, season seven, that they can put their a, 1c, where they want it to be, that they can have a variability that they choose, right? Like, let's give them those tools Exactly. But the next thing to say after that has to be, this would all be easier if you didn't eat some of these things, or if you limited the amount of times you eat those things. But if I start with that, then I'm just everybody else online telling you what to do, and you're not going to listen. And then you never know how to use your insulin. And you run around with a, 10, a, 1c, and it just, it seemed to me to do it in this order. Was,

Jordan Wagner 49:41
yeah, and I agree that that is the appropriate order to do it. And that's, that's how I approach it too. Like I have some of these conversations a little bit deeper with some of the patients, but a lot of the patients that I am doing this with, they had to come back to the hospital for another reason. So we've already established rapport in the past. Yes, of. How to get them going. And now it's like, all right, you know how to use insulin for the most part. Let's start adding on top of that. Yep, yes,

Scott Benner 50:08
it's super duper important, and it's not me. It's not a bait and switch for me. I still think like I would rather you be in a world where you have two choices about your health, your blood sugars and your variability and your nutrition, I would rather one of them be good than neither of them be good. Yeah, without a doubt, at least. Let's give you that like, if you're gonna eat a ding dong, then, by the way, that sounds so wrong. I'm gonna pick something else. If you're gonna eat a ho ho, then eat a ho ho and don't have a blood sugar spike from it. But for the other people who eat differently. You know how to use your insulin for an avocado and toast, exactly right? Like it works for everybody. It does anyway. I'm and I'm not talking down to anybody. I am totally going to have a Dorito this weekend. I just want everyone to know it. And Dorito is the food I use in the nutrition episode where I'm telling people like, you know what sucks for you? Doritos. But if I see one, I just want to be clear, Jordan, I'm gonna eat it. I mean, like, and that's the thing too. There's, there's a balance to in all of this, like, we've been talking about the whole time. Like, I think, personally, my quality of life would be a little lower if I was like, Yeah, I'm never gonna eat pizza again. I eat pizza every Friday night. Yeah, you know, and I've learned how to dose for it. I know that eating that pizza and the quantity that I eat is probably not the healthiest thing in the world, but I enjoy eating it. I enjoy spending time with my family and doing that. And so to me, that's worth it, right? So there's, there's that balance there. And in fairness, the next series that Jenny and I do is going to be called, What am I calling it? Bolus for? Probably the number four. I don't know why the number we're going to go out to the community and say, Tell us all the food you can't Bolus for. And Jenny and I are going to do short episodes where we talk through making a Bolus for each one of those items. And I guarantee you, most of them are going to be lucky charms and stuff like that. Yeah, you know. And fair enough, no one's perfect. Life's not perfect. We can all sit here and say, don't eat a seed oil, or don't do this, or don't do that, but we also just said it's hard to sleep because of technology and the way life is. It's also hard to eat because of, you know, how populated the planet is, and the way that we have to make food so that everybody can eat like it's not, it's not just you're out there making a bad decision, you're out there trying to live in the you know, you're swimming in the pool. Somebody threw you in basically. So, yeah,

Jordan Wagner 52:25
it's, I mean, just an interesting thing I learned in nursing school, and you see, if you just look around, is especially in the United States. It's like, one of the few countries in the world where a lot of, like, lower income people have access to food, but it's, like, very low quality food, yeah, whereas, like the rest of the world, they might not have access to any food at all,

Scott Benner 52:46
right, no, there's a lot of problems in the world. Like they're really, I mean, I'm not trying to say they don't exist. Also, my income is not challenged, but I grew up that way, and so did my wife, yeah, and we fight the things that were, like, bred into us as far as the way to eat. Like my, I know my wife wouldn't like me to say this, but my wife will eat like a garbage person sometime. I'm like, you know, we have money. I'm like, we're not poor anymore. Like, we're not like, you know what I mean? Like, I'm, I can't have a cook come in and slaughter the cow in front of me or anything like that. But, like, but we can afford it a reasonable meal, but she just grew up a different way and like and the things that occur to her, like, I watch her have to, like, say to herself, like, and my wife's she eats well, and she No, but her first thought is always the thing from when she was a kid, you know. And then in she stops herself most of the times, but there's also times she doesn't, you know, so holidays are a great example. Like, my wife equates holidays and certain like candy, or she almost can't stop herself from going to a movie and not buying popcorn. Yeah. It's not that tradition that built in tradition, almost, yeah. But then once she buys it, I see her take a couple bites of it, and she's like, I don't want this. Like, I actually said to her the last movie we saw, it was thunder bolts, in case you're all wondering. Like, she took two handfuls of popcorn, and she's like, I don't want this. And I said, Hey, next time. I was really like, I think it was very sweet. I said, Next time, let's buy a smaller one, because you don't want this. And she goes, No, you're right. And I was like, Okay, so like, let's see what happens. Like, when I go see hopefully, Mission Impossible part two, which I'm very excited to see. Yeah, those are great movies. Oh, my God. The last one was awesome. Like, hopefully she'll say, like, give me a small popcorn because, like, the, you know, help the little girl on her feel like she's at the movies. And, you know, cover for the fact that the adult owner doesn't want this popcorn at all. Super interesting. Anyway, I'm sorry, and by the way, go outside. Well, tell them about the sun, yes.

Jordan Wagner 54:46
Well, yeah, just get outside. I mean, if you're getting outside consistently, there's a high likelihood you're also increasing your activity. So that's a huge part of it there. But one of the big things is you. With, you know, vitamin D, right? So vitamin D in low levels, has been associated with insulin resistance. And there's even some some theories of diabetes diagnosis for type ones that point to the fact that vitamin D is low in a lot of type one diabetes, getting outside the sun, hitting your skin, helps our body to be able to make its own vitamin D, and so you don't need to go outside all day long. But like again, speaking to the person who you know works in the office, maybe you take your your lunch break and you go outside. And I know that's not always possible, but to the best of your abilities, just getting outside at some point during the day is going to be it's going to be really helpful for you, right? The other thing tying it all into sleep here is that when you're getting that full spectrum light coming from the Sun that helps balance your circadian rhythm, so your natural sleeping patterns, things like blue lights, so that's going to be lights coming from screens, or like the overhead lights in the office or perhaps at home, those things can actually really mess up your your circadian rhythm there, and the sun is a natural way to be able to balance that there. Just just as a side note, like they do have those blue blocking glasses that you that you can wear and block out some of the lights. You know, there's different colors. Yellow is going to be approximately 50% or so, the orange is going to block out closer to 100% so depending on what when you're wanting to do it, those are good options, too, if you're stuck inside. But it is just truly best just to get outside, get get a little sun. If you're not in a sunny state, that's okay, but like just getting outside, you're still going to get the benefits. To an extent, it might not be as much as, like, where I'm at in Arizona, you're going to get some benefit, for sure, so you're probably avoiding the sun and still getting it. Yeah. I mean, I am in the sun all the time. If you'd ever drove past my house, you bet go there's Jordan. He's not wearing a shirt again, because I just, I always have my shirt off, doing yard work and things like that.

Scott Benner 56:58
Yeah, awesome, Jordan. I can't, I can't. Thank you enough for for coming on and putting together these few episodes for me. If you have more you want to talk about, you, let me know you could always come back.

Jordan Wagner 57:07
Absolutely. Sounds good. Scott, awesome. Thank you. Yeah, of course.

Scott Benner 57:19
Thanks so much to Jordan for spending his time with us. If you're enjoying Jordan on the podcast and you'd like him to come back, go find him on Instagram, the diabetic murse, and let him know how much you enjoyed him on the show. This episode was sponsored by touched by type one. I want you to go find them on Facebook, Instagram and give them a follow, and then head to touched by type one.org where you're going to learn all about their programs and resources for people with type one diabetes. Are you tired of getting a rash from your CGM adhesive? Give the ever since 365 a try, ever since cgm.com/juicebox beautiful silicon that they use. It changes every day, keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better. This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. When I created the defining diabetes series, I pictured a dictionary in my mind to help you understand key terms that shape type one diabetes management. Along with Jenny Smith, who, of course, is an experienced diabetes educator, we break down concepts like basal, time and range, insulin on board and much more. This series must have 70 short episodes in it. We have to take the jargon out of the jargon so that you can focus on what really matters, living confidently and staying healthy. You can't do these things if you don't know what they mean. Go get your diabetes to find Juicebox podcast.com, go up in the menu and click on series, Hey, what's up, everybody? If you've noticed that the podcast sounds better. And you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way, recording.com, you got a podcast. You want somebody to edit it. You want rob.

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