#1191 Canadian Dinner Rolls

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bonnie 5:00
Did silence my phone.

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

Bonnie 5:51
You exercise exercise yesterday.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bonnie 18:13
What do you mean they killed?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bonnie 24:53
I hope to

Scott Benner 24:58
do your best Okay

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

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

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

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

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

Bonnie 26:08
Oh, okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scott Benner 35:59
diabetes related.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bonnie 41:44
I it's just blurry.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bonnie 47:59
We have the Great Lakes. You

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

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

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

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

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

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

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

Bonnie 49:00
well, those are the lakes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scott Benner 56:55
look the other way.

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

Scott Benner 57:00
understand. Yeah. No,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unknown Speaker 1:20:09
Correct.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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#1192 Grand Rounds: Dr. Marwa

Dr. Marwa is a pediatric endocrinologist.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Marwa 10:26
Right? Yeah,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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#1190 Ask Scott and Jenny: Chapter Twenty-One

Scott and Jenny Smith, CDE answer your diabetes questions.

• Scott to Jenny: If I gave you a magic wand and you could make everybody with diabetes do one thing, what would you make them do?

• Jenny to Scott: What do you get as the main reason that companies don't tend to hit the whole market of desires for everyone with diabetes? Why does it feel like each one is only choosing a third of a pie?

• Jenny to Scott: How many days do you watch for a trend?

• Jenny to Scott: How do you feel about AI specifically in diabetes? Also, do you think that all the tech, info, apps, and everything is creating more mental health stuff in the diabetes realm?

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 1190 of the Juicebox Podcast.

On this episode of Ask Scott and Jenny instead of the listeners asking the questions, which we'll get back to in the next episode, I asked Jenny a question and she asks me a few. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin. There is an incredibly simple way for you to lend your knowledge to diabetes research without leaving your home. That's right, if you've ever wanted to help type one diabetes research but didn't have the time or couldn't make the commitment. Now you can t one D exchange.org/juicebox. Head over there and take the survey. The survey takes about 10 minutes. They won't ask you one question you don't know the answer to and you should be in and out of there in like 10 minutes, you need to be a US resident who has type one diabetes, or is the caregiver of someone with type one. Go lend your knowledge to the resource that helps them get help, maybe even you and while you're online, go check out the Juicebox Podcast private Facebook group, where you'll meet 50,000 members Juicebox Podcast type one diabetes. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. head there now to learn more about ag one. It's vegan friendly, gluten free, dairy free, non GMO, no sugar added no artificial sweeteners. And when you make your first order with my link, you're gonna get a G one and a welcome kit that includes a shaker scoop and canister. You're also going to get five free travel packs and a year supply of vitamin D with that first order at drink a G one.com/juice box. 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/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med this episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed ever since cgm.com/juicebox. All right, Jenny. Welcome back. How are you? I'm good. How are you? Excellent. Thank you. I had an idea this morning. Yay, in the shower, and I texted you. And I knew we were going to recoil in the shower. No, I mean, I want to say respectfully I waited till I was dressed. Because I do think that would be weird. Even if you wouldn't know that I was naked when I texted you.

Jennifer Smith, CDE 3:11
I was thinking about the water on your phone while you're trying to do things.

Scott Benner 3:15
You don't do this, like Arden calls us from school from the shower. She facetimes from the shower, all of her friends. They FaceTime while they're showering all the time. The girls do. Yeah, that's bizarre. They put it up high enough that you can just kind of see their shoulders and their head and they shower and talk to each other. Think it's the only time they have time to talk to each other actually, because they're all in college maybe I don't know. But anyway, that's anyway, I just want you to know I was fully dressed before I tech. And

Jennifer Smith, CDE 3:45
you had an idea. Also, I

Scott Benner 3:47
want to say this. My mom has passed on now but my mom had an incredible way of calling me or texting me as I was getting into the shower for years. And she passed away and I thought well, at least that won't happen anymore. Except for Isabel from the Facebook group. She picked right up where my mom left off. Doesn't matter if it's like, if it's like right away in the morning and I'm like get up out of bed and I jump in the shower. If I get up and I mess with the dogs and two hours later I get it doesn't matter. I find myself reaching for that faucet or I just got in and Isabel's Hey, can you look at a post on the Facebook group? Or did you mean for this to happen in the episode today? I'm like, How do you know I'm in the shower?

Jennifer Smith, CDE 4:26
You look around during my meet one

Scott Benner 4:29
moment I get no hot water hits me and I have a good idea like the one I had today for us. So we've been doing some ask Scott and Jenny stuff lately, which we'll get back to the next time you and I talked but today I want to ask each other a question and just see where the conversation goes. Okay, so I texted Jenny and I said come up with a couple of questions for me. And then I came up with one question for you. Only one well, I feel like there's a conversation and so I don't want to eat up too much time and I wanted you to have like something to pick from That's why it was like your you get more. Oh, and I've tried very hard not to consider your answer or what you might ask me today, because I just want it to be kind of free flowing. So anyway, that's the amount of effort that goes into the podcast do you guys love? Can I ask my question first?

Jennifer Smith, CDE 5:15
Sure. Do

Scott Benner 5:16
you want to go first? Do you have like, Oh,

Jennifer Smith, CDE 5:18
good. I came, you said, let's think of five questions. I thought of six. You

Scott Benner 5:23
have six questions. All right. Well, I'm gonna ask my ego first. Well, okay. So you have to listen to the podcast pretty specifically, I think to know this. But the moment that I began to think about getting better at diabetes, started with me asking Ardens nurse practitioner CDE, maybe Which one did I ask maybe the CD?

Jennifer Smith, CDE 5:46
She could have been Bolus? Or he I mean, it wasn't she

Scott Benner 5:49
and I maybe she has both. I don't know. That's neither here nor there. Okay. Anyway, she's definitely a CTA. And I said, If I gave you a magic wand, what would you make people with diabetes do one thing, you'd only make them do one thing. And she said, without much thought, I'd tell them not to be afraid of insulin. And that went on a whole thing. I wrote a six part blog series for back then it was on the pods blog about not being afraid of insulin, but the truth was, I was afraid of insulin. So it wasn't like a blog from like a learned person who was like, here's some tips about how not to be it was me talking myself out of being afraid. And I think it helped Arden immeasurably. And then I think it spawned a lot of what people hear now on the podcast. So my question to you is, if I gave you a magic wand, and you could make everybody with diabetes, do one thing. What would you make them do? This episode of The Juicebox Podcast is sponsored by ever since and ever since is the implantable CGM that last six months ever since cgm.com/juice. Box. Have you ever been running out the door and knocked your CGM off or had somewhere to be and realize that your adhesive was about to fall off? That won't happen with ever since ever since won't get sweaty and slide off, it won't bang into a door jamb. And it lasts six months, not just a couple of days or a week. The Eversense CGM has a silicone based adhesive forged transmitter, which you change every day. So it's not one of those super sticky things. It's designed to stay on your forever and ever, even though we know they don't work sometimes. But that's not the point. Because it's not that kind of adhesive. You shouldn't see any skin irritations. So if you've had skin irritations with other products, maybe you should try ever since unique, implantable and accurate. So if you're tired of dealing with things falling off, or being too sticky or not sticky enough, or not staying on for the life of the sensor, you probably want to check out ever since ever since cgm.com/juicebox, links in the show notes links at juicebox podcast.com.

Jennifer Smith, CDE 8:11
That's a great question. Oh, and I make them do. I mean, I would have referred to insulin had you not already brought it up. But being a dietitian, and not a nurse. Okay. I would. And I don't want this to sound judgy. But I would really write like, there's no judgement. In fact, I say to people all the time, when I'm like, this is like the no judgement zone. I'm here, you know, to help to cover to whatever we're going to discuss. But I would really love for people to truly understand what the impact of food outside of blood sugar does to their overall health. Okay? Because, you know, with diabetes, we're really focused on blood sugar numbers, right. And food is a big part of that. There's kind of three tiers exercise food and insulin and food being a major piece of that. I think we focus too heavily on not being afraid of the insulin. But because of that we sort of lose the overall in, in what is our body really need just from a longevity a health perspective.

Scott Benner 9:21
Okay, so are you saying that, because we try so hard to tell people at diagnosis, this isn't going to change your life. You can do whatever you want. You just count the carbs and put in the insulin right now, of course, knowing that it's not that simple. And that advice never really helps anybody but the intent of it is there is an amount of insulin that covers your food. Yes, but you're saying it takes out the piece. We start considering the impact of the food outside of the blood sugar. Right, right, because I know how to Bolus for Marshmallow Peeps so I can eat them because I can eat them. I can eat whatever I can Bolus for. And so some people might be hearing that and going, I definitely thought Scott would disagree with that. Because he says, I don't care what you eat, just know how to Bolus for it. So this is interesting because it breaks apart like the the sort of tear structure that people who are passing information on to other people have to consider. Because you have to think about everyone you're talking to, like whatever you say, has to work for everybody. It's hard, or in general, like you don't I mean, Jen is a general, yes, but yes, when you're in the public eye, you can't just start saying something that would really work for a low carb person, but not work for somebody else, because then they'll be out there trying to, I just think I don't I don't imagine that people listening would know, the kind of like, back of the brain pressure I have. I can speak for myself about what I say out loud, you know, and so we make this one comment. You can cover it, you can eat it. What's the I almost said stupid, saying, but I'm sure some of you like it. So I don't want to say stupid saying but sorry. What's the saying about? Uh, I can eat anything except poison and cupcakes with poison on it. Have you ever saw that diabetes meme? You've never seen that? I've ever seen that? Yeah, it's in response to Oh, can you eat that? Okay, okay, you have diabetes? Can you eat that? I can eat anything but poison or cupcakes with poison on them? Like that's the response. Right? And, yes, you absolutely can. But it covers the initial problem. Because you don't want people to run into eating disorders. You don't want them to know. Yeah, exactly.

Jennifer Smith, CDE 11:37
And that's a very, it, there's a really hard line to honestly walk. And I think there's a broader, there's a broader issue there. But when you do have diabetes, because blood sugar, and the stuff that we use to manage blood sugar can have effect on overall health. I mean, everybody knows about the complications. That's one big thing that everybody's told about right. But not only does blood sugar impact your overall health, we have nutrients that are a basic necessity of life that we're supposed to be putting in to fuel our body to fuel the energy that gets produced in all of ourselves. I mean, I heard something the other day, which just It struck with me, it was some it was a podcast, someone who was talking about, like the most complex computers, right, and was comparing them to ourselves. Our cells are unbelievably complex, like self driving computers, and the way that they work to keep our body like energized to keep blood flowing, to keep organs working without conscious effort. It's amazing. But what we also put into our body due to our body, the activity that we do with our body, it all plays into that health. So if we're only focusing on managing blood sugar, and covering whatever food we desire, eating with insulin, sure, you may have lovely looking blood sugar numbers. But if you're only eating as your example, peeps all day,

Scott Benner 13:13
there's no nutrition. And so I think it's this kind of like cascading tear, like, you have to take the humanity out of it for a minute. And just think of yourself as a person sitting across from a doctor, their number one goal is for your blood sugar to be stable and low, whether they can accomplish that or not. That's the thing they're thinking of, they want that. And then they don't want you to have diabetes, complications, these are the things they're thinking about. So they're saying learn how to use the insulin. There's no doctor in the world that thinks that, oh, I'm going to talk you into eating healthfully. If you haven't been already, you know, on the day, you were diagnosed with diabetes, right? Like, so that runs into the where I come from, when I say, Look, I don't care what you eat, I want you to know how to use your insulin. I don't mean I don't care what you eat. There are plenty of things I don't think you should eat. But but it's not my job to explain it to you. And it's to me, it's my job to talk to you about how insulin works. So this is like this supercomputer is sitting up there. And it's crunching numbers and doing all this stuff. And then I'm like, You know what, I should try to make this harder. I'll throw a shovel full of dirt on the monitor and pison to the keyboard and see if this thing could still do it. It's still going hold on a second. started throwing the mouse across the room, like can you do it now? And that's where the body is, is really astonishing. Yes, yeah. You can pee into your keyboard for years and it'll keep chugging along and then one day, it craps out. And then what do we do? We always go I don't understand what happened. You know, right.

Jennifer Smith, CDE 14:47
I mean, the body is meant to be again, a self healing machine it it does the best that it can. It's the reason that wounds heal. It's the reason that we can get better from you know, the common cold and all those kinds of things, but If the basis of what it's working off in order to run smoothly that with pianist computer

Scott Benner 15:09
just popped into my head, but yeah, good.

Jennifer Smith, CDE 15:12
Right. So what we put in makes a big difference in the running of that. And we talk about ages, you know, age levels of diabetes are very, very, very young to very old. And so what you start out with in terms of putting in, for somebody who is diagnosed young, can make a really big difference in their long term health. Right? If

Scott Benner 15:35
you think about your cells in your body, or you as a whole person, like, imagine if you were just walking in a straight line forever. And every day, I hung another one pound weight off your back. And you'd be like, Oh, I can do this. I can do this. And then there'd be a day where I just hang one more, and you could not move forward anymore. Sure. I think that's a way to think about poor poor eating choices. Like really, like, you know, I can get away with it today. But then we run into that psychological thing, which I talk about, pretty frequently through the podcast, I think, but people are so hopeful, which is lovely and necessary, I think hope is what keeps you from losing your mind, right? Yeah. And, but that hope, misguided, makes you feel like I could smoke a cigarette today and be okay, like, that's not gonna hurt me, right? I only did coke at a party on Saturday nights in college. Like, like, no kidding. Like, like, I'll be alright, like that. It's gonna be okay. It's just a soda. It's just this it's only a grilled cheese sandwich with bacon. I skipped the french fries. Like like, you know, like, yeah. And so yeah, that coke instead. Yeah. Have you ever, like had a stick of butter out and use it for cooking, and then look back and thought there's a half a stick of butter gone. That's in me now. You know, like, even like deep frying things. You don't mean like you deep fried. I make potato chips here. Sometimes, you start with a gallon of oil and dumped some into the pan. And when you're done, you eat the potato chips. But there's a quarter gallon of oil gone. You don't think about where that's at, you know? Right? Anyway, if you could magic wand everybody listening. So I'm assuming if you could really magic wand them, you'd make them not remember it. And then they would eat kale salads and like all things that were really good for them, and they would just be happy with it. They feel like they were having Twinkies while they were eating whatever god awful things you eat. And then

Jennifer Smith, CDE 17:30
I'm gonna say, Gosh, you imagine that I eat kale salads, like all day long.

Scott Benner 17:35
I think you've washed your keen wild down with fresh something. I don't know exactly what

Jennifer Smith, CDE 17:41
I do like kale. I do. And actually, my boys really like that, honestly, in place of potato chips. I make kale chips. They're very tasty. And they're good for you. So

Scott Benner 17:51
it is a lot about training your tastebuds though to true. Yeah, yeah. So you started your boys early enough that they don't know from anything else.

Jennifer Smith, CDE 18:00
Now that they're older, they're aware of they've been to parties, they've been to kids houses and you know, that kind of stuff, they can definitely identify the differences in what we have and what we allow in our house. Yeah, versus what is available. And what I like to see, the majority of the time if we do eat out like we have a favorite restaurant here, that's, it's like a salad kind of place where you can put your own salad type of dishes together with the proteins and the vegetables and the toppings and that kind of stuff. And I like to let them choose. Because I really like to see, what are they going to put together? Yeah, now of the choices on the bar. There's nothing really that's, quote unquote, bad, right? But I love to see that they choose a little bit different each time. Sometimes they want to choose something that they've not tried before. Like the last time we were there. My little guy chose artichokes, because he was like, Mom, what are those? I'll pick those are artichokes. He's like, delicate, interesting, but those aren't there to

Scott Benner 19:04
get home peeled and are just trying to figure out what to do with it. I would.

Jennifer Smith, CDE 19:06
It starts early. I mean, and if I was on a grand scale, if I could wave the magic wand, not just in the realm of diabetes, but it would be for a much bigger scale change to education. I've always said if I were gonna go back to do something within my degree, but do something different. I would absolutely go back to do something about childhood education about health and nutrition is I think it it's sad that it starts it doesn't start at the right place. And that if they're not getting something at home, they're clearly not going to get it in school because that's not a focus at school.

Scott Benner 19:46
I believe that for many people thinking about food begins when they are in their mid to late 20s and their stomach starts to hurt or they have a kid and they think oh I don't want this kid to eat the way I eat. Like seriously because we don't do a good job of You know, of teaching. And we've talked about this before, but there are plenty of things that people actually genuinely believe are good for them that are garbage. And they don't know it. Absolutely. They have no idea like so. And I've been guilty of that before. I've eaten things and thought like, this is good for me. And I remember I told the story one time if I was eating the veggie sticks, yes. My wife's like, what are you doing? I'm like, There's vegetables. And she was a no, there's not just like MB there, potato chips acuity. And I was like, Oh, I wonder why there was so good. As far as talking about changing your palate, like, my palate has changed slowly. Over the years, I've cut things out. We've talked about it cut out oils, at one point. I'm very, very steadfast about that. But even in this last year, on the GLP, medication, there's just some things now because you feel like it just feels different. Like I was at a party once there was a chip bola and I grabbed two potato chips, and I was eating them. And first of all, they were crappy potato chips. Like, I know you're having a party and you're trying to save a couple bucks. But you invited me to your house like could you give me mean but never neither here nor there? I found a Trash Can I spit them in a napkin? I was like, I don't want to eat these. Right? Yeah. And that's different world for me to some degree. Okay. So you would help people understand nutrition better? I would, okay. But let's say, I'll go back to your initial thing. You're not judging anyone? Like I am. No, yeah, it doesn't matter. I'm gonna go back to the beginning of it. I don't care how you eat. Your body's not gonna have time to urge to reject life because of your poor nutrition if your blood sugars are all over the place. And that's what's when we're talking about diabetes. That's the first step. Correct. If you need to eat a Twinkie, and you can't stop yourself, let's at least learn how to Bolus for it. We'll talk about not eating the Twinkie later, or under percent agree? Yeah. Cool. All right. Well, what's the question for me? I used to hate ordering my daughter's diabetes supplies. I never had a good experience. And it was frustrating. But it hasn't been that way for a while, actually for about three years now. Because that's how long we've been using us med. Us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do. It's important to me that the supplements I take are of the highest quality and that's why for a number of years now I've been drinking ag one. Unlike many supplement brands ag one is researched and developed by an in house team of scientists doctors and nutritionists with decades of experience in their respective fields. For ag one quality isn't just a buzzword. It's a commitment backed by expert led scientific research high quality ingredients industrial leading manufacturing and rigorous testing. At each step of the process. Ag one goes above and beyond industry standards. And that's why I know I can trust what's in every scoop of ag one ag one supports the Juicebox Podcast with their ads and they also support my immune health. So if you want to replace your multivitamin and more start with ag one try ag one and get your free one year supply of vitamin d3 k two and five free ag one travel packs with your first subscription at drink ag one.com/juice box. That's drink ag one.com/juice box. Links to AG one US med ever since and all the sponsors can be found at juicebox podcast.com. Or in the show notes of your podcast app. Using my links help support the podcast production and keeps it free and plentiful. Oh, I'm excited. Do you text people naked in the shower? No, I don't already answer that one. What's the next one?

Jennifer Smith, CDE 24:43
I do not do I turn my phone off. Do you really? I don't take it in that like that's, I just keep it outside because you know I use I mean using loop obviously if be close enough in terms of like keeping things running but I have a watch. I can see where my blood sugar is. I don't need it. Air I don't need visual or noise. My husband is the one who he listens to podcasts. He's always got music going in the shower and like, I like the noise of the people are gonna be like, this is weird, but that's like the noise of the shower. Jennifer,

Scott Benner 25:15
you said you ate kill. You're not going to get weirder for most people than that. So I want you to videos in the shower. I listen to podcast this morning. Oh, yeah, no. Oh my god, you're ready. Hold on. I was a little worried that I left something in an episode that I wasn't supposed to leave in. So I listened to myself in the shower this morning, which is, I don't know if you know the word douchey. But it really is.

Jennifer Smith, CDE 25:39
Well, you were trying to work at the same time to work. Yeah. Yeah, I will say that if I could do something in the shower, which there's no way to do this. Like I love reading, you would read in the shower, I would entirely read in the shower. In fact, I would be the person who would finally realize that this shower is probably too cold. Or you get what I'm reading is lost in reading. That's like

Scott Benner 26:03
waiting in a hot tub. Would you like that? If

Jennifer Smith, CDE 26:07
I had a hot tub, that would be lovely.

Scott Benner 26:09
Let's get Jenny Awesome. That's all the year Wisconsin Cognos, by the way, did it snow like Snowmageddon there this week?

Jennifer Smith, CDE 26:15
It did actually the funny thing, so it snowed on. Was it Tuesday, and then Wednesday, and then it stopped. It was raining like downpour Tuesday morning until about noon. And then I looked outside and it was snowing. And I was like, well, that's

Scott Benner 26:34
my brother's job got closed down. It's snowed so much. And in Wisconsin, that's saying something. So

Jennifer Smith, CDE 26:40
it is especially I mean, you know, we can have snow until the end of April here, quite honestly. But this was definite snow and it was heavy and thick and really wet. But today, like a good probably at least 75% of it's gone. It's sunny. It's like almost 50 degrees outside. And it's

Scott Benner 26:58
beautiful. You know, we had here this morning. Rain earthquake. Seriously 4.8 on the record, feeling I was in here going? Okay. Like everything was shaking. It went on for at least a minute, like so it started, it will get to your question for me a second. Oh, yeah, it was your first question is, have you ever been in an earthquake hazard? Because if so, then we're recovering everything here. At first, I'm like, is the washing machine unbalanced? And then I thought, I don't have anything in the washing machine. And then I was like, Oh, this is an earthquake, because I've lived through one other one in New Jersey like 10 years ago. Like everything, exactly what you think of like, and everything's rattling around. And then at the end is it dies off? Your feet are still vibrating on the floor for like the last 30 seconds. You can feel it under your feet. It's really interesting.

Jennifer Smith, CDE 27:48
I've never been in an earthquake. Well, I've

Scott Benner 27:49
been into, but there are East Coast earthquakes. I don't know if they count or not. All right, I'm sorry. What's your question for me?

Jennifer Smith, CDE 27:55
I'm trying to decide between, they'll get to here that I think would be a good one. Let's see. So, okay. You've, you've talked to a lot of heads of diabetes tech kind of companies. I've heard them, you've told me about them. Right? We've all heard you talk to them. And what do you get as the main reason that the companies don't tend to hit the whole market of desire for everyone? Yeah, with diabetes, right? We see products that aim for safety. But when we look at what the systems that aren't approved, provide safety is already in there. Right? Do It Yourself covers this and it allows for more flexibility and more self adjustment cetera. So why are we still focusing on safe numbers? Who somebody deems safe? When many people I know it's a small percentage of what the big market is really? Why can't they just make products that cover everybody and your desire to sort of streamline it the way that you want? There you go, I

Scott Benner 29:14
have to ask you first did you ask this because you saw people talking about what pumped by in the Facebook group? That's not why you thought of that. Oh, cuz I've been thinking about it. It's so interesting us because I've been thinking about this to some degree for the last two days, there's been two big, like, really like, lots of 130 Comment, like, you know, post, okay, it's a great group, you really should join it. If you're not at where people are like, Hey, I'm about to get a pump give me the pros and cons of all of them. And as I'm reading through them, I had the same thought you did each one of these devices. It's like it chose a third of a pie. Right? How do I mean that? I mean, like, it feels like, I'm just gonna come out and say it, it feels like on the pod tandem, Medtronic and I Guess Island, it's almost like they looked at a pie. The pie was split into quarters, and each quarter was a goal, right. And each one of them picked a goal and then ignored the other three goals is kind of how it feels. Does that make sense? Yeah,

Jennifer Smith, CDE 30:13
that's absolutely what I'm getting at. And then the broader scope, the, you know, the my PI piece, and all the people that I would definitely put in the same, you know, you Arden goals and everything, kind of in the same pie piece of desire and target and independence and wanting to work with your system and have it work to your goals. I don't understand why with the safety that we know how to achieve. We can't get systems that allow people to do all of that in parameters that are personalized, right? Right now, the lowest target blood sugar that's on the market in a system is Medtronic and what's their target? Their target is you can go as low as 100. Is that the seven? ATG? That's the 780 G. Okay. 5.5, if your millimoles

Scott Benner 31:06
what is on the pod five 110 110,

Jennifer Smith, CDE 31:10
which is similar to control IQ tandem, which is 112

Scott Benner 31:14
and a half or 113 and a half, right? Some crazy like that. I love that. Although

Jennifer Smith, CDE 31:18
if you're setting up the pump, it actually is 110. Okay, you don't set it up as one 12.5, which is just it's part of like, somebody explained it to me the other day, and I can't remember exactly what she told me. But yeah, it's not what gets set in the pump as the target, right. But it is essentially 112.

Scott Benner 31:36
And the islet is shooting for an A onesie in the seven, it's

Jennifer Smith, CDE 31:39
shooting for that. And you do have the ability to navigate, low, moderate and high target as one pivotal kind of point. The only other point that you can put into eyelet is your weight. That's it. Those are those are your pivot points.

Scott Benner 31:53
Oh, Jenny, are you saying I could lie about my weight and make it more aggressive? I feel like that's what I just heard you say? You didn't say that. You would never say that. Nothing you hear on that Juicebox Podcast should because I actually don't know that that that works or not. That's just popped in my I want to be very clear, I'm not joking around. I have no idea if that would work. But as I'm sitting here, it makes little so you

Jennifer Smith, CDE 32:13
are thinking about it in the right way. Because it's basing its basing it off of your starting weight that you enter. So

Scott Benner 32:20
I wonder if you had insulin resistance like PCOS, if you could make it. Alright, that's for another podcast. So I drew my pie right in front of me. And I wrote more aggressive and I gave that to tandem. No tubes. I gave that domine pod. low effort. I gave that to pilot eyelet. And I don't know what to call med tronics version because I haven't seen it enough. You

Jennifer Smith, CDE 32:45
know, I would say of I don't know what to call it either. Because I would say it's

Scott Benner 32:51
is it pretty equivalent to the control IQ or where do you would you choose the tandems algorithm over it?

Jennifer Smith, CDE 32:57
For the correct ability feature? I would actually choose Medtronic interestingly, okay, Medtronic correctives are more frequent, its corrective boluses. It also does do Temp Basal increases, similar to control IQ. But based on blood sugar, it also is willing to give corrective pulses, like the standard control IQ algorithm setting. Yeah, but it does it more frequently, which means that you can get around high is much better for some people much better with Medtronic 780 than you can because tandems just slower in its Dilip decision to give you a pulse out,

Scott Benner 33:35
you're gonna see an ad on social media that says Jenny Smith says I would use Medtronic before tandem.

Jennifer Smith, CDE 33:43
Actually, that's it for some reasons. Yes, for some reasons I would actually choose tandem tandem is the only one that's approved that you can actually, if you know your basil is are well said if you're that type of person who has really awesome, you know, settings, and you want the system to just work off of them. Control IQ is a beautiful algorithm because it it takes your settings and adjust up or down off of them. Yeah.

Scott Benner 34:07
So your question back to me. Sounds more. Here's how I was why.

Jennifer Smith, CDE 34:13
What do you think is the reason I'm gonna

Scott Benner 34:15
give you my why in a second. And I could be guessing but what I really feel like you're asking me is how come Omnipod fives algorithm isn't more aggressive, like control IQs? Because that fixes a lot of like your concerns, right? Yeah,

Jennifer Smith, CDE 34:29
it does. Yes. One really big negative to me in terms of Omnipod five, which I think has a host of really wonderful pros. But one of the big cons is that Omnipod five only suspends it doesn't take away slowly, as it sees something happening. That's a drift down under a target that it desires. Okay? Instead it stops and that creates a lot of issues for people with rebound actually with rebounds, especially when you're coming into a meal.

Scott Benner 35:00
Yeah, yeah. Cuz it could tell away coming into a meal because it doesn't know you're going to eat two hours from now if it's trying to stop a low. But if it's trying to drift, you know, I get your point. So, listen, I'm no business executive, that's for sure. If you guys could sit in on any of the business meetings I have with the advertisers, you would do the same thing that I'm sure they do in the meetings and and the cameras go off, I'm sure you would say to yourself, I can't believe he is doing business with those people. I talk just like this in business meetings, people stare back at me like what's happening? So here's the here's the funny thing that we're not talking about. Is that that pie, except for low effort, three quarters of that pie belongs to any of the do it yourself algorithms that exist on the internet?

Jennifer Smith, CDE 35:49
That's my point. Yeah, I don't understand with everything that we have in the do it yourself world, all of the research and the proof in the pudding that they've put together. I don't I don't get why, at the top level, these big companies are not just saying, You know what, this is lovely. It's all put, why don't we just deal with them and put this into?

Scott Benner 36:13
I will tell you something that I said, because the person I think I set it to doesn't exist at the company anymore. But this is gonna have to go back. I mean, four or five years ago, right? So I think everyone knows that Omnipod was a little behind the pace getting to an algorithm, right? Yes. And I think the reason for that is probably an upper management, they were a little unclear about the direction they were going until they brought these people in and got very solidified and decided, like, you know, on the path that they're on now, that's my perspective, having worked with them, you know, a little bit over the years. So they got the management in there that was like, Hey, listen, let's make insulin pumps, and let's go. And then they were behind by them, because tandem was already moving. Medtronic had already been through their first generation, we also don't give Medtronic enough credit for going first in the repeal algorithm market, because you knew they're going to take it the ask because it wasn't going to be perfect. And it was the first time and people certainly gave him a lot of crap over it. But

Jennifer Smith, CDE 37:09
the data that they got in order to move forward and build, yeah, give data to other companies to actually say, what can we improve? On this, right?

Scott Benner 37:17
The Trailblazer doesn't usually get the credit. And I definitely think in retail algorithms, Medtronic took one part for that. But I was sitting with somebody one day on a call. And like I said, These people don't exist it on a pod anymore. So I'm not worried about saying this. And they're like, Hey, we're gonna we're building an algorithm, like we're gonna they were talking about how they were going to go about it and everything and and I said, whatever you're doing, stop. I'm like, stop, put two people who speak Russian on an airplane, find a guy named Ivan, give him a bag full of money, get him a visa, bring him to Boston and let him build your algorithm for you. Please, like, please go get the guy that wrote this code that this loop thing my daughter is using just go get this right now. And, boy, I said it every time I could to anybody who would listen to me now listen, are they going to do that? No. Is that even reasonable? No. But it also like, you can't tell me that all these companies haven't picked through that code. You know what I mean? Like, just correct. Yeah. Make it like that.

Jennifer Smith, CDE 38:28
And you know, the other thing I know, all these companies have people who have diabetes on their teams, right? I know that they do. Are the people without with diabetes, not the ones who are like, are they not able to give feedback? Are they not able to say, Hey, do you see this big group of people? Knowing love? Like, shouldn't we be thinking along these lines? No. I mean, if they ask me crap, they don't even pay me. I'm just going to tell them, I'll give you my opinion. Yeah, it

Scott Benner 38:58
was really offering my opinion, I was like, just do this. And because loop is an example. You can choose a version of loop that makes Basal adjustments to try to stop highs. Or you can flip the switch the other way and decided to let it make larger bonuses like Right, I've always said to people, like set up algorithms the way Adobe Photoshop is set up. There's beginner, intermediate, and advanced. And when you click on one of those tabs, you get more features. Just make your algorithm like that start everybody at beginner tell them you got to be in for six months. And then you know, if you have a certain percentage of under whatever lows I don't care how you do it like to legally Cover yourself. Let them move up to our intermediate, make them take a test let them move up to intermediate. Can you think it would be so sick? I mean, I really believe it would be very simple to do. And so the question is, why don't they? I think that comes down to time. Limitations of humans and money. So, but what limitation is going to be completely out of the limited in my opinion, what

Jennifer Smith, CDE 40:02
are the limitations quite honestly, come on limitations. So keep this

Scott Benner 40:06
here but see your job, see your job is different, right? Your job is everyday you sit down, you look at a person. And if you do a good job helping them do better with their health, you one your employers happy, right? And the people who are paying your happy Chinese, I don't know if my employers are happy, but you understand, like, we all have jobs, okay. But these people are saying, we're going to make an algorithm, for example, it's going to take so many years, and then it's going to have to go off to the FDA, and it's going to take so many years, and then we're actually gonna have to make it and it's going to take so many years, we're looking at five years before we start getting our money back. They gotta spend money for five years, they gotta run that whole organization with no return on on their and what if it fails, like so let's do something we know for sure is going to work. And we'll lean into who we are. And on the pod listen on the pod is tubeless. My daughter's only ever one an omni pod, right? loop works on Omni pod. So

Jennifer Smith, CDE 41:08
in this day and age, I'm not saying years ago, I'm saying at an age, we already have the we already have the information. Nobody needs to sit in a little back room not getting paid for anything and make it up. They're not making anything up. It's already out there. It's it's free. It's freely out there. Jenny,

Scott Benner 41:28
I've heard that this island guy because of the war in Ukraine can't even use he can't even like be involved in making a loop anymore. Like I mean, I think we could have got him out of there for $25,000. And like a can of Coke. You know what I mean? Like here, so I don't know, maybe he probably lives in Dallas. He's probably listening right now. I'm like, s hole. I live in a very metropolitan area. But seriously, like, there's been other people since him. Oh, yes. Like there's

Jennifer Smith, CDE 41:53
there are many, many people in the whole

Scott Benner 41:56
basically people with type one diabetes who know how to code who sit down and say, I want to figure out how to do this and in their person. Like Arden is not even using loop anymore. She using Iaps. Fantastic. Like, just fantastic. And like, I don't know, like and then you saw tide pool. They tried to do it. And I mean, God bless them. But that ain't going nowhere. You really mean like like that at

Jennifer Smith, CDE 42:20
this point. I

Scott Benner 42:21
mean, Holy Hannah, we're gonna be I'm gonna be dead by the time it like, you know, like they told us that driveable pump. Yeah, and listen, and maybe that's even the pump companies saying, maybe we don't want to be involved in that. I don't know, I don't know the business of that. But that Business Plan to Eat taken too goddamn long is what it is, by the time they the time they get that mainstream enough that algorithm is going to be I'm not gonna want it anymore, you know? So yeah. But ya know, your points not lost on me, Jenny. I mean, somewhere between money time, limits of people. And by what I meant by limitations of people is that everybody in their job, they got to succeed every year to get a bonus to get to keep their job to move up. And they can't sit around for five years going. It's common, it's common, because they're looking out for themselves, too. So, yeah, I don't I mean, I don't know, I've interviewed a lot of people. And I generally think they're telling the truth when I'm talking to them, like I really do. But I also think you're only talking about the things that they're willing to talk about, or

Jennifer Smith, CDE 43:21
the things that they know about from a department angle, right? Not everybody is able to share all the aspects of all the things that are going on with a particular product, you have your job, somebody else has another piece of that job. And you may not be allowed to talk about certain features or things.

Scott Benner 43:39
So point, by the way, that code is open source. Like, I'm going to tell you right now, if you made me the king of any one of these companies, I'd go in, I'd sit down and go, Hey, everyone, stop what you're doing. Go get that algorithm, get it into our goddamn pump, because we're going to take this market over we are going to like it would in six months online, people would know, yours was the one. And you know, they all know it. They know because they all talk about like, well, we're this but they're that, like, you know, they do it in their marketing back and forth. But the truth is, is that it's none of them are talking about the real truth, which is that loop is just way better than all of them. Yeah, that's all, you know, but people ask me, What's the best algorithm? I tell them? It's the one my daughter's using right now. And if she's using a different one, six months from now, I guarantee you that'll be the best one because I ain't sitting around. You know,

Jennifer Smith, CDE 44:32
I haven't built on my phone. I just don't I haven't played around ups. Just put. Okay, I haven't played around with

Scott Benner 44:42
lots of things. But it's also scary. Like I'm counting on like a guy named Ivan not to be impacted by a war in Ukraine. Like you don't you mean like is the Ukraine? No, it's Ukraine. Right? And like so. Like, that's crazy. I know. That's crazy. Like I know, that's insane. But I don't know how to tell you that. Like the other night, I watched Arden come back from class and by watched I mean I could see on her Nightscout she got back from class. And I think she just was really hungry and she walked in her dorm room and she ate I think she pushed the button and she ate right. And her blood sugar climbed to like 185. And I watched that algorithm just Bolus and Bolus and Bolus and crushed it and bring it back down and she didn't get low and it was over. And that was it and or we put her on a GLP medication. Jenny knows this Ardens I'm gonna go through the whole thing. But Arden's insulin sensitivity went from one unit moves her 43 points to one unit moves her 90 points. Because of this GLP she's on. I don't have to wait for it to relearn. I gotta call my doctor, I just went to a manual. I was like insulin sensitivity when they just kept I told her I'm like, Just keep moving it until it works. And that's it. That's all we did. That's how technical I like I said, Hey, try one to 53. And then a day later, I said make it 65. And we moved up the GLP medication a little bit. I was like, make it at, like, you know what I mean? So what's

Jennifer Smith, CDE 46:10
funny about this is that that was actually a question on my thing for you was I was gonna ask, how many days do you watch for a trend?

Scott Benner 46:19
Day? So I watch for a trend, I do it till it works. Like I don't know how to like. So there's a weird when going back to what we talked about in the beginning? How would I talk about that in front of other people? So you know, what you and I usually do when we talk is I let you give the very technical answer. And then I just tell people what I do. And then they can figure out where in between that works for them. Sure. Yeah. So Arden injected a GLP medication. She started with point two, five units of ozempic. And her at that point, her insulin sensitivity is one to 43. Two days later, we were seeing low blood sugars already, which is uncommon, like you know, there wasn't it's not even a therapeutic dose of that medication. But here it was right. She felt a little full. She wasn't eating as much. I thought oh, it might just be food. I watched it. She had a low, the algorithm couldn't pull her out of the low. And so I changed her insulin sensitivity. Right. Then the next day, I changed her basil. And I think I had the whole thing set up three days after she three and a half, four days after she injected the ozempic. The first time I watched that work, I made little tiny adjustments like the turned insulin sensitivity, like two more points or made the Basal like point five less than I watched her meals, I made her insulin to carb ratio weaker. And till I didn't see Lowe's before she started eating. And then I left it there and watched it. So I mean, I had the whole thing adjusted out in like five or six days. Right? But how long would I wait? I knew what was happening. There was a variable and play here I had, I had set settings up for Arden and her physiology. And then we changed fundamentally how her physiology worked with this variable and I changed it immediately.

Jennifer Smith, CDE 48:09
Right and you had a variable that you were paying attention to. It's not

Scott Benner 48:13
like out of nowhere, she started exercising I didn't know or something like that. But that's where we started talking about real world stuff. Where if I just noticed on like, on Thursday, she was low. And I was like, I don't know what happened. I'd wait. I wouldn't do anything. If it didn't happen on Friday, I'd go ha if I came back around next Thursday, and it happened again. Then I started being like, Hey, what did you do at school on Thursdays?

Jennifer Smith, CDE 48:35
Right? Yeah,

Scott Benner 48:36
that'd be my first question. What do you do at school on Thursdays? And have you been doing something different running around more blah, blah, blah? Are you eating lunch? Like like is that the day is like something? And then if I couldn't see a variable, there'd have to be one. If you were only low on Thursdays, there'd have to be one. You know what I mean? Yeah.

Jennifer Smith, CDE 48:54
And that's where looking historically at information, which I know that you do, you know, at her information, but I think that's where it becomes really important and trending, to look at some data from the past to spot some of that. Because if you are really trying to make a baseline change, because you sense that something needs to change, then, you know, a couple of days of a trend around a particular time of day, can sometimes give you a foot in the door about okay, I can change it this way. Kind of like you said, I change it the next day. It's not enough, but there was a trend to start with. So I know that incrementally now over the next couple of days, I can make little daily changes. But you have to first start with a trend right I

Scott Benner 49:40
also set up some profiles for Arden when we were with her two weeks ago. She was starting to get low overnight, and it was always happening at like 330 in the morning, which means that she's eating around 10 And that last Bolus is messing her up somehow. And I didn't want to change all of her settings because it was only happening at some points in her menstrual cycle, not the whole thing. So I built a 90% profile and an 80% profile. So she can be like in the bottom of the Iaps app, it just says normal. I think you can touch that and then choose other ones that your program. So I said, Listen, I said, see where you touch this. And then this comes up. She goes, Yeah, I'm like, if I text you 90, touch that touch 90. And she goes, Okay, so I started like, a week and a half ago, I texted her at night, I was like, I just sent her 90. And that was it. And then in the morning, I sent her normal. And so I was kind of practicing overnight, and it stopped the lows. And then I waited to see if she'd remember to do it. And she didn't. So then I was like, Hey, I think we want to do 90 overnight, as long as you're on this injection. And then we'll see what happens after that. But yeah, I mean, how long would I wait? I mean, there's no way, you know what they always say, they always say, wait three days. And then people's responses. If I wait three days, it'll change again, by the time it happens, or it'll go away. Or I think that's what happens. I think people think it's going to go away.

Jennifer Smith, CDE 51:10
And I think that's where spotting. That's why I asked like how many days I mean, in many doctors offices usually actually say let's wait a week, right? That is too long. Right? It doesn't mean though, that you you just let things happen while you're watching for a trend to appear over a couple of days, right? So a bedtime, you're always having a rise in your blood sugar, okay, correct the rise. But if it's only tonight, and doesn't happen for the next six nights, that's not a trend. So you don't have a profile change to make. You need to accommodate around whatever variable created that high to begin with. Versus okay, I'm high, I corrected it. Tomorrow night, I go high again, I correct it. By then it's more like

Scott Benner 51:57
anything, Yeah, something's happening. You're I'm always very careful of not making band aids all over the place. Because you can make so many different little blind adjustments and everything gets so messed up, the only thing you can do is start over. Because you can't even tell what the end that's what doctors are notorious for, is like where you're getting lowered to aim, but will turn your Basal down to aim, you know, a sooner than that. And be like, Look, I guess the way I would want everybody to think about it is the way I talk about all the time, which is insulin for now. Insulin taken now is for later. But more importantly, what's happening now is because something because of something you did previously, right? Yeah. So it's the same idea. But it's a different way of thinking about it. Like when something's happening at one o'clock, please go back backwards hours and look to see what got you there. Do you have time to ask me the other one? Are we done? Are you are you? No, no,

Jennifer Smith, CDE 52:53
I've got about 10 minutes. Let's see. I actually came up with a whole bunch. Which ones do I want to ask though? Well, this one, how do you feel about AI in diabetes specifically? And do you ever think that it will completely 100% hit the mark of people with diabetes? Not really having to think about more than like, putting their pump on? Okay. I mean, I have some thoughts about that. But I was curious what you think, oh, I

Scott Benner 53:25
want to hear what you think, too. So you have two different questions, kind

Jennifer Smith, CDE 53:27
of I mean, it's all within the same framework, though of AI. Right, it'd be the first part. How do you feel about AI specifically in diabetes?

Scott Benner 53:37
I have a company right now indexing the entire podcast for me. Okay, so my goal is that you'll be able to go to a website and ask a website, ask the website a question. And it will only answer based on everything that we've all of us have ever said to each other on the podcast, all 1200 episodes, and it will continue to index into the future.

Jennifer Smith, CDE 54:01
So the be the next question leads into that concept. So that idea, I think that's actually easy for AI to do. Yes. At a deeper human level, though, I think more in terms of like educational, right, not even necessarily the techie part, but like, educationally, when you have someone that you're working with who has like, one concept to manage what happens when now AI is doing the instructional and they have multiple medical things, some of which could actually have completely opposite parameters of management. Yeah.

Scott Benner 54:42
So other things could be impacting that there's no way the AI would even know about

Jennifer Smith, CDE 54:47
right and that takes a human. Do you think that AI I guess we'll ever get to the point of thinking more human like because this takes it takes analysis on a different level than computer Hey, out

Scott Benner 55:00
without input, though, because like, you have to teach the AI, the podcast so that it can answer questions that have been answered in the podcast already. Okay, if you want an app to tell you, Hey, you got low here, like we see your low. I think you should have eaten 15 grams of carbs at this time or four to say, hey, we see a low coming. Go ahead and eat this. I think that's going to exist pretty quickly. Sure. But if you like I actually think that you're well, I don't just think I've been I actually was just it's so funny you how are you reading my emails? Jennifer, what's going on? I've been approached recently by a company, I'm still assessing it. And they want to be partners, like they want to get involved a little bit. And they have an app that is going to look at your pump and CGM data and say things to like, Hey, you should probably have 10 grams of carbs right now to avoid a low. And they've asked me if I want to learn more about it.

Jennifer Smith, CDE 55:59
I wonder if it's tough to tell me later? If you can, I'll tell you right. Now that to me?

Scott Benner 56:06
No, not that one. No. Okay. That's the one that I know about that had to be so frustrating for people listening.

I'm still assessing how I'm going to answer this this inquiry? Sure. I think it can get to it. But the problem is, it's the same problem as Why don't the pumps all do what they should be all doing? Because you need somebody to put that effort into it. And that's where it never happens. Like because yes, I listen, there was a guy on here one time talking about, you know, if you had location services on your phone, and you went and got pizza at Pizza Hut, and you said, Hey, I had three slices of pizza. And this was the Bolus. And here's what happened to my blood sugar afterwards, I needed more insulin and blah, blah, blah, then the next time you went back to that Pizza Hut, the location services would say, I'm at that Pizza Hut, where last time this happened. So this is how much insulin you should use for a slice of pizza. That's very doable. But somebody would have to do it.

Jennifer Smith, CDE 57:11
You don't I mean, somebody has to collect all the data to essentially teach it, how to navigate that you

Scott Benner 57:17
first have to teach it for yourself. But I'm saying someone actually has to go to the trouble of putting it together. And what I usually find is that the end users don't want complicated when it comes to diabetes. So if there's a big setup where I have to always wear a watch, that tells me where I'm going, or I have to remember to tell it, hey, this is Pizza Hut, and that's my local, like pizza place. They're different, like that kind of stuff. No one's gonna do that stuff.

Jennifer Smith, CDE 57:41
I would I would,

Scott Benner 57:43
I'll say something like I've done, I'll tell you something that I've very privately told any person who's ever come at me with a diabetes that and then like, can you tell me what you think of this app? I'll tell them all the time, the same thing? I don't think this is what people want. I don't think people want more involvement. Yeah, I think even if your app does what you say it does, you're not going to be able to get it widely adopted. That's good.

Jennifer Smith, CDE 58:07
I think that you looked at all of my questions somehow. Because that's actually, one of my last questions was, with all the tech and the info and the apps and everything that we have collecting? I guess, do you think it's created more mental health stuff in the diabetes realm, because

Scott Benner 58:26
won't change a goddamn thing. It's like everything else, there's 10% of people who are going to really pay attention to it, they're going to love it, they're going to use it, a small percentage of them, we're gonna go kuko nuts over it. And everyone else is going to just go like, I just shoot my land as it all works out. Like get it. I mean, like, people, again, are always the last speed bump. Right? So you're asking, Will AI get to the point? Like, it isn't a movie for diabetes? And I would say not in my foreseeable future. But here's the caveat, I do have a lot of hope about this. The way things are figured out now for medicine, like, you know, people become researchers, like not every doctor is that is see somebody with a stethoscope, right? Some people work in labs their whole life. Some people work very hard and do good work for an entire lifetime. And they're actually going in the wrong direction. And they don't even know it. They're just going through the scientific process. They're doing what they're supposed to be doing. They get to the end of their career, and they go, Huh, I zigged when I should have zagged How about that? And it's the amount of waste of time it's how it works. I don't see how it's not possible that in the next 10 years, we don't have AI, running tests, and and doing decade's worth of work in a couple of days in short time. Yeah, yeah. And saying, Oh, we tried that path. It didn't work. Throw that away do that or here's what we learned here. And to keep compiling it together, that I actually think is gonna happen

Jennifer Smith, CDE 59:55
as a time saver in research and information and bringing together faster you My

Scott Benner 1:00:00
lifetime, we're gonna see things happen with medicine that we didn't imagine because AI is going to be able to run the lab workforce, like, that's my expectation, and that that I actually kind of believe in. So none of us are gonna have jobs, if that works, we're all going to be button pushers, like or algorithm askers, or something like that, you'll be the vice president of, Hey, Siri, tell me, I shouldn't say that out loud. And so but like, you don't mean like, eventually, you'll just be able to run tests over and over and over again and validate them and validate them and validate them and come up with life lifetime's worth of work in in very short order, and then make some decisions that I'm hopeful about actually. And I don't think that's crazy to say, if I'm if I'm being honest, but these apps the way they are right now, they're gonna tell you, Hey, eat something to avoid a low or right you go for a walk right now for this many minutes, we think your blood sugar will fall this much. I mean, that's,

Jennifer Smith, CDE 1:00:55
again, they still require input from the user. And that's where it's the more factor in a lot of these, that could give you some, I guess, some decision tools, but you have to take the effort to tell it what you're gonna do, or what you've done in order for it to make enough and I guess, to gather enough to tell you what to do next time. And like you said, it's a great concept. But a lot of people it's just it's too overwhelming already know,

Scott Benner 1:01:25
we live in a society now where kids in their 20s Don't have sex anymore, because it's too much effort. Like if you can't put the effort into getting laid Jenny, I don't know how you're gonna put the effort into bringing down your fat rise on your, your pasta Bolus, right? Like, I mean, seriously, like, like, we're very insulated at this point. And people have a very high expectation that things are going to happen quickly, and just happen without a lot of input. And this is always because of all the variables we're talking about all the time. All these variables that impact your blood sugar, that the thing, the algorithm, whatever is going to need to know all these things are happening to give you back good data. And more importantly, companies that make money aren't going to put themselves in legal jeopardy by promising that if you forgetting to tell, if you saying there's 30 grams of fatness when there's really only five is going to give you a four unit Bolus that you didn't need. And then you're going to turn back to the company go hey, you're you're working. You're working on this machine tried to kill me just now. No one's gonna get involved in that. True. That's it. You want to fix people with diabetes right now in a way that is value fix people help people with diabetes in a way that's valuable right now. I'm not kidding. Two guys have briefcase full of money, fly to Russia find Ivan drag his ass back here and have him put his algorithm in your pump. And I guarantee you a year from now I'll be doing ads for your pump and everybody will buy it and that'll be the end of it. I fixed your whole game and I want a piece of that money by the way, damaged by

Jennifer Smith, CDE 1:02:50
give you the idea on a piece or find a piece

Scott Benner 1:02:53
of the money to Jesus, I just lost half my money just like that. All right, thank you. We're gonna do more of these because you and I are. Yay. I don't want to say during the recording because it will sound pompous. But I want to say we're very good at this. And I found this enjoyable. Yeah, we're gonna do more of this. I like okay.

Jennifer Smith, CDE 1:03:11
Yeah. Okay, bye.

Scott Benner 1:03:19
I'd like to thank ag one for sponsoring this episode of The Juicebox Podcast and remind you that with your first order, you're going to get a free welcome kit. Five free travel packs in a year supply of vitamin D. That's at AG one.com/juicebox Arden has been getting her diabetes supplies from us med for three years, you can as well, US med.com/juice box 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 of the sponsors. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days. With the ever since CGM you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juice box. 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. You have questions Scott and Jenny have answers. There are now 19 ask Scott and Jenny episodes. That's where Jenny Smith and I answer questions from the audience. If you'd like to see a list of them, go to juicebox podcast.com up into the menu and click on Ask Scott and Jenny. Actually, I think there's way more than 90 At this point, but you get the idea. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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