#1929 Fight Fire With Fire - Part 1
Fight Fire With Fire (Part 1)
Nick is 28, a professional firefighter, and has had type 1 for thirteen years. Part 1: diagnosis at almost-15, the teenage years he calls a rebellion, and how he turned it around in 2022.
Jump to a moment
- Diagnosed just before 15, with the family history to spot it. Three weeks of relentless thirst — an entire pitcher of water at dinner and still parched — until his mom saw how much weight he’d lost at a water park. An uncle with type 1 helped connect the dots fast.
- The teenage years were a stalemate. Nick describes clinic visits as being berated for numbers without being handed tools to change them — so effort and no-effort earned the same lecture, and he checked out. He’s candid that some of it was teenage pushback, too.
- 2022 was the turn. A new job he wanted, a rekindled relationship with the girlfriend he was dating when he was first diagnosed, a seven-year-old son to be present for, and an A1c he saw hit 9.4 — together they moved him from “better high than low” to actually dialing it in.
- Settings, a new pump, and a new attitude. A fresh nurse practitioner at the same practice gave him a clean slate. Scott reframes the base of it as timing, settings, and understanding food’s impact — with mindset as the thing that makes the rest possible.
- Type 1 doesn’t bar you from the firehouse. New York’s fifteen-week academy and annual physicals want stable glucose, an A1c under eight, and no severe lows — held to the same physical standards as anyone else. On shift, Nick often runs exercise mode all day and pre-boluses only a fraction, so a call never catches him with too much insulin on board.
- Hereditary Angioedema (HAE) — US HAEA — Background on the rare genetic condition Nick’s girlfriend manages, for listeners who want to understand it.
- T1D Exchange Registry — US residents 18+ with type 1 can complete the survey and help move T1D research forward.
- Diabetes Pro Tip series — The management foundation — settings, timing, and food — that underpins the changes Nick describes making.
Every word of the conversation
Cold open & sponsors0:00
Hello, friends, and welcome back to the juice box podcast. If you don't love today's episode, you can have your money back. Friends, we're back for another episode of the Juice Box podcast. This is a two parter. This is part one.
I don't forget to find part two. I think this one goes up on a Friday, so part two will be on Monday. What else I want you to know? T1dexchange.org/juicebox. Head over there now and take the survey.
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Say testing?
Testing.
You're good. Okay. I'm not gonna speak again. The next time somebody says something, it's gonna be you introducing yourself. So however long it takes you, and then just go ahead and start.
Meet Nick — firefighter, 13 years in2:47
Hi. My name is Nick. I'm 28 years old. I've had type one diabetes for thirteen years, and I am a professional firefighter.
Oh, cool. Nick, when you were 15, were diagnosed?
Actually, it was just before my fifteenth birthday.
Right there.
Not even a month before I had turned 15.
Oh, brothers or sisters?
I have two younger sisters. So I am the oldest of three.
Two younger sisters. Okay. Does anyone else have autoimmune issues in the family?
Yeah. So my mom has Hashimoto's thyroiditis. Mhmm. And her brother, my uncle, also has type one diabetes. And then we have some odd unrelated autoimmune in the family.
Like, my stepmom has MS. My step uncle actually had type one diabetes. But those are the my mom and my uncle are the big big two contending factors in the family.
Nothing on your father's son?
Not that I'm aware of. I think he has some minor psoriasis, but nothing else that really comes to mind. Okay.
Alright. Well, so let's talk about it. What made you wanna come on the podcast that I'm I usually don't start with that with people, but I get far fewer men. So I'm interested in what made you reach out.
Sure. So I actually only started listening about a year ago, I would say. And, when I started getting into it, I actually talked to my girlfriend about it and she
Nick? Nick? Hello? Nicholas? Nick.
Nick. Nick. Nick. Yep. Hey.
You started talking to your girlfriend about it, then you went blank. Sorry
about that. I must have hit something.
That's okay.
No. So I started talking to my girlfriend about listening to it and all about it. And then my birthday in March just rolled around, and she's like, so I didn't wanna do it, you know, without you asking you, of course. But she's like, I think it'd be really cool if you went on and shared your experience with how you've managed it and, you know, your job, and it's kind of a cool perspective. So
What did you think of that when she said that to you?
I was I don't wanna say really taken back. I was kind of surprised that she had thought of it that way, but at the same time, kind of not because she's actually really supportive of of me and my work and, you know, my diabetes. And she's honestly been somebody who's been in my corner with my care and making sure that, you know, I'm good about taking care of myself. And And she also lives with a chronic illness, so I think we both kind of understand the importance of being able to have space like, safe spaces to talk about these things and, you know, kind of feeling empowered to be able to function in normal society and still, you know, kinda kick butt while also dealing with all of her medical concerns.
Are you comfortable sharing her her illness?
I am. Yeah. It's funny. I actually talked to her about it before this all happened, and I'm comfortable with it. Yeah.
What what what is she dealing with?
His girlfriend’s HAE, and why he came on6:04
So she has it's a genetic illness. It's sort of rare. It's called hereditary angioedema or HAE for short. And, essentially, what that is is in most people with HAE, you have proteins in your blood. Your c one inhibitor is is the specific protein, And that essentially people with HAE have a deficiency in that protein, and it essentially causes extra fluid to leak into your tissues and it causes swelling.
Oh, yeah. Okay. And it can be anywhere. A lot of times people have it like airway swelling where it can almost mimic anaphylaxis, but it's not like an allergy based thing.
You know? You
can have it there. I mean, you can have it in your face. You can have it in your abdomen. You can honestly honestly have have it it anywhere. Anywhere.
Anywhere. Anywhere. And it's usually caused by either trauma or, like, stress or infections or things like that. So it can be sort of random sometimes, or I should say a lot of the time kind of out of their control when it happens. So it's kind of a a rarity.
Not many people have it. But
Does it impact her the same way every time? Like, you know, her abdomen, her face, or something, or is it different?
So she the way that she kind of explains it to me is that once you have a swell in a certain part of your body, you're more likely to have continuous or recurring or repeat swelling in that same area.
I see.
So she had has like, one of her tell signs is when she has a headache and she starts getting a little bit of, like, a droopy eye on her one side. And I'm like, hey. I think you might be starting to have a swell. You know? And she'll be like, okay.
And then she'll have to obviously watch it. And if it progresses, treat it.
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Yeah. So, there are prophylactic measures that she obviously takes. So depending on the patient and their severity, but she takes an injection, a subcutaneous injection once a month. It's a prophylactic, but when she does have breakthrough swells, she has different medications that are actually c one that that protein, they're like replacements.
Mhmm.
So almost think of, like, glucagon for us diabetics. Right? She can take a subcutaneous injection of that c one replacement. They also have an IV versions too that you have to go to the hospital for, but, but she can take those every so often, and that helps curb the swelling. It replaces the deficient protein, and then, you know, after some time, that swelling down.
As far as impact on her life goes, how does she describe it?
So, I mean, day to day, she does a great job. She, you know, has a busy job. She's busy, you know, helping take care of things at home. I I don't think day to day it has too much impact, but I think, obviously, when she has a swell, the day to day tasks can be, you know, very demanding because it takes a lot out of her Mhmm. Both physically and mentally.
Okay. So you think that somewhat based on her ex her health experience and she sees you interacting with the podcast and she thinks that it would be good for you to to come on and share? Do you think she thought that your story was just something other people would wanna hear? Like, do you do you see what I'm saying? Like, is she trying to help you by sending you here, or is she trying to help others by sending you here?
Honestly, I think a little bit of both, because there's been a lot of times that we've talked and, you know, she's like, you have a physical stressful job. A lot of people may or may not be comfortable managing, you know, a chronic health issue Mhmm. Working that type of job, or they might be selling themselves short because they don't necessarily feel that they could do it or might not even know that they're able to do it if they wanted to. You know? And I think kind of that whole overcoming adversity type thing for both, hey.
You know, you should be proud of yourself. You did this. But also sharing for other people, hey. If he can do this, you can do this.
Awesome. Know? Well, let's do that then. Also, I you will, at some point, undoubtedly hear me give you the tiniest bit of context that I have for the three years of volunteer firefighting I did between 16 and 19 years old. So I'm sure I'm I have my thumb on the pulse of firefighting.
I bet you. I'll know a couple of words, I guess, is what I'm saying. Okay. And and I'll I'll I'll I'll have had a few experiences.
Sure.
But okay. So let's go back to, you know, to right before your fifteenth birthday. Do you recall Mhmm. The diagnosis? And I'd like to know maybe not so much about the beginning, but what the next three or four years look like.
The three weeks before diagnosis12:17
Sure. Yeah. So, I just remember having this weird kind of new onset, you know, being 14, not really knowing too much, but, that I was, like, always thirsty and always having to, you know, pee or go to the bathroom a lot, especially at school. When I was in high school at the time, I felt like every period, I was going to the bathroom to fill my water bottle and to use the bathroom, like, once or twice in, you know, every forty five minute period. And I was just like, oh, I'm sure it's just, you know, me being dehydrated or something.
I kind of wrote it off. I really didn't think too much of it. So then at that point, it just kept kinda getting worse and worse and worse. And I remember as a family, we had gone out for dinner, and I was just beyond thirsty, you know, drinking so much water to the point where, like, everybody else was sharing pictures of, you know, drinks and water at the table. And I had my very own pitcher of water, and I drank the entire thing and was still thirsty, you know, just couldn't quench that thirst.
How long do you imagine this went on for?
Honestly, I think it had went on probably about three weeks Okay. Ballpark, if I can remember. The the tipping point to the to that story, though, is, it was February break during school, and we had went to a water park as a family because I was 14 and, you know, of course, no 14 year old wants to be around their parents all that much at that time. It was the first time that my mom had seen me, like, without a shirt on.
Mhmm.
And she had said to me, she's like, oh my god, Nick. Like, you look like you've lost so much weight. And I think once she had seen that and then started putting the other pieces together, she kinda remembered, I think, my uncle being you know, having those symptoms.
Okay.
So when we came home from the water park, we went to the pediatrician. They tested my urine and my my blood sugar, and, obviously, we were told right from there to go to the children's hospital, and I was admitted and
How is it? That. Yeah. Well, I thought you were gonna say you're at the water park and you're so thirsty you drank that terrible water.
But Oh, no. I I was thirsty, but I was that thirsty.
No one's that thirsty, Nick. Shocking. Do you remember what your reaction was to the news?
I think subconsciously, after the three weeks, I kind of knew something was up because the symptoms weren't getting better. Mhmm. I don't know if shocked was necessarily the word I would have used. I guess I was kind of surprised that it was that. Like, it wasn't necessarily on my radar.
Mhmm. But I don't remember feeling some big emotion about it. I think I was a lot more calm than people were actually thinking I was going to be, you know. I don't remember feeling, like, terribly sad or mad or upset about it. But
Did did the emotion ever come?
Maybe a little bit. You know, I I think it was more so later after the fact that it kind of came, that it kind of set in like this is a reality. Honestly, the first time I had had a true emotion after I had my hospital stay and I had come out after, you know, my my two or three days there, I remember my eyes were still adjusting from my sugar being so high. And I was so mad because I woke up in the morning, and I'm like, okay. I gotta count my carbs.
I'm learning how to do all that stuff. And I could not read the cereal box. My eyes were blurry, and I got so upset that I couldn't read the cereal box. And I remember I actually had to wear cheaters for a while until my eyes finally adjusted back to normal blood sugar levels. But that was, I think, the first time I'd actually had, like, a true heartfelt upset emotion about it.
And that's about your body not doing something you expected it to do?
Well, yeah. You know? And it was like it was almost like a like a crash out, you know, like, okay. I just got diabetes. I just got out the hospital.
Like, now my eyes don't work. Like, what the hell? You know? Again, being 14, 15 at the time, there was there was a lot of change.
Couldn’t read the cereal box16:53
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You know?
Yeah. Yeah. No kidding. So moving forward into high school, did you go to college afterwards? Did you go?
The vocational track into EMS19:16
So I did not. So I actually during high school, I didn't really love school, but I kind of knew kind of where I wanted to be, which is actually where I'm at now, which is cool. I actually went in my junior and senior year. Our high school does, like, a vocational program
Yeah.
Where half of the school day, you actually go to the vocational school and you learn the trade in which you picked. Mhmm. And then the other half of the day is, you know, standard typical high school.
We did we did two weeks on, two weeks off. It was fantastic.
Okay. Yeah. Yeah. That's that's sort of cool.
Yeah.
Because for us, it was your junior year, you went to vocational in the afternoon, and then in your senior year, you did vocational in the morning Okay. Half of your school day. So that's kinda how we split it up. So, when I was doing that, though, I was in the EMT program. We had an emergency medical technician class at our vocational school
Mhmm.
That I was interested in. So I took that, and then right out of high school between or just after my summer job of my senior year, I had, gotten employed full time, and I worked for an ambulance company a private ambulance company full time. So
Wow. That's awesome. But so going through high school, any trouble with your friends, your parents, your adjustments, your health, or was it smooth sailing, or how would you describe that time?
It was pretty smooth sailing. I actually had another sort of friend that before all this came about, we all were, like, volunteer firefighters together too. He actually had type one, so I was able to kind of see, like, oh, this is this is doable. You know? But there was a lot of other kids that knew I had it, but didn't necessarily really think anything of it.
Mhmm. And, obviously, it being around my family, like, hanging out with my cousins and stuff wasn't really a big issue. You know? But I don't think it necessarily affected too many of my friendships. I think it was more of a pain just trying to learn how to count carbs and, you know, having to take shots all the time because I was MDI back then.
Caused any issues for your I'm sorry. Did it cause any issues for your sisters? Did they feel, like, left out? Did they feel like you were getting more attention? Or did you Yeah.
That that's that's an interesting question. I remember my sisters, because they were younger, when I had gone into the hospital, I remember my mom telling me how upset they were because they thought something, like, terrible, tragic had happened. They really didn't understand. But I don't necessarily think that it affected them in that way. I think my parents actually did a pretty good job kind of keeping everybody in their own thing.
You know? Okay. Nick Nick has this, and we take care of this. But I feel like or at least I've never heard them say that they had ever felt left out because of it, you know, or or all the attention was was turned towards me.
Did you did you feel awkward because for that you had this thing and they didn't?
Not really. I mean, I also was a little bit older, so kinda being, you know, 15 years old, a teenager now, like, my parents were involved, but they definitely had a a more hands off approach, especially because I think they were well versed in it with the family history. And I don't know. I think I think it actually didn't cause as much issues because they did obviously help, especially in the beginning, but I feel like I kinda took on my own care a lot earlier than most people
in design, or do do you think you took it over yourself, or were your parents setting it up to to go that direction?
I think a little bit of both. I think my mom had knew that, you know, the only way that both her and myself were gonna overcome this, I think, was if if I kind of started leading in my own direction. I mean, don't get me wrong, 15 years old, I was not making choices that I'd be making now as an adult Mhmm. In terms of my diabetes, but, I think it was a little bit of both. I think she needed to be able to forcibly relinquish some of that to me Yeah.
So that she would have peace of mind that, hey. He's doing this. He can do it. He's gonna be okay. You know?
Berated at the clinic, no tools23:47
When when you say now that you're an adult, at what age do you think that that transformation began to happen? Do you have any idea what started it?
Yeah. So, I mean, I've always been on trying to to take care of myself, but I think I, like, truly kicked in to, like, high high gear only a handful of years ago, probably in 2022, which is when I got my current job and which is when I started dating my current girlfriend. So I think those are kind of the really big contributing factors. I mean, I've had kind of varying levels of success and varying levels of trying to keep things in line, but I think the the actual toughest, tightest that I've you know, Ben had started in '22.
Yeah. Do you have any context for what your outcomes were like fifteen, sixteen, seventeen, eighteen, nineteen, twenty? Like, do you know what your a one c's were, what your goals were, or how, you know, would how could you characterize or how would you characterize management?
Yeah. For sure. I I wish I remembered what my a one c's were, and I tried to look and I couldn't find them. My mom didn't remember either. Of course, she would take me to my appointments, but, I was MDI for a while, and I had always remembered just getting the normal talking to at the to children's clinic because we had gone to the clinic attached to the hospital for my endocrinology appointments.
And it was always, you know, you're not doing enough and, you know, your numbers look like this and like that. And admittedly, I do think that looking back, I could have done better. Mhmm. But I also think the environment wasn't really one of, like, education. They were kind of just you go in there, you know you're gonna get kind of berated for a half hour, and then it's over type thing.
You know? I didn't really particularly care for the endocrinologist that I used to see at the children's clinic either, but, so I don't think my outcomes were obviously as good as as I would like to have been or should have been. But, I mean, it definitely, you know, gets better with time and with age and, you know, practice and things like that too.
But your recollection is your recollection is going to the doctor, being berated. That's how you felt about it?
I mean, I think it was again, looking back.
Oh, Nick, you hit the button again.
Everyone's always yelling at you. Like, you know, it's always adults
first. Versus Nick, I'm stopping you because you hit the button again. You said looking you said that's okay. You said looking back, and then I didn't hear you again. So do that, though.
Like, you you should don't be sorry. Use your perspective now and tell me what you think was going on back then.
Yeah. Yeah. Definitely think it was just being a teenager, you know, it's there's always that that push against the authority. I definitely had some of that as a teenager. So I I think they were obviously trying to get me to have better control or control that they saw was better
Mhmm.
Than what I was doing. And I admit that even looking back, I remember feeling like, yeah, I know I can do better. But there was a part of it that, you know, was just kind of in that little bit of a rebellious state. You know, I knew I had to take care of it.
But So some some pushback against authority, do you think there was some shame? Like, the feeling of, like, I know I should be doing something. I'm not doing it, and then it just compounds on itself when someone points it out to you?
Yeah. For sure. I mean, especially sitting there in that office. Yeah. You know?
For sure that that feeling. You know? And there was also a lot of like, I look back though too and even even in terms of, like, adjustments, like, I don't feel like a lot of adjustments were made to my numbers. So then even when I was trying harder and I still wasn't having outcomes, they're like, well, obviously, you're not trying. And I was like, okay.
Well, I am. Mhmm. You know, I I am I'm trying, but I I feel like because they were always worried about, oh, the honeymoon this and, you know, you're still growing and all of that's very valid, but it was like, okay. I tried and still felt like I was getting the the speech, the talk. You know?
Yeah. And then I wouldn't try and I would get the same talk. So what was the point of putting in all the effort?
You know? So so you get the talk without any tools to make any changes?
For sure. Right. For sure.
And and now and and in fairness, you're not sure if you would have used those tools if you had them, but you are certain you weren't given them?
At in the beginning, absolutely.
Okay.
Yeah. Okay. Absolutely.
Alright. And then I'm sorry. You said there was a certain time a few years ago where you started to change how you how you thought of it and, I guess, how you stepped up for yourself. So do you have any idea what started that? Or is it do you think it's an age thing?
Or do you think it was meeting a girl? Or I mean, what do you think it was?
I mean, I I think it was honestly a combination of all those things. I think that I had finally grown up enough, I guess, personally, that I was like, this is kinda getting out of hand. You know? And, obviously, I had met her, which funny enough, not to backtrack, but my current girlfriend was actually my girlfriend when I was diagnosed with diabetes in high school.
The right person, the wrong time29:29
She was your 15 year old girlfriend?
Yes. So we were in high school and we you know, 15, it's nothing
Yeah.
Overly serious, but, like, we were, you know, dating in high school and I was diagnosed while dating her. So fast forward, we reconnect years later and here we are back again.
How do you reconnect years later?
Honestly, I think this was a really good case of the right person with the wrong time. Okay. I I think in high school, we definitely were just kinda hotheads and just, you know, young kids full of hormones, and I think she was definitely a good person. She comes from a great family. Mhmm.
But I just definitely think that it wasn't the right time. So we ended up kinda staying distant friends, and then down the road, we had just kinda reconnected
and again. Oh, when do the hormones stop asking for a friend?
I'm not really sure. I just feel like you wake up one morning and they're just different, I guess. I don't really know.
I know. I know. I felt like there's there's a time where you, I for me personally, like, I've had a couple of different seasons where I've woken up and thought, I'm just not as mad anymore.
Right. Right. Exactly.
You know?
Like Or or
I I just don't feel as aggressive anymore. Or Right. You know, I I don't
have to prove myself every waking moment anymore.
Yeah. Yeah. Yeah. I I I'm not I I mean, to be candid, like, I'm not spending an enormous amount of time trying to figure out how to see a boob. Like like Right.
When that goes away, man, when that goes away, it's, like, it's such it's it's such a it's such a relief. Right.
You're like, wow. That was actually low key a little crazy.
Yeah. Yeah. Yeah. Or or I'm just like, I guess I don't care that much what she thinks about me. This is awesome.
Right. She's mad. Okay. Okay. Yeah.
Got it. No. Yeah. You know, you you go through a ton. I mean, gosh.
I, it's funny because, you know, your kids always you know, like you said, there's always a pushback against authority against your parents, etcetera. Mhmm. And when it's happening on the parenting side, you're like, I don't understand why this is going on. Then then you look back and see yourself at that age, and you're like, oh, I was doing the exact same thing as that.
Right.
But what is when you're on the other side of it, man, it's like your context is way different, you're just like, this doesn't need to happen. Like, we don't really have to do this. Like, we could skip this part if you want. You know? And Right.
And that's not how it works. No. But okay. So you met each other. That's great.
How old were you when you got back together?
Jesus. I was four four years ago now.
24.
So 20.
24.
Okay. Yeah. Yep.
24. Well, that's that's nice. And I'm sorry. Before we started recording, you said something, and I don't know if it's not a thing you wanna talk about or not, but I I'd like to contextualize it if I can in this in this section of the conversation. But you have a child?
A seven-year-old son at home32:22
I do have a child. Yeah. He is, seven.
Oh, wow. Lives with you, lives with his mom?
So he lives with me. That's kind of a story in and of itself. He lives with me and my girlfriend full time.
Wow. Okay. Well, that's crazy. That's not crazy, but it's it's it's nice. Yeah.
Do you have any concerns about him, type one? Do you find yourself looking a little closer when he looks thirsty or something like that, or have you had him tested?
No. I have not had him tested, and that's not for any particular reason, honestly. I mean, I'm not for or against it per se. I really don't have any sort of kind of feeling about it. I've thought about it.
Yeah. I mean, I definitely look towards those things, you know, keep very being very vigilant if there's any, you know, signs or symptoms that he's displaying. But, hopefully hopefully, he, you know, comes out of it unscathed. But I I always think, you know, you're you're just gonna be super cognizant
Yeah.
Of it having it yourself for your kids. You know?
So it's a fine plan. You'll know what it looks like when it comes. That's for sure.
Yeah. For sure.
Do you think if he were to get it, you think it would make you feel any sort of way? Do you think you'd feel responsible? Or, like or do have you considered any of that?
A little bit. I mean, I don't know if responsible would be the way I would feel. I mean, obviously, there's a pretty good shot if he gets it, he's gonna get it from me. But I don't know if responsible's the way to feel. I mean, I would obviously feel bad because diabetes is hard enough for adults, let alone for kids to go through Yeah.
You know, especially as they grow and that kind of changes their life, you know
Certainly does. 10 years old. Yeah.
But I think the the good thing is though is that having lived it myself, I think it really gives a good perspective on what's acceptable and what's not in terms of care from doctors, even in terms of technology. But I think the technology, even since I was diagnosed thirteen years ago, has improved tenfold. It's gotten better, and we've gotten better pumps and better CGMs. And
No. I'm sorry, Nick. You're wrong. Listen to the Internet. All this stuff sucks.
Yeah. It's just horrible.
Yeah. Just doesn't work. Yeah. So, your technology that you began with back then, do you remember what you had when you were diagnosed?
Pumps, pens, and starting over34:53
When I was first diagnosed, I came out of the hospital with, you know, a a test kit, a blood glucose meter, and, insulin pens.
Mhmm.
And then I don't remember exactly how long after, but a little while later, I had started on a pump. My first one was the Medtronic. I think it was the Paradigm pump,
if I remember that correctly.
And then I had moved to, I think it was the six thirty g from Medtronic. So I'd moved through those. I didn't really they didn't really groove with me. I didn't really care for those. I especially did not care for the CGM with them.
So then after kind of falling by the wayside and, you know, not really taking perfect care of myself, kinda going back to pens again, kinda came back to it. I started on the tandem t slim, and then I even actually trialed the Omnipod
Mhmm.
For a while not long ago. I actually used your link. I got my free month trial.
Thank you.
I yeah. I then refilled the prescription. So I did it probably for about two months, but couldn't really get behind the algorithm. So I actually came back to the tandem and that's where I'm
at now. Oh, nice. I'm I'm glad you tried. Thanks. What about CGM?
What are you using for CGM?
I got the Dexcom g seven.
Seven. Okay. It's gonna go to the fifteen day, I think, soon soon enough. And then I I just listened to their investor call about the about the g eight. There's some ideas in there that are seem pretty attractive.
We'll see.
Yeah. I actually just listened to your episode that you'd put out about it the other day
Oh, thank you.
About it. Yeah. Yeah.
Appreciate it.
So So okay. It's definitely definitely cool. Yeah.
Yeah. Yeah. No. When you get to a point where you're saying to yourself, I've gotta do something here. What Mhmm.
Is it is it a one c? Is it how you feel? Is it like, what what's the thing that like, when you think something has to change, what is the thing you're thinking of that has to change?
A 9.4, and the decision to change37:04
Yeah. I mean, I think it was a combination of those things. My, you know, a one c's and before 2022 were definitely elevated. I had actually looked in, like, one of them was, like, a 9.4. And I'm like, yeah.
That that's not good. And I obviously didn't feel great because my sugars were elevated. And, you know, I had kinda just sat down between my girlfriend, Angelica, you know, talking with me about it and even reflecting myself. Like, I'm an adult. I finally got the job I want.
I have a child that I wanna be here for. I have a good relationship that I wanna be here for, and I feel like garbage. You know? Yeah. What are we gonna do to kinda fix those things?
So that's kinda when I really strapped in and
And then
really honed in.
What did you do? Because I finally get to ask this question because you already you already said that you've only been listening to the podcast for a a year, which is great because, seriously, like, a lot of times I ask this question, and I really do wanna know what people did. And then a lot of people say, well, I started listening to the podcast. But you're not gonna say that because you started listening a year ago, but you've made this change for yourself further back in time. So when you when you had this epiphany that you wanted to live and be and feel I wanna live, damn it.
When you when you when you when you had that epiphany from an eighties movie with, I imagine, Denzel Washington and a nice lady, When you have that epiphany, like, what do you what do you do? Like, how do you how do you identify the things you need to change? How do you get the tools together that you need? How do you make the decisions? Like, where do you start?
Sure. Well, I I just kinda told myself, like, enough of the bullshit. Like, it's time to be accountable for yourself. I went to my endo, and I actually had seen a new practitioner when I went back in 2022. So that kinda helped bridge the gap because I had had the same office, but I had had a new nurse practitioner in there.
So I was like, okay. New person. This is kind of a clean slate all over the board. Right?
Mhmm.
So when I just went in and said, I know. I've I've been in this situation before. You can berate me. You can say whatever you need to say, but I'm here. I wanna be accountable.
I really wanna dial in on my, you know, all my numbers. I wanna improve my a one c, my time in range. You know, I explained my job and and how that's gonna be even more important to me now. And, she had just kinda said, okay. So we'd really kinda honed in and and tuned in all my my numbers and then got me onto the the tandem not long after that.
And
Settings, a new pump, and different attitude.
Yeah. For sure. I mean, those are probably the big three things. I mean, I know people have their feelings about pumps versus MDI, but I definitely think no matter what it is you're doing, it's having the right settings. And lot of it's mindset, though.
You're never gonna be able to change something that you're not willing to change yourself.
I think it's I think it's settings, timing, and understanding the impact of the food. And, I mean, obviously, your desire to do it and, you know, that stuff. But I just mean, functionally, I think those three things are kind of the base of it. And you found a doc you found a doctor who did so you made a switch. Would you if you had this epiphany with the previous doctor, do you think it would have gone as well?
Well, I didn't necessarily switch practices. It was the same practice, but I had had a new practitioner
Oh, okay.
Inside that practice. Does that make sense?
Yeah. Yeah. Yeah.
So I don't necessarily know if it would or would have changed my outcome. I mean and depending on what I had brought home too, I might have even chewed on it and thought about it and said, hey. Maybe there's somebody in the office that I could connect with better if I was not having a good, relationship with that that specific person Sure. You know, who I was dealing with constantly. So I definitely think that could have been something, but I think it sort of worked in my favor.
And now her and I have a a really good relationship, you know, patient provider relationship, and we're really open with each other about things, and it really helps with management and making decisions.
I would imagine your follow through and success probably even emboldens her or him. Yeah. Yeah. Yeah.
I definitely think so. And, you know, there's been a lot of things in in having the the medical background because I am a paramedic, you know, I think that also helps because there's a lot of things that we can kind of talk about that aren't just scraping surface level anymore. We can kind of dive into some more, you know, probably more advanced topics than she can tell the the regular kind of layperson, you know, which is cool.
I would also imagine that, you know, when you do this all day long with people who maybe are not having success, you could probably easily get to start feeling like, you know, I can say this stuff, but it's not gonna matter. And Oh, 100%. Yeah. Yeah. And then once you see it matter, you might it maybe gives you a little more energy to say it again.
You you know? So Right. Yeah. You might you might be helping more people than yourself by doing that is my point.
Right. Kinda breaking the the cycle per se.
Yeah. A 100%. Okay. So how old were you when you just I mean, it sounds like you wanted to be a fireman for a long time. But but what's the process of so did you start out volunteering?
From cadet to career firefighter42:30
Yeah. So when I was in high school, our local area had, like, you know, the the junior firefighter cadet programs or whatever just to get high school age kids interested in it. I had wanted to do it a lot longer than that, but that's kind of where I started. So I did volunteer, and then my volunteering kind of went by the wayside after high school only because I didn't go the college route. I started working full time.
But, obviously, that experience came back to benefit me in getting the actual career, you know, firefighter role.
So I I wanna ask a question, but I don't wanna put you in a bad position.
Well, you can ask it.
Go ahead. You seem like a really bright, thoughtful person. Did you you. You're welcome. Did did you was it hard sometimes?
My my experience was that I was around a lot of good guys and a lot of solid people, but Mhmm. There weren't a lot of conversations to be had sometimes.
Is that In the in the fire service?
Yeah. Yeah. Yeah. Is that is that is that and now I've interviewed a number of firemen that have all always have been, like, really thoughtful guys. And so, like, was that your finding, or did you find a lot of people did you find a lot of similarity in personality where you I'm trying to figure out a nice way to say this.
Or or did you run into, like did you run into a problem of, like, not being able to I guess I should just say it this way. I had trouble meeting other like minded people such that it was it felt valuable to spend that much time in that scenario. Sure. Yeah.
I I can get what you're saying. I honestly, I think the biggest drawback from all that is, like, the politics side of it.
Oh, yeah.
I think that being there and having an interest in your community, I think that already kind of brings people together, I think, even different walks of life. I mean, you have a guy who works a desk job, you give an electrician, and you have a guy you know, you have all these different people in the volunteer service that bring different aspects of their lives, but you kinda come together and have this this common thing together at the firehouse.
You know? I agree.
But I think that in the volunteer side, because a lot of it's just different than in the career division and there's politics in the career side too, but I think the politicking in terms of who your friends are, who you hang out with is the group of people you're automatically associated with at the firehouse. You know? I think that's that's kind of the challenge there.
Then the running for positions and and
Right.
Chief and battalion and those sorts of things. And then suddenly, there's it it does get well, you're right. I actually I should have thought of it more like that. The politics was crazy.
Mhmm. And that's the thing. It was all about who you know or who you hang out with and not, you know, who's actually qualified and and willing and and able to perform these jobs versus when you come to the career side, you have to take a promotional exam. You have to interview. You have to have certain Mhmm.
Training classes to be able to hold, you know, leadership positions.
You know? So I would imagine as a volunteer, did you did you go to fire school? Did you or were you too young for that? Because I I think I went when I was 16.
So Yeah. So you can go when you're 16, but I didn't have a car yet. So getting to be able to go to fire school while I was in high school was kind of a challenge. So I had set up going just after, but then my parents were kinda like, listen. You didn't go to college and that's fine, but you're either gonna go college or you're gonna work full time.
Mhmm.
So I started working full time and that's kind of again where that had gone by the wayside.
I see.
But
But but my point is you had some training. Like, you had worn a pack, you'd crawl through smoke, you'd done things like that as a younger person.
Yeah. For sure. I mean, I definitely was not, you know, baptized by fire.
Guess. Right. So but you knew enough about it that when you said, like, I'm gonna become a professional firefighter, you you had context for what that meant.
Yeah. I mean, I had, you know, I had been around the the tools. I had I had worn the gear. I mean, I I had done, you know, in house trainings and stuff like that. I definitely had enough to say, like, this is something I still like.
This is something I wanna continue to do and do more of. You know?
Did you have hands on when you were volunteering, or or were you in the background?
I think I had some hands on, you know, obviously, because of my ages, at the time, I say hour because my and I had a bunch of friends with me too. But I I think being that age, you kind of do get put into the background a little bit just because you're kind of restricted as to what you can do legally. But, I mean, I tried to be as hands on as I as I could have been.
Yeah. I put out a couple of pretty cool fires when I was doing that. So, like, by my like, you know, sometimes, you know, when you're volunteering, sometimes nobody shows up. Yeah. You know, and once or twice, it's like a driver and me, and they look at you and they go, alright.
Well, let's go. And Right. Next thing you know, I'm battling a a full on car fire by myself in the middle of the highway. Right. Yeah.
Like, I was running the truck, and I'm like, I'm 18. This is insane. So but but, nevertheless, my my point is that you had some you had context for it. You decide you wanted to do it. You've got type one already.
Type 1 and the fire academy rules47:46
So when you when you say to yourself, I'm gonna do this professionally, like, what are the steps you have to take to even, like how do you even make sure that that's a thing that's okay? And then from there, you know, are there extra hoops to jump through as a type one?
Yeah. There's not a ton. I mean, every I'm sure every state and department probably has different standards. But, I mean, diabetes is not a condition that it completely excludes you from being a a professional firefighter, but there's obviously stipulations. I mean, they wanna see good, you know, glycemic control.
They wanna see that your numbers are stable. They obviously wanna make sure that you're not having frequent or super symptomatic or super severe hypoglycemic episodes.
Yeah.
And then every year to be an interior firefighter, volunteer, or career, you have to get a physical done. So they obviously recheck your a one c. And then usually, because you're diabetic, a lot of times they'll ask me to do, other tests. Like, they'll have my doctor maybe write a note that's saying, like, you know, in her standpoint, I'm cleared for duty, a stress test, like a cardiovascular stress test just to make sure that there's no underlying cardiovascular disease from the diabetes too. Mhmm.
So just kind of extra things like that, but, I mean, we're held to the same, you know, standards in terms of medical and physical standards that somebody without that condition would, would be, you know.
So when you started actually training, how long well, first of all, how long was the the the actual training?
Yeah. So where I'm from, New York State, we have a a fifteen week long fire academy. So you actually drive to the fire academy. You live there for your four days that you're training, and then you come home for a long weekend. Weekend.
Mhmm. So that's fifteen weeks that you're down there.
And what was the first thing that jumped out at you that your diabetes was gonna be in the way of or needed adjusting for, or did that never happen?
Probably not down there because, again, I'd gone to training in '22, and I was still kind of on that tail end of I was on MDI at that point, but I definitely was kind of managing it a little bit
Differently.
Less aggressively. Yeah. I mean, you know, definitely taking less insulin to account for physical activity, but not necessarily as calculated as I probably would be doing it today.
Okay. So back back then, was it better high than low?
Yeah. Oh, a 100. I mean, that was that was the mentality. A 100%, I'd rather have a high blood sugar and just not have to waste my mental space worrying about it at that point.
So were you Then you shooting for blood sugars when you were working in a certain range? Like, what was the range you cared about?
So I was kind of on and off with a CGM back then too. I mean, my range was probably, you know, one fifty, one eighty. I mean, I'm I'm sure that there was times that I was operating and exercising with blood sugars that were in excess of one eighty.
Sure. And and their their whatever their rigor was for your health, an a one c in the sevens was okay?
Yeah. So, I mean, the the fire academy went off of the department's personal physician's recommendation. So Once you got the they want you to I think the the standard is that they want you to have an a one c of under eight, if I remember correctly
Okay.
Which obviously is not, you know, necessarily the the end goal.
Yeah. But Optimal for you. But
Right. Okay for this.
Okay. Okay. Yeah. Alright. So so you managed it within the rules and and did your did your learning and got out.
Mhmm. How long does it take to get a job after that? And does anybody do you get any pushback from houses because you have type one?
Sure. So I actually the way it normally works, unless you put yourself through it, you're actually sent from your employer to the fire academy.
Oh.
So, you take your civil service exam, which is your written exam. And then depending on how high you score is wherever you fall on your list, you then have to take, you know, an oral interview with whatever hiring board that that specific department has. Then you've also have to take your physical agility test to make sure that you're physically able to perform job related duties. Once you pass all that and you get offered a job, they hire you. And then usually a couple weeks after that, once they get you kinda oriented, you are then sent down there and start your academy experience.
And then come back. Do you do you is there positions or are everyone just a firefighter? Like, I mean, you have trucks that are are, I would imagine, pumpers. Right? And you probably have a ladder.
Like, did does somebody assigned to the ladder, or can people bounce between trucks? Does it not matter?
Yeah. So I think every department kinda does it differently. I work for a department in a little bit of a smaller city. I mean, we're only, like, just under nine square miles. We have, like, 20,000 people in our city.
Everybody needs to do everything? Correct. We
a lot of bigger career departments will have specific jobs where you do the same job until you bid out of it. For us, every shift we go in, it actually rotates. Sometimes you work in the ambulance as a paramedic. Sometimes you're driving the fire engine. Sometimes you're in the back of the ladder truck.
So Mhmm. It's kind of fluid, but it's also nice because it kinda gives you the ability to do it all. You're not just stuck doing one thing. You kinda get to do all the aspects of the job.
Riding to the call — dosing for chaos53:30
Yeah. Tell people how invigorating it is to drive fast in a giant truck while the horns are blowing and a siren's going off. It really does get your adrenaline going.
It does. Yeah. Honestly, sometimes sometimes driving is is more of an adrenaline rush than getting ready in the back because
Yeah.
When you're going there, there's just there's some like, things are just moving quickly. It's loud. It's chaotic. People are screaming at each other. You know?
Yeah. It's it's definitely an adrenaline rush for sure.
It it it it is a thing that I don't know that you could explain to another person about, like, you're sort of in your gear already, but you're on your way to something and you're not really sure what's happening. And then suddenly, like, the word comes in, like, something's happening. And you're suddenly you're you're you're putting on breathers and you're, you know, you're pulling your hood on and you're like, oh, this is really happening. Like, we've gotta do this now. And you're doing it in this tight spot riding in this truck and, you know, there's giant engine just screaming.
Nobody can hear anybody. And and you know, like, at some point and often, by the way, times, you're riding backwards, so you can't see when you're there yet, which I always, like, contextually, like, I was like, are we there? Like, how much more time do I have? You know? And then you roll up, and then you hop off that thing.
And sometimes you look up, and something's on fire. And you're just like, okay. And then boom. It just turns into a dance. People just go do a thing, and it's pretty magical actually that that, you know, a bunch of a bunch of people who are who are willing to do this to begin with, pull it together, and, like, make something like that go so well afterwards.
So Right. I don't know how to another way to think of it. And when they're all volunteer too, man, it's not lost on you that a school teacher's driving the truck and some guy's grandfather is, you know, the chief on the scene and, like, these are not this is not their job. You know? Like, I we we used to have a guy like, there was an insurance salesman.
He was running most of it, and he was great at it. It was Yeah. Really something. And, you know but, obviously, different levels of professionals. But
Sure.
But but really I mean, it's in it's invigorating, man. You get there and you're at a 10. Now does your blood sugar jump when that happens?
Usually. Yeah. So, usually, it does a little bit, and then it kind of, you know, levels back out later because you got physical activity that you're doing. You know? So you're using your sensitivity for insulin goes up, and whatever glucose you got in your body is obviously getting used up.
So but definitely I mean, I've definitely looked at my graphs, like, after a fire. Mean, like, oh, yeah. That's exactly when we got sent to that. You know? If you're you're looking and it goes up and then it's coming down and you know?
Well, I mean, in a world where I can see on my daughter's graph when she's taking the test or she's arguing with a friend, like, you know what I mean? Like or something like that. Like, in a world where you can see that sometimes, I imagine this is something again, people, you have no idea that a truck is just it's a massive heavy thing, and it you are flying, and it is screaming, and people are talking. And it's it's all and you're putting on this stuff and, you know also, if you've never been inside of a burning building, it's something else. Like Yeah.
Yeah. There's it's this is another level of life you're not aware of if you've never done that before. It is intense.
Yeah. It's it's almost like sensory overload sometimes, you know, because you physically feel things, you hear things, you see things, then you're you're growing up on it, maybe you can smell it, and then you go inside and you lose half those senses. Mhmm. You know? And you come back out and you get them all back again.
So, like, even on a on a nine diabetic standpoint, just on a regular human body standpoint, like, having all of your senses come in and out at different times is is is kind of almost like a like a holy cow. Like, what did I just do?
Yeah. I had a lot of different impacts. And all of a sudden, you're climbing a ladder. You're hanging off I mean, you're half hanging off a roof, cutting holes and grooves, and, like, you're just like, what is like, man, this is this this got real, real fast.
Yep. For sure.
Or or then days can go by, I imagine, too. Like, so so how do you even balance your insulin for that? Because you don't know you're gonna get a job that day. And and Right. The rest of the day could be nothingness.
You could be riding from alarm system to alarm system all day long.
And Right. Exactly.
Right? So what do you do?
So I I mean, the best thing that I do is a lot of times I'll put my pump into exercise mode for my entire shift, just to kinda help cover the the demand. Because, again, like you said, it could be we sit around and have lunch and do some training and hang out
Mhmm.
Or we're busy taking call after call after call. Yeah. So kind of putting the pump in that that mindset of, hey. I wanna ride a little bit higher. I want you to be a little less aggressive with my basal insulin, you know Mhmm.
Is definitely, a big key contributor.
Do you ever do you ever eat and then get a call and think, oh god. I have a ton of insulin on board. Like, this is a bad time for this?
Yes and no. So that's kind of my one compromise at work is that I will still try my best to pre bolus because I know it's important, but I'll only pre bolus maybe a fraction or only take enough insulin where I, like, I know, okay. If I get a call right now, I can eat half this sandwich, let's say
Mhmm.
On my way downstairs to, you know, to go get my gear on and stuff. So I'll only take enough insulin to at least cover that so that at least I know, hey. I don't have a ton on board, and then I'll obviously finish my meal and take the rest afterwards.
Yeah.
Sometimes that works okay. Sometimes it's not as optimal as as being home and having a nice, you know, ten, fifteen, twenty minute pre bolus for food. Sure. But I would also rather be safe at work for myself and for the guys I'm working with.
Done yet.
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Best parts come and you're not done yet.
Part two, right there in your app. Go on. We'll wait. Same app, same show, don't you fret.
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The best parts come and you're not done yet.
To learn more and see if you might be able to get Twist from the pharmacy and try it for free, head to visit.twist.com/juicebox. That's visit.twist.com/juicebox. Or give them a call at 18774. That's +1 (877) 489-4478 and tell them Scott sent you. Twist requires prescription and is indicated for people with type one diabetes six and older.
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#1928 Bolus For: High-Sugar Drinks
Bolus For: High-Sugar Drinks
Scott and Jenny Smith take on the drinks people forget to bolus for: regular soda, milk and chocolate milk, juice, and the sugar hiding in powdered lemonade. A liquids-are-rocket-fuel edition.
Jump to a moment
- Liquids get overlooked — and they hit fast. Scott’s whole premise: people bolus for the meal and forget the drink. A can of regular soda runs mid-40s in carbs, all sugar, and Jenny’s guidance is to pre-bolus hard and consider a short walk after, because liquid sugar absorbs faster than a teaspoon of the solid kind.
- Fat and protein soften the curve. Whole milk (about 12g carb, 8g protein, 8g fat per 8 oz) rises more gently than skim, where there’s nothing to slow it. Higher fat means a flatter rise — but it still needs a pre-bolus, not none.
- The “healthy” chocolate milk can be worse than soda. A 14 oz Nesquik carries 41g carb and 39g sugar, roughly a soda’s sugar in a bigger package. By contrast, ultra-filtered Fairlife cuts the natural lactose sugar and boosts protein, which changes both the number and the strategy.
- Eat your fruit, don’t drink it. Grape juice lands near 59g carb for 12 oz — Jenny pegs a grape at roughly a gram of carb each, so a glass of juice is dozens of grapes with none of the fiber to slow it down.
- The hidden-sugar finale. Scott does the math on the powdered lemonade of his childhood: a gallon is around 277g of sugar, and it would take only about eight gallons to equal a five-pound bag. The lesson lands as comedy, but the point is real — the drinks around the food often carry more sugar than the food.
- Bolus For series — Scott and Jenny Smith work through how to bolus for specific tricky foods and drinks, one at a time.
- Diabetes Pro Tip series — The management foundation behind the show — pre-bolusing, settings, fat and protein, and more, with Scott and Jenny.
- Small Sips — Listener-voted, bite-sized takeaways on insulin timing, carb management, and balancing highs and lows.
Every word of the conversation
Cold open & sponsors0:00
Hello, friends, and welcome back to the juice box podcast. I've been asking for a week and a half now. Have you gone and filled out the t one d exchange survey? Please do. 18 and over, US citizen, have type one diabetes.
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You'll find those links in the show notes of the podcast player you're listening in right now and at juiceboxpodcast.com. Today, we're just gonna pick a couple of difficult drinks and do them all at once.
The premise: liquids we overlook2:08
Oh.
I'm gonna and regular soda. I wanna do
That's good.
I wanna do milk and chocolate milk. I assume that will also encompass hot chocolate, but that's it, really. I just think that these are things people drink, and they need to know how to bowl this for them. And I'd like to talk them.
And chocolate milk.
Don't you think? Are they not different?
They are different.
That's why brought
them all. Yeah. No. It's it's great, but it's it's just an interesting simple thing.
It's very simple, but I don't think it is because well, because I think that we have a a propensity to overlook liquids and condiments when we're bolusing. And so True. I I really do think that. Not that not that, you know, soda isn't pretty obvious. Right?
But still, let's talk about it. So I'm gonna I'm gonna just do the thing. I'm gonna go to the thing, the machine. And I'm gonna ask you, what if what if I'm just gonna have a soda? That's it.
Blood sugar's good. I'm I'm I'm I'm walking around my house. I'm gonna open up a 12 ounce can of something and drink it. Is it going to, like, spike my blood sugar for sure? Like, put this person in a specific situation.
Let's make their blood sugar a 110. It's been nice and stable for a while. They're on an automated system and or they're even who cares what they're on, really? They've been nice and stable for a while. They're thirsty.
They're gonna grab a soda. Prebels
A regular soda. Regular soda. Clear.
Sugary sugaryific soda. Pick your favorite. Sure. Have you ever had a soda?
I have had soda. Mhmm. Yes. Of course, I've had soda.
Yeah. In '78? When was it exactly?
Pick a soda. Oh my goodness.
Favorites? Pepsi?
I would have picked I will tell you, I would have picked not a cola type.
Okay.
I would have picked what is it Sunkist?
Really?
Is the orange soda? So and there's, again, there's always a story to something. Right? But my short story is that my grandfather always had a refrigerator in his garage. He had a dairy farm.
And for all the help like, he always had a a cooler or a fridge that had was stocked with drinks. Sunkist was one of them. And my cousins and I and my younger brother, we would usually, we were supposed to ask to have the soda from the fridge. Right?
Special soda.
Right? Special soda. Mhmm. But we don't just, you know, sneak in the garage and, like, grab a can and then go out behind, like, the the chicken coop and, like, drink it.
Other kids are smoking cigarettes. Jenny is stealing a soda. Go ahead.
I'm stealing a soda, but it was sunkissed. Like, that was the favored one of of my three boy cousins and myself and my younger brother. Mhmm. And then when I found out I had diabetes, my grandpa clearly knew what we were doing, and what showed up was diet sunkissed.
Oh, your grandfather changed over the refrigerator for you?
Part right. He always made that as an available sneak. And he kept the other ones in there, but he always made sure to have a diet in there because he knew that I needed that.
Well, isn't that nice? Did you how old were you when that happened?
So, gosh, I mean, I was diagnosed as a, 13 year old.
Do you remember that feeling loving
to you? I do.
Yeah. Absolutely. Did he ever mention it?
Did he ever mention it? You know, I don't think that he did. I can't remember that as
a cry while we were trying to talk about ballet soup for soda. That's so nice.
But I you know, it's just it's the reason I would pick sunkissed is mainly because that's my memory of it, And that was my, like, flavor or grape soda. I like the fruity flavors for whatever reason.
Yeah. Yeah. I'm with you.
Not like the cola one.
Well, let's go with Sunkist.
There you go.
I have a 12 ounce can. That's such a nice story. We have a 12 ounce can of regular sunkissed orange soda. It is 41 carbs.
Yep.
Yep. 41 added sugar, grams as well. Sodium, sixty five milligrams. There's obviously no fat or protein in it, and there is caffeine, nineteen milligrams. But after talking to somebody who had a was telling me how much was in a Monster Energy drink, I now don't think that's very much caffeine at all.
No. It's it's not. It's actually less than most tea.
Yeah. It's a a small amount. Yeah.
Yeah. It's a small amount.
So okay. Blood sugar is a 110, nice and stable. It's hot outside. I want a soda. Do I just go 41 carbs and wait, or is it gonna get on top of me no matter what?
Soda is rocket fuel — pre-bolus hard7:12
It is. It's all sugar. You said 41 of carb, 41 of sugar. That means this product is literally like taking teaspoons of sugar and putting it in your mouth, only it's in liquid form. And liquid absolutely gets absorbed faster than a teaspoon of sugar does.
Okay. So it's just rocket fuel?
It's it it is. Absolutely. You will see a change in your blood sugar if you do not pre bolus the crap out of this. You are can I say that?
Sure. You can. One me just did, but sure.
Okay. You have got you have got to really pre bolus this, and you're starting at a nice number. One ten. You're nice and stable. You whoever whatever you did prior to this may add into, but you still need to pre bolus this.
And are you gonna 41 grams of carb is no joke.
That's a lot. Also, I'm That's a lot. As you're talking, I'm now mesmerized by this. This is the number. 41 for the Sunkist, 41 for Pepsi, Mountain Dew, 46, Barq's root beer, 44 to 45.
Like, this is the number. You want
mid It is.
Yeah. Mid forties for a can of soda. Can you believe the number one prescribed automated insulin delivery system is now even better? Omnipod five is now stronger than ever with algorithm updates, including a new lower one hundred milligram per deciliter target glucose option designed for more time and range and with fewer interruptions for more time in automated mode. That's right.
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The Dexcom g seven is sponsoring today's episode of the podcast, and it features a lightning fast thirty minute warm up. Thirty minute warm up time. That's right. From the time you put on the Dexcom g seven until the time you're getting readings, thirty minutes. That's pretty great.
It also has a twelve hour grace period so you can swap your sensor when it's convenient for you. All that on top of being small, accurate, incredibly wearable, and light. These things, in my opinion, make the Dexcom g seven a no brainer. The Dexcom g seven comes with way more than just this. Actually, up to 10 people can follow you.
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Links at juiceboxpodcast.com to Dexcom Omnipod and all the sponsors. But you can remember it. Dexcom.com/juicebox. Check it out. Mhmm.
Okay.
Can you contain the spike?10:13
A 100%. And it's the hard thing is to acknowledge one that we are looking for any carb intake. It's gonna create a rise. With something like this, it's gonna create a pretty significant rise. And your question is, do we just bolus what our insulin to carb ratio would dictate we need?
Do we bolus more and wait even longer? Do what what do we do to mitigate the impact this is going to have?
Yeah.
It is an experiment for yourself unless you've had the experience before and you can draw from that. This one time instance is gonna be your best thing to do is pre bolus and drink the soda and see what happens and then possibly go outside for a walk.
We're not gonna see one of those, like, lollipop situations where you it pops up and pops back and comes back down again. This is soda's gonna take you up, and you're gonna stay there after that.
It's it's gonna come up. I mean, there's nothing really holding up when we have carbohydrate intake or sugar intake. The rise and fall is meant to be to mimic or go along with how our insulin action is. Mhmm. But this is very quick sugar, so the intake of it is gonna create the rise, which we're gonna try to contain because of the pre bolus strategy.
And then on the back end, it's not really going to linger if all the settings are correct Yeah. And our bolus ratio is correct. It should bring us back down despite us going up quick.
Okay. And I'm gonna ask you what I imagine to some people will be a controversial question. I don't mean it that way. Gun to your head, you have to drink a soda. Would you drink a regular soda with sugar, or would you drink forget your diabetes for a second, or would you drink a diet soda?
Regular vs diet: the ingredients debate12:11
Without diabetes in the picture?
Just I'm asking about, like because people argue about this all the time.
Yeah. I I mean, from a caloric standpoint as well as from a a sugar standpoint Mhmm. Even without diabetes, I'd probably drink the diet soda, but it's hard to forget what I know.
And you know what? There's a lot of chemicals in it?
There are a lot of chemicals in both of the products. Whether it's regular or diet, it it's all chemically made. There's nothing natural. You don't go in the field and pick a can of soda. Like, there's there's nothing natural.
Only, Jenny. Because then your grandfather wouldn't have even needed that that refrigerator. You could just pluck it off the off the vine.
There you go.
So wait. Okay. Let's take a second here. List all ingredients in a Pepsi and a Diet Pepsi. Because this is the argument online all the time.
People are like, you can't drink sugared soda. We have diabetes, blah blah blah. And somebody says, oh, it's better than all the chemicals and the other thing, and then they argue. It's like it's like a it's a gimme for the Internet. If I wanted to put a post up right now that reached 30,000 people, I would just make that argument.
It would pop off in two seconds. The algorithm would love it. Send it on its way. Regular Pepsi ingredients, carbonated water, high fructose corn syrup, caramel color sugar, phosphoric acid, caffeine, citric acid, natural flavor. Okay?
Mhmm. Carbonated water, and this is diet, caramel, color, aspartame, phosphoric.
Is essentially NutraSweet.
It's it's
a sweetener.
Phosphoric acid, potassium, benzoate to preserve freshness, caffeine, citric acid, natural flavor. Oh, hold on a second. Asulfamane potassium?
Asulfamane potassium is another type of sweetener similar to aspartame or sucralose or what it's it's a chemical based non nutritive sweetener, and it's often used more in drinks like this. I can't remember exactly the chemical reason, but it it's sweetness supports the flavor a little bit better than other types of alternatives. Okay. Now you didn't ask me what kind of diet soda
I would choose. I went Pepsi diet host. You would pick something with, like like, doctor Brown something or other, or am I getting close?
Doctor Brown.
I don't know.
Do know that brand a 100%.
I know you.
I would actually pick Zevia. Zevia? Yes. Z e I a.
What's it got in it then?
So it's sweetened with stevia and monk fruit. Some of them. It may not many of them may not have monk fruit, but, it's stevia monk fruit. So it is alternative sweetener that is not chemically a 100% creative.
Am I gonna drink it and think that I just lick the the floor, or what is it? Is it good?
No. You're not. Okay. In fact I mean, when we have when we have soda, like, a root beer float for, like, a special something that I'll make, I absolutely get the Zevia root beer.
Mhmm.
And it is quite tasty. It's all clear, so there's no caramel color
Yeah.
Which you can see in regular Pepsi and Diet Pepsi. Many of these ingredients are very much similar.
Mhmm.
Right? There's not a lot of difference, outside of the aspartame and the sulfate potassium.
Do you agree with, Chad GPT's breakdown of the question, does diet soda cause cancer? No good evidence says diet soda causes cancer in normal use. The best plain English answer is probably not, but don't drink endless amounts of it. The scary
always the answer.
The scare mostly comes from aspartame, which in many diet sodas in 2023, the, let's see. WHO cancer agency IARC classified aspartame as possibly carcinogenic to humans based on limited evidence. But another WHO FAO safety group, the JECFA, reviewed the same issue and kept the acceptable daily intake at forty milligrams per kilogram of body weight per day, who gave the example that a hundred and fifty four pound adult would generally have to drink around nine to 14 cans of diet soda per day depending on the aspartame content to exceed that limit.
Right.
Yeah. I think some people will drink that much soda every day.
They may. Yeah. But they also this is a it's a bigger consideration than just soda or diet soda. Right? The bigger consideration is that with diabetes, many sugar free products come into your or or could Mhmm.
Come into your day to day intake. So your soda intake is not all you're going to get with these artificial sweeteners in it. You may have candy products, you may have baked products, because now we have a whole host of low calorie or no sugar or even some of the keto types of products that are on the market, which they may be great blood sugar wise. But you did the equation, right, of this person who can get this much, can drink this many cans. Nobody's going to do that math.
No way.
You're not keeping track of the amount of, in this example, just aspartame daily that you're intaking and by 02:00 in the oh, I've had my limit. I can't have any nobody does that.
Soda's over now. No more soda today.
Right? So
Yeah. Now I'm gonna have water. No. So I've asked my next question that I see in this argument. Do artificial sweeteners make you hungry?
So it's what do you think
about it say? Well, I am curious because my consideration and what I typically have coached, and I I did do some weight management coaching years ago Mhmm. And still, you know, in somewhat in some of the stuff that I do. But when you are filling let's say your body is hungry and you don't want something caloric, but you wanna take away by putting in a film, like a fullness factor, something in your stomach. And liquid does a good job with that.
But when your body really does need something caloric, when you put in something that is false in calories, your body still craves the calories it was looking for. You may have a fullness factor for a bit from the liquid, but you end up still craving something that has true calories that your brain can acknowledge, Oh, I have been fed. I can turn this piece off. I mean, there are a whole bunch of hormones in the body that we've got that indicate fullness versus hunger, and they do get dysregulated in somebody with diabetes to begin with. And then you add in a lot of, like, sugar free beverages, which in whatever realm you're drinking them and whatever the sweetener is, whatever, they're great as a additive for hydration.
Mhmm.
But you really shouldn't be taking these in to replace calories that your body does need. Okay. And in that, absolutely, these types of products can make you more hungry because you're not putting in food when your body's really telling you, hey. I'm hungry.
Yeah. Your body wants or needs calories. You're tricking it to thinking other that it got some, and then it realizes no, and then it still asks you for more food.
And then by then, you might be more hungry, so you might put in more calories than you would had you just eaten an apple and, you know, a piece of string cheese, for example.
Yeah. Okay.
So I'm curious what, your friend chat GPT has said.
I he agrees with you or she. I've never I've never I've never asked her preference.
But That's why I said, dear friend.
Most people, artificial sweeteners do not seem to create major hunger effects by themselves. But a cleaner answer would be that compared with sugar, they may leave you less satisfied because you got a sweet taste without calories. Compared with water, they usually do not clearly make people eat more. A 2024 review of randomized trials found that non nutritive sweeteners when replacing sugar were linked with about a 175 fewer calories per day on average. But when compared with water, they are not associated with a significant change in total cal caloric intake.
So I I guess it's the feeling that it leaves you with, like an unsatisfied feeling
Right.
Which which is where the question that people say it makes me hungry.
Yeah.
Yeah. So it gets oversimplified into diet sodas make me hungry. Gotcha. Okay. The stevia soda, by the way, carbonated water, natural flavor, stevia extract, tartaric acid, caffeine, citric acid.
Mhmm. And they must have maybe they did. Maybe they took monk fruit out. I know it it was in there at some point. Maybe it's not in there any longer or maybe it's in some of the flavors.
Yeah. But
they're all pretty good. I've had I've tried many of the flavors.
I met a man a couple of years ago who was thinking of buying ads on the podcast to launch his, natural soda company. Oh. Yeah. I don't know whatever happened to him, But he was on it. Was doing it by himself.
Sent me some samples. Some of them were pretty good. A couple of them I didn't like. But it was it was interesting. I don't even remember the name of it to be able to check to see if it it actually took off or not.
Nevertheless. Okay. Let's jump to milk. They say it does the body good. I heard it in a in an ad when I was a kid.
On to milk — does the fat matter?22:15
Yes.
I think that was just an ad from people who sold milk.
But Probably. The dairy industry.
Yeah. They were like, hey. It's great for you. I swear to god. Is it good for you?
Is it would you drink milk? May I guess?
You may guess.
There's no way you drink cow's milk, but go ahead. I'm asking now.
I don't I don't drink cow's milk any longer. Yeah. I don't drink cow's
milk. Is there any connection to the fact that, like, inside when I was a kid, girls started developing it earlier, and they used to say it was from cow's milk, hormones in cow's milk.
Well, they yeah. And I don't know what studies have proven relative to that, but it is a reason that we now have the non hormone treated dairy types of products, and they're clearly labeled as, you know, dairy cows didn't have any hormonal whatever. Mhmm. In general, is milk it's a caloric, I guess, piece that does contain all the macronutrients.
Okay.
Especially regular whole milk and even 2% milk, and if 1% if you can find it. They have carbohydrates, They have protein. They have fat. They're a they're a pretty complete type of food product Mhmm. If you're looking at it just from the macronutrients.
Yeah.
I mean, there's also calcium in it. Right? So is there quality in milk? Sure. If you're just breaking it down to the nutrients, there's quality in the milk.
Are they adding stuff to the milk or to the cows or to the feed? How does it get to the milk?
Yeah. I mean, it's all based in general, our cows eons ago compared to the cows that we have now. If you take care of dairy cattle, you are you're taking care of them because they are your breadwinner.
Yeah.
Right? And so you depending on what you're using and what type of feed or whether they are grass fed instead of being grain fed, I mean, there's a whole bunch of different thoughts on the quality that you get from the milk and then even from, like, grass fed beef comparative to non. There is there's a difference when you look at the product that comes out.
How it gets out. When I
was a
I would, my dad would drive to a place a few blocks from where we lived, and you'd walk in, and they they were milking the cows right there and selling the milk. Like, just like that. That place, by the way, that farm is a seven Eleven now. But Oh. Yeah.
I'm so I'm so sorry to say. But that's how we used to get it back. Was it even pasteurized, I wonder? Or or were we it's interesting.
I would expect that they probably have
do that. Yeah. I wasn't drinking it
wrong though. With in the farm, I'm sure that they did. Yeah. I mean, I I loved my grandfather's dairy farm. It was it was so much fun to go to.
We had fresh milk all the time when we went there, so it's not like I've never had milk.
Yeah. I
grew up drinking milk.
Whole to skim, and why fat softens the rise25:39
Here it is. Whole milk, 12 carbs. Actually
Mhmm.
Whole milk, 2%, 1% skim milk, all have 12 carbs. Yep. I have it as an eight ounce glass. Protein, all eight. The only difference really is the fat.
Yeah. Whole, I have it 2% at 1% at two and a half, and skim milk, zero.
Right.
So that's it. They're just they're skimming the they're literally skimming oh, skim milk. They're literally skimming the fat out of the milk.
They are.
Never thought of that before. Never thought In my life, I didn't realize that's why skim milk was called.
That is so funny.
Look at us learning. Okay. Well, me, the rest of you are like, yeah, dummy. But, so are we does the fat in the milk change the bolus?
To some degree, if you consider the breakdown in whole milk, right, eight grams of fat and 12 grams of carb and about eight grams of protein, the protein and the carbs are the same. But when you add fat, as we've talked about so many times before, there is more of a stabilizing effect. And because the fat in this is almost as much carb,
Yeah.
You would have a lighter effect of whole milk. The same thing with whole milk yogurt and any of those types of dairy products.
Mhmm.
The higher the fat, if there is carb in it, the more stable you should see. Doesn't mean you don't need any pre bolus for it.
Yeah.
But it still will have lower effect than something like skim milk where there's no fat in it at all. There's nothing.
I'm trying to decide if my reference is so old that I shouldn't make it. But if you think about I'm gonna see how much of this you get if I just say it like this. If you think about Laverne de Fazio and her drinking and her drinking milk and Pepsi in a little television show called Laverne and Shirley in the seventies, She would take milk and Pepsi and mix it together. Is that the perfect low treatment drink for a type one? Oh.
Is it possible? No. Because that tastes good.
Well, because it would have bad imagine.
You can't imagine. Because it would have the zhuzh of the sugar, but not as much of it with the milk and the fat. I don't know. Please report back if anybody's drinking milk.
No. That is very interesting. I I would have never thought of that reference. I do know it, but I would have never.
Are there three people who know what I'm talking about? Probably not.
Oh, there have to be more people who know what you're talking about.
While you were talking, I I asked about my question, and it just goes to show how things can get out into the world and not be true. I asked, do hormones in cow's milk cause early breast development for young girls? And it says, probably no. Cow's milk has not been shown to cause earlier development, blah blah blah. Concern makes sense because milk naturally comes from out of hormones.
A large US prospective study, 5,500 girls, found that milk intake after age nine did not predict earlier first periods. In comparison, the drinks the girls drinking more than three glasses a day versus one point one point one to four glasses weekly, intake did not significantly predict age. Yeah. This this is just a thing somebody said out loud when I was at an age I heard it, and I thought it was true. The Internet.
It really does.
Wonder too if this reference is to more recent
milk. No. It was something I heard when I was younger. So it's just somebody going like, you know what I've noticed? And then, you know, it's probably this.
And then people said it, and we didn't have any way to check back then. So Yeah. People were like, you know what I heard? And then I said it thirty five years later. But I checked.
You checked, and you got a reference.
Yeah. So, anyway, that's not that. Alright.
I wanted to bring in from a milk perspective.
Go ahead.
Chocolate milk and the Nesquik trap29:43
So what about another kind of milk, chocolate milk?
Oh, I got I got the the Hershey's chocolate right here. Hold on a second. You're gonna know this off the top of your head probably. One tablespoon of Hershey's chocolate syrup, 45 calories, 11 carbs. Wow.
10 grams of sugar, no fat, no protein.
I'm even talking about, like, you buy the chocolate milk at the store. You're not making it with Hershey syrup at home.
Okay.
You're buying the chocolate milk at the store. Look at the carbohydrate difference. You just said, what, a is it a teaspoon or a tablespoon of
a Hershey's tablespoon. That seemed reasonable. You did tablespoon. Would do, like, two tablespoons. But
So if we do the tablespoon and we do the milk, right, we've got 20 some grams of carbohydrate in total. Right?
Well, you end up putting 22 of sugar into the 12 of the milk. Right? So one, two, three.
It's almost You did two tablespoons?
Yeah. I did. But, mean, what am I gonna drink? Like, a light I don't I want a nice dark chocolate if I'm gonna have one.
Okay. Yeah. Yeah. So It's pretty close, would think, because I I believe that a cup of regular chocolate milk is around 30 ish grams of carb.
Yeah. I I did Fairlife.
Oh, and the Fairlife's gonna be a lot less.
Is it? Oh, then I need another one. What what would another
one is something I was gonna bring up as well because there is there's a difference for Fairlife in bolus strategizing and everything.
Okay.
But regular chocolate milk is typically for a cup, like, 30 grams of carb. And in general, I think it's 2%, so it's probably got about five grams
Okay.
Of fat, but it should have the same amount of protein.
Fairlife: more protein, less sugar31:24
I just realized I should do like that Nesquik one. Oh. Because that's that comes in little bottles and the thing. Nesquik chocolate
Oh my god. I haven't thought about Nesquik and the bunny in a long time.
Yeah. The bunny. That's the only reason I remember it. Oh, goodness. Nesquik chocolate, this is low fat 14 ounce bottle, 250 calories.
Wow. Wow. That's twice as much as a soda. Total carbs, 41. Same carbs as soda, 39 sugar.
Added sugars, 18, protein, 14, fat, four, sodium, two forty. Wow. A Nesquik chocolate low fat milk, 14 ounces is
But 14, not eight.
Yeah. But So
this is more than a cup.
Yeah. But but still, like, it that's how it comes in the store. And that's far more, I would say, far less healthy than a regular soda.
Is it
Yeah. Am I wrong? They trick you with the milk and the bunny. They
it has more fat and protein in it, but it has a lot more sugar in it.
I'll tell you what else it has in it. Low fat milk, sugar cocoa processed with alkali, calcium
Alkali.
There you go. Calcium carbonate, cellulose gel, natural and artificial flavors, carrageenan. Carrageenan. Thank you. Salt, gallon gum, cellulose gum, vitamin a palmitate, and vitamin d three.
Why they bother with the vitamin? I guess it was already in it. There's they were just like, oh, we have to write down
vitamin d. So oh,
yeah. That's right. They took it out and put it back. Thanks, government. Wow.
That's interesting. So Yeah. Versus
Reading the label out loud33:12
a four now compare it to the Fairlife.
Yeah. I'm looking right now.
Even just the regular Fairlife versus
I have a 14 ounce here of the Fairlife. Okay. Two hundred two hundred and fifty calories, 22 carbs, 21 sugar, 10 added sugar, three protein, eight fat, 350. So it's a lot of sodium in this stuff.
But look at the protein difference.
Yeah. So yeah. 23 versus 14. Yeah. So because why?
How what is what is
Well, that is I Fairlife Faucus is an it is it's an ultra filtered type of milk. And that, to my knowledge, my understanding, it increases the protein content, and it takes the sugars down, the natural lactose based sugars in the milk down, not added sugars. And the processing, there's more calcium in it than, and I believe, if I'm not mistaken, Fairlife milk is also considered lactose free.
Okay. That would change that then?
Well, it would change for people who have lactose intolerance.
Okay. I'm now jumping around. Welch's 100% grape juice, eight ounces. 140 calories, 39 carbs, 36 total sugar. No added sugar.
Juice: eat your fruit, don’t drink it34:34
No need. Protein one, no fat, tiny bit of sodium because juice is like what do they always say? Like, eat your food, don't drink it? Is that the
Eat your fruit, don't drink it.
Eat your fruit, don't drink it. Yeah. Jeez. So how many grapes would I have to? Hold on
a second. Each grape is about a a gram of carb per grape is usually what I teach people, and that's for a grape that's, like, the size of a nickel.
I'm just gonna ask the machine. There's no need to think anymore, Jenny. We're just driving a conversation.
Prefer to think.
Yo. You keep thinking. I'm gonna I'll
do it
like this.
Not that I don't use AI. I I do because it is a helper. But
Eight ounces equals 39 grams of carbs. So the easy math is one ounce equals about five grams of carbs. And so 12 ounces of grape juice is 59 carbs count, you know, as the as the grapes. How many grapes are you saying? You'd have to you'd have to eat 15 how many grapes to get to 59?
It's a it's about it's approximately a gram of carb per grape.
59 grapes? Oh my god. Let's do orange juice. I could eat
juice juice should be less. If it's not if it's not, you know, sweetened orange juice, if it's a 100% real orange juice, it is definitely a lot less carb. I think it's in a cup is, like, 30 grams if I remember correctly.
Yeah. I have, eight ounces, one cup orange juice, 110 calories, 26 carbs, 21, 22 sugars, no fat, a little bit of protein. So so grapes are that's why you call them sugar bombs when you talk about them. I mean
They're they're yeah. They're just I mean and the Welch just didn't have added sugar, did it, right, that you were looking at? It was really just concentrated grape.
I don't think it needed it. Yeah. Because it had 39 carbs, 36 sugar, no added sugars. So yeah. Isn't that I just I know that juice is, like, such a thing.
You know what I mean?
Like It is.
A lot of people drink juice.
Yeah.
Wrapping up: condiments and beer carbs36:47
Alright. I think this was good. I like doing this.
This is a lot of fun. I like talking about beverages because as you said, I think early on was beverages, something that you wash the food that you know has calories down
Mhmm.
With. And we really do have to pay attention to what's in a beverage, especially if we're drinking lots of that particular beverage all day long. And if you've never considered if you're newer to this, you may not really consider the drink that you have having an impact on your blood sugar. And it's valuable because it could have a pretty quick impact depending on what the content of what you're drinking is.
Yeah. I'm gonna, I'm gonna finish by making my point over from the beginning. I don't think that we think about drinks or condiments. A tablespoon of ketchup, regular Heinz style ketchup, has five carbs in it, four sugars. A tablespoon is not a lot of ketchup.
So you It is not. No. You Like
a soup spoon size.
You very possibly have twenty, thirty carbs just in ketchup sometimes or barbecue sauce, which would probably have more sugar than I think ketchup does. To make the point, I'm not promoting drinking, but a 12 ounce can of regular Budweiser is a 145 calories, 10.5 grams of carbs, 1.3 protein, and, alcohol by volume 5%. But there's far fewer carbs and in beer than there is in soda. So just saying. Just, you know
We're not advocating that you could drink beer and
replace your soda. But It's a it's so you can see the difference. I I do not have people on on the Internet saying, like, Scott told me to drink beer instead of soda. I didn't say that. I'm just trying to make the point that you if I asked you, are there more carbs than a Pepsi or a beer, I think people probably might have said beer.
So but or maybe not even realize that their alcoholic beverage
Has carbs in
at all. Carbs in it.
Yeah. What other alcohols have carbs in it that nobody would think of? Like like
I mean, hard alcohol doesn't. It's the fact that most often we mix our hard alcohols like vodka and whatever with something else. Right? Mhmm. Yeah.
Juices, regular sodas, whatever it might be.
Glamberry, that kind of thing. Right? Yeah. Alright, guys. Listen.
You can do you can be Jenny and sneak a sunkist once in a while. You know you had the diet sunkist after they were there. Right?
Oh, of course I do.
I know you did.
Don't worry. 100% because at that point in my life, was I reading the aspartame and all the stuff in it? No. Because that was what we also had.
Yeah. Oh, please. Right. I make that point all the time around not understanding the impacts of food. I'll say it here.
The Country Time lemonade reckoning39:41
My mom used to buy a I mean, it felt like a trash can size of, like, lemonade scoop powder or something like that, and we would just take a count.
Country time.
Yeah. Yeah. There. Actually, hold on a second.
Country time lemonade.
Lemonade powder. Let me see if I can this is how it'll end. Because I've said this so many times. I've never actually looked it up. I just used it as an example.
So we had a one gallon Rubbermaid pitcher.
Mhmm.
You know, the ones with the little white, like, things you spin.
That you twisted it?
And then eventually they get really dirty and, like, they're disgusting. You know what I mean?
I do.
So, you know, pitcher.
Never understood about those pitchers is that one side of the twist was a very large just open hole, and the other side opposite of the twist was a hole
Serrating. A
square with with right. I was like, what what like, I'm not straining anything. It never even as a kid, it never made any sense to me. And then my mom told me, she's like, but oftentimes people will put ice in these pitchers.
Stop the ice from coming
out. It stops the ice from coming out, and then it made sense to me.
There you go. Just like that. Jenny understood. Country time lemonade. So we'd have a giant I mean, a and we didn't even get the country time.
I was I was the kind of broke where we got the, like, the one in the white container next to it, where you're just like here and this. And so, I wish that wasn't true. I wish I was drinking like Hobo's Hobo's drinks. You understand? Like, not even, like like, there there were literally, like, people, you know, homeless that were buying the stuff better than mine.
So they were like, I don't do the white container, with no photo on it like you do. Poor person. But, nevertheless, two tablespoons of this powder is a 100 calories, 26 carbs, 24 sugar. So two tablespoons is that. And I asked, you know, but how do I make a gallon of it?
Regular country time lemonade, one gallon, takes about one and a third cups of powder or eight scoops. The package commonly lists eight scoops for a gallon or 1.13. So drinking it prepared, you're getting the same 26 grams of carbs per cup. But in that gallon oh my god, Jenny. Everything makes so much more sense now.
Oh, my life didn't have to be this way. A gallon of this is 277 carbs. It's all sugar.
Yeah. Yeah.
It is. My whole life.
And that's we yeah. But but and your whole life is not only yours. Think about how often we've seen the big gigantic orange container at cookouts, and you push the little button and out the spigot comes the drink, and you fill it six times during the entire six hour, you know, cookout. It's all sugar.
Oh, wait. Wait.
Like, just fill it with water.
How much how much sugar how how do I describe that I want the sugar in granules? Does that it does not equal, how much sugar
Oh my I
I guess granulated is this? Oh, I'm so afraid. I I I don't I know people can't see me. I'm genuinely disappointed. Like, this is just I mean, we it was always in the refrigerator.
And if it and if it was gone, you just took it over to the sink and not even, like, please, in case you're wondering, filtered water. That didn't exist. You just jam that in there, throw in a little ice, throw in another cup and a third. And by the way, do you think we were doing a cup and a third? Honestly, you've heard the stories.
You think somebody hit the third of the cup out? No. They were like cup and more. So oh my god.
Well, Kool Aid is not much different, I would expect. Right? The the difference in Kool Aid is that Kool Aid, when I grew up, was not premixed little containers like the country time. It was packets of powder that had no sugar.
Yeah.
And then you sugared it the way that you mixed it, right, with the water and the sugar and the powder, and you mixed it up. And then you couldn't wait until, like, all the sugar was completely dissolved at the bottom of the pitcher with your purple fluid that you're drinking.
The purple fluid? Yes.
Because that's what it was.
Eight gallons to a bag of sugar44:06
Okay. Here's how I decided to do this. One gallon of country time lemonade sorry, country time, is about 277 grams of sugar. Okay? Mhmm.
So I'd need eight gallons of country time lemonade to equal it's only eight gallons. A five pound bag of sugar. Oh my god. Oh, that's why I was fat. Never mind.
Alright. Asked and answered. I know what happened. Alright.
There you go. It was all your country time, non labeled.
Can I just say at end, I I'd like to thank the Eli Lilly Corporation for for making me fit? And I don't hold my mom accountable. She's passed on. Would be unfair. Oh my god.
She did what she could.
Well, I mean, she could have put some diet sunkist in there, but I guess that didn't occur to anybody. So Jesus. God. Alright, everyone. Godspeed.
Good luck. Don't drink your sugar. Bye bye.
Thanks.
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Then click series. Then there's pro there's small sips right there. Pro tips at the top, bold beginnings, bolus four, asks that. There's a lot of them there. There's actually a little search there too.
Could you just type small sips into the search? Oh, wow. That search works great. Look at that. And then you could go right to, like, all results for small SIPs.
Oh, and that takes you to the FAQ. You should check out the FAQ page too. I think that's juiceboxpodcast.com/jbfaq. Seriously, that thing's amazing. Actually, the whole website is I mean, have you, like, seen it?
You should you should go check out the website. The website rocks. It is a potpourri, a never ending cornucopia of support for you and your diabetes journey. That's right. It really is.
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Yeah. I don't like that. Fix that. Oh, Claude. Oh, hell.
I forgot to say thank you. Thank you so much for listening. I'll be back again very, very soon. What is that noise? Stop it.
Stop. Can you hear that? It's my chameleon squeaking. Are you squeaking? What are you rubbing the branch against the don't tell people I have reptiles.
They'll think I'm weird. Thanks so much for listening. I'll be back very soon with another episode of the juice box podcast. Look at me. Get all deep in there Been another episode of the juice box podcast.
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#1927 Hero of the Day -Part 2
Hero of the Day (Part 2)
Part 2: a positive MODY 2 result reframes everything. After a year and a half of insulin and anxiety, Felix comes off insulin entirely under a supervised hospital trial — and his numbers hold.
Jump to a moment
- A positive result, then a bigger question. Eight months after consent, genetic testing confirmed MODY 2. The endocrinologist said Felix could relax — and Silvana’s first thought was that if he could relax, maybe he never had type 1 at all.
- The human cost was real. A year and a half of intense anxiety around lows: Felix stopped eating at school, faked insulin doses, quit the bus and birthday parties, and the family slept in his room. Silvana calls it disordered eating that was heading somewhere worse — and stresses it has since resolved.
- Nigel’s hypothesis about the set point. His theory: because they dosed insulin so tightly, Felix’s own insulin never got a chance to kick in, so a C-peptide test read low — making a MODY 2 kid look convincingly like type 1. This is one family’s reasoning, not medical guidance.
- A supervised trial off insulin. On January 21, under hospital supervision, Felix ate freely for twelve hours — chips, juice, white bread — peaked just above 180, drifted back to his baseline, and showed no ketones. That day he came off insulin. Six months later: 94% time in range, 6.4 A1c.
- The long view for MODY 2. Described as non-progressive with a low complication risk, Felix is now monitored lightly and lives as though he doesn’t have it. The earlier positive zinc-transporter antibody, they were later told, was likely a false positive — subsequent testing was negative.
- MODY (Monogenic Diabetes) — diabetesgenes.org — Background on maturity-onset diabetes of the young from the Exeter research group, including MODY 2 (GCK).
- Juicebox Podcast on Facebook — The private community Silvana turned to alongside the podcast while sorting out Felix's atypical presentation.
- T1D Exchange Registry — US residents 18+ with type 1 can complete the survey and help move T1D research forward.
Every word of the conversation
Hello, friends. You found part two. Scott knew you would. He believes in you. Right where he left it back in your ears.
Let's finish the show. We're glad you're here. Part two. Part two. Scott knew you would.
Part two. Part two. You found it right where he should. Part two.
You made it.
Let's get back to Scott. Wait. You haven't heard part one. Go find it now. Part two.
Part two. Part two. Part two. Scott knew you would. Part two.
Part two. Part Scott You found it right where he should.
Welcome back my friends to the diabetes show that never ends. Remember this, nothing you hear on the juice box 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. Have you taken the survey yet at the t1dexchange? T1dexchange.org/juicebox.
Head over there now if you're over 18 years old, have type one diabetes, are a US resident, and want to help type one diabetes research to move forward. There may even be other benefits for you. Go check it out. T1dexchange.org/juicebox.
Picking the story back up, six days later1:34
I was so out of it. I was so out of it.
Well, we're recording now, so let me let's go over that. And so Okay. This is gonna crack you up because I was about to say to you, hey. Where did we leave off so that we can keep going? But if you don't know, that's okay.
We'll figure it out together. Hold on a second.
I don't know. I I don't know.
Okay. So what has happened? Why is there so much noise in my room? Let me fix this. Okay.
Okay. So you and I recorded. I had to run to go to a doctor's appointment with Arden, and we cut it short. How in the heck are we going to figure out where we stopped?
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I remember you saying something along the lines of Nigel being the unsung hero in this, and he's been talking to me about being the unsung hero all week. So Oh, I see. Less of that.
Oh, you don't need you
you don't don't need all that.
Let's see what we could figure out here. Hold on a second. Alright. Well, I'll tell you what. I'm gonna have to hit stop for a sec.
We I just went back and just listened for a little bit. We were up to the part where you were telling me that your life had gotten very crazy. Nigel took over the research, and he started looking at the insulin use, and that's where the story ends.
Okay. I think, what I'd said just before we start was that we'd we had did I say that we'd received a positive MODY?
I'm gonna tell you right now. Just go from the idea of your mom's health was taking up a lot of your time, and so you guys sort of pivoted. Your husband started to, you know, look into it.
Okay. I
And and then what he came up with was, if you're taking in all this insulin, you must be type one. How could that be going on for such a long time? And then you started to talk about Modi, and I cut you off.
Okay. So I think that just before that, the reason he started taking you over is because we had got a positive MODY diagnosis, and we were at the stage where okay. Let me go back. Let me rethink.
Take take a second.
I don't
Yeah. Just feel what feel where it feels right to just hop in and start to and by the way, what you can do is I'll leave this bit in so people know what happened. You have by the way, you are recovering from COVID, and I cut you off in the middle of a thought and stopped recording with you. So and now it is since then, by the way, I have flown to Louisiana, spent one, two, three, four days at the ADA scientific sessions, flown back, lived a day in my house, and now we're talking to you again. So if I'm not mistaken, it's been six days since you and I did this, right, about
And you've done a lot more than I have because I've just sat on the couch and tried to recover.
I have to tell you what. In a in in a week and a half, I'm headed out taking about a 100, listeners on a cruise, a seven day cruise. And I have to be honest with you, after that, I'm gonna sit on the couch for a while. So so what so just whatever it occurs to you, just start talking. We'll find it again.
Recapping the anomaly5:59
Okay. So I think we went back to what had happened initially. So, initially, what happened was that we were told that Felix was an anomaly. We were always being told that he was atypical. And at that stage, I and that was right at the beginning.
I started thinking, well, how can he be atypical with all these things? How can his his blood sugars not go too high? How can he eat, I suppose, more carbohydrates than would normally, be able to be eaten without taking insulin? Why has it taken six months for him to be put on insulin? We could explain it away by the honeymoon, but the paediatric endocrinologist would always say, oh, you know, he's he's quite we've not seen this before, and she's quite experienced.
Mhmm.
So fairly early on, I started researching, and I came up with perhaps it could be moody. So we're going back to the beginning. Yep. It could be moody. I tried to convince Nigel, my husband, and he was having none of it.
He was thinking it was all wishful thinking. And then when we got the blood test results right at the beginning, I think three months in, we couldn't understand them. We ended up seeing whilst we were waiting to see our public, pediatric endocrinologist, we actually saw a private pediatric endo who happened to be the head of the hospital that we were going to, and he had an interest in Modi too, which we didn't know about. It was just pure luck. And he suggested that we get tested.
So I think that put Nigel over the line. Even though we weren't sure, we'd got blood tests back that showed that Felix was antibody negative for three antibodies, but two were pending. And his C peptide levels and insulin blood levels were good. So there was a chance. And I think what swung the paediatric endocrinologist over the line was that we didn't have a history of type one.
There was a lot of type two in the family on both sides, but never really nothing no type one that we knew of.
Can you tell me So what do you think about that piece of information rang a bell for them? They ever say?
What do you mean?
Like, what about the fact that there was no history put them in another direction?
I think it was not only that. It was the it was a combination of that and the fact that the bloods looked good at this stage, that the bloods did not so there weren't any positive antibodies. So a combination of both. And I think he had a particular interest in Modi too, so he was possibly crossing his fingers and thinking, oh, perhaps we've got another case of this. As time went on, Felix's figures looked he looked like he was progressing, so we were giving him more and more insulin.
Forty units a day — the type 1 picture9:26
By the end, by, the end of last year, he was on about four thirty to forty units of insulin a day. So let's say twelve units of Levemir and the rest was Novaapid. So quite quite a bit. So from that perspective, paediatric endocrinologist was saying, well, it looks like it's progressing. He's able to accept more and more insulin.
His timing range is still really good. His HbA1c wasn't really shifting. It was like from 5.7 to 6.4, but, it didn't really go beyond that. We tried I think I talked to you last time. I we tried to get genetic testing, and that was a bit difficult.
The hospital firstly the genetics department firstly denied us testing, saying that we should go to a place that was closer to us. We tried that and that wasn't successful, so we went back to the hospital. And by the time we started talking to our paediatric endocrinologist again about possibly getting tested, Felix had had follow-up bloods, and he now had one positive antibody, and his c peptides had decreased. Mhmm. And so from the paediatric endocrinologist's point of view, it was fitting her narrative.
She had, you know, kind of predicted that he was possibly in a honeymoon stage, and there will come a time where his antibodies will become positive and his C peptide will come will reduce or decrease.
Let me
So that's what
Let let me ask you
a no. No. Don't be sorry. Let me ask you a
question there. You get on a roll when you're I I feel like you're, like, looking into your mind's eye when you're talking, and sometimes I feel like, oh, I just
wanna Yeah. It's almost like a debrief.
Right. Right. Right. And I just I feel like I wanna say something, and I'm like, I I we don't have any visual cues. So can you tell me why it mattered to you?
Like, why didn't you just say, well, listen. Moody type one, you know, classic blah blah blah. He's gonna get insulin. He's gonna use his pump. He's gonna use his CGM.
What do we care? Like, why why did you kind of have your teeth around it? Was it
Well, there is sorry. There's 17 types of note Modi, and I had no idea if he there was some that were were there was no way that he he could have possibly had because the symptoms are very different or, you know, that but there are a few classes of Modi.
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Hoping for a diagnosis that needs no insulin14:21
That didn't require insulin or required just tablets. And so
Were you just hoping for one of those?
We were hoping. Yeah. I think we were hoping, but I think just I think by this stage, initially, I was just listening to the podcast. Then I started looking at the Facebook page, and he really didn't fit the what you would think would be the typical a typical type one.
Mhmm. His presentation didn't sound like other people's.
The presentation was a little bit different. It seemed we were either doing an absolutely fantastic job at keeping him at a great level, which I thought we were, and we possibly were, or there was something else going on. And I think because the hospital never said it's definitively type one? I mean, in appointments, it was kind of said, but in letters after appointments, it was always, you know, we can't 100% rule it out. So what happened is we went back to the paediatric endocrinologist and by this time his bloods were more indicative of a type one presentation.
So it was really difficult to get the genetics department to agree to have some testing. And I think the we have a really good relationship with a paediatric endocrinologist, and I think she thought that we wouldn't be able to move past it.
I see.
And she just wanted Felix on a pump. She just wanted us to move on, and I think we have a mutual respect for each other. I think we've always been really open, and she's always thought that we've done a good job, and, you know, Felix is our priority. I think and I can't really put words in her mouth, but I think it was just because she thought that once we had the testing, we could move on. Are you We could actually just move on.
Are are you and Nigel older parents?
Yes.
You are. Okay. And he and Felix is your only child?
Yes. Yeah. So I was 42 when I had Felix, and Nigel possibly won't wouldn't consider him an older parent. He's turning 50 next week. So he was he's seven years younger than me.
So 35. So he wasn't
Wanda, hold on a second. We've been talking for an hour and fifteen minutes. Right? You didn't tell me you robbed the cradle. How did this happen?
What what what what let's take a let's take a turn for a second. How'd you get a younger boy? How what what happened there?
What I did is I left Sydney and went to Melbourne. And, it's great when you don't have, you know, family and the expectations of work, and you just become your own person. And so I don't know. I just met
Are you telling me Melbourne? Are you telling me you you went to a new location, let your hair down a little bit?
I think so.
No kidding.
I think so. I I yeah. I think so. I think, I grew up in a very strict Italian household. Mhmm.
A very loving one. So but and I just followed the, you know, university, go go go to work, work, and did the right thing, I think, according to everyone. And when I moved to Melbourne, I
still doing shots off
of it
was started doing shots off a young men's chest. Is that what you're trying to tell me? Oh, Silvana, really? Am I onto something here?
Not on air. Why not? It was it
no. It was it was great. It was
great. Pause for a second to really absorb how good I am at this job, and, and then we'll move forward. Okay. So you're So, Scott Yeah. Go ahead.
Scott, possibly shouldn't tell you that, me having partners in the past that were younger as well, in Sydney, I probably shouldn't tell you that that happened as well.
So You've got a tight
I don't think it was Melbourne. Oh. No.
It's just
I don't know. Maybe I I think I'm quite petite, and I think I look younger than I actually am. Perhaps not now. I'm 57, but I did a while ago. So Is it I I have no idea.
Yeah. Every I I met a I met a a, you know, a grown woman this weekend. And as I stood in front of her and chatted with her, there's part of your brain that goes, she might be 14. And, you know, and she's 28 and Yeah. And telling me about her job.
And I'm like, some people just have a a, like, a look that just it's crazy, you know, how much look and isn't it sad when it goes away because you spend I used to have that. I always look younger than my age. And then one day, you find that you're still saying it, but it's not true anymore.
That's true. That's true.
I did I did I did say to someone this weekend, because they were talking to me like I was much younger than I was, and I said, I see that my dark hair is confusing you. It's like but but I am much older than you think. But but never thought. Okay. Well, it was a nice little it was nice to get to know you for a second there.
That was because we really jumped right into the whole Modi thing when we started talking. Yeah. Okay. So you're you're starting to, like, pull this information together, and does that change things? I mean, does the does the learning and the figuring out change your direction, or does it just allow you to put down the wondering and move forward?
Eight months for the genetic result20:30
I think what happens is that well, what definitely happens at the end of last year, we so so what ended up happening is that the genetics department agreed, for us to have Felix tested. The hospital had been great. They'd actually extracted his DNA months and months, I think a year prior. It's just that there wasn't that approval. Once that approval happened, it wasn't expedited because I think the hospital everybody thought that it was just a tick the box so that we could move on Mhmm.
Rather than a fact finding sort of mission. So that meant that I signed the consent for everything to for the go ahead on, I think it was the day before Christmas when the genetics department closed down in 2024, and we were not told that he was he had actually tested positive for Modi two until August of the next year. So it took eight months.
Oh, wow. How did the how did the news how did the news change things?
Well, we didn't think it was going to. So in that appointment, the pediatric endocrinologist basically said, the genetic the genetic testing has come back, and you're positive for Modi two, and you can relax now. And my first thought was, well, he doesn't have he doesn't have type one. If we can relax, he doesn't have type one. And she told us that it is possible to have type one and Modi two, but she had not seen this before.
I mean, Modi in itself is quite rare, so we weren't sure if she'd never seen Modi before or if she hadn't seen that presentation before.
Mhmm.
She did say that Felix's numbers were higher than expected from Modi two person, and but there's a spectrum. So Felix may have the worst of it. And he's also going through his teenage years, so apparently during teenage years your insulin requirements are higher. And she said that we wouldn't really know whether or not he'd have type one until we did bloods again. And so we went back to the to bloods.
I kinda well, I think both Nigel and I said, well, his bloods have shown a low c peptide. They've shown a positive zinc transporter. How that you know, we were told that that is indicative of type one. How can we now be saying that it may not be type one? I mean, to be truthful, Nigel was hoping against hope that it was Modi two.
I think for Nigel and I think at that moment, I realized for Nigel, he'd been a real burden, the whole taking of insulin, because for him, he has dreams of taking Felix traveling, which we'd done a lot of before mom had got sick. Mhmm. But traveling and diving, he scuba dives. And with diabetes type one, it's more difficult. And with Felix and his anxiety, he really didn't like being away from me because I was the one that really oversaw the whole insulin thing.
So Nigel didn't see a distant well, say a short term to medium term future where we could he could travel with Felix on his own. So I think Nigel was hoping that it was Modi two, and his head was already thinking of ways in which we could test it. I was grateful that it was moody too, but we were both extremely exhausted. So it was quite strange. Yeah.
We were really happy, but we were also quite numb. We'd had a year and a half of just dealing with Felix and his anxiety around type one.
The toll: anxiety, and disordered eating24:57
Yeah. I was gonna say it's been a long time and a lot of focus on something, and your story doesn't seem as dire because of your accent and the fact that you say Nigel and mom sometimes. And I'm not even I'm not I'm not even joking. So but but this is a a harrowing, like, chunk of time in your life that that, by the way, wasn't that long ago either. Right?
No. And it was it was really difficult for Felix. So, in terms of just just to segue a little bit, Felix has loves numbers. So as soon as he had a finger pricker, you know, he always wanted to know what, his blood sugar levels were. As soon as he got a CGM, he started becoming anxious because he could see his numbers all the time.
And he was testing. He was looking at his numbers a 150 over a 150 times a day, and that progressively came became worse when he experienced his first low. So he's won for accuracy. So things like his finger prick not not being the same level, like his his blood sugar level being the same as his CGM sent him, you know, in a spiral. So he wouldn't trust his CGM.
He'd finger prick all the time. He stopped eating at school because he was too scared to take insulin because he was scared that he'd go low. He would eat. He became quite anxious about lows and totally ambivalent about highs. So he was happy to be at, say, just under one hundred and eighty all day at school so that he wouldn't experience a low and be at school
Yeah.
With From his calm. Nobody to help him.
Incredibly calm. Yeah. And we
were sleeping with him in bed because he didn't wanna be alone. He stopped catching the bus to school. It became he lied about see, it was quite ironic because he actually did not have problems with injecting. So injections were not a problem. He had pens.
It was just the amount. So we would argue about how much he would eat because he refused to give himself more than five units of NovoRapid at each meal. So at one stage, had the social worker, the psychologist, the dietitian, the paediatric endocrinologist. You know, we had all these meetings with all these people trying to assist Felix, not with type one per se, but his anxiety relating to type one. And it was really, really difficult.
It was it just changed the dynamic dynamic of the whole family. We were always under constant stress because mealtimes are often. And so every mealtime, he'd argue at length about what he would eat, what he didn't want to eat, how he wasn't hungry, how he would take insulin, but he'd take it away from us and pretend. And then we'd look at the needle, you know, the pen, and he'd taken less than he'd said. And so things towards the end were spiraling spiraling out of control because his blood sugar levels were variable, a lot more variable than they'd been leading up to that point.
But we think it was because he was underbolising. He was eating, you know, sweets to keep him up at a certain point without telling us, and we just didn't know. We just we would think, well, you know, this must be a protein, you know, the effect of protein. This must be this, and it could have been anything. We just and as soon as we got him down to a nice level, he'd eat, he'd go and get something to eat Mhmm.
And not tell us. So it was spiraling totally out of control. He for a year and a half, he didn't see his friends. He was too scared to go out with his friends. He wouldn't go to birthday parties.
It really impacted, I think, his independence. He's you know, like, he was 12 when he was diagnosed.
Sure.
And I think there was a real impact on his social growth as a result.
Are we talking about a are we talking about an eating disorder? Are we talking about an anxiety issue that that was just touching everything? What do you think is it still happening?
“Disordered eating, not an eating disorder”29:39
No. No. So no. It's not still happening. I wouldn't I wouldn't have called it an eating disorder.
I would definitely have called it disordered eating.
Okay.
So I'm not sure. So I think it would have been leading to that. Before that, he is not a fussy eater. He's quite small as all of us in our family, and he's quite thin. But he was he's never been a fussy eater.
He and initially, when we started with insulin and he wasn't he wasn't traumatised, he wasn't, you know, panicked or or anxious, we never had a problem with what he was eating. So, you know, I'd heard on the podcast, you know, some kids, especially when they're younger, they'll say that they'll eat something and then they won't. They're not hungry. He'd always eat what, you know, was placed in front of him. So he had no problems at all.
It was anxiety. It all stemmed from anxiety.
Mhmm.
So and no amount of counsellor, dietitian was really working. He was on this he was on this path on his own. He felt he was just anxious. He was just extremely anxious of going low.
Okay.
He actually just before he was diagnosed with ninety two, he he asked me whether he I thought he would ever be able to live outside of home on his own. And I actually said to him, because he listened to the podcast with me, on our way to school and on the way back, and he and I said, but Arden does. And he said, oh, yeah. That's right. And so, you know, he felt a little bit calmer with that, but it was horrible.
It was for him. It was just it was traumatic, I think.
Yeah. Can I can I ask, is he is he a particularly bright boy? Like, is he smart, thoughtful? Like, because he's having deeper thoughts than I think his age would indicate. Do know I'm saying?
I would say he's extremely smart, but he does suffer from anxiety and he suffers from ADHD. So what the ADHD does is that he hyper focuses on things, and he creates habits that are not necessarily self fulfilling. You know, they're not they're not great for him. So I think he he can spiral quite easily. And so he really enjoyed the numbers.
His thing. Maths is his thing. He loved the numbers. He really understood the variables. He really understood.
But for the anxiety, he would have been able to manage. The anxiety
I I forget. I'm sorry. Is the anxiety a family tradition?
My mother has anxiety. Mhmm. I would say that I'm a type rather than anxious. But
Yeah. That's what people our age call it, by the way.
That's true. So I don't know. But my mother definitely suffers from anxiety. Felix has suffered from it for a long time, but it manifests in different ways.
So even when he was a little boy when he was a little boy, you could see it in different things?
Well, when he was a little boy, he was too scared to, he was very smart, so he'd win awards weekly. He was too scared to stand up and in front of assembly and receive the award. So he's another example is he he has done Taekwondo for many years now. He's he's going for his third dance soon, so that's great. But when he started Taekwondo, you know, you have to grade every so often.
His first grading, I think his first 10 gradings, he cried. And, I said to him, it's okay. No one's really looking at you because, you know, it's it's full of parents. You know, there's all these kids grading, and I was saying nobody's looking at you. Everybody's looking at their own child.
And he said he said and I said, you're not going to it doesn't matter if you fail. You don't I said something along the lines of you're not going to fail because no one fails at the beginning. And he said, I'm not really scared about failing. I just don't want everybody looking at me. So I think he never really liked being the center of attention.
Mhmm. He grew out of that late in primary school, but it reared its ugly head when he started high school. He went to a big high school. He didn't know anybody. It was a selective high school, so he suffered very much in the first year of high school of imposter syndrome, thinking that he wasn't
He didn't belong at this selected school. Yeah.
Yeah. He didn't belong because he hadn't we've never tutored him. We've never really pushed him. We've just we've just gone along for the ride, really. And Are you Yeah.
Going to address the anxiety some way?
Well, we do. We've seen psychologists on and off. And at the moment he doesn't seem to be anxious about anything. He doesn't like trying new things. That's his perfectionism.
So we try to I I try exposure therapy once in a while, so I'll just kind of throw him in the deep end, and he usually he's usually fine. I'm not sure if it's the right thing to do. But he's fine at the moment, but but we are he's he's exactly the opposite at school now. He really
It's working.
He's finding it difficult to focus. No. He's finding it really difficult to focus, and he's not enjoying working. He doesn't work. He's still doing well, so he falls through the loops, I suppose.
Like, he
Oh, he's smart enough to get by, you're telling me?
He's smart enough to get by, but I don't think he he's in year 10, which is two years before he does what we call the HSC, to then go on to university if that's what he wants to do. Right. So he's surviving, I think, at the moment on pure talent. But it I yeah. Which is great, but not so great.
But he loves school. He's got a really good set of friends, and he absolutely loves school.
He likes being there.
Good thing.
ADHD, screens, and an addictive personality36:47
And now are we worried
I think.
Savannah, are we worried about, like, him getting a little older and self medicating the anxiety or the ADHD?
We haven't really this year is a year of looking into ADHD because until last year, we were looking at type one and Modi. So he has a very addictive personality, and I'm a little bit worried about that. Yeah. He's seeing a psychiatrist for further testing next month, and we will be seeing a neurodevelopmental educator. I didn't even know they existed so that he can get assistance at school Because he he performs well, but he's not doing any work in class.
So all the work he does is at home, which puts a stress on family
Right.
I think, because there isn't any other time to do anything else. So we just have to get, I think, him focusing a little bit more at school and us having family time at home and catching up on on the last year and a half of stress.
Yeah. This
is I think we'll get there.
Yeah. Yeah. I mean, it's a long, long process. I hear a lot of people talk about it. You know?
I mean, I can tell you, but, obviously, my family has, you know, type one and a lot of the stories you tell, like, you know, my my son when he was, you know, Felix's age younger didn't you know, was was always kinda thinking like people are looking at me when they weren't. Mhmm. It's a thing we had to kinda get through. I would I would characterize everyone in my family except for me as anxious in some way. And Mhmm.
You know, Arden has a a terrible needle phobia that I think is is purely from anxiety. And Yeah. And we're working through that right now. I don't have enough information yet to to share with people to to see if it works or doesn't work, but I I will at some point. I hope I see it.
I mean, my wife is classically, you know, what what people in our generation would call type a. Right? Like, give her something to do. She does a perfect job at it. She won't stop till it's finished.
You know, the minute it's done, she's on to something else. Never feels like she's done. If I just get this done, then I'll be there. Like, that kind of talk. Like, she's a great employee.
Mhmm.
You know what I mean? Like, it it's you should hire my wife. Like, you give her something to do. Mhmm. If it's gonna get done, it's gonna get done really well.
But that doesn't leave a lot of room for her in her life.
Yeah.
And I'd I mean, I've been watching these three people since I, you know, since I since I met my wife, basically, and I've been married for thirty years this summer.
Congratulations.
Oh, thank you. It does feel like something to congratulate somebody for, actually. Mhmm. And I'll tell you, like I mean, you guys a lot of you guys listen to this podcast for a really long time. I'm fairly good at figuring things out in life.
The anxiety thing is it's not it's there's no, like, simple answer to it. And it it impacts No.
I
different people in different crazy ways.
I totally agree. And we've tried so many things, and it's really difficult because Felix is getting to the age where he's not necessarily going to be receptive to all of my, you know,
ways of trying. You know? Or
You're so long. I know exactly. Here's how I usually put it. They get they get an opinion. And then Oh, sure.
Yeah. And then they start and then they start pushing back, or want to, you know, delineate themselves from you, which, by the way, those things are, you know, very healthy. But but you start to have this feeling of, it's a ticking clock then. Right? I only have so much time to get him to a place, show him something, make him believe, make something work before he's one day not gonna have to listen to me and he won't.
And then it doesn't it feel like you've this is how I feel. I don't wanna put words in your mouth, but it feels like you're shepherding along this thing, and it's a lifelong it feels like a lifelong job that somebody is gonna show up in the middle of and tell you, hey. You've been working really hard at this, and I love that it means the world to you, but you don't get to say anymore.
And That's true.
Yeah. But you have to step back and watch the rest of it happen. Yeah. Yeah. It's a terrible feeling.
No one should have children. It's very, very hard on you. Know. If we were smart, we all would have just done what you did and, you know, moved to Melbourne and found a young guy and had a party and then let the let the planet die. What were you all having kids for?
Would have been one nice road go at the end. You know?
Uh-huh.
No. My gosh. I feel for you. Do you do you consider medication? Do you consider alternative therapies?
Like, I mean, you sound like a person who's been down every rabbit hole there is to go down.
Medication, stigma, and treading carefully41:57
Oh, everything. So at the moment, he's on new medication because the old medication didn't appear to work. And we've seen an integrative paediatrician for the first time, and so we're on a very supportive supplement protocol, I could say, and also new medication, but we're finding, and it's been four weeks, we're finding that it appears that he acts as if he is not medicated. So we've taken a step back. So what I'm assuming we've got another appointment next week, and I think what I'm assuming is that the new medication is not at the right dosage yet.
But, you know, you have to kind of tread carefully because it took us a long time to even or it took me a long time to even consider medication.
No. I yeah. I hear you. And then the process takes so long that the kid can get frustrated. Like, if this none of this works, why are we bothering?
That kind of thing. Yeah.
Well, I was more I I he doesn't get frustrated so much. He kind of enjoys not having not having great focus. He loves being distracted at at school. He loves being on his screen. He loves I think it's more oh, I've gotten I've gotten my train of thought.
It's just it's just difficult having to try things and see them not working. I think the reason why I really didn't want to start medication with him is not because I don't think medication is valid, it's more that he already had self doubts and anxiety, and I didn't want him to think that we were medicating him to fix him. So I didn't want that to be another source of anxiety. Yeah. And I think I was overthinking it because he doesn't overthink like that.
He's in some ways, he's a typical boy, a typical teammate
for both the easiest. I I that's what that's what if I could if I could go back and choose, I just take three boys that are outside throwing rocks at each other. I'm like, that's perfect.
Yeah. Is
were you ever worried about stigma around medications or even just the idea that you can't overcome it on your own?
I was I've got quite a not quite a few friends, but it's funny how many people come out of the woodwork when you start talking about your child having been diagnosed with ADHD. It's like, you know, it's quite so I had friends that unbeknownst to me had children that were my child's friends that had ADHD that were being medicated.
So
I don't think and he now goes to it, like I I was saying, a selective school, and there's a lot of quirkiness in that school. So I think there's a lot of people, and I'm this is just inferring. I I don't know. But I would suspect that a lot of those children are twice exceptional. So so gifted and with a some sort of diagnosis, you know, some being on some sort of spectrum.
So I don't think he is stigmatised or that I feel that he's stigmatised, but in the same breath he's very secretive is not the right word, but he really doesn't he's got close friends, but I don't think many of them would have known that he had been diagnosed with type one diabetes, but for the fact that he had a CGM, you know, or but for the fact that he may have experienced a low in school. He doesn't really like talking about himself on a very personal level. So at that level.
Yeah. I struggle between the delineation between this is who you are and why are we medicating you. Like, just go be lovely you out in the world. And the the point when it gets in the way of health or your ability to take care of yourselves like, I'm not I'm not saying like, some people might hear me saying, like, you know, I want like, medic medicate that kid until he fits into society. Like, I I don't mean it quite like that.
The phone he wasn’t supposed to unlock46:40
I mean more about, like, just the feeling that, you know, you're gonna be able to release him into the world one day, and he's gonna be able to take care of himself and be be healthy and happy and that that stuff.
I would totally agree with you. I think from our perspective, it was more that we were saying that he's a bright boy, and he's a beautiful boy, but getting dressed was totally typical for him. You know, even now, now that he's he's on this new medication, he will get dressed, but his shoes aren't on, or his hair's not brushed, or and and some people may say that's a typical teenage boy, but it's always setting the table. There's always half the things missing. You know?
It's just
Mhmm.
He's he really, really struggles. And what I and where I see it most is just focusing enough to to study, to actually and we don't mind if he can't, but it's really frustrating to see someone who easily grasps concepts, but he won't stick to it for more than a minute because he can't, not because he doesn't want to, because he's unable to. And that that inability is what, I think makes me sad or makes me want to think that, you know, we should do something about
it. Silvana, why don't you just make him a data engineer and let him go live his life? Just teach him how to code for god's sakes. He'll be fine.
I swear.
Yeah. Yeah. I will
will tell you a story. We gave him a phone. Everyone has a phone at school. Well, it it's banned in schools, but, you know, going to school, he he started catching the bus in high school before he'd been diagnosed with type one. Mhmm.
And he wanted a phone, and he wanted an iPhone. We said, no. You're not going to get an iPhone. We're going to give you a phone where we can kind of track where you're going. There are apps on the phone, but we'll give them to you once you you know, we'll unlock them once we can see that you're you've been responsible because he'd had a history of playing with, say, for example, my my mum's phone until it had gone dead, and then we'd go out, and that's her lifeline to ring us if she needs help, and she wouldn't be able to.
So he doesn't really think beyond the now. And so within the first three or four weeks, he'd done something to the phone. He was able to access all the apps that Nigel had locked down. Nigel, who is a software engineer Mhmm. So he'd
Oh, okay. I see. You you laughed because you knew. Go ahead. I gotcha.
Nigel just could not do anything. I have no idea. That is not my area. You know? And so we took it back.
It was under warranty. We took it back to the shop who took it back to the manufacturers and said that it would be an easy fix. We didn't get a phone call back for five weeks, and at five weeks, I got a phone call saying, we're not sure what your son has done, but when he turns 18, he's got a job because the the code that he has used is phenomenal. We all just have to give you a new phone because we don't know how to how how what he's done. And so I'm just hoping he stays away from screens.
He's too addicted to them, but, you know, I mean, that that's his passion, I think.
Yeah. I mean, it just it listen. I there's a ton of lovely people who I know who, you know, code to your son. You know what I mean? Like, have his his, you know, his skills, his talents, his eccentricities, and, you know, good with math and understanding computers and things like that.
And there's just I don't know. Like, I I really do fall in between just let them go be who they are and you know? But someone's gonna have to pay the rent one day, and it often isn't that person. You know what I mean? Like, it there and that that's the fear when you're a parent.
Like, is my kid just gonna be, like, you know, young Sheldon, or is he gonna, you know, is he gonna be tearing apart old computers in, you know, in the back room of his apartment that he hasn't paid the rent on in six months, is about to get kicked out of and hasn't eaten in three days and doesn't know it. Like, what's the it's hard to know. You know what I mean? Like, it I
don't know.
It's all frightening. And I think it's possible I find myself saying this a lot lately, but I really think it's possible that if I made a podcast about something other than an autoimmune issue, I would not be talking about anxiety this much with people. Yeah. I just feel like there's got to be something intertwined between inflammation, autoimmune, anxiety, ADHD, that sort of stuff.
Just feels like agree with
you. Yeah. Yeah. It just feels like it to me. So I don't know.
Like, hopefully, someone will figure something out in my lifetime so I can either be wrong or and move on or be right and pat myself on the back for a second. Listen. Before I let you go and by the way, tell people again what time it is where you are.
It is almost midnight, but I have got a few more things to say.
Do you? Well, then let me do something while you kinda collect your thoughts. Okay? Yep. I just want people to kinda see this.
Type 1 vs MODY 2, side by side52:09
I have a little breakdown list here. I hope this is right. I used the Internet to do it. Differences between type one and MODY two. The cause of type one, obviously, immune system attacks, pancreatic beta cells reducing or eliminating insulin production from MODY two, a change in GCK, oh gosh, glucogenesis gene.
Gluca can you say it?
I I don't know how to pronounce it, but it's glucokinase.
Glucokinase. So I don't know
if
that's Yeah. Which makes the body regulate glucose at a mildly higher set point. Insulin production, little or no insulin, obviously, with type one over time. C peptide often low or declining. MODI two, insulin production is usually preserved.
The pancreas still responds but at a higher glucose threshold. Autoimmunity with type one, positive islet autoantibodies typically not autoimmune in MODY two. Antibodies are usually negative. Typical glucose patterns. Type one can be highly variable without enough insulin.
Glucose can rise quickly and dangerously. MODI two, mild stable fasting hyperglycemia often present from birth and usually not very progressive. Diabetes genes, notes fasting glucose is commonly around 5.5 to eight millimoles in MODI. Symptoms at diagnosis, we know thirst, frequent urination, weight loss, fatigue, all those for type one. For MODI two, often no symptoms frequently found incidentally or example, for example, during a routine lab or pregnancy screening.
There's DKA risk, obviously, with type one. It's not typical with Modi treatment for type one. We all know it requires insulin to live and manage, for blood glucose. Let me take a drink. For Modi, usually no glucose lowering treatment is needed outside of pregnancy.
Meds, insulin often have little effect because the body keeps defending the higher set point. Complications and risks, I don't think we need to talk about them about type one. We're all well aware. For MODI two, they're generally rare in classic GCK MODI because hyperglycemia is mild and stable. There's, of course, a family risk in type one, but it's not, simply just one to, you know, parent a child.
In MOTI two, it often is what they call autosomal some what is that? Autosomal dominant. A parent with the variant has about a fifty percent chance of passing it to a child. And genetic testing confirms, Modi, of course, you know, glucose a one c and c peptide and autoantibodies confirm type one. So that's I just wanted to make sure people had that that idea.
Nigel’s hypothesis about the set point55:02
That's So yeah. So MODY two, as we found out, is basically, Felix having, an elevated set point for insulin secretion. So when we go back to the beginning, when he had a slightly higher, fasting blood sugar level, that's because that's where he sits normally. He doesn't sit at a low level like everyone else, a normal level. He sits higher.
And therein lies the problem. He was he was he presented with a higher fasting blood glucose level that was slightly higher. So he wasn't in DKA. He didn't he was totally asymptomatic. It was a coincidental finding because we'd gone in to talk to a naturopath about ADHD, but, you know, the blood showed that.
And so it was almost automatically assumed, him being lean and a child, that it looked like very early onset type one. So going back to the to the last appointment when we were told it was Modi two, the endocrinologist just said, well, we can't really take him off insulin because he seems to we don't know if it's type one and type and MODY two. We've not seen that before, but it could be. But he seems to be at the worst end of the spectrum of MODY two, so he'll need insulin. Nigel, in his good mind, he was, you know, his mind was ticking over, he did suggest coming off insulin, and the endocrinologist said, no.
There's still a risk of complications. So MODY two is supposed to be non progressive. And I suppose, like you said, insulin's not usually required except in pregnancy, and Felix is not going to ever get pregnant. So so when when Nigel suggested coming off insulin, it was a definitive no, and it was a definitive no for me because I thought, well, I don't understand Modi too. Why is it okay for Felix to have a higher fasting blood sugar level and not have complications?
But, anyone else, why has he got this superpower? And initially, we were told that we don't know why. You know? We don't know why. And then we were told that it's because they think it's because there's very little variability.
So Felix's set point is high. Mhmm. So he will release insulin at a higher set point, but he then when insulin is is released, he'll come back down. So his variability is the same variability as or similar variability to somebody who doesn't have diabetes, but at a higher level. So if you're not looking for Modi, it does look a lot like type one.
Mhmm. So this is where I think last time you said that Nigel was the unsung hero, and I'd vowed never to say that in the same sentence, but I was at this stage, we were really exhausted. I'd been looking after Felix for a year and a half, not sleeping at night, and Nigel started the research. I'd started it, and he continued it. And he started looking at, well, why can't it only be Modi two?
Why insulin masked the MODY58:42
You know, why does he have to be on insulin? How can I convince the paediatrician that he needs to be off insulin? And what he did find was that insulin that's given through a needle, so exogenous insulin affects your own insulin production and suppresses your own insulin's production. So he started thinking, well, the reason why Felix could take so much insulin was because we were giving him insulin before his own insulin kicked in. So we were so good at giving him insulin that he never got to the set point of wherever he needed to be for his own insulin to kick in.
And as a result, when he got a C peptide test, it resulted as if he didn't have any insulin, but he did. It's just it was never kicking in because we had totally tight control of his his insulin
Is there a
his blood sugar level.
A feeling that the additive insulin before that somehow changed his body's, I don't know, need or the set point, or is that no. Nothing like that?
No. Not at all. I think I think what the pediatrician looked at was the fact that the c peptide level has decreased. He had a positive antibody, and we were giving him more and more insulin, and he could accommodate that. He could just accommodate more and more, and a person who doesn't have type one shouldn't be able to accommodate all of that.
But Nigel hypothesized that if we kept him below his set point, a MODI two a MODI two patient could accommodate as much insulin as was needed because he was never producing his own he was never secreting his own insulin. So it's like he's a type one, so he presents like type one. Mhmm. That was his hypothesis. What strengthened his hypothesis was that Nigel doesn't like doctors, and every time he's gone to a doctor, he has been told that he's insulin resistant.
Right? And he had a long time ago, he had one of those glucose tolerance tests.
Yeah.
And the doctor said, this is very strange. The way that you're reacting is you've got an insulin response, but it's happening late. I've never seen it before. And so Nigel hypothesized that he has most likely has MODI, and that's the way that it presented. And then we got on forums and found that lots of MODI two patients had been misdiagnosed as either type two or type one.
And you can't really be misdiagnosed as type one if you are not taking a lot of insulin. So we went back. He he finally convinced me because I really didn't want Felix to go off insulin. I just thought, you know, I'd in my mind, I just thought I want to keep him as low as possible. I don't understand this mody two thing being high and being fine.
We went back Nigel managed to convince me. We went back to the endocrinologist and asked if Felix could come off insulin. And she initially said no, and then she said, in the same way that she said before, okay. So that we can go on a pump later, why don't we trial it under supervision at the hospital? But as soon as he starts showing signs of ketones, we stop the experiment, and we said yes.
So earlier this year, and we will not ever forget the date, it was the January 21, Felix was admitted into hospital for that supervised trial of insulin withdrawal. He was asked to or he ate loads of hot potato chips, had an apple juice, had two sandwiches with white bread, had cheese and crackers, had milk, had as much as he wanted to eat, and his glucose response was great. So he did go to about I think about a he he went to a 180, just a bit above that with all of that food, and then came back down. He was supervised for, I think, twelve hours eating whatever he wanted to eat, and there were no signs of ketones. And the same thing happened.
He went up higher than, you know, higher than a 180, and then he'd come back down, but come back down to seven or eight, which is his baseline. And eight is I keep on forgetting. Eight times 18. A 144. So higher than we would have ever wanted, but indicative of Modi only.
Off insulin — and the long view1:04:09
So on that day, he came off insulin, forever.
How long ago?
So that was January of this year.
Oh, wow. Six months.
Yep. I love that. A month ago no. At the end of April, we went back for our follow-up appointment. The pediatric endocrinologist has been in contact with us regularly just to make sure, particularly in the first month.
We had our follow-up appointment in April, and he's been eating since then. Since January, he's been eating like he would normally have eaten prior. A lot more junk than I would like because he's
been eating
for lost time.
Yeah. Yeah.
And his time in range is 94%, and his h b a one c 6.4, which is what it was when we he was on insulin just before he was taken off insulin. And that's in line with all the articles that say that that indicate that, insulin for MODY two, patients doesn't do anything. It's just not it it doesn't change h b a one c. It may change, your insulin levels a little bit, but it doesn't change the average. And I think the reason why is that because Felix's set point is higher, he will always we can get him down to, you know, four, but it will bring him back up to where he naturally sits
What
which is higher.
So what are they telling you about, like, a lifetime with this and what to look for in the future and how this might go for him for his long term health? Have
they Okay.
Yeah. And before I before you answer that, I've had a number of Mody two conversations in my life, and not one of them isn't confusing. I just wanna say that. But but but so, like, I you know what I mean? Like, what's your what's your short term, you know, midterm, long term desires, goals, reflections, things to pay attention to?
And then I gotta stop you because the editor's gonna scream at me because this thing's two hours long. Go ahead. Go ahead.
Sorry. So what we've been told is that there's only a very small percentage of people that develop any sort of complications from MODY two. So because it's a non progressive type of diabetes. So long term, he just gets monitored at this stage. It's not even long term.
Short term, in the next year, we'll have an appointment in one year's time. He'll put a CGM on in six months' time to make sure that he's still tracking like he is, because we did have that positive zinc transporter antibody. So initially, we were told that he's got he's more at risk of developing type one, but now we've been told and what we've researched is that zinc transporter is the most likely antibody that can result in false positives, and it was only mildly positive. So it may just have been a bad batch of tests. I don't know.
So it may just not because every he's had subsequent antibody testing, and it's negative. So for us, long term is that he will possibly not even be monitored. His risk of developing type developing complications is minimal. It's higher if he becomes bigger. So I think if he starts developing type two, but then that's, something that you look for in the future, and he'll be an adult by then.
So he just lives as though he doesn't have MODY two.
Interesting. Are you
The interesting thing
Yeah. Go
ahead. Is that, it's very rare that MODY two just happens de novo as a, you know, spontaneous mutation, it's very likely that it's a genetic mutation inherited from one parent. Nigel has been tested. He is a 100% positive that he's MODI two just given his presentation throughout his life, but he is a little bit afraid to get the the the result because he's a scuba diver, and he doesn't wanna be limited. The other interesting thing is that Nigel's father has been on insulin for twenty years.
Mhmm. He against he our our advice, he took himself off insulin unsupervised about a month ago, and he was fine, but he had to eat low carb. But he is quite he's got a wide girth. So I would suspect, and I'm not a medical professional, that he possibly has two. He definitely has Modi two and possibly type two.
I
see. He's he's 70 rather than type one.
So Well, this is fascinating and and twisty and turning and oh, is there any part of you is there any part of you that's that's disappointed that you even noticed it? Do ever just think, like, would it just been great if we didn't know about this and we just went along?
No. Because Felix would have been on insulin all of his life, which I don't think would have been a problem for me if I'd managed him, but he I I really didn't see a way that he would overcome his anxiety. It was so Impactful. Full on. I just can't it was it was he just couldn't get out of his head.
Yeah. So I didn't see a way I couldn't see a way out. So I I'm actually the opposite. I think if I'd never thought of it, you know, wished for it initially, if it had never been proposed to the hospital, Felix would have been diagnosed as type one forever, and he would have been on insulin forever. Whereas now we have a child who's not on insulin, so his anxiety doesn't manifest in terms of that that, in terms of having to take insulin shots.
And the likelihood of him having complications is very like, I think it's one percent.
Yeah. And I hear you. You're actually you're actually the hero of the story, though.
Oh, thank you.
Yeah. We gotta take the the the
Nigel here.
Yeah. Let him know. That's enough. One week of him prancing around the house, calling himself. That is enough.
Yeah. But we do really want to thank you because I think without the podcast, we wouldn't have been, I think, empowered enough or knowledgeable enough to kind of deal with Felix's anxiety. We were by the time that he was on insulin, which he didn't need Mhmm. We felt well, I felt at least that I had a good grip on what insulin was about, and I also understood that there were so many variables and that it wasn't a, you know, you give this much and set and forget. You know?
Like like, the hospital was kind of starting to talk to us about.
Yeah.
So I think
Well, I'm the hero then. I mean, honestly, really, what I'm hearing, Silvana, is that this is me. Okay. Although what I'm really hearing is that everybody involved in this story picked up a mantle at some point or another and helped drag it across the finish line. In the end, like, it's yeah.
Whatever the day was, that day needed a oh oh, Silvana, this will mean nothing to you, but I can finally use a Metallica song title as a we're gonna call this one hero of the day. There we go.
Why would
Because at some point, Nigel was. At some point, you were. Maybe I was for a half a second. And your son, of course, is Felix is is living through all this and dealing with it. He's obviously, day to day, the one who's, you know, dragging most of that mantle across the line.
So Yeah. That's true.
Yeah.
We that's really sad. It I I don't wanna say it takes a village, but, apparently, today, it it it does. And part of your village is a podcaster in New Jersey, and part of it is a a formerly hot guy that you married a long time ago. I don't know. Maybe Nigel still is.
I don't know. And and a mom Of
course he is.
Of course. And a mom that doesn't wanna give up, and now you're gonna turn all this focus on the next thing and see if you can't work something else out. I have to tell you.
That's true.
Yeah. No. You're a you're you're exactly the kind of person I like in these situations. I
Oh, thank you.
No. 100%.
I think I think also credit is really due to the endocrinology team because even though they didn't necessarily agree with what we were thinking, they humoured us. You know, they respected we had a good enough relationship for them to think, let's see. And I think everyone was surprised, and it was a learning experience for everyone. I think the hospital now possibly has different protocols in relation
to open mindedness.
Atypical. Yeah. Yeah. Think so.
Yeah. No. For sure. Well, you did a great job in your COVID cloud of explaining all this. I don't know if it'll make it into the recording, but when we jump back on for the second half, Savannah said, I don't remember anything I said in the first half of this.
So
None of it whatsoever.
Yeah. I hope you feel better soon, and I, you know, I wanna wish a lot of luck to your to your family. Of course, I you know, the one thing I feel like I don't have a resolution on, if you can just take a moment at the end, is how is your mom?
She has dementia. So it's a, you know, it's a long goodbye. It's you know, we lose a little bit of her every day, but she's still the same person inside. So she's turning 87 in a couple of weeks' time, and we're going to celebrate that. She still recognises us, so that's a positive, and she's a wonderful the most wonderful person you'd ever meet.
You know? She's loving and kind and extremely generous. So I suppose I'm repaying all the support that she's given me Yeah. Throughout my life because I'm an only child as well. So Yeah.
Well, I'll I'll So
You have a very complete story, a unique perspective, and I I really appreciate you coming on and sharing it with everybody. It's really it's just lovely of you to do this.
Oh, thank you. It's been lovely speaking to you at normal speed because I listened to you at one and a half speed.
Oh, that must
be crazy. Well, it was just to get all of the episodes in. So
No. I'm sorry. That's my fault. But but I've I've not tried to listen to myself at a at a faster speed, but I can't imagine it's a good idea. Well, gosh, seriously, I go to bed.
But I will. Dan, no. Thank you so much for doing this. I I really can't I can't thank you enough. This is a a unique story, but it it touches on a lot of things that impact people.
So, you know, you did a great job today adding, you know, everyone in your family's story to the the tapestry of the podcast. So, again, just really grateful. Thank you.
Well, thank you, and thank you for giving me the opportunity. It's been fun.
Of course. Hold on one second for me. Okay?
Thank you.
Alright.
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