#1968 Hide and Go Seek
Hide and Go Seek
Kristen is a pediatric nurse who gives Tzield for a living. Her own son was caught at stage two, got the infusion, and she talks about what it bought them — and what it costs.
Jump to a moment
- She works where kids arrive in DKA. Kristen is a pediatric emergency and charge nurse who has caught many children in DKA — and is now part of the only pediatric center in her state that infuses Tzield. When her own son showed signs, she describes his pediatrician telling her she was being insane.
- His early picture didn't look like typical type 1. Drenched sheets, dizziness, and then dangerous lows — at one point as low as 16 overnight, and drops of 200 points in twenty minutes. His doctor's working theory was dysglycemia with reactive hypoglycemia. He was confirmed at stage two, and started a Tzield infusion in August 2024.
- How they explained it to him. Kristen describes Tzield to her son as a fancy game of hide and go seek — hiding his beta cells from his immune system for a while, knowing that eventually they'd be found. He's since progressed, but she credits the delay with giving him a slower, less panicked way to come to understand type 1. Now approaching his own decisions, she says she'd want him to have it again but respects that it's his body.
- The price is a big part of the conversation. Scott looks up the list price live — roughly $15,000 per vial, with most patients needing a two-week course — and the two of them work through what that means if insurance covers it versus if you'd paid cash and six months later heard the CGM alarm. Kristen notes her center has given it to only a handful of kids in two years, partly because there is no broad population screening.
- The back half is about her own health. She describes stopping Mounjaro, then struggling to restart, and eventually learning she had a fibroid roughly the size of five pounds pressing on everything around it — which Scott notes lines up with his wife's recent experience. Tzield and cost figures here are one family's experience and one live lookup, not medical or financial advice.
- Diabetes Pro Tip series — Episodes 1000-1025 — settings, insulin timing, and food impact.
- Bold Beginnings series — Scott and Jenny Smith for newly diagnosed families.
- Juice Cruise 2027 — July 21–26, 2027, from Orlando — deposits open now.
Every word of the conversation
Cold open & sponsors0:02
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Hi. My name is Kristen. I'm a mother to a type one diabetic who actually got TZL'd. Today is actually two years exactly from the time that he started his TZL treatment, and he's still not in insulin, which is pretty cool. I'm a pediatric ER nurse as well as an infusion nurse.
A nurse who catches kids in DKA1:59
So throughout my times, I have caught a lot of kids in DKA in the ER. And then I now I'm in the infusion nurse that gives TZeal to other kids. So it's just been kind of an interesting journey. It's not something I think I ever would have thought about in nursing school, because diabetes made no sense to me. But now I have a type one diabetic.
So it
makes no sense to me.
I'm trying to decide if you're on a journey or a Ferris wheel. It's you might just you might be trapped in a little bubble that you're unaware of. Let let's start a little slow, pick things apart. So you have one child, obviously. Do you have more?
I have three children. So they, what we call like, most people call stair step children. So they're, thirty two months from start to finish. So, currently, they're 13, 11, and 10, because one just had a birthday. But the middle one is the one that is a type one diabetic.
Why do they call them stair steps? Because in the time it takes you to take a step, you're pregnant again? What is the
Well, yeah. I so for for most of the year, they're, like, like, they're, like, 12, 11, and 10. Right? So it's just, like, there's no skipping a stair.
So there's, like, one age after the
other after the other.
Okay. How old are you?
I'm 39.
39. Okay. You have these kids. Which one of the children, the middle, the oldest, the youngest has the type one?
The middle, the 11 year old.
Okay. How many how do I wanna ask this? I'm gonna start with autoimmune in your family. You, hypothyroidism, somebody got celiac, anything like that?
No. We actually have zero autoimmune in, either side of the family. When he got diagnosed, like, the only autoimmune, like, blood related autoimmune that could get traced back is, like would be his great grand like, uncle. Like, so it's his great grandpa's brother. Mhmm.
A great-great-uncle, maybe3:52
We think probably had type one because he died as a teenager, but, like, I mean, he's, like, you know, grand great grandpa's, like, 90. So
Yeah. We're talking about a while ago.
Yeah.
Yeah. Okay. Well, what about, your child's health first concerned you, and was your profession in any way valuable?
Oh, I do not think I would have caught his diabetes had I not been a nurse and had I not been, like, a pediatric ER nurse, in particular. So he, probably for a year before he was actually diagnosed so he was diagnosed officially 04/08/2024. But probably for a year prior, he would wake up, and he's not my complainer child. The other two children, I love them dearly, but I probably would have just been like, whatever you're complaining to miss school. But he was not the complainer, and he would be like, I'm dizzy.
And he would wake up, like, covered in sweat. His sheets were be soaked from being drenched in sweat and being dizzy. And I was like, what does that mean to you? Because he's eight at the time.
Yeah.
And was like, the room is spinning. And I was like, this is weird. So I actually thought he had low blood sugar, and so I bought an Accu Chek, like, to check him at home and was just randomly checking his blood sugar anytime he complained about being dizzy. But it was enough, like, in the morning that I was like, this is weird. He was never really fully nighttime trained because he has, like which he would, he would hate if I actually said his whole name.
Because, like, even before diabetes, like, I like, my husband and I were both late nighttime trainers. So I was like, you kids are screwed from us. We're sorry. It's bad genetics. But he would, like, go from being, like, almost completely dry in his, like, pull up overnight at eight to, like, stopping them again.
And I was like, this feels like diabetes. And I went to his pediatrician, and he was like, Kristen, you're insane. Just because you're a nurse does not mean this is happening. And I was like, it feels wrong. So they sent him to a cardiologist because he's dizzy.
“Kristen, you're insane”6:06
Right? And, like, he would get dizzy while working out. And so the cardiologist is like, nothing's wrong with his heart. And then he was like, you should see a neurologist. And so we saw the neurologist.
He was like, this is not neurology. I'm like, I think it's that he has diabetes. And the neurologist
Said, but wait. I have one more friend who has a boat. Can you just go can you just go talk to one more
Well, the he didn't send me to an endo either. Now granted, the neurologist is, like, February '24, and he was like, I think you're probably right. Just keep better track of it. And this is a neurologist that I worked with a lot, like, in the ER. So he knew who I was.
I knew who he was. And he was like, if your suspicion is this, just write it down better so that way you can track it more. And it was probably maybe a month later. It was, like, my kids' spring break. We sent them to my parents' house who live, like, four hours away, and my mom was is also a nurse.
So she was like, Kristen, I think you're right. And so he was complained one morning. He loves bacon and eggs. He'll eat bacon and eggs anytime of the day, and he didn't wanna eat it because his stomach hurt. So she checked his sugar, and his fasting glucose was, like, one seventy something.
She had already given him, like, you know, a good nana does, like, a bowl of sherbet. Right? Because, you know, your belly hurts. Here's some sherbet. That's how, you know, I grew up as a kid.
Your stomach hurts. Just eat some ice cream.
My gram my grandmother would give me ginger ale.
Right? Like Yeah. But she checked his sugar then after that, and it was well over 400. And now she's like, I'm gonna take him to this children's hospital. And I was like, no.
You're not. I was the charge nurse at the time in our ER, so I literally get the phone call from my mom. And I was like, if he's not Kussmaul breathing, please do not make me jump through the hoops of transferring his cares from two states away, like, over here. I was like, it's such a hassle. Like, just drive him back and bring him to me at work.
How far away? What kind of a ride?
It's, four and a half hours. I think my dad made it in, like, three. How old how
old are your parents?
Oh, no. Now there's see, my dad just turned 72. So my mom's 67.
So they were they were just about 70, late sixties. Yeah. Driving Yeah. Like, about out of health two states away.
Right. So, like like, I live in Indiana. They live in the Met say, like, the Met Illinois side of Saint Louis. So Okay. It's just like Flat and far.
Flat and far? Yeah.
Yeah. It's top on one interstate and just book it.
Yeah. Yeah. You guys should get a hill. It might be it might be awesome. It's fun.
Yeah. So, okay. So, obviously, he made it okay. And because you're telling that story in a lighthearted way. And and so he gets to you.
You put him in through your health care system. Is that hard?
I mean, it was hard. Like, I had to call like, because, I mean, literally, I was I was I was the charge nurse that day of our and I work in a, like, a level one pediatric trauma center. And so I was like, I am now, like, not capable of being level headed to, like, make all the decisions that a charge nurse does. So I like, the charge nurse of a trauma center is the one that, like, this ambulance is coming in. They can go to this room or they can go to this room or we have because kids are I wish kids and guns didn't exist, but that's a whole other thing.
Charge nurse at a trauma center9:38
But they both do?
But they both do, and guns and people aren't safe with guns. Like, I people can own their guns if they want. I just want people to be safe. Like, the amount of shootings I've seen of children is really bad
Yeah.
Which is it's just part of what I've dealt with for work. So I was like, I cannot make these decisions. So I had to call my my manager and was like, I need you to replace me because my son's coming in and he may be in DKA. And he was like, got it. I will come in and replace you.
And I was like, thanks.
Yeah. No kidding. Also, test my knowledge on this from interviewing other people. Every day, some small kid comes in whacked out on weed that they find and eat. Right?
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Oh my goodness. The amount of yeah.
Yeah. High little kids that show up from gummies. Right? Because they find their parents' stash somewhere or something?
Or it's like grandmas or aunts or whatever. And, like, I say this in the the most loving way possible that, like, I don't care what you do. Just kids think it looks like candy, so they're gonna eat it. So just be a little like, either have a conversation. Hey.
This is adult candy. Don't touch it or, like, hide it better.
And people lock up your weed. I mean, it's not hard. I I every time I interview somebody with your job, they're like, every day. Happens every day. And it's not it's not a laughing matter in some cases.
It's incredibly serious. They if they get too much. Yeah.
And some of those, like and buy from reparable people. Like, you know, even if they're sketchy reparable people, like like, you don't know what your drugs are laced with. The amount of, like, kids that have come in that have accidentally, like, gotten fentanyl, like, mixed in whatever, like, party drug they were going to do and nearly died is
It's astonishing, isn't it, how often it happens. Yeah. Yeah.
Yeah.
Yeah. Okay. I'm sorry about that. Just weird left turn. It just it always pops into my head.
Like, I I don't know. Like, just it can't be hard to put your gummies somewhere where a kid can't get them. It can't be. I mean And just
talk to them. Be like, don't touch mommy's candy.
Yeah. Mommy's got a lot of stress. Okay? So don't touch this. Dad's a lot.
You understand? I need one of these at the nighttime so I can sleep.
Yeah. Like, every day.
Yeah. Every day. Yeah. Okay. So he gets there not in DK in DK?
How did it go?
No. So he's not in DK, and this is in March '24. And so the doctor that actually, took care of him is obviously worked with her, but she was also a type one diabetic. She was diagnosed as an adult in med school
Oh.
Which is a fun story in of itself. So she was the one that took care of him. So I think because I had like, I was a nurse. I worked with these doctors. They knew that it, like and, like, when he got there, like, it had been four hours.
So sugar was still, like, 200 something, so it was coming down. Non DKA, they gave him a bolus. It came back down to normal. But I because I think of, like, having worked with these people, they called endocrinology, and they were like, what tests should we run to make this easier for you and them? And so they ran all the antibody testing.
Antibody testing in the ER14:33
Oh, very nice.
At the time, that wasn't something that they did for, like, an unexplained hyperglycemia. It is something that they, a lot of our doctors now do because of my son. And they can't explain, like, if you're not having a stress response or you've been on steroids, like, they are now trying to run, those antibody testing in the ER because, honestly, insurance companies fight less when it comes to, like, ER things versus, like, doctor things. So Yeah. They just approve it, and so it's easier for families.
So what started out as, like, a little benny for you at work turned into a thing where they said, why aren't we not just doing this for everybody?
Right. So, like, our doctors now are like, well, obviously, we caught his early. And so they've done it a few times to catch a few other kids that they have suspicion or, like, in stage two like, stage one or stage two.
Yeah. That's awesome.
Yeah. They've done it a few times to catch kids.
Oh, very cool. I I that that's up I I find that, uplifting and hopeful to hear. So, when so because I'm assuming because you caught it so early, he does he need insulin in that moment?
No. So he didn't need insulin.
Okay.
And so then we just went home, and they're like, set us up with a follow-up for an endocrinology, which is, like, actually only six weeks away, which I love our health care system, but, like, pediatric health care when you need to see specialists, sometimes you wait six to nine months to see them. So six weeks, I was like, yay. Six weeks.
Insane.
Which is just there's just not enough pediatric specialist, honestly. So
It's a shortage problem. A shortage of doctors?
Yeah. Okay. And if you think about it, like, for here in Indiana, pretty we have actually two children's hospital, but in general, pretty much everybody comes to the hospital that I work for, to, like, see their specialist. And so if you have kids from multiple states coming in, then it just takes a long time because there's so many patients and there's only so much time in the day and there's only so many doctors.
Okay. Well, it's still six weeks is a long time. Did that worry you that it was gonna be that far away?
It was not my favorite thing, but also, like, I'm I'm a nurse. Right? So, like, I know a lot of the symptoms. I know how to care for things. And so it in in my head, I'm like, he's not dying currently, so we're okay.
Right? So, like, when he was, like, way younger, Scott, he also had epilepsy. And so I had to give him, like, CPR. Like, I had to rescue breathe for him in our yard
Jesus.
When he was, like, two and call 911. So, like, I whenever I think about things, I'm like, I'm not doing that. Right? So, like, anything else in comparison is he's okay.
You have a little bit of parenting perspective around health already because that why the hell did you have a third kid when that happened? That would've stopped me right there. I would've been like, hey. She was good.
She was already born.
Oh oh, you so you're giving CPR to one kid while the baby's laying next to you in the grass?
Well, so, like, my oh, it's a mess. All three of my kid we're a whole fun genetic thing. All three of my kids had epilepsy when they were younger. My youngest is my daughter. She still has it.
Okay. My but two thirds of kids will outgrow it. So my two older, my boys, outgrew their epilepsy. So yeah. But he's he was two at the time.
So I had, like, a 3.5 year old and, like, a, what, one year old at the time. So, like, I had put them all in the, like, car seats because there's three of them. So I, like, buckled them all in the car, and then I went inside to, like, grab, you know, like, lunch boxes because we were gonna go do, like, a parents' day out thing where I dropped two kids off for, like, an hour, and I have, like, some sanity as a mom when I was had three kids that close together.
But instead?
But instead, I come back out, and my three and a, like, 3.5 year old is he's just screaming that his brother can't hear him. The worst experience ever because, like, there's a particular look of, like, color skin when people aren't circulating blood well. It's very pale and, like, translucent.
Mhmm.
And at the time, I wasn't a nurse, but, like, I knew that, like, I knew that color skin, and I was like, oh, this is not good. So I came back out and he's, like, seizing, and he's just, like, Casper the ghost. And I was like I had to pull him out of the car and call 911.
Your husband home?
No. When you Of course not. He was at work. The next
time you saw him, did you go, we should have just got, like, a parrot or something? Like, what were we thinking? I don't
I mean, we didn't have any other kids after that. Like Oh, no. Yeah. For sure. Was diagnosed, we were already pregnant with my third, and I was like, we shouldn't have more kids.
Like, we're just we're done.
I don't know if you realize that that the universe is trying to tell us something. Our kids shake. They stop breathing. This one has diabetes. I feel like maybe we should go back in time and not meet each other.
Just, like, I sorta I said to my sometimes I just apologize to my wife. I'm like, I'm sorry I found you attractive all those years ago. I apologize, for what happened afterwards. Well,
I mean, I I'm a firm believer that, like, you're given the kids that you're given because you can handle it. Like, I think of, like, other people that I know, and I'm like, they could not have handled my life, and the kids would like, my kids would not have probably survived as well with them.
I don't know how to tell you this, Kristen, but some of those people get those kids anyway. So
I know they do.
100% I see. They end up in the ER whacked out on gummies. So
Right.
Those people couldn't handle putting the gummies away, let alone the other stuff. Okay. Oh, my gosh. I'm so sorry for you. That's a lot to go through, especially as a young mom and having just given birth too and everything.
She's, like
I mean, mean, it is what it is. Like, nobody and nobody died. Right?
That was
the close of, like, someone trying to die, but no one died.
Not today, Satan. Yeah. So okay. Sorry. At what point does somebody introduce the idea of TZeal to you?
So we actually then we had March, and then we got admitted in April. So this is, like, March 22 was, like, our first, like, visit to the ER. And then April 8, he we actually got a new puppy, and this puppy is not trained, but the heaven sent of this dog. We had gotten a new puppy, and we had let the dog sleep with him at night, like, just to snuggle because he wanted to read the the new dog. And he brings the dog back out, and she's like, she's biting me.
Cake icing in his gums21:28
And, like, because he had fallen asleep, so she bit him awake. And I'm not even kidding you, Scott. Like, he handed me the dog. He starts walking back, and he turns around. He goes, mom, I don't and, like, very slurred, slowed speech, not okay.
And so I checked his sugar, and he was 16. Like, that, like, that's not a compatible blood sugar for
Being alive?
Your break.
Yeah. Yeah. Yeah.
And I was like and so I yelled at my husband. We're, like, rubbing cake icing into his gums because he's he is out of it. Mhmm.
The kids are trying to die again. Right. I mean,
this kid has this kid's got, like, you know, nine lives. Okay? Yeah. He's used a few of them up. We live like, we have a hospital that's much closer to us than the hospital I work at.
It's, like, five minutes. And so my husband's like, should we call 911? I was like, I am faster than going through dispatch. But that was like, I don't recommend that for anybody else. It was one of those moments that I was like, I should have just called 911.
Like, even as an ER nurse, but I'm a little proud. And I was like, I am not calling 911 for my kid.
To drive them five minutes from our house. I can get there.
I mean, they would have taken him to my work, but, like, we show like, I show up into the, like, ambulance bay of this other hospital, and they're like, you can't park here. And I was like, his blood sugar's 16. And so they take him, and then I park the car, and I walk inside.
Listen. Wait. But he's not on insulin at that point.
No. He's still not.
He's still not on insulin. But boom, he's 60. This I listen. 16, obviously, very low. But the the number of people who tell me about having, like, in the run up to their diagnosis, very low blood sugars.
So a lot of people bring it up actually. And and you weren't having luck getting it up at home with what you were trying?
Well, I mean, I just doused him with cake icing and took him.
Oh, you didn't wait.
That's not a like, knowing what I know as a nurse, like, if you have, like, your your liver should have, like, given, like, changed stuff into glucagon and given you some glucose, you know, and, like, brought your sugar up. So the fact that he got to 16, I was like, that is grotesquely not appropriate with life, really. And so I was like, I need I need more blood work. Like and we got the little the hospital was like, well, you could you're a nurse. You could probably go home and take care of him.
And I was like, can you just admit us to the children's hospital? And they're like, why? And I was like, because I can't do this It's it's anymore.
I'm I'm done. I like, you don't you don't want me to drive these kids into a lake, do you? Why don't you just, like, let us come sit for an hour? I I I have insurance. Leave me in.
Let me in. Yeah. Also, yeah, like, what are we doing here? That's a big thing to have happened. Yeah.
Yeah. Okay. So do you get answers?
So they worked him up for what's essentially Addison's disease or did a controlled, like, glucose test and which is a miserable, terrible test, and it was fine. And so or, actually, they didn't do it correctly the first time, but it's where he has to fast. And then if his they check his blood sugar every hour. And if it's below 50, then they check it every fifteen minutes. And until you get below, like, a certain number, and then they do, like, 20 vials of blood to, like, test your body's response.
Because they're like, why did this kid get to 16? Yeah. But they didn't quite do it right, and so we just got sent home because it was the day of the solar eclipse in 2024, and I really didn't wanna be in the hospital for it. So we went home.
Did you think, oh my god. Every moron in the world is gonna show up at this hospital today. I gotta get out of here.
Right. Well, like and where we lived, we were, like, relatively close to totality, and I was like, I just wanna go home at this point. We've been here for three days. My kid hasn't eaten for, like, thirty eight hours. Like, this is miserable.
Did you ever get an answer about the low blood sugar?
Dysglycemia, and a 16 overnight25:36
No. Well, the answer eventually was that this is what they've theorized has happened is that it's dysglycemia, right, which typically means that you're high, but it also could mean that you're low. And so we ended up going back two weeks later because he dropped deck down into the thirties at night, and the lovely new puppy bit him awake again. So she's she's a little mini dachshund, and I'm like, if I could train you, I bet you you'd be a great diabetes dog because she licks or bites him when he's high or low without any training, and I love that dog so much for it.
It's interesting, isn't it? Well, something who cares why? I'll take it.
Right? I was like, but if she hadn't been awake that night, like, he had already gone to bed with a blood sugar of 16. I don't know if he would have woken up, to be honest, which I don't like to think about that too much because your body has all these reserves and systems to help you and especially not being on insulin. Like, his body should do those things, but his body also shouldn't have gotten to 16. So what they his doctor thinks is that he has what's called reactive hypoglycemia.
So he was going high, and then he crashes. And you could see that he got a CGM at the end of April twenty twenty four. That's when we got, like, a more urgent follow-up. So we, like, actually met with all the endocrinologists. His doctor came to see him in the hospital, and she's like, we are gonna do more antibody testing because if you wanna do TZeal, like, insurance company likes two antibody testing.
So that's when we learned a lot more about TZeal, and we got his CGM. And then my child got a cell phone even though I didn't want him to have a cell phone. But
You you got freak you got it freaked you out pretty good that that low blood sugar.
I mean,
I It would have made him.
That he could be that low overnight and knowing what I know, I was like, this is not gonna end well for me. So
Yeah. What did did did you think to get him a CGM at that point?
Yeah. So he got released from the second hospital stay with the CGM.
Mhmm. And was that what did it teach you? Was he getting low a lot after that?
So he would go like, especially after eating, he would actually go high. He'd go up to, like, two fifty to two eighty almost every meal, and then he would plummet. But he, like, rapidly dropped. So his CGM, like, it would be he could drop 200 points in twenty minutes with, like it's like he we joke and we're like, he has a lazy pancreas.
It's like two eighty back to 80 in no time at all.
Yeah. And so it was like, I don't wanna work. I don't wanna work. I don't wanna work. Oh, I should get up and work.
You know? And then it, like Flips humbled him with, yeah, insulin, and he just tanked. And so then he would go really low, and then he would come back up. But it was terrifying. So he had, like, really, like, harsh, like, a roller coaster seat, you know, drops on his CGM after eating.
Sorry. I was taking a pill. Could he, sorry, could he feel that?
No. Which is even worse. Like, he is very unaware unless he's, like now he's more aware, like but it's he's under 40 before he's aware, or he's dropped probably a 100 points in ten minutes. Like, he's learned over the last two years. But at the time, he had literally no idea.
And we would have no idea because he would act just fine until he was, like, under 30, and then he would not act fine.
Jeez. And is this the point when somebody says TZL to you?
Yeah. This is when his doctor, like, that second time was like, hey. Like, I think, like, he's he's stage two type one diabetic. Like, he's obviously having dysglycemia. At the time, we had gotten his initial antibody testing from back in March because it takes, you know, what, three weeks or whatever for them to come back, and he was positive for GAD and zinc transporter
Mhmm.
At the time. And so she's like, she explained to me, she's like, he is a type one diabetic. And I was like, what do you mean stages? Right? And, like, I'm a nurse.
And I was like, I don't know what you're talking about, lady. Like, what what stages are you talking about? And so which sometimes in health care, people talk to, like, other health care people. Like, we know what we should all know, but we really don't.
They talk to us. They talk to us that way too.
I'm like, talk to me like I'm five. You know? Like, sometimes when I'm in chat GPT, I'm like, can you explain something to me like I'm a five year old? Because I need it broken down very simply.
Well Health care people frequently tell me health care people. That's not the right wording. But people in health care frequently tell me that when their kids or they or they are diagnosed, that they feel like they got the bums rush because the person talking to them was like, well, you get it, and then just let them go.
Yeah. Pretty much.
Yeah. Even though the I've been told that the people saying, well, you get it, oftentimes, they get the vibe they didn't get it either. They were just like, well, I don't understand, but maybe you will. So good luck. You know?
It's I I understand the how that could possibly happen. So when they say TZLD, you have no context for it. Do you look it up? Do you have questions?
Not a clue. And so I actually looked it up, and it was ironic because there was another kid, like, the hospital I was at, like, on their, like, social media post was like, hey. This kid had gotten TZealed, it's been, like, six like, as part of a research trial, and it's been six months or a year, however long it was since he had gotten it, and they had made a whole post about it. So I was like, that's ironic that, like so I got to read it. I, like, Facebook stalked the mom and was like, hey.
Seeing another kid's post about Tzield31:39
And, like, asked her questions, and she was lovely person. I answered all of the questions because I was like, what did this do? What does this look like? Like, so very lovely person to be like, hey. My like, I saw your son's post on our, like, hospital page, and my son's potentially getting TZL, and she's just, like, literally called me up and answered all my questions, which is great.
Yeah. So how long ago was this now that you did the TZLed?
He got it literally his first day of his TZLed infusion was 08/05/2024. So it's been exactly two years.
Did you book this day on purpose?
No. I did not.
Isn't that
crazy? You actually changed this to to this day. It was gonna be a different day.
Did I? Oh, that's right. Because oh, be I moved this up because I put you on a travel day, and I didn't realize you don't know that, but that's why I had to move you. I'm I'm I'm going to ADCS tomorrow. And so That's fun.
Oh, so I moved this this day. It's what they call, kismet. Is there a word that goes around this? I don't know exactly. And does he take insulin today?
No. Get out of here. Isn't that cool?
I will say I and he hate he doesn't like me. I think he's getting to the point where he needs to, but also the last two weeks have been very stressful. Stressful. And so, like, when he's been eating, it's been going high. He started school today, but it's at a they they've always gone to private school, and he is going to public middle school.
So not only is he moving schools, but it's starting middle school. And so I think his, like, stress response is higher.
Yeah.
And he's been eating, like, bags of Goldfish. And I was like, can you please stop eating, you know, half a carton of Goldfish because your sugar's two sixty, child.
So he wears a CGM all the time?
He does.
Okay. And he knows he has type one diabetes, and he expects that it will come, you know, and need insulin at some point. Is that how you've explained it to him?
Yeah. I was I've told him. I was like, look. Like, you will 100% need insulin at some point. We explained TZL to him like it's kinda like a big fancy game of hide and go seek where we hid his immune like, his beta cells from his immune system for a while, but eventually, you're found.
Hide and go seek, explained to a kid33:51
Okay. Does now having done this for two years now, aside of whatever health benefits you're gonna get from not having diabetes for two years, psychologically, would it have been better for him to just get diabetes two years ago or no?
I don't know. I it's it's kind of like a hard hard thing. Right? Like, because he's now 11, you know, going on almost 12. So, like, his maturity level is much higher.
Right? And his ability to, like, take care of himself is higher. I don't he doesn't like to be the kid that, like, stands out or draws attention to himself. And so I think he's enjoyed not having to, like, be on a pump or be on insulin. He is needle phobic.
Like, of my three children, he's the only one that cares about getting stuck. And so I'm like, why is my needle phobic child the one with diabetes? So I don't for him, it's not the insulin. It's the having to poke himself. So I think it's been nice for him over two years.
It's like he wears the CGM, but, occasionally, we we finger correct to, like, verify because sometimes we use a Dexcom and sometimes it's wildly inaccurate. He's also a competitive swimmer. So, like, especially after he's been in the cold water, it's not particularly accurate.
Okay.
And so he's learned to be like, this is just one part of diabetes. And so I think he's now comfortable with that. And so now it'll be I think it's given him time to, like, get comfortable with one part and then get comfortable with another part. But, like It's nice
so that's a nice way to think about it that it's been just a slower, amount like, a longer time for him to accept what's going on to understand it and not put him in, like, a medically, like, panicky situation while he's trying to figure it out.
Right.
It'll be interesting to see if your experience once he starts needing insulin still just ends up mimicking a newly diagnosed person or if their value actually carries over or not. It's interesting.
Yeah.
Yeah. Jeez. I'm sorry. I I know the whole thing sucks, like, one way or the other. Like, it's nice to talk about, like, oh, he took the drug, it kept his diabetes away for a couple years, and that's awesome.
But still, the whole process is terrible. What about the
I mean
Go ahead.
I I mean, I just wish there we gave it to him in the hopes that, like, one, I know the benefits of, like, having better blood control, you know, for his sugar is, like, long term. Obviously, health insurance companies have recognized that benefit because TZeal was not cheap
No. At all. Yeah.
Yeah. So the fact that they, like, covered it is kind of insane still to me, but it's just like, it it sucks. Right? Like, it's just it's trying to buy time. So now tZeal's been approved for, like, you know, newly diagnosed stage three.
Whether he'd do it again37:00
We actually had that conversation with his doctor, and we're like, does that mean that he can get it again? At the time he got it, it was a onetime dose, and she's been looking into whether or not he can get it again because would it be considered him newly diagnosed as stage three, and could he get it at the eight weeks and the six months and preserve more of his beta cells? So that's an interesting but there's so few, I feel like, stage two kids that got TZL that there's not a lot of, like, data about what you whether it's beneficial to get it again or not.
Okay. That's not just an an an insurance thing?
I think it probably honestly, Scott, it's probably gonna be an insurance thing, but I that's like you know, it was what? Approved a month ago, right, for stage three
Mhmm.
Or two months ago. So, like, it's just a recent theme. So it's like, can he get it? You know? Like, because he's still not on insulin, which or is he like, well, how is he going to be classified when he needs to be on insulin?
He'll move to stage three. Right? But for insurance purposes, does that make him eligible for TZILD? And the answer is his doctor and I have no idea.
Yeah. Are they looking into it?
He she is. Yeah.
What what's your inclination? What would you like to do if money isn't the issue?
Oh, I mean, insurance covers it. I think on his I would like for him to have it again because I saw such a benefit, but he's also at the age where it's kind of his body and he knows the risk and benefits to it. He had we learned he was allergic to adhesives during it with his PICC line. So he had, like, really bad blistering rash around his PICC line, and he got pretty GI upset. So he was, like, sick for, like, a week.
So I don't know if he would want to do it again, and then I respect him enough to let him make his choices on that.
Hey. GI, impact from the adhesive allergy or from the TZ?
From the TZ.
Oh, poopy? Like, the
Well, yeah. So day four, days one through five, you this is my knowledge as an infusion nurse giving it. Days one through five, you they're increasing the the medicine, like, the actual, like, dosage of TZeal. Day five is when you're at your max dose of TZeal. But they, like, slowly introduce you, because it can cause allergic reactions, so they introduce it to your body more slowly and build it up.
So on day four, he got he was, like, so sick. He just essentially lived in the bathtub, and it was coming out both directions, and he was miserable for days.
Oh gosh. Hey. Did they do the Benadryl thing like they do with the iron infusions?
Yeah. So he got, Benadryl. He eventually got he gets a bolus. So a lot of the times kids will get Tylenol or ibuprofen, depends on which doctor writes it, and Benadryl. And then they'll get a bolus of fluids like normal saline before the TZOELD.
And that bolus of fluids goes over thirty minutes to an hour. And then t zealed goes over thirty minutes to an hour depending on who writes it and what the kid's weight is, and then you get observed for an hour afterwards.
How much how much total time are you there?
It's, like, four hours. Every
How many days in a row?
Fourteen.
Is there not a longer there's a fourteen day. Is there also a longer infusion time too, or am I making that up?
It's fourteen days, I for stage two, and then I think the ones for stage three are actually only gonna be twelve days.
Twelve days. Okay. Shorter, though. Yeah. So and so now to kinda put your, like, professional hat on for a second, like, forget he's your kid for half a second.
Is it is it worth it? Like, is it is that a lot to go through for a person, or is it a small thing to trade for, you know, what you've been hopefully benefit on the other side?
I mean, he's seen a lot of benefit from it. Right? And so there's a lot of things in health care like this, I feel like, gives hope. Like, it gives time. Right?
So, like, we know it's still going to happen, but it gives hope of, like, what am I buying for this time? Obviously, when blood sugar is higher, like, all those small vessels, like your fingers and your toes and your eyes and your kidneys, like, those capillary vessels get damaged more by high blood sugar running around. And so the longer you can have better control over your diabetes, the better. I did a lot of research into TZL prior to, like, giving it to my kid because I was like, what do you mean I'm gonna give him this biologic? And it's gonna, like, alter him in some way.
You know? Like Yeah. I was like, I'm like, that that feels a little weird.
We're not getting Spider Man. I'm not sure what I'm what I'm doing here.
Right? I'm like and it's, like, it's just interesting. So it's a it's it's a zippo map. So all of the maps, if I can I'm I'm pretty sure if I if I get this wrong, my coworkers are gonna give me a hard time, are, like, 90%, like, human and, like, part mouse. I'm almost positive that is correct.
And so it's, like, how it's made is very different, and that's why sometimes people have reactions to it.
Yeah. I always said temazeplav. It's temazo what?
Mab.
Temazepam? Yeah. Okay. And that was the drug name back when they were still were back when Provention Bio had it, and they were they were still bringing it to market. I actually spoke to a person the other day that I know who worked at Provention Bio.
And, it's been a lot of years since I had conversations with them about, oh, we're making this drug, and it's gonna do this. And now, like, look where it is. You know? But it's a it's a lot of years ago already that that from those conversations to this. Do you think did you think when you did this like, I know they I don't know what they tell you.
They tell you we're not sure if it's gonna work or how long it's gonna work if it does. Is that kinda how they put it?
She said, she's like, we've had kids where they've gotten in, and it's only worked for six months. But she's like, in general, it lasts about two years. Some people in the research trial, it's lasted ten years. She's like, we have no way of knowing who who benefits, you know, for what time frame.
What was there any part of you that was like, oh, we're gonna get the ten years?
Oh, I mean, it's, like, secretly hope. Right? Where I'm like every time I'm like I'm like, are we gonna make it? You know? And so, like, when we made it a year, I was like, we made it a year.
You know?
Mhmm. So where
Now I'm like, we've made it two years.
Right. And two years is awesome. But, like, where are you now that you're seeing, like, higher blood sugars? You're like, oh, it's like is it disappointing, or do you feel good about the decision?
I still feel good about the decision. Like, I just pulled up his Dexcom. So, like, he had, lunch at, like, 12:30, so, like, an hour ish ago. Yeah. And he's, like, one forty four.
No. That's awesome.
So, like, it's where I'm like, now if he eats he loves chips and salsa. And so he eats a bunch of chips and salsa. It's never I'm like, you're and he feels sick afterwards, and I'm like, you're eventually gonna have to take insulin. He's like, I don't want it. And I'm like, so, like, sometimes I'm I get, I think, cautious of, like, he's selective of what dietary things that he does because he doesn't want his blood sugar getting getting high.
Mhmm. And I'm like, I don't need you to have, like, an eating disorder because you're, like, avoiding food Yeah. To not raise your blood sugar. And, like, you you're a kid. You should be allowed to have pizza and cake and Somebody chips and salsa if you want it.
Yeah. Somebody pointed out to me recently By virtue of having type one diabetes, you have some sort of disordered eating. Like, it is a weird relationship with food no matter what. But I take your point. And and so you'd like him not to eat chips and salsa, but you don't wanna tell him not to.
But he's also if you say to him, well, we'll take insulin, he's gonna say what any kid would say. Well, like, no. Don't wanna do that. And then, you know, jeez. I see, it feels like a quagmire to me.
The whole thing feels like I don't know. Feels like a relationship where I'm I'm getting good news and bad news at the same time all the time. Am I wrong about that?
No. I mean, it's it's both. Right? Like, it's always it's the up and downs with any sort of, I think, chronic illness is, like, sometimes it's fine and sometimes it's not. Right?
And so, like, when it's fine, you're like, oh, we're good, and then it's not. And you're like, oh, this sucks. Yeah. You know?
Okay. I I appreciate that. What I don't know. How many people have you given it to that obviously, you didn't give it to your kid, but, like, how frequently are you giving it to people?
So well, now we're gonna give it to people more because it got approved for stage three. So, right, like, most kids aren't caught in stage two. My son never probably would have been caught had I didn't have the, like, nursing knowledge and just that gut instinct of, like, this doesn't feel right. So the problem is, like, we there there's not good, like, general population screening. Right?
Like, my my son, his name's Kaden. He doesn't he has no like, we have no family history. There's no reason for him to have been screened. Right? And so it just he's just that one outlier of, like, he doesn't have like, there is no history.
There's no reason to suspect that any of us would have had an autoimmune disease, let alone type one. And so to catch it is, I think, rare. I've given it to see, he was kid five. I think we gave it to kid nine last month. I'm currently out on disability from work.
So, I had surgery myself. So they gave it to a kid while I've been out.
Okay.
But, you know, so, like, you're talking in a span of two years, they've only given it to, like, four more kids. Now I do know that there are more kids that are getting approved for it that are in stage three. And so there there's, like, two or three kids in that boat that are going to get it pretty quickly.
So if if your son got this and it only lasted for six months, would you say it was worth it? Trying to figure out what the time cutoff is before you go, ugh, we shouldn't have done that.
Like, I think it will depend on, I think, on families. Right? So, like, for me, it's it wasn't a big burden to go to essentially my workplace. Right? Yeah.
Whereas we're the only pediatric center in the state that can give it. So some kids have gotten approved for home infusions, but I like, insurance companies don't really like that. So if you had to drive three hours, like, every, you know, each day and stay in a hotel, like, would that have been worth it? Maybe not because that's a huge inconvenience on the family. Right?
Like, some parent has to take that burden for two whole weeks.
Yeah.
For us, we could drive fifteen minutes to the infusion center, get his med, and come home.
Go to mommy go to mommy's work and do it.
Right. Yeah. I was able to not be at work, you know, during those times because they're like, nope. That's reasonable. Like, I took FMLA.
Yeah. No. For sure. I mean, that's a it's a it's a long it's a long day and so many days in a row. Obviously, he needs you to be with him.
Okay. No. I'm just trying to I don't know. Like, it's one of those things. Like, it makes sense if it works.
What it would cost to pay cash49:19
If it doesn't work, so I could see myself looking up and going, like, imagine if you paid cash for it. What was the cash price?
So much money, Scott. My insurance company paid the adjusted rate. Right? Mhmm. Insurance adjusted rate for all of it, including the PICC line, was, $478,000.
That was the that was the cheap price that they gave the insurance company.
Yeah. That was that was what my insurance actually paid the hospital.
I wonder what the bill was. Like, what it would have been if the if they if you said I'm gonna buy this cash, you think it
would I don't I don't even wanna know. It's so much money. I remember you said complaining about, like, way long ago, Tamiflu was, like, $70 to have it compounded when my kids were little and they couldn't take pills.
Yeah.
And I was like, that's a lot of money for medicine. And now that I've been a medical parent I mean, for epilepsy for a long time, it's been over a decade, like, of being a medical parent for different disease and two ish years for this. Like, I'm like, this isn't like, $70 is nothing.
So, I'd like to go back to the world where I was complaining about $70, please.
Right?
Yeah. Yeah. I I'm gonna see if I can find out what is the cash price for tZeal. See if we can find out. I mean, if it's if it's a 500,000 on the the knockdown price, I mean, is it is it a million?
I mean, I don't know. But you also, like this I love insurance companies. I hate insurance companies. When you use insurance, like, I think you know, like, my insurance will, like, has this adjusted rate at my hospital, but might have this adjusted rate somewhere else. Right?
So, like
Yeah. But still, like, it's a negotiated price. That's the only infusion center that does it in your state. If you had to go there for cash, that's where you'd go. And and they're not gonna give you the adjusted price.
So and if you can't pay, they're not doing it. That's for sure.
I know.
Yeah. Yeah.
It's so much money. It's more than my house.
Yeah. I I'm just saying, like, imagine you did that, and then six months later, you woke up and you heard, like, beep beep. And you see Jim, you'd be like, hey. What the hell?
I'm sorry. They're like, I paid a house for this. No.
I traded a house for six months. I don't know. It's just to me like, look. I hope it I hope it they learn more and it stretches time out, and I my expectation is, hopefully, that'll happen. But, you know, it's just a it just seems like it's a lot it's a heavy lift.
I guess the
heavy lift.
Yeah.
Yeah. And I mean and we got we've gotten two years out of it. Right? So, like, that it's been two years of no insulin. He wears a CGM still.
We all we've kept one on since TZeal partially because I like research. And so he his doctor and the fellow that saw him wrote a whole research paper on him. That's like a published journal article now. But, like, it's I think what doctors have always theorized has happened, and so he kinda is, like, that proof of it. And it's also proof of, like, how does TZLD actually, like, affect this per one particular kid's blood sugar.
Mhmm.
He didn't have to wear CGM, but he would have to be, like, you know, before and after meals, like, two or three times a week. And he was like, I don't wanna get stuck that much, so he would rather one CGM stick every ten days.
Yeah. Well, listen. It it's they must have a sale here because, the Internet says that Sanofi's official website list price effective July 2026 is a mere $15,218.05 per vial. So 14 vials would cost $21,352.70.
$15,000 a vial53:13
Is it just one vial that's needed for their weight?
No. I oh, oh, that's a good point. It's a two milligram vial. You mean they could end up needing more?
Mhmm. I think I think I don't know. It's been so many years. I think we give about twenty five milligrams, but don't hold me to that.
Oh, wait. Wait. Wait. Wait.
I could be wrong. How many I think every infusion one of his infusions was, like, 30 to $40,000.
I was gonna say, didn't ask the right question. Like, how many vials do you need is the the extension to that question.
Yeah. And, obviously, like, if you're, like, one, right, like, you're a little itty bitty baby, you don't weigh the same as, I think he was, like, seventy pounds at the time. Actually yeah.
Did they did they just lower the age for it too?
Yeah. So stage it's lowered, I know, for stage two down, I think, to one. I don't I think stage three is still higher, but it's just how I think they researched it, you know, in that research study. So what they got it approved for.
Okay. And saying for an adult, like, weight, it could be so what what if this is right, it says most patients need 14 vials, one single dose vial for each day. However, dosing is based on body surface area, BSA of BSA of one point four nine four m to the m I don't know or less. I don't know what the hell that means. Or generally 14 vials total, but two vials may be required on days five through 14 making 24 vials total.
Oh, good luck. I I mean, I don't know. Yeah. I it's a it's a it's a I don't argue any side of this. Like, I think it's a thing if you could afford it or if you can if your insurance covers it and you wanna do it, I you should do it.
You know what I mean? And and and I hope it lasts you forever. But I I don't know. Like, I've always my question around t ziel's always been when this little bio company made it, prevention, I thought, oh, that's cool. It's this company, and that's all they're working on.
Then they sold it, and they sold it off to Sanofi. And Sanofi paid a lot of money for it so much so that when you look at, like, how hard it's gonna be to find patients for it and how much it costs and how what a a pain it is to actually even do it, I thought, are they buying the molecule or are they buying this idea? Like, I can't figure out. Do you know what I mean? Like, do they think this drug does something else, or did was somebody just punch drunk one day and was, like, 3,000,000,000?
No problem. We'll take it. Like because I think that's what they paid. How much did
Yeah. No. I I wanna know how much they paid. Oh, shit. Yeah.
I I don't know. Like, it's I live in a world like so my infusion center, it does about forty percent of the kids that I see are oncology kids. And so we give, like, chemo and cancer drugs. Okay. But, like, this new field of, like, immune drugs and biologic drugs that, like, can help with a variety of other diseases.
Like, I feel like it's booming, and my guess is drug companies just want part of that. Because, like, if you have that knowledge and how that works, can you use that same process that made TZealed in a different drug? Like you know what I mean?
Like Oh, that's exactly how my brain, like, thinks about this. Like, they must think they're buying something else. Like, Sanofi bought all of Provention Bio, not just TZeal. So they just bought the whole company. They paid $25 per share in cash in April 2023.
The announced equity value was approximately $2,900,000,000. Sanofi's later financial reporting describes the complete transaction as approximately 2,800,000,000. There was some sort of a must have been a coupon day. Largely a difference in rounding and transactional accounting, TZeal was central asset acquired in the deal. So they bought the they bought the company because of the TZeal, which back then they called, Timis Bob.
Yeah. And, again, my point is is that it's a thing that a lot of insurance companies don't cover. Even when they cover it, they make $400,000 on it, and you're a center who's only done 10 of them. So at your this is an argument to me that at your center, they've made $4,000,000. Let's say there's 50 of those centers, which I don't imagine there is, but 4,000,000 times 50 is, hold on a second.
I'm gonna guess not 2,800,000,000, but let's take a look.
I know. Or, like, we're also a pediatric center. Right? So, like, if you're an adult that's, like can get it or and adults will get it as, a home infusion. So I don't I mean, I don't know.
But you're also buying the rights to the drug.
That's what I'm saying. It feels to me like they're buying the molecule is what I'm saying. Yeah. I know nothing about nothing. No one's ever said this to me.
I know I just said five minutes ago, I know somebody that developed the drug, but I've never spoken to that person about this in my life. And, but 50 like, if 50 centers sold ten dose the like, to 10 patients, that's $200,000,000, which is nowhere near $2,800,000,000 is my is my point. And and it's hard to find the people to do it for. Like, that's been the central, like, problem behind this since the since they bought the drug. Like like, you know, remember, like I probably shouldn't say this out loud, but, like, you remember, like, screen it like you mean it?
Mhmm. Yeah. I mean, don't you don't have to dig too deep into that to see who's trying to get people to screen for their diabetes a little bit. And so, like, the point was that they're like my guess is they were like, we have this drug. This is amazing.
How do we find people to give it to? Oh, that's hard. And and now the and they're still at it years later trying to figure out screening and, like, you know, this whole thing. My point is that that's a lot of work to do to try to make back that much money on something that costs that much where you can't find people and insurance probably isn't gonna cover it. So so that's a that that would be like me saying, hey, Kristen.
I got this sofa. You wanna pay me for it? Give me $3,000,000,000, but you can't sit on it. You know what I mean? And you'd be like, well, why would I pay you that much money for a sofa I can't sit on?
And I'd be like, I don't know, but you're going to, and then you do it. So the so what's the reason in there? I that's the thing I wanna know. I'm gonna keep making this podcast till I figure that out. I have other things too.
Sanofi's latest public count says more than a thousand patients have received TZL. That's amazing. Separately, more than 900 patients received in clinic development studies. Okay. Well, nobody paid for that.
So let's just take it on faith that a thousand of these things made them $440,000, which to me does not sound how, like, this is working because I think your hospital probably got half that nut. Right? So let's say two right? I'm not wrong about this. So about 200
You're not wrong.
Yeah. Yeah.
Like, the med cost this, the hospital cost this, the doctors cost that, the surgeon to put the PICC line.
Yeah. So we'll use the number on the 14 vials. I just said 230,000 real quick. So, I mean, that's it's 200 and it's 230,000,000, which is a 250,000,000. I don't know how how how good you are with your, or the other answer would be, again, not $2,800,000,000.
Now Yeah. If they can get three so if my math is right, they need 3,000 more people to make up the first Billy, and then they need 4,000 more people to make up the second Billy. So that's 7,000 more people. And then probably another three, they need to they need to get 10,000 more people to take this drug to break even on the purchase price. And that's not adding in however much money they've spent trying to market it, which I'm gonna tell you, I bet you has been a lot.
So, again, they could have bought a baseball card and flipped it. You know what I mean?
I mean, they could have. And so you're probably like, it's not just the drug. Right? So they probably bought the scientific property of
that. I'm saying what is in that? What's the magic in there? Yeah. That's what I wanna know about.
Us little people will never know.
Well, they are definitely nobody's gonna like that I ask this question out loud. I can tell you that much for sure. But I'm dying to know. I I wanna know what they think they bought. That's what I wanna hear about.
Come tell me about that. I'd love to I also wanna hear I'm gonna start dig deep by this. It has nothing to do with anything. But this new, Lilly drug, the GLP, the I'll learn the name of it one day, but retrutatide or whatever that is. They I think they're saying it's gonna build muscle.
A GLP, and a five-pound fibroid1:02:27
First of all, yes, please. And secondly, I wanna know about that. Like, let's start talking about that a little bit. You tell me I'm gonna lose weight, be hungry, build muscle, cha ching. Let's let's go.
You know what I mean? You take that GLP, Kristen?
I've I've taken it before, and then I just got really bad. Like, I almost had, like, a short bowel obstruction, so then I I was like, it's not worth losing weight if I'm gonna be this sick.
Which one were we on the Ozempic?
I was on, Zepbound Zepbound. For a while, and I was like, I just am so sick on it. It was just not worth
You know when you were a kid, you said if you loved it so much, you'd marry it? I'd marry Zepbound. I just wanna say that. Yeah.
Yeah. I hear you talk about it all the time, and I was like, man, he's so lucky. I was like, I was I was
What happened to you?
Why I was puking like, I literally I was so constipated. I could not
That's not good.
Like, go. And so, like, I literally ended up almost with, like, a bowel obstruction to the point I was, like, profusely puking all the time.
What dose?
Literally, on, like, the five milligram. Like, I could never get past it.
You did you try
losing weight on five milligrams either.
Did you try the, like, magnesium trick?
I did. I tried magnesium. I tried, like, pulling it out in a vial and microdosing. It just
Scott, I could and then eventually, it came out the top. Is that what you're telling me?
Mhmm. Yeah. Pretty much. Did you So I was like, this is not okay.
Did you change your diet? Did you, like, get away from fatty foods?
I mean, eventually, I just ate, like, nothing but, like, fruits and vegetables is the only thing that sounded good, but it just I, like, barely ate, didn't lose weight, and was puking and miserable all the time.
I can't tell you. This is the saddest the saddest thing I've ever heard. I'm so sorry for you or anyone else who is not enjoying it the way I am. This is sadder than, than foreign brewers. I I a purse a person who can't take sap.
I mean, it's so good. The thing is is I had taken Mounjaro for a long, long time, like, when it was, like, way back when it was Mounjaro before Zepbound was a thing, and I lost so much weight.
Wait. But it's the same drug.
Right. But when I, like, stopped taking Mounjaro and tried to get, like, on Zepbound, I just my body was like, no.
No. But that I'm telling you it's literally the same molecule.
I know it is. But my body part of it well, Scott, like so I told you I was on disability. I ended up having, like, surgery because I I had a giant uterine fibroid and I had to have a hysterectomy. And so, like, I had gained all my weight back. So part of it's like now that that's over, I'm like, I wonder part of my constipation problem was that I literally had no room in my abdomen.
Get right back to it. Get right are you kidding me? I would I would dive on top of a needle like it was a grenade, and I was saving buddies in World War two. I'd be like, oh, right on top. So I just thought I'm
gonna try again. But
Well, I hope it works for you. I how you said you're 40
I'm 39.
39. Excuse me. I just said this on the podcast the other day when I was recording, so I guess I could just say it again. My wife just had the same surgery for the same reason. She had, like, a softball size uterine fibroid.
Mhmm.
And the recovery is terrible.
Yeah.
Yeah. How long you been off?
Get six I've been off, I go back to work next week, actually. So I've been off for five weeks, and this is probably the first week that I don't feel quite terrible.
Kelly goes back Friday. You she literally had hers, like, maybe a week before you, maybe not even a full week before you. Yeah. Yeah. I was surprised at how hard it was.
Like, when they gave her the six weeks at first I I said this on another episode, which you'll hear. Like, I don't I won't wanna belabor it. But, like, we were both like, six weeks. Stop it. Like, you know, like, my wife's never taken a full day off or anything, and I was like, six weeks.
I was like, she ain't taking off six weeks. The other day, she said to me, she was, I could use a couple more weeks. And I was like, she but she went to the doctor today. They cleared her for activity as long as it wasn't rigorous, which I took I was like, listen. I don't know how rigorous I could actually be.
Like, the but, like, you know what I mean? Like, so was like, I don't think we're in that much danger. You know what I mean? But did they go, like, laparoscopically for you?
Yeah. So mine, I mine was laparoscopically. Mine was, like, literally my, fibroid was the size of five, like, five pounds. So was, like, almost like a really full, like, Chipotle burrito. Like, it was it was massive, which I had gone to doctors for years and was like, there's something wrong.
And they're just like, you're fine. You're fine. Lose weight. And I'm like, but I did lose a bunch of weight, and I'm gaining it all back. And I it was a whole thing.
I actually accidentally fell down my stairs and hurt my hip and then had to get an MRI because my hip hurt. And the lovely ortho doc was like, ortho docs have a reputation. They're not all this way, but a lot of them are, like, athletes and they kinda have that jock vibe. And so he was like, blah blah blah. You need to go see an OB GYN.
Like, he's just, like, didn't know how to tell me. And I was like, you have to tell me what my MRI said. And so it was found accidentally, but it was huge. And my OB GYN was like, who squeezed me in, lovely lady, will recommend her to everybody because I was like I called an office and I was like, I they're like, it's gonna be nine months. And I was like, this is not a nine month thing.
Like and so they
Yeah.
Saw me very quickly. Yeah. She was like, no. Absolutely. Are you not waiting for surgery?
That is massive. That needs to come out.
How many grams how many grams was it?
It was it was five pounds.
Wait. That's like, wait, that's like is that like 2,000 grams?
Yeah. It was literally this massive. It took up my entire, like, pelvic region.
Oh, I'm gonna tell my wife to stop complaining so much. Hers is only eight hundred grams.
No.
Oh, no. That was Yeah. Wait. Will I tell
her Mine was huge.
When I tell her to stop complaining, that'll go well. Yeah. That's not gonna go all fast. Wow. Holy hell.
Wait. Is that the time when you couldn't take the Zepbound?
Yeah. So that's why, like Yeah. When I'm trying to hit the Zepbound, I'm like, I can't poop. Right? And I'm like so I'm like, I probably couldn't poop because I like, this thing's pressing on my colon, like, on the inside.
So, like, we just I think it's important. Space.
I think it's important first for me to not in case people can't tell from listening. But, by the way, if you can't tell from listening, shame on you. I am not a doctor, and you shouldn't take any of this advice. But, like, I'm gonna guess if you took Manjaro, you were fine. Tried Zepbound while there was a five pound burrito in your stomach, then I'm gonna guess that that was the reason you couldn't.
Okay.
So I mean, probably.
Yeah. And so, I mean, immediate like I said, throw yourself right back on Two and a half. Boom. You'll be fine. I wouldn't do two and a half for more than a month.
I'd go right to five. You're gonna you'll be fine. And if not I mean, I'm not telling you what to do. You can do whatever you want. I'm just I think you're gonna be okay, keeping in mind I barely graduated from high school.
So, but you're gonna try it again, you said.
Yeah. It's something I was gonna I'm gonna try again just because I
How much weight are you trying to lose?
Well, I mean, I I feel like everyone always wants to lose weight. So, I mean, with having my hysterectomy, I lost, like I've 10 pounds less now than
I was gonna say at least five pounds. Yeah.
Half of that was, you know, that. But I wanna lose I wanna get back to, like, one sixty. Like, I'm five six. Like, I've never been, like, a skinny person. I'm a very athletic person.
I have a bigger belt. And so, like, even when I was on Mounjaro and I got down to, like, one fifty five, I was skinny and sickly looking. Like Mhmm. So my body is not meant to be, like, itty bitty, like
Okay. Yeah. I mean, wherever you're comfortable is the right place. So oh, that's awesome. Well, good for you.
I it sounds like you got things going in the right direction, I would say. That's that's a nice thing. It's also interesting that your kid has type one. My wife's has type one. You both have a very similar thing.
It's interesting. Yeah. I don't know if it means anything, but it's interesting. Sorta like the Sanofi thing. Interesting.
Thanks. Okay. Alright. Well, we've done a good job here. Have we not talked about anything we should have?
Have I missed anything that you wanted to talk about?
No. I think we covered it all. It's just I didn't know if I, like when I emailed you, I was like, I don't know if I qualify. You're just like, you're nurse who gives it, and you're a kid who has had it. Like
What do mean qualify? Does anyone on here sound like they're qualified to do anything? This is just people just telling their stories. I'm certainly not qualified. I just wanna be clear about that.
I mean, you all
should listening to the podcast, and I'm like, I don't have anything to give these people. Like, my son's not on insulin.
No one's ever once come on this podcast and thought they were gonna be a valuable addition to it. It's pretty interesting how people think. They always are like, almost everyone gets done and goes, if you don't wanna use that, you don't have to. And I'm always like, what are you talking about? Like, that was great.
They're like, I don't know. Like, I was nervous, or I didn't know that. I'm like, you're out of your mind. This is fantastic. People get it.
I have a beautiful, like, guy told me online the other day. Really meant a lot to me. I'll mention it here. He said I kinda see the whole podcast as like a he's like, I see Scott as like a social scientist almost. Like, because we've been having so many conversations trying to, like, connect things together.
Like, I have no idea if your fibroid, my wife's fibroid, and our kids type one has anything to do with each other. But imagine if I just said it out loud and thousand women just went, oh my god. That's happened to me. Like like, imagine if, like, that's a thing that gets connected along the lines. If six months from now, two or three more women come on and go, hey.
I heard you say this thing. And, you know or by the way, because this happened to my wife, just interviewed a woman the other day who's just a she's just a mom of a kid with type one. But in her regular life, she's a some kind of, like, nurse. She it's a name for it. I forgot what the hell it was.
But she works in hormone replacement for women and GLP, and I said, you should book again and come back on just and talk about that. So she's gonna come back on. We're gonna talk a little bit about menopause and, you know, how to do stuff like that. I don't know. I just think it all ends up connecting together eventually.
So I'm really grateful you came on. Thank you. Seriously. Scott. Plus, you have a nice, what they call personality.
Like your you got a good vibe is what I'm saying.
Well, thanks.
Yeah. No. For sure. Like, your husband is a lucky guy. I'm sure he complains about you constantly behind your back.
And
He never does. He's very sweet. He's stressed so stressed yesterday and brought me coffee, and I was like, I love you.
He wait. Listen. When you had a what'd you say? A burrito? That's a that's
so Literally, it was, the size of a chipotle burrito. You know? Like, those things are huge.
The big wrap. Yeah. The ones where the guy go when he when he tells you the the white chicken and the bacon cost extra.
Mhmm.
Yeah. Yeah. Yeah. Bacon's extra. Okay.
I I mean, what am I gonna knock at bacon now? Like, you're already charging me $90 something I'm sure is worth $4. Like, why don't we just splurge and get the bacon as long as I'm taking out a mortgage here for the burrito? But that's a a very specific complaint about Chipotle. They're very expensive.
Anyway, I I've never eaten Chipotle. I'm only the guy that goes to pick up Chipotle for people. Because they'll they the the people behind the counter are like, how do you want this? Like, I don't this isn't for me. I wouldn't eat this.
Get a million anyway, it's not the point. So this thing's inside of you. Your husband never, like, walks up to you and goes like, hey. What the hell's in there? Are you okay?
Like, did you look distended? You must have looked prank pregnant.
Literally, for, oh my god. The last year, I'm getting a different, like, normal doctor after all of this. Mhmm. Because, like, I like and she she had been a great doctor up until this point, and a bunch of doctors left the practice. So, like, I think she just got burnt out, and they didn't have as much time to, like, normally dedicate to patient care, which is becoming a thing, right, when people retire and there's not new doctors.
And
Yeah.
And so but I was like I was like my my poor husband, I was like, I I was like, honey, like, I can't. Like, I feel like I'm pregnant. And I had gone to the doc, like, this is weight team. Like, any sort of relations were painful. Like, in that, I was like, this is not normal.
And they were like, you're fine. And I'm like, you're just anxious and used to lose weight. I'm like, that is not a lose weight problem.
Told you that? Mhmm. Come on. I usually blame the guys, but really? Like, she's like Yeah.
She's like, get moving, fatty. That's what she said?
Or she's like, I know that you're anxious. Like and she'd be like, well, now that you work in cancer, mean you're gonna die of cancer. I'm like, I don't think I'm dying of cancer. I think there's something wrong with me. Right?
Like, it was kinda like but wait. When you have to schedule an appointment because something's wrong and it takes four months to get in
While that thing's growing in
minutes to see you. Right? Like
I don't know. But you describe yourself as athletically built. Like, it's it's it's you knew that's not what it was. Right?
Right. And I'm like, there's something wrong. Like, you know and it's I'm not as athletically built because, like, it hurt. Right? Like, it like, my hips hurt for, like, a while.
Like and I'm like, you can't go workout or run or do all like, lift weights or squats if you can't, like, bend at the hips. And, granted, I'm also a nurse. Right? So I'm, like, going to work. I'm like, this is physically painful.
Or I'm like, I should not be
Yeah. Like, you're describing a physically active person, and the doctor's takeaway was you're probably anxious about having sex, about having cancer now that you've changed jobs, and what you're having a hysterical, like, swelling and get moving, and you're like, no. I'm act what a weird leap.
Yeah. It was just one of those, like or I'm like and there there's stories like this. I if you talk to people at health care, like, this happens to people. Right? Right.
And I'm a nurse, so I work in health care. I'm like, this is not okay.
No. No. I'm not okay. Listen. I'm done making excuses for people.
Okay? There's a burrito in your belly and someone goes, you're probably just anxious. I don't know what to say about that. Like, that just seems like you jumped to the way wrong conclusion. And I do think for certain, we you and I talked about this before we turned on the microphone.
But if you would have typed all your complaints into any one of these large language models, any one of these chat GP whatevers, it would have come back and said, have you looked at this? And how hard would it have been to run a Doppler over here real quick and take a look?
Right. It really would have just been a simple ultrasound, and it should have been caught. My sim my symptoms of my fibroid got really bad when, and I had to cancel my OBGYN appointment when my son was in the hospital the first time. So, like and then I just was like, well, I can go to my primary care for this. So it was my bad, and my then my OBGYN retired, and then I just never got a new one.
It got much bigger. You could've shined a flashlight on yourself sideways and seen it probably.
Right. But, like, you could, like, press on your belt, like, my belly, and I was like, it was huge.
What is this?
It was like a twenty four week pregnant belly. Like, the OBGYN is like it's like you've been twenty four weeks pregnant for a year. And I was like, yay. It's not me.
Even your your practitioner, did they not did they go are you still getting your period? Like, I would have asked. Did did you get asked that?
Well, they asked, and I was like, it's it's abnormal. Like, oh, well, just welcome to your age. Well, like, it's probably perimenopause. I'm like, I hate you all.
Yeah. No. No. No. You're being nice because you're a nurse, but I know what you're thinking.
And so okay. They my last two questions, they leave your ovaries?
They did.
But you're still on an estrogen patch now?
No. I'm not on any hormones. I go back to my six week follow-up next week, and then, my guess is I probably will be because I'm having way more symptoms of perimenopause than I've ever had.
So Oh, the lady I talked to yesterday who I'm gonna have back on says that if you get on them in that first ten years, it extends your life and it it eliminates a lot of issues like osteoporosis, brain like, all kinds of things. Like, if if it's appropriate, I say she's saying you should do well, I'm saying look into it, but you should do it probably. So not not that you haven't figured this out already, but you've been sitting around for five weeks. I'm sure that's what you've been googling.
Well, I've been home with my kids in the summer, so it's been fun.
These kids, they're ruining your life. I know it. Don't worry. It's fine. Alright.
You're awesome. Thank you very much for doing this. Hold on one second for me. Something new just arrived from MiniMed. It's the MiniMed Flex system.
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And don't forget using juice box podcast links helps support the show. Friends, my diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. I am joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down the complex concepts into simple actionable tips. The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, where you can listen to it at juiceboxpodcast.com by going up in the menu.
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#1967 Healthy Little Girls Don't Sleep All Day
Healthy Little Girls Don't Sleep All Day
Gina was diagnosed at seven with a blood sugar of 2,000. Fifty years later she chairs a university social work department and brings Scott an idea: the story you tell about your diabetes can change.
Jump to a moment
- Her grandmother noticed what everyone else had normalized. Gina was seven, staying with her grandmother, who first tried to fatten up a thin granddaughter with pancakes, malteds and ice cream — and then heard her sleep all night and nap all day. Gina can still hear the line: healthy little girls don't sleep all night and sleep all day. Her mother had taken her for a clear checkup six months earlier.
- A blood sugar of 2,000. She was flown home and admitted, and remembers a doctor telling her parents in front of her that he didn't know how she wasn't already in a coma. She practiced injections on an orange, used regular and NPH for over a decade, and tested her urine until home meters arrived around age twelve.
- She was given responsibility on day one, with no bargaining. Her parents handed her diabetes tasks from the moment she got home. There was no carb counting and no CGM. Later, as an early pump user, she describes effectively teaching her own doctor how to manage a pump patient — and a gynecologist dismissing cycle-related swings she was reporting.
- Social work gives her a different lens. Gina chairs a university social work department and spent years running services at a New York City shelter for adults with medical and mobility issues. Her framing: education is only one piece. People have to move through grief — denial included — to reach acceptance, and someone who is stuck in denial isn't going to manage their diabetes no matter what they're told.
- Narrative reframing, and externalizing the problem. Her closing idea is that we all tell ourselves stories about who we are, and that separating the problem from the person — a failed site is a failed site, not a verdict on you — changes how a bad day lands. She also asks Scott, directly and kindly, to use more inclusive language on the show; her second spouse is a man, and she describes how assumed straightness can leave some listeners wondering whether the podcast is meant for them.
- Mental wellness series with Erika Forsyth — For more on the emotional side Gina describes — grief, acceptance and diabetes distress.
- Diabetes Pro Tip series — Episodes 1000-1025 — settings, insulin timing, and food impact.
- Listener survey — The survey Scott describes in this episode; results at juiceboxpodcast.com/surveyresults.
- Touched By Type 1 — Sponsor of this episode — programs, events and the annual conference.
Every word of the conversation
Cold open & sponsors0:02
Hello, friends. Welcome back to the juice box podcast. 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. Alright.
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Now for all of you podcast addicts out there, here's a conversation that goes, I think, almost two hours, hour and forty five minutes maybe. I hope you enjoy it. Today's episode is sponsored by Tandem Diabetes Care, the Eversense three sixty five, and touched by type one. There are links in the show notes and at juiceboxpodcast.com to all the sponsors. When you use those links, you are supporting the Juice Box podcast and helping to keep it free.
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Please take a moment to learn more about them at touchedbytype1.org. Also, follow them on Facebook or Instagram. When you get to touchedbytype1.org, check out their many programs, their annual conference, the d box, dancing for diabetes. They have a golf night. Gosh.
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Seven years old, in the 1970s2:28
Hi. My name is Gina, and I was diagnosed with type one diabetes in 1978.
78? Yes. When young Scott was just seven years old. How old were you?
Nine.
Nine. Look at you. 57?
Yes.
Ah, 55.
Doing that quick math?
No. No. Don't worry. I'm showing off showing off what I learned in summer school, my sixth grade summer. They kicked me out of kicked me out of is the wrong word.
I removed myself from algebra too late in the year due to the fact that my brain doesn't understand math. And I then had to go to summer school where I learned that it was just going to be super simple mathematics over and over and over again. If I wanted to get through it, I needed to be able to whip out my times tables and my gazentas real quick. And I'd never put any effort into it my entire life, Gina. I don't know if you were a good student.
I certainly was not. And I went home. I was staying with my grandmother because the school was closer to my grandmother's house. That's a detail nobody needed. But I went back to my grandmother's house, and I sat down at the dining room table.
And she's like, what are you doing? I'm like, I need paper. I have to teach myself the the one times two, three, four, five, six, seven, eight, nine times times tables, which I didn't know by heart. And then I just crammed them onto my head that night, and that was it. So anyway Amazing.
Yeah. Well, is it?
And you still have it.
Is it not amazing that in the first seven years of school, I hadn't done that already? I think that might be the amazing part. So you're diagnosed at, well, at a young age, at a long time ago. Would you tell me a little bit about the cares that you gave yourself, that your family gave you in the first, I guess, maybe decade?
Grandma's pancakes and malteds4:19
Sure. So actually, if you want a little bit of my origin story, I was visiting my grandparents in Florida, and when I arrived my grandmother noticed that I was very, very thin, and I recall knowing where all the water fountains were back before we had bottled water. And she said I'm going to fatten you up, and was just feeding me pancakes and malteds and ice cream and, you know, all of these things, and then obviously that wasn't working. And one day she went out to the to get her hair done, and I was a good kid, so she said, why don't you stay in the house because I didn't want to go with her. Stay in the house, don't answer the door, don't answer the phone, and I'll be back.
And I took a nap, and I came when she came home, I was still asleep, and I can still hear her voice in my head saying, healthy little girls don't sleep all night and sleep all day, something is wrong. And she took me to a doctor, and the doctor did blood tests and determined that I likely had type one diabetes, and they made arrangements to fly me back to Brooklyn where I was where I grew up for my parents to have me admitted to the hospital. So I got on an emergency flight, flew back home, they took me to the hospital. I remember the doctor greeting me in the elevator and sniffing my breath and saying, yes, fruity breath, and, immediately admitting me to the, pediatric ICU. And my blood sugar are you sitting down?
A blood sugar of 2,0006:14
Well, I am. Was?
Eight 2,000.
Holy god in heaven. What are you sitting?
My my blood sugar was 2,000. Really? I remember the doctor saying to my parents in front of me, and maybe also to me, but, you know, I don't know how she is in in a coma or dead already.
Awesome. Yeah. How long do you think this had been going on before Angela Lansbury in Florida figured this out? And by the way, how long how long did it take grandma to figure it out? Days?
Yeah. Why don't we just hire people like her and put them in the in the doctor's offices? She she's like, you're skinny. You ate something. You slept.
You're sick. Yeah. Right? Yeah. That's great.
I mean, you know what? I mean, she obviously was experienced with her own children and grandchildren. And when you don't see someone every day, you can see a problem that people every day don't notice because some things just become normal. Right? They're normalized for you.
Yeah. No. Of course.
Yeah. So and, you know, my parents you know, my dad would say, well I left all the healthcare stuff up to your mother, like they had different very gender related roles, you know, especially in the 1970s the way that they approached parenting.
And
so my mother had taken me to the doctor like six months before and I had a clear check up, so as far as she knew everything was fine. But they did remember that I had gotten sick at one point, which might have been the triggering illness since it is autoimmune.
Are there autoimmune in the family? Mhmm. Celiac? Not
no. No? That's the amazing thing.
No. Come on. No no thyroid, no celiac, no type one, no vitiligo, no people have a lot of allergies. Is there anything at all?
Yes. My father had a lot of allergies, which I have inherited. And my maternal grandfather said that he recalled a family member might have had type one diabetes.
Okay.
But he was born in nineteen o seven, and you know, he's long since passed, so his, his family members would have not likely had access to insulin.
Because of the time. Because the time. Yeah.
Because of the time frame. Right? If they had type one diabetes, they would not have been long lasting. The memory wouldn't be strong enough of watching someone navigating with it, taking care of themselves, etcetera. Okay.
It was it was
a fuzzy memory for him, so it's possible.
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So I'm an anomaly in my family.
Congratulations on being different. How long did they take I mean, how long are you in the hospital coming in with such a an advanced situation? I
A long hospital stay, and an orange11:12
was in the hospital over the Christmas break holidays from school because I remember Christmas and New Year's passing. I remember getting gifts, and I remember my schoolmates calling me and, you know, then needing to go back to school, and school had already started. So I was because I was in the ICU, and then I was in a regular room
You know what we should
where I had my education.
Mhmm. What we should tell people, Gina, because we are, let's just say, older than on than many who might be listening. They probably don't realize that Christmas vacation used to be awesome. Like, two weeks, three weeks sometimes depending on where you wasn't like, you know, you leave on Friday, you come back, you know, after the first or something like that. It was like it was a legit vacation.
I remember. I remember. So you were in there a long my point is is they're probably like, oh, like a week. You were in there a long time. No.
Yeah.
Yeah. Yeah. No. I I was in there a long time. This was at a point in healthcare history where insurance didn't pay by the diagnosis, they paid for every day that you were there, and hospitals kept you in longer.
And this was one of the things that I wanted to mention to you is that I remember watching a video, which I've since Googled to learn a little bit of the history, but I remember watching a video with a cartoon character named Eddie, and Eddie stood for exercise, diet, and insulin, and that was how they introduced children to diabetes and their parents to this this this balance of how much you exert, what you eat, and how much insulin you take. And it was formative for me.
How about that? Yeah. Good one.
And I learned how to inject syringes. First, I practice on an orange.
Mhmm.
And then I practice on one of my dolls.
Think of it
in a a
more human vibe. And Yeah. You were shooting I mean, it's the seventies. Was it I mean, were you pig in
A decade of regular and NPH13:32
Regular in NPH.
Were regular in NPH.
Okay. I was regular in NPH, and I was home urine testing because glucometers weren't introduced in my life and in the market until I was about 12. Yeah.
So how long are you regular in NPH for?
I was actually regular in NPH for over a decade. I wanna say, well, actually into adulthood
So through college?
Before I was introduced to Lantus.
Yeah. Through college? Yes. Yeah. Yeah.
Okay. And and had it become the norm, but you didn't switch, or was is the timing that it you switched over when it became more readily available?
So I'm not really sure what you know, I had when I was an undergrad, I had, you know, a primary care physician, I had a couple of different endocrinologists, and my a one c was like 7.1, and I didn't ever wind up hospitalized with ketoacidosis, and I had a few scary lows, but I used to try to run high at night if I went out with my friends because I would go out dancing and, you know, have some drinks and, you know, I would go clubbing. So there was a lot of dancing involved and other things. And and so running a little high and testing once in a while probably kept me alive, and so they were happy with the 7.1 because, you know, I was pretty active in my twenties, but never athletic. And then I started having some problems. When I visited an endocrinologist, I was having issues with essentially my complaint for years was feeding the insulin, basically.
Cycles nobody would take seriously15:31
If I went low, I would just consume everything in the kitchen, and I started putting on weight. And then also, I was having struggles because of my menstrual cycles where what looked like what could be predictable became very unpredictable at a certain point, and the doctor was not very compassionate about it.
No. It's And
this is actually
They still aren't, Gina. Is that why is that one of the reasons you wanted to come on the podcast? Just talk about that.
I wanted I wanted to talk about that, and I wanted to talk about something called narrative reframing with you.
Okay.
Because I've been thinking about this.
Before we jump into narrative reframing, dancing and other things. Other things were drinking or other things were weed? It was the seventies and eighties. Right? Which was the other things?
Actually, I was young adult in the nineties. Oh, the nineties?
And Sorry. Cocaine. Yes. I apologize.
No. No. Never used cocaine.
Oh, okay.
I know. But, yeah, I just I you know, you you go out and you party.
I mean, I can see your nose ring. We're talking face to face. I see you. I see you're 57, still your hair is long and flowing, a little curl in it. I see you jumping around.
I know what's going on over there with you.
Thank you.
You're feeling it. Yeah. Yeah. I get you. Okay.
Well, tell me about this reframing thing. What do you I I guess maybe for a half a second first. Tell people what you do for a living, what your background is.
Social work, and a homeless shelter17:01
Okay. So, I am a social worker by profession, and I am the chair of the social work department at my university
Mhmm.
The University of Saint Joseph, in Connecticut.
Connecticut? I hate driving in Connecticut, but keep talking.
You don't have to drive. That's the power of Zoom. I spent many years I'm born and raised in New York City, and I I spent my whole adult life in New York City, at least, until I moved to Connecticut. I did live in New Jersey for a little while, but doesn't matter. And I worked for many years as the social services director and then the program director of a homeless shelter for adults with medical and mobility issues, and we had many, many clients with type one and type two diabetes, many of whom were diagnosed while they were living at our facility and had a really difficult time adjusting, accepting, wrapping their brain around, making changes at a time when they really didn't have agency over a part of their life.
Oh, wow. Yeah. I guess it really does double down on the difficulty. No kidding. Yeah.
Yeah. How long do people generally stay in the shelters before they're able to move to some sort of more permanent situation?
So I'm not really sure what the landscape looks like in New York City now, but during the time frame that I was there, the idea was to get you from a triage into a shelter bed where you would remain until you got housed. And for some folks, it was a very quick turnaround. For others, there, you know, there were things that had to get done before someone could get housed. Right? So lots of times, people would have their identification stolen or they lost all of their belongings or they didn't have a reliable source of income because you would have people who say were working, but they didn't have savings.
And, you know, there were people who were working poor who had a catastrophic situation. They blew through their savings, they couldn't work, and they wind up in shelter. Right? That was the most common story that we had, and so we had to help them get some sort of benefits or find a job that they could do. I had one client who had diabetes and she was a bus driver, and she didn't have, good control of her diabetes and she her vision got too blurry to legally be able to drive.
Grief, denial, and acceptance19:47
Oh my gosh. So there's just Yeah. Just kind of trauma and tragedy stacked on top of one another, and then someone says to you, oh, by the way, now you have diabetes on top of all this. Yeah. Mhmm.
Yeah. It's gotta be almost impossible. How do you help people through that, or is there not an answer?
I mean, there are a lot of answers to that. What I can tell you is psychoeducation is only one thing, and you do a lot of psychoeducation, by the way, as well as general informational education. But there has to be a grief period for some people Mhmm. And you have to work through part of working through grief is denial to get to a point of acceptance. So there's the stages of grief.
Right? So there's denial, bargaining, sadness, anger, and acceptance. And for a lot of folks, that is a path that they take a very long time to go through. And if you can't work through that and you're in denial and not working on managing your diabetes, then you can have the complications. Right?
So that's something that not everyone goes through the exact same way or, you know, some folks are like, k. I have my week. I'm ready to go. Other people really struggle, and I think you see this in in the in the forum.
Yeah. For sure. No. I it's it's kind of fascinating how it strikes different people and the path that sets them on, how long it takes some to get through it, and how some just can never feel. It feels like, I don't know, what it feels like from the outside, but it feels like something's got a hold of them and they just can't knock it off.
You know what I mean? They can't get free of it. It's, it's interesting, really.
And it is interesting. And you're a parent of a child with diabetes, and there are a lot of parents, and I see it's fascinating as an adult to see the parental knowing as a child how I experienced it. And that was something I kinda wanted to talk about a little bit with you. Yeah, I
Responsible from the first day home21:53
hope so.
As a child I was empowered. I was empowered through Eddie and by learning how to take the insulin myself, and my parents gave me diabetes related tasks, although they were largely, know, obviously
Accomplished. Responsible. Yeah. Yeah.
Right. So I had a dose of regular NPH, and it was my job to fill the syringe, and actually what we used to do is we used to pre fill syringes for a couple of days because I always took the same amount twice a day. And so I I was responsible for that from the moment I got home. There was no conversation. There was no bargaining.
It was, you know, this is gonna be your role. We're gonna, you know, also learn, you know, the the the ADA diet at the time, and they gave me, like, menus. And there was no carb counting. You didn't know how to do those things, but my mother had to learn how to make a diet that worked. And there were no CGMs, which is something else I wanted to talk with you about.
Yeah. Sure.
Is I had to learn how to read my own body. Right? I woke up one morning. I remember clear as day. And in fact, my my father recently passed away.
Oh. But before he passed, I had a series of conversations with him, and I shared with him a memory of the first time after coming home that I had low blood sugar, and he remembered it basically the same way I did, which is that I was in the bathroom brushing my teeth, and I went I was trying to put the toothpaste on the toothbrush, and the toothbrush kept turning. I was like, why won't it stay still? I I, you know, I can't get so I started crying, and I ran into their bedroom. Like, the toothbrush won't stand still, and I didn't understand that it was my my own body
Yeah.
Not able to hold it, and they immediately recognized that as a sign of low blood sugar and treated me with some orange juice at the time.
I'm gonna use that anytime something doesn't work for me anymore. I'm be I say the computer won't do what I want.
It frequently doesn't.
I just think it's a great way to make yourself feel better. It sounds like that's I there's something wrong with this toothbrush.
Yeah. Yeah. Of course. Awesome. That's really awesome.
So I was listening to some of your interview episodes Mhmm. To sort of prepare for today, and there was a mother who had a child who refuses to wear a CGM. And in that episode you said I wish I understood what the kid was going through, and none of us can because everybody's an individual. I can tell you for myself though, I kind of cheered that kid because I said that kid is learning how to have hypoglycemic awareness and hyperglycemic awareness because she's not relying on a machine to tell her she is living in her body and learning the at least that's what I think, is learning the rhythms and the signs and the symptoms within her own body. And that has saved my life more than a CGM.
Even if
Not knocking.
No. No.
Because there are some people who really have really bad hypoglycemic unawareness where that is the only thing that's gonna save their life. Right? And I think that's probably true for people who are diagnosed late in life. But this is just a hunch of mine that if you are a kid or a young adult where you don't have any kind of nerve damage and you don't have you know, presuming you are otherwise healthy, learning how to feel and live in your body, and learning those signals and trusting those signals and watching how they change over time is is vitally important. And when you don't have a CGM, you don't have a CGM to rely on.
You're not using your brain.
Yeah. No. I mean, it's it's interesting because it's obviously, it's a multifaceted idea. And Mhmm. I take your direct point and I can't I I I agree with it.
And then I start to think about all the people who don't have a CGM, who have a one c's in the nines or tens, and I think
Mhmm.
Is there not a trade off in there that I'd be willing to make? So I don't I don't maybe I don't understand how my body works as well, but my a one c is two points. Like, I just wish there was a way to, like, to a la carte all the experiences that I hear people talk about going back all the years. You've you've had diabetes. I mean, I didn't do the math, but '88, '98, 2008, '18, you're almost up to fifty years.
Right? Mhmm. Yeah. You're getting there. So Yeah.
And and so you you have a wealth of experiences layered over top of generations of different, like, management concepts. And, you know, I bet they're from what my interviews that I do with people who've had type one diabetes for a longer time, I always take their point that they've had an experience that they found valuable. They wish people who have more modern, you know, I don't know, ideas or or technologies Mhmm. Could experience. And at the same time, I have also spoken to people who after you talk to them for a while ago, yeah.
I guess though had I not had to go through that, that would have been okay too. I wonder how to blend all that. I you know, think through the conversations is how and people will blend it on their own in their own lives. But dig in a little more.
I can tell you sorry.
No. Just dig in a little more to it, please.
Well, I can tell you that I used to test more than 10 times a day.
Yeah.
I would finger stick first thing in the morning. I would finger stick before every meal, two hours after every meal before I went to bed, and I would also test if I felt off, anytime I felt off. Yeah. And that helped me find patterns before we had CGMs.
Oh, yeah.
And the folks who have an a one c of nine or 10, I I a 100% agree with you. A CGM will probably do wonders to tracking those blood sugars. Will it help them to learn how to identify and fix patterns? And that is the other piece of it.
Yeah. And I oh, I But aren't are there not two different people? Are there the people who would have that experience, identify those patterns, make changes, and the people who have that experience and never change and still have a again, incredibly high a one c. Do know what I mean?
And, yes, the answer is yes. Right? And so and that's where self efficacy comes in, and that's where relationship with doctors come in, and that's where denial comes in, and, you know, all the things. You're either ready to work on it or you're not ready to work on it, and there's also the ability to work on it. Some folks have really struggled with things like high levels of detail.
Right? So some people are not detail oriented. Some people are maybe neuro spicy and find all of that information overwhelming, and they really need somebody else to hand hold and hand them something simple. Right? That's legitimate.
And for the folks who have that type of struggle or for the folks who, you know, are are overwhelmed and just can't put their priority there, they need the help. And that's where things like CGMs and pumps that have simpler to manage algorithms, like the Omnipod, I think, for example, or I think the islet, but I've never used an islet. You're not gonna you're not aiming for perfection. Don't let the perfect be the enemy of the good in that case. Right?
Anything to lower your a one c and relying on the judgment of a doctor who you trust, those are those folks. Right? You just And then when they're ready to deal with some of those details, then they can start. Apply. You have folks like you and I.
Well, that was just gonna say everything. You just described the spectrum. Where do you fall on the spectrum?
No. I'm total type a personality. I have a PhD, and I am both, qualitative and quantitatively driven. And so I I look at my subjective experience, and I also look at numbers and patterns.
Okay. Wow. So yeah. So because that's also that also I don't know. That's part of why your advice or idea of what people should go through is what it is because it worked for you.
That's the other thing. Right? So I just I I I think it's a great point. I just I want people to hear it and realize that they're gonna fall in any number of categories. I've I spent a little bit of time at ADCS talking to some people, from Beta Bionics, and I advocated right to them.
I was like, you should go to GP's offices, find people with type one diabetes who are have double digit a one c's who are never gonna figure this out and start slapping these things on them, you know, as fast as you can, and it's gonna give them a much better outcome. And then someone said, do you think your daughter would ever use it? I was like, no. We don't think about it the same way. It's like, that's not our need, really.
Not to say that the pump isn't a good idea. It's just not our need. Right. Yeah. Yeah.
Okay. Let's what what were you when you started off, you you said something about reframing, but then you jumped over to this. I wanna make sure we don't lose that.
Oh, sorry. Yeah. I've kind been talking over you. There were questions that you wanted to, ask me to kind of steer the story, which you're very good at, by the way.
Why do you what why do you think I'm may I take a half a second? Why am I good at this?
Because you know how to ask open ended questions. You're an active listener, and you're engaged with the people who come on to speak with you.
Is it that easy? I just don't know what I'm talking about, so I ask question. I like that you say here, I'll reframe you. You ask open ended questions. I don't understand anything, and then and I'm generally curious.
Uh-huh. I can't fill I can't fill in with my own statement until I can. Listening, that only makes sense. We went to all this trouble to set up this recording. It would be bizarre if I was in the middle of it like, uh-huh.
Uh-huh. And what was the other what was the other part? Active listening.
Genuinely curious, open ended questions.
I I I desperately wanna understand why all you nude knicks do what you do, and me too. I I'm fascinated by people. When they when they see something and then I and I see their next reaction, I always think, like, why was that what you thought to do? Not not even, like Mhmm. Not even pejoratively.
I just I'm just interested. I'm like, why what what got you to that? I I don't know why people aren't more interested in that stuff. Anyway and then you do it enough times and turns out we're all not that different. So you can you Yeah.
Yeah. And then you can then you generalize. You seem like a soothsayer when you do that. Sometimes sometimes I'll guess things about people. I'm like, how did you do that?
I was like, I mean, I've heard your story 9,000 times. And I'm hoping that other people will realize that and then say, oh, maybe I'm not, you know, some anomalous thing. Maybe there are ways to look at other people's stories and think, oh, that this happened. This happened. This happened.
The answer was in this direction. I should look in that direction. Anyway
Yeah. Absolutely.
Erica says I could have been a therapist.
Well, you are, all the things that you do in your podcast and some of the things that I just mentioned now are the basic engagement and early skills that we teach social work students.
Oh, cool. I have
one. Coming with them naturally.
I have a kindergarten understanding of therapy. That's awesome.
Accept the compliment.
Oh, I'm taking the compliment. But I'm also, at the end of this episode, gonna read the review into it where the person's like, Scott seems to think he's a therapist now. I don't think I'm a I don't think I'm a by the way, to that person, I don't think I'm a therapist. I just think isn't this all interesting? You know what I mean?
No. Anyway
There's a saying that hurt people hurt people.
Okay. You think that's what that person did with that review?
I think people who I think people who are in pain will often lash out at others.
No. I think
so too.
I I I really do. Actually, I recently I don't know what happened. I got I don't get bored very often. I got bored a couple weeks ago, and I started using I started using bad reviews of the podcast to write songs and then let AI perform them. And then I would listen to them and bop along with them.
A couple of them are are really catchy. And I did that. I thought they were amusing, and I put them out on social media. I actually put them into the podcast too. And then I got a note back from who I'm assuming is one of the people who wrote one of those reviews, who then gave me a direct personal review of me listening to it to tell me how pompous I was.
And I was like, you're just so full of yourself. Was like, I just thought it was funny, but okay. Anyway, I might have got that part. I and and in complete candor, when I listen. I read what people say about me.
I I I don't if you think it's, like, fundamentally changing who I am, you're wrong. But, like, I do hear it, and I think, oh, that person's got a good point or that there's validity to that. I'll I'll look into that a little bit. I just thanked somebody the other day. I'll tell you.
His name's Chris. He he works at Tidepool. And when I very first started making this podcast, like, twelve years ago, he gave me some feedback that was like, hey. Be careful when you're talking. Sometimes you frame your questions as if you have diabetes.
And I was like, oh, I don't think I do that. And then I listened to what he was saying, and it what I do is sometimes when I'm what do they call I don't I do things. I don't actually know what it's called. I do that like, you ask a question. I ask another reframing question.
I kinda go back and forth with it to so I can unfold it for you all. I shouldn't tell you how this all works, but I unfolded for all of you guys so you can see it. And often, I'll put myself in your position in the questioning. I'll say, so if I wanted to impact a high blood sugar, what would I do? And he said, that can seem like you're, like, maybe acting like you have diabetes, and it stuck with me for twelve years.
Mhmm. Like, I'm careful about that. I know I do it, but I do it in all line like, not just around diabetes. But I am super careful about it, and I'm cognitive of it. And there are plenty of people who've said many things about me, and I go, well, you know what?
That's not completely untrue. And, you know
So I I think there's a difference, though, between constructive feedback and just being mean. Yeah. Right? And sometimes it's hard to gauge tone over comments. That's one of the limitations of online interaction is that you don't get the tone, and sometimes people will have the potential to sound more harsh when there is a message in there that they're genuinely trying to offer, you know, constructive critique.
I And it's, you know, to your credit that you're able to, you know, we wade through that and take in the constructive criticism.
I'm blessed with just enough narcissism not to actually care that you don't like me. So I can but but I do care about the the can I ask what might sound like an out of left field question? It's only been I I would honestly say three or four times in twelve years. But sometimes and I'm wondering why this is. If I'm playful around sexuality with men, no one cares.
If I'm playful about it with women, sometimes they'll respond to me as if I've been something that I know I wasn't doing and that the person I was doing it with doesn't feel that way. I and I was wondering, like, do you think that just comes from a per I've always just assumed this comes from a personal experience they've had that hit too close to home or something like that. I'm gonna give you an exact example. Okay? Yeah.
I interview a woman in her mid to late twenties. She and I have a what I consider to have a lovely time making the podcast. So much so that when she responds back after the recording, she sends a long, just effusive letter about what a good time she had. Not not something I prompted from her she sent to me.
Mhmm.
Two, I don't know, months after the episode comes out, I get a review back about can't you see how uncomfortable you made her? And I thought that hit me harshly. I was like, I made her uncomfortable. And here's what I did. She was telling a story about her father working a lot when she was growing up.
And I characterized it as your dad came home from work, slapped your mom on the ass, ate something, went back out to another job. Like, that was kinda like how I characterize him coming in and out of the house really quickly. She laughed and said, actually, that's about exactly right. And went on and went on to have a good time. That person pointed to that and said you were you were clearly making her uncomfortable, But that she wasn't uncomfortable.
And I know that because I'm a good conversationalist, and I know that because I spoke with her afterwards and people don't know. But when I shut the microphone off, I say if anything made you uncomfortable, please tell me now. We'd be happy to take it out, delete the whole thing. You just let me know. I want you to be okay.
And then she sent a letter thanking me for the conversation. These were all, to me, seemed like reasons to think she hadn't been uncomfortable. I that sticks with me forever. Like, what like, do you know what I mean?
That's projection. Yeah. The person listening had significant discomfort with that conversation or that you know? The when I when I hear that, my reaction is, you know, a man who comes in the house, has food, slaps his ass on the wife has slaps
wife is The way you said it was way dirtier, Gina, just so you know, but go ahead.
At least, Sounds very sexist. And if you grew up or you you've had experiences of abuse, particularly sexual abuse, or just in an environment where, you know, there was nonconsensual touch of a variety of, you know, ways, sexual and nonsexual, you're gonna be triggered by that.
Yeah.
Right? And so the person who so that probably was was triggered by that, whereas the person you were speaking with wasn't.
Yeah. And I'm and I'm not projected. And I also grew up I'm older. See, you're older. It didn't strike you the same way.
Also, when I think of my parents being happy, that's a you know, I that's one of the happy scenes I see in my head. Like so I can only draw from what I've, like, experienced to begin with too. Also, I'm just gonna say, I enjoy tapping my wife on the butt. And so and she does to me as well, by the way. Although, I have no butt, so you end up hitting me in the spine or the upper thigh.
I saw a video of myself walking away the other day, and I was like, never from that angle again. Where's my ass, Gina? It's just not there.
Struggle is real, Scott. Struggle is real.
Anyway, I
And I'm not offended officially.
Thank you. So it's interesting because I mean, that's a more of a a bombastic example, but there's other small examples throughout the podcast where it's the same thing. And I it took you it took me a while to realize because it seems it took me a a a while to realize it's them, not me in those situations. But that also seems like an incredibly out of touch leap to make. So as what I think of is myself as a thinking person, like, I really tried to live through all the possibilities so that I wouldn't leap to a conclusion that was incorrect because I wanted to hear them and and be cognizant of what they were saying.
And I still am, by the way. Mhmm. But in the end, I came down on the side of I don't think most people cared about that. No. Probably not.
Yeah.
I will say that there are there are some pretty strong generational differences that can be observed in the ways in which we navigate social relationships, the way we speak with one another, what we think is acceptable versus an older or younger generation. And this is, of course, broadly sweeping, but I'd like to give an example of you know, when we were children, we would have older relatives. I don't if you experienced this, I experienced this. We would have older relatives come up, oh, Gina, so good to see you, scoop you up, give so and so a kiss, you know, smothering you in kisses or hugs or whatever, whether you wanted to hug and kiss that relative or not.
Right?
Parents today, my I have friends in their forties and a couple in their thirties who have kids who see that as nonconsensual touch, and will allow their kid to decide, do you want to hug and kiss so and so? Whereas we were told, go give auntie so and so a kiss. Right?
Yeah.
And so it's it's it's a it's a different lens, and and that's going to be true, you know, obviously across different cultures even within The United States. People have different meaning to interactions, and some people are gonna read meaning into interactions in a different way than you intended.
It's interesting how it shifts to my son's 26 now, But I know there was a moment when he was five, six years old where my wife's grandmother, they were get everybody was going in the pool and she had his bathing suit and she just pulled his shorts down, like, out on the patio to put the suit on him and he has never forgotten that. But it's but but I think about growing up and we used to do that all the time. Like like, we'd, like, maybe run behind a door or something like that, you didn't go in the house and go into a bathroom to get changed. Like, you ran into the garage or behind a wall or something like that. Like so you know what I mean?
Like Mhmm. You know what I'm saying? And so but but my son's not like a different human being than I than people were thirty years prior. He just lived through a different world until he got to That's right. Till he got to that experience.
Yeah. That's what frames you is your your outside impacts. I don't know how we
social environment.
Yeah. Yeah. Yeah. I'm sorry. I don't know how we got here.
But Nope. What I heard was you thought I was great. So let's keep moving. And tell me more about everything you wanna talk about. I'm I've so far, you have not said one word I haven't been incredibly interested in.
Oh, thank you. I you know, I sent you an email with tons of things, and now I'm even trying to remember. You were asking about my journey.
Mhmm.
And I guess in broad sweeping terms. This is how I managed my diabetes with multiple daily injections, testing 10 or more times a day, and until a doctor, an endocrinologist switched me to Lantus, at which point I I started having more lows and learning how to drop, you know, what was, you know, the regular insulin and then switching to Humalog when Humalog first became available, and learning the whole curve of of of, you know, the the onset duration and leaving your body without a pump, and really complaining about things like feeding the insulin, putting on weight because I was feeding the insulin, I didn't make that connection until someone pointed it out to me. Even when I met with a nutritionist, like, that did not come up in conversation. You're putting on weight because you're feeding the insulin.
It's interesting because when you think of the food as medicine or lifesaving, you stop clocking it in your head as calories. Also, the time we grew up in, proven by your grandmother's response, I'm gonna fatten you up and then giving you pancakes and things like that, nobody understood nutrition at all. Like, if you saw if you saw an underweight child right now, they'd say, well, we need to get him more protein and more this and more good this. And now it's was just like back then, like, what does what makes people bigger? Eat that.
You you know? Pretty interesting. Yeah. Anyway yeah.
Yeah. Sorry. Anyway no. No. It's fine.
It's fine. It's there was a lot of leaving it up to the doctor to understand and make the changes, and me not having as much agency and coming with complaints that were not getting honored or respected. I had a male endocrinologist who did not fully appreciate the difficulties I was having in relation to my menstrual cycle, who actually compared me to one of his male patients as the ideal patient, if you can imagine.
Teaching her doctor to use a pump47:34
So you're saying you're saying you're having problems and he's saying, no. You're doing terrific?
No. No. He's saying you're the problem. Oh. I have he was saying you're the problem.
I'm not the problem. I work with lots of patients. Look, I have this male patient who is you know, does everything I tell him to do and he never has any of these fluctuations. And I said to him, I'm losing sleep every night from low blood sugar during certain times of the month,
and what are we going to do about it? The answer is you just must not be doing something because That's right. Because Bill is okay. Exactly. That's it.
Exactly. Oh, wow. That's interesting.
And this doctor so I was seeing I had an an exam with my gynecologist, like, an annual exam with the gynecologist, and I was talking to him about my cycles, and he looked at me and said, have you ever considered going on a pump?
Okay.
Can you imagine that? The gynecologist
You got it suggested your your gyno? I I'm I'm I don't wanna get stuck on it. I'm having trouble wrapping my head around somebody who made it through medical school being told that you're having a a situation, seeing that your body functions a lot differently than the other person and then pointing to another person over there and going, no. You don't understand. You're doing it wrong.
I mean Mhmm. Way to not take responsibility. Way not to see the big picture. Way not to understand what you're doing. And then how does the how does the gyno end up knowing?
Is it one of those dumb things where they just have a friend with diabetes or something like that, or did you ever find out?
Yeah. He had a couple of patients
That was it.
Who went on on the pump, and he was like, you know, this is something new. This is around two year 2000 Mhmm. Actually, that that he recommended it. And so I went back to my doctor, and I was the very first pump patient he had. So we learned together.
Because at that time, I was there were so many other things going on in my life, it didn't occur to me to also look for another endocrinologist.
Well, you may you may have ended up helping a lot of people by going
I think I did. Yeah. I think I did. And this also relates to some of the things that you talk about in your podcast. So, so bear with me.
I, so we we went on the pump. It was it was an anonymous ping. Mhmm. It was an anonymous ping. And we met with the pump you know, the the representative or whoever does the training, and we learned together.
We learned together. I learned how to use the pump. He learned how to be a doctor that worked with a pump patient through me.
That's kinda awesome.
And a fascinating thing happened. Oh, actually, our relationship improved because he was able to see in real time the struggles that I was having Sure. And try to understand patterns. As we were both trying to understand patterns, I gained a sense of agency. And also, a not great thing happened.
He decided he was one of these doctors who decided that not every patient should be on a pump and that he was gonna have a gatekeeping function as part of his practice to determine who's appropriate and who's not appropriate for a pump.
He didn't say to himself, I've made some poor decisions in the past. Maybe I'm not the best arbiter of this one.
No. He did not.
That's not a thing that usually happens. I So I may I just say for a half a second, I I really dislike that. I I dislike the idea that there are people out there who guess I heard people talking about this weekend. I was at ADCS this weekend. I heard somebody saying this made me upset.
There are not people who can't. There are not people who don't want to. There are not people who don't have the ability. Everyone this is not it's not that difficult. They could figure it out.
Don't don't hit me with, well, what if they forget? You know what I mean? Hopefully, least they'll shoot their basal. Like, all that stuff is just some old excuse from another time. It's a insulin delivery system that once they get on it, they'll experience better outcomes.
Their brain fog could could lift. Their fear could lift. Their lows and highs could go away. They could be functionally a different person in a year. I'm gonna use a completely different example.
Someone saw a photo of me from yesterday and said, oh my god, Scott. I saw you last year at this time. Look how much different you look now. Do you know I weigh the exact same amount? I haven't changed at all.
My body seems to be reshaping and reforming. I'm gonna guess because the GLP is replacing some sort of a metabolic dysfunction I have. Right? And the longer I live on the GLP, the healthier I look and the better I feel. But if you go to most people and say, went on a GLP and here's all the things that improved for me, they'll go, well, yeah.
Well, you lost weight. Mhmm. That But
they simplify it and water it down.
Yeah. Right away. And but yet, I think it's important that I weighed a hundred and seventy six pounds in the picture yesterday and a hundred and sixty seven sixty six pounds in the picture from a year ago. And a year ago, I do not look as bright and healthy. My skin doesn't seem as taunt.
Like, everything about me looks better today. I don't know that a year from now, I'm not gonna seem even different again because I've been living under a burden for so long. I bring this up because if you have somebody with a high blood sugar, not for a day, but for a year, but for a decade, they're going to be burdened in ways you're not measuring anymore. And one of those ways might be their ability to figure out how to use a pump. So get them on it, get them down, get them stable, get going.
I can't be the only one to make sense all the time, Gina. It's upsetting, and I don't I'm only one person. You go ahead and make sense too.
Okay. Thanks. So I'm gonna respond to that with there is there are so many benefits to having a pump and having a CGM. There is one downside, which is that I and I see this over and over again on many diabetes forums that I follow, is that people only know how to manage their diabetes with their pump. They don't have a backup, they don't know how to manage the backup should something go wrong with the pump.
Yeah. And that needs to be part of the training process. Right? People who are neurally diagnosed are overwhelmed Mhmm. And and they're trying to get a handle on things, or people who've been in denial and now they've lost a foot and now they've decided I need to get my act together before I lose anything else, right, are overwhelmed.
You've got both ends of that time spectrum, and the pump may be the thing that stabilizes them. Right?
So how
It has to be integral to any practice that once you've stabilized a person and they really understand how to use a pump, that they understand their diabetes management, that they also understand how to go to long acting and short acting insulin as a backup if their pump fails them, and to have it as a practice when you travel.
So I completely agree with you. In the real world, how do you make something like that happen? In a world where most people will walk into their endocrinologist and say, hey. I think fat is impacting my blood sugar. They might hear back, no.
Fat has nothing to do with it. It's just carbs. Or a doctor would say, don't understand. Bill's okay. Why is Becky not okay?
That that seems like the same thing. When when we're dealing with a level of I don't know, I don't know, I don't even wanna call it anything. When we're dealing with that level of of input coming back from physicians sometimes or, you know, I've been getting more kinda wrapped up in the idea lately that every time you ask a doctor how come you can't help somebody, they say, well, I just don't have enough time. And it just feels like it's become like a convenient excuse for why patients don't do well. It's not on me.
It's the insurance. I only have fifteen minutes with them. Blah blah blah. Like, so hands up. I'm out of this thing.
So if that's the world, we can't even get them we can't even get people who are not inclined already to go home and work it out for themselves into a good place. So you have to get those other people into a good place through the system that's set up, which doesn't happen. And then once we get them to a good place, have the wherewithal and the energy and the drive to then tell them, hey. Let me show you a backup way to do this. I don't wanna curse, Gina, but how's that gonna happen?
You know what I mean?
I think this is where you have to reach people's own self interest.
Okay.
Because what happens is is people, I see this all the time, on the forums. Hey. I'm away, and, my my pump failed. Does anybody have backup supplies? Yeah.
And in some cases, great. You can rally. You can get those backup supplies. Or I forgot my supplies, but I forgot this piece of the supply or whatever the case may be. Right?
Or the pump just failed, and then the person is in panic mode and they don't know how to handle it. That's the conversation you can utilize the next time, or that this is what don't rely on your doctor. Right? This is where you have to, as an individual with diabetes, where I, as an individual with diabetes, always want to make sure that I am set. Right?
This is a self preserving measure.
Yeah. I don't know. So I I listen. The the pathway from your lips to their ears and acceptance, I mean, that's it that's I don't forget this thing that you're talking about. We could probably put a 100 things on this list of things I don't know how to get accomplished.
Do you know what I mean? Like, for for
Yeah. Yeah. Yeah. Yeah. I'm too busy.
There's too many things.
I'm overwhelmed.
Right? People prioritize what they find important.
Yeah. Oh, listen. Arden just left for work. I said, you can take your bag with you with your supplies? She goes, no.
It'll be okay. And I said, what if it's not? And she goes, I'll come home. It it Well, that's
a legitimate answer if she's only, like, fifteen minutes away.
It is, except she's at work. So Okay. Yeah. If if that that her work doesn't want her to leave if her pump should fail. And I and listen.
What I said was cool. That's it. Mean, she's 22. She can do whatever she wants. Right?
And so but when my wife and I talked about it, I said, it'll happen to her one day, and then she'll decide if the juice is worth the squeeze or if she should, you know, bring the bag or not bring the bag. But but she to your point earlier, I forget what you said, but I feel like it tied into something you said early. Until it happens to her, she's not gonna be able to, like, quantify it. And she and right now, she's sticking up for the way she feels, and I I didn't argue with her. I was, right on.
I was in charge. I'd put it in her car, and I'd say, what's it hurt to have it with you? You you know what mean? It's like, it's just a it's a little tiny bag. Absolutely.
What's it hurt to have it with you? But Yeah. Maybe that's not how it's gonna go for her. I don't know.
And it might not. But you're Yeah. But she's an adult, and you recognize that she's an adult.
Million percent.
And now she's on her journey, and a lot of people have a hard time with that.
Oh, they ought to make a podcast and talk to 2,000 people with diabetes because the one thing I can tell you for sure is everybody's gonna do what everybody's gonna do. Mhmm. That's it. You're not forcing anyone into your vision of anything ever. Diabetes
No.
Dating, politics, whether or not that Netflix series is good. I love the Gina. I tell my wife about it, my wife, because it makes me nervous. They're always yelling. And I was like, I love that about it.
Go the bear, the TV show. You don't know the bear?
I don't know.
My god. Gina, what are you doing with your life? Putting out there helping people, going for walks?
No. I've been I've been I've been obsessing over heated rivalry.
What is that? What is that?
Heated rivalry?
I don't know that one. I just lived
through a Oh my god.
I just lived through a summer where that godforsaken Love Island was on my television every time I walked through that one. I I don't I don't
watch reality show. It's, it's a hockey romance.
Oh, oh, the the gay hockey show. Yeah. I know it. Yeah. I mean, I didn't I haven't watched it, but I know it.
That's alright.
I I love I love that you're you're deep into it. Nope. No pun, Gina. And thank you. I appreciate the laugh.
Go on.
Exactly. He's so rude to her. Did you hear he said that thing? Listen. I don't know.
I wanna let you all in on a little secret. Oh. Go ahead. Go ahead.
No. I'm sorry. Keep interrupting you. I I
Go ahead.
The endocrinologist who I eventually left, one of the reasons he told me that he didn't think that he was gonna put all his patients on a pump that they don't all they didn't recommend they all be on a pump is because some of them already don't take care of themselves, And if the pump fails, they won't know what to do.
They're dying already. You don't think trying something's a good idea? That really does fascinating me. That fascinates the hell out of me. His answer was, listen.
These people are in a major problem. Their health is declining quickly. They're gonna have all kinds of problems. You wanna try something different? Nah.
Probably won't work.
Mhmm.
What would I say what would it hurt? I I listen. I said this to somebody on an interview a few months ago and it stuck with me as a thing that I said that I found. Like, I was like, oh, that was smart. I should I'm glad I said that.
I I said I am a person who doesn't quit. If you threw me out of a plane, I'd flap my arms. And and I find it strange that's that somebody else wouldn't too. Mhmm. Like, it's not over yet.
Keep fighting. No. What are you doing? And if it's not working, then why not try something crazy? Because nothing else is working and we're about to crash into the ground.
That's it. I'd start I'd start I'd start chirping like a bird to see if one of them would come over to catch me. I'd start trying to fly. I would do the Superman thing once just to see. I'd hold my shirt out on the side to see if I can make, like, flying squirrel wings.
I would be doing something when my body exploded into the ground. And I don't get not saying here, take a pump. It's worth a shot. You're already in such a bad deal way way. Also, why not just cognitively reframe it for them?
Just lie to them. Go, you know what, man? We've been doing this all wrong. This pumps the answer. Here's all we gotta do.
You're gonna feel so much better. Well, I can't believe I thought of this before. Put it on yourself a little self deprecating. People don't self deprecate enough. I do it a lot.
It's a good it's a good tool. And you do a little bit of that, and then you go, here it is. And they can do the lion king sound effect. Give them the pump. Help them get their settings straight.
Watch them have a nice experience. There you go. I I and if it doesn't work, you were dying anyway. So I don't that make any sense to me. What a dummy.
Yeah. Was it an old person? Yeah.
He was, you know, that's that's hard for me to say. I was in my thirties.
Was he probably
close to my age now.
Scott, I thought he was almost dead. Older than me. He was 58. Oh my god. You should have seen him.
Well, listen. Now that the GOP exists, Gina, I'm gonna live forever. That's the first thing I've learned. And secondly, I'm starting to see I listen. This will sound like being an evangelist that I'm certainly not, but I'm starting to walk around going like, I I I'd spray a little of that GLP on that one right there.
I like, I could see, like, like, that would really help with this or help with that. I stand around the other day with some people. They might hear this if they hear it, it wasn't you. I was standing around with some people the other day. And these people were younger than me by a decade and I looked younger than them by a decade.
And they're talking about all their health issues and one of them is he's overweight. He's struggling with a lot of different things. Misusing a prescription drug with his doctor's advice, trying to stay in front of his problems, not the right thing to do. Guy knows it's not the right thing to do, but it's helping enough. And I said, no one offered you a GLP?
They said, yeah. No. No. They did. I said, why aren't you doing it?
He goes, I'm worried about the side effects. I said, what about the side effects of the thing you're doing already? He goes he goes, that's a good point. I never thought of that. Mhmm.
I don't know how to I don't know how to listen. People are maybe the smartest thing on the planet and the dumbest thing on the planet at the same time. I was like, why don't you try this this other thing? And the first my neighbor, I hope he hears this. Diabetes type two, doctor gives him a GLP.
Why don't you wanna take it? My wife's worried about the side effects. Now I don't know if his wife's worried about the side effects or that's what he told me. It's just all fear. I said, what about the side effects at dying?
You're not worried about that? You walk around telling me you got neuropathy in your feet. You're not worried about that? No. You're worried about maybe make poopy too much?
I was like, don't that sound better to you? Also, by the way, that regulates. It gets better after time. Like, I I've been at this, like, three and a half years now. Don't be a quitter is what I'm telling
you about. If And I'm so pleased to hear that that it's working for you. You're doing other things in addition to taking the GLP one, I assume. Yeah. And and and
also on top of
Are you exercising?
You changed your diet? This cup. I've lift this cup with this water four times. I listen. I'm gonna tell you something.
Part of a whole picture.
I Mhmm. I wanna tell you that's true, but I also am gonna be honest with you. Not all the time, and it doesn't matter.
Okay.
Yeah. I don't know what's in the magic, but it doesn't matter. So I'm literally, at this point, just going, listen. Better living through chemistry. Mhmm.
I can't wait till the next one comes out. Hey, Lily. Hurry up with that ritrutide or however you say it. I'll learn how to say it later. Yeah.
Give it to me. I'm gonna call my doctor and ask him about testosterone. Why do I gotta work out? I'll figure it out to you. I'm living forever.
I'm telling you right now.
So, Scott, I wanna I wanna give you something to think about that just occurred to me as I was listening to you.
Thank you.
Which is that we all live in our own bodies. Right? And nobody else can tell us how to live or feel in our own bodies. I can tell you there was a time where I weighed a lot more, and this is not about body shaming, and this is not about fat shaming. Some people are very comfortable in very different body sizes.
This is just who you are, and we're all individuals. Sure. I felt uncomfortable at a certain weight, and I felt like I wasn't living in my body, I wasn't navigating the world in my body, I was existing and dragging my body along. And when you live with that feeling, that becomes normal. And trying to imagine a new normal and trying to imagine that you can actually do something about it to feel better and feel different is scary and may be scarier than staying where you are.
And that's that's the cycle of change where people are just not ready. They're not even think about it or they're thinking about it, but they're just not ready to get there, and many times they simply don't believe that the things that they do can make a difference. And part of that comes down to the way that endocrinologists treat some of their some endocrinologists treat their patients Mhmm. Like a numbers game and not a person, and tell them what to do instead of engaging in partnership with them around managing your diabetes.
Well, you have
to And that's where Mhmm.
You have to listen to people. It's ironic that I cut you off to say that. You have to listen to people and then and then actually hear their problem and then have enough introspection and understanding about diabetes to not just hear their problem and reflexively say back the first thing that pops in your head, but actually be able to figure out what they need to help them and put them in that position. And that's not easy. I would also tell you that I everything you just said, I a 100% agree with.
The guy that's making this podcast, a 100% agrees with that. The guy standing in his yard with his neighbor doesn't think like this. I'm not asking a lot of open ended questions and having reflexive like that kind of thing. I'm just looking going like, man, look at me. You've known me for twenty years.
Don't I look better? Doesn't doesn't my life seem like it's going better? Aren't I telling you all the benefits from it? How could you still be scared? Like, when someone handed it to me maybe this is just how I'm wired.
When I so first of all, I went and asked for it. I Mhmm. Somebody handed it to me. I was lucky even back then. My insurance covered it.
I brought it home. It was a Thursday. I remember it was a Thursday because I started opening the box, and my wife's like, what are you doing? I'm like, I'm jamming this thing in my side. And and she was like, why don't we wait till the weekend?
And I was as I was sticking it in my stomach, I was like, why? She goes, what if it gives you I was like, don't care. I was like, I said, have you seen Mindy Kaling? Let's get going. That's exactly what I said.
Girl from the office looks fantastic. And I was like and I was like I was like, seriously, I'm like, if something bad's gonna happen and, you know, my wife is talking about going to the bathroom, like, some, like, stomach issues. I'm like, we work out of the house. It doesn't matter if it's Monday or Saturday or Thursday. Let's go.
You know what I mean? Now due respect
She wasn't ready for you.
Yeah. So I didn't I didn't push her again. I was just like, whatever. Live your own life. I'm getting out of this.
And and then, you know, she did start on Sunday like she said she was going to, which is fine. And by the way, we've both been doing it for three and a half years. I've been doing it five days longer than she's been doing. And and in the end, it didn't it didn't mean anything, but it it is a good picture of what you I hope it was a good explanation of what you just said, which is, like, for me, I was like, let's go. And she was like, well, let's go on Sunday.
And and I was like, okay. I'm like, right on. I've since learned, by the way, if anyone wants a hot tip, doing it at the end of the week is great because it's more effective in the first four, five ish days. So if you're having trouble eating a lot over the weekend, taking it later in the week will really have that kind of full effect laying over you over the weekend if you're trying to anyway. Did you do it for
The only thing I was thinking the only thing I was thinking was if you started in the same day, you could remind each other.
Well, we've since Take it. We've since like, it's funny because over three and a half years, we've since synced up, unsynced Uh-huh. Synced up, unsynnced over and over again because I'm listen. You know, I've tried a lot of things over the time. Like, there's times where I'm like, on the fifth day, it doesn't work as good.
And Arden skipped her pen this week. I'll just try a two and a half pen and see what, like, a does on on day of five. And didn't enough. So, like, I was like, okay. I'm I'm, like, learning how to do it more and more.
I honestly believe that dosing more the way insulin is dosed is gonna be eventually the beneficial the most beneficial way to use a GLP. But we're gonna have to get past I
thought about that too.
Yeah. Yeah. I was just gonna ask you. Did you lose it through going for a long walk, or did you try a GLP as well when you said you need to lose weight?
No. Actually, I started in during the pandemic, I started walking. I was lucky enough to live in Connecticut in an area that was, you know I afforded the ability to walk, and I then I was the winter hit and I couldn't walk anymore, that's when I got a I'm just going to name drop, I got a Peloton treadmill.
Oh,
wow. And I love my treadmill, and one of the people who I fell in love with is Robin Arson, who herself is a type one diabetic.
Yeah. Yeah.
And so that became a role model for me, but she became a role model for me. And I was because I because I love charts, I started charting everything. My workouts, my caloric intake, my weight loss, I was able to gauge, you know, using my watch and things, metabolic rate, and knowing how much to lower my caloric intake and adjusting my insulin, and I switched at that point from a t:slim to an Omnipod because I found that the t:slim was not robust enough in holding back on corrections. That might be the wrong terminology to use,
but It was too I would
go into exercise mode Yeah.
It was too
it was
aggressive for you.
Yes. It was too aggressive. It was trying to correct highs that I was trying to burn off through exercise. Ah. And then I would wind up having lows, and I just couldn't I just couldn't get it.
A GLP, and 205 to 1451:12:49
And no matter how many times I fiddled with, you know, my settings, because some days I would do a run. I went from walking to running, and some days I was doing, you know, weight training or various things, and it just wasn't cutting it. And so that was when I switched to an Omnipod, and I switched to an Omnipod because Robin, our son, was on an Omnipod. I said, well, if she's using it and finds it effective, maybe I should try it too. Awesome.
And for the for a very long time, it was exactly what I needed, and I went from two zero five pounds down to, at my lowest, a hundred and forty five, I think. Wow. And I did not use any GLP ones. And then
That's awesome.
And then thank you. And then I met my current spouse.
Current wait. Your current spouse?
Yeah. My yeah. Well, I I was married before, but my Got you. First Got you. My first spouse passed away
Oh.
Of cancer
I'm sorry.
Age 52. So so I was I had a number of years where I was not interested in dating, and then I started dating again. And the exercise probably helped a lot with my overall
Yeah.
Bodily, you know, autonomy and feelings and and things. And and so we started dating. I started exercising less. We both put on that, you know, like, the freshman 15.
I like that you're like, I'm looking better. I'm ready to go out and find a guy. Here's a guy. I should have a Cheeto. No.
No. No. No. No. I will I will say I am married to a man, but you may wanna consider not automatically assuming heterosexuality with any of your guests.
I I didn't, but you said husband the first time.
Did I? Yeah. Oh, then I stand corrected.
Your husband died of cancer. Your husband passed to cancer.
Oh, my first my first spouse was, yeah, died of cancer. He died of cancer.
Oh, cool. Yeah. Yeah. Can I ask you something?
That doesn't mean my second spouse is also a man. Actually, my second spouse is a man, and we just started yeah. But go ahead.
Language that makes people feel welcome1:15:01
I I'm gonna take a side word with you for a second because I'm super interested. You're not wrong. It doesn't mean your second spouse is a man. What does it matter that I assumed it was?
Because people who are listening, who are members of the LGBTQ plus community
Right.
Want to hear themselves. And when you center heterosexuality by assuming that everyone you speak to is straight and cisgendered, then other people the people who are not feel othered and wonder, is this a welcoming podcast for me?
When you do that, are you not asking people to change who they are to make you comfortable? Because I don't have All
you're doing is all you're doing is creating the space by not making assumptions.
Have I so I've been making this podcast for twelve years. I couldn't possibly be any more live and let live than I am. And I think you listen enough to know that. Right?
Yes. So I don't think that you are.
I couldn't possibly care what anyone does almost in any scenario. Mhmm. Right? So that doesn't make this a good space. Like, how much do you need for me?
And and where does it end? Do you see what I'm saying?
Well, I yes. All all I'm suggesting
Oh, I don't I'm not disagreeing with you. I'm trying to have a conversation. I just wanna understand.
Yeah. Yeah. Yeah. Yeah. So all I'm suggesting is that when you are talking with people Mhmm.
Don't make an automatic assumption. Use the language other people use, or you can ask a clarifying question, which you're very good at, you know, if the person wants to share that. Because then the folks who are listening are gonna fill them gonna they're gonna find themselves. Okay. Every single person has a way of finding themselves in your podcast if the people you are speaking with, you're not making assumptions about what they're
off So
like life is.
I have two thoughts. Mhmm. Use the I I should use the language they
use. Mhmm.
Why don't they have to use the language I use? That's my first question. And my second question is for every person who I make feel comfortable, am I not making a different person feel uncomfortable no matter what I do?
So when you use the language the other people use about themselves, you create comfort. But you're not a therapist
Mhmm.
So you're not obligated to be, like, super conscientious about that. Right? It's just a way to generally help people feel more comfortable.
If you and I started this conversation and I thought and you said to me, hey. I, you know, I I refer to myself this way or this or something about me, then I would sit here and I would cognitively try to over overwhelm my my Mhmm. My wiring and do something that didn't come naturally. Right? Which is like I mean, a pronoun thing is a really great example of that.
Like, I would I call you whatever you want. I couldn't possibly care less. And, like right. But, like, my that's not how I'm wired. And I'm also having an off the cuff conversation, like, with a person I don't know.
So it's there's a lot going on in my head. I'm trying to balance our conversation. I wanna make sure people listening are interested. I'm trying to keep it moving, but go slow enough that people can get their story out. I'm watching the time.
Like, you know, I'm doing the technical stuff. I'm doing a lot of different things at the same time. Mhmm. So but I'll still put that effort in. When I Yes.
Yeah. When I'm not when I'm not aware of it, it's never gonna be the thing that I say. Like, just because So I didn't grow up
with it. Yeah. Putting the effort in, I think, makes a world of difference.
Yeah. No. I effort in. I appreciate that. I because it's hard to know, and and there is there is the other there's also by the way, there's people with biases in in other directions.
So you also, like
Right. There's gonna be people who listening to this podcast who are
Hear this and then go, I'm uncomfortable. I would like Gina right up until this moment. Like, that kind of feeling. Like right? And then if I and and if I just hear what you said and I and I acquiesce really quickly, those same people will go, oh, I thought Scott had a backbone.
And while other people will hear it and go, oh, thank god. He's willing to adjust. Like, you can't like, what I've learned making this podcast is that the podcast is me. If you like it, I that's wonderful. And if you don't, there's very little I can do about that.
And if I and if I try, I run the real risk of taking all the people who do like me and making them not like me too. And now I have and now I'm trying to wedge myself into your world. I don't fit there. Eventually, I'm gonna trip up and you're gonna you're gonna get rid of me. And I've gotten rid of all the other people who already like me the way I was.
It's really like, it feels from this position, it feels like a thing you can't win. And it's and it sucks because I
hear you. We're in a we're in a very divisive point in history in The United States. And I hear you, and there are people now who are listening to this. They're gonna go, oh, I don't like Gina anymore. And you know what?
That that's fine. You don't have to like me. I'm not saying what I'm saying. Like, here's here's people who are secure in themselves, they're gonna be fine.
Right. Yeah. No. No. No.
Yeah. No. Most people are I I really do think it's a it's an edge issue. Not that it's not important. I just mean that I don't think it affects as many people as the middle of us.
And and I am But
I will and and I will say there are a lot of people who are members of the LGBTQ plus community who make up a larger percentage of the American public. Only you know, I realized that there you probably have people listening across the globe. So Yeah. As I'm saying that. But in The US and Canada who are listening, who that's not an issue for them.
They're here to hear about diabetes. It's just nice when someone also feels in included because somebody else didn't make an assumption.
Yeah. Right? Listen. And that's all. I a 100% hear you.
I'm on board. I am gonna tell you that there's a way that I am. I've never once had anybody try to include me in it. So I it just pisses me off. I'd like to get a I'd like somebody to worry about me once I'm just joking.
I I I
wonder if you ever take a vacation.
I don't. No. But I my my my my wife was like, oh, this place we went to one time came up on my feed, and I was like, why are you looking at it? We're not gonna go there. And she's we're trying to go away for three days on a car trip.
We've been trying to do it for the better part of the last seven weeks. Like, leave early on a Friday, come back on Sunday night. Don't seem to be able to accomplish it. But but thank you.
Vacation, Scott.
I meant I meant podcasters. When is somebody gonna, like, worry about podcasters and how they I'm just joking. I'm in a I'm in an it's an it's an interesting you know, I was talking to somebody this weekend about this. Like, somebody asked me about, you know, we I just got done. Well, I didn't get done.
I I made a a survey public of listeners. And the survey kinda tracks your your health and your mental health outcomes after listening to the podcast. And it's incredibly positive, like like, what what's coming back from the people who, you know, decided to take the survey. And some the the question to me was, there's parents on here, there's adults on here, there's all age ranges, all different kinds of diabetes, gestational, pregnancy, and this and that, you know. What what's the big secret to talking to all of them and have them have these outcomes?
And I was like, I don't know. It's whatever I do seems to work. I don't even know how to parse it. I don't even think it would be worth my time to try to figure it out. Like, the collection of my experiences, my direction, this thing I do, the way it occurs to me to do it leads people fifty fifty, by the way, adults and caregivers to report back that after listening to the podcast, a one c comes down a median 1.2 points.
Time and range goes up into the 80%. Time low goes down. Health and happiness scores go up, like, the whole thing. And and and when they complain about the podcast
Mhmm.
I asked them what doesn't work for you. And the the the overall problem is that people can, the early going, feel Mhmm. Like other people are doing better than them, which in the seventies would have been called Uh-huh. You know, trying to get to a place you're not at yet. And so I don't even worry about that because if that's the worst thing that's only some people are saying, I say to them, keep flapping your arms.
I bet you won't feel that way at some point. And Yeah. And anyway, like, it's it it anyway, so it's an odd thing to have the a skill that you can't quantify. But, like, I can't tell you why it works. I can only tell you that it seems to.
And then when somebody says you should do this or you should do that or don't talk so much or you're so obnoxious or all the I I all that stuff. It's fine. All all that stuff comes back. Like, you're like, I don't maybe I don't care what you think, and then it's hard not to apply that on top of everything else. Because if I cared, I couldn't do it.
Does that make sense? Yeah. Yeah. It's a
No. Yeah. No. There's there's an emotional boundary that you have to
It's an incredibly
to take in it.
Weird job. Like and for and you think, oh, this stuff's all over the place. It's not. There's probably only there's probably roughly six 18% of 400,000. So whatever that number is, people who are making a podcast that's even listened to by more than a 130 people an episode.
So I I have a really weird job that not a lot of people have. You know? Anyway Yeah.
And you do an amazing job with it.
I wasn't fishy, but you're very nice. Okay. More diabetes. More diabetes stuff.
Okay. Yes. Let's get back. So, first of all, with the with the GLP one, so I went to putting some weight back, and then I had a couple of injuries, like sports related injuries that I've never had in my life.
That's what you get for getting active.
Yeah. I know. I worked for a nonprofit in my early thirties. We did an event called a fun run, and I told my boss that I wasn't gonna go because the word fun run was an oxymoron. And now here I am.
Here I am now trading for a 5 k. But I had some injuries. I wind up also not being so strict because now I was dating with someone, living with them, marrying them, and your habits are always going to change when you're incorporating somebody else in your life.
Yeah.
And then I reached a point where I said, you know, I need to kind of steer some of this back and I don't have some of the same bandwidth that I had a few years ago, and a doctor gave me a sample of Ozempic which I used at a very low dose and it made me very, very sick for weeks. Then the endocrinologist another endocrinologist in the practice I switched because this one a number of reasons, but none of them bad reasons, right, said why don't you try Zepbound instead? My body just went, yes, that's the ticket.
Yeah. No kidding.
My a one not my a one c, my total daily insulin went down so much that my basal rates are so low at some point that I worry that if I go up in a dosage, I will have a euglycemic ketoacidosis.
Yeah. Yeah.
Hey. So I have to watch it very carefully.
What percentage do you think it went down, your total daily insulin? Where did it start? Where did it where is it now?
You know what? I haven't actually looked at that number.
That's
okay. But I know I know that it has Yeah. Over the last few months.
I think the I think it sometimes impacts Arden up to 30 or almost 40% on her insulin needs. Yeah. Yeah. I see it.
It's prob it's probably between 2035%, I would Amazing.
But I was not taking a lot of
insulin before, which is why it's worrying that I your point.
Yeah. Yeah. Also, fewer lows, fewer highs.
Mhmm.
Is that I also switched to the twist pump. Oh, so your Mhmm. Your your loop your twist with loop. How do they call it? I should prob I should probably know.
I think they I think they pay me little Yeah. You're you're you're loopy, Mitzo. And that's been good for you?
Yeah. It has been good for me. I when I was on the Omnipod, it was very good for the workouts, but I had some issues with stubborn highs that I just couldn't ever figure out how to manipulate Mhmm. Because you don't have control over the the basal rate. Yeah.
And it looks at total daily. You do you do have a little bit of ability to control that in ways that I get yelled for on the on the websites when I try to offer suggestions, I've stopped giving suggestions. But ultimately, I I would have, you know, morning highs that I just couldn't overcome.
What were you doing? And What what would you have told somebody online to do?
So one of the things that my endocrinologist and I, like, basically discovered was that when when you change your basal rate in Omnipod, such that if you're going out of the algorithm and just using it like a dumb pump, right, you have a basal rate. When you go back in, it looks at your total daily insulin, but it bases it off of the background of your primary basal rate.
Can I guess?
And so
Let me guess the thing you might have done because this is a thing I've heard recently. End of the pod where time comes up, You take it off before you disconnect it. You make a big bolus to jam up your total daily insulin number and then put on the next one. Have you done that?
No. I didn't I didn't do that.
Also, not a doctor. Not advice. You shouldn't do that. Go ahead.
No. Yeah. No. No. No.
No. I wouldn't do that. Yeah. Yeah. No.
But I had, I would change my basal rate, and then I would have it relearn me.
Oh, you just reset it?
Mhmm.
Yeah. I mean, resetting Omnipod five is is, I think, a thing a lot of people do. So Mhmm. Yeah. Because when your needs go up, if it's not if it's not jumping with you as quickly as you need it to, then just give it new numbers and have it start over at the new total daily insulin.
That's that's exactly what I did. Yeah. Yeah. That just makes sense.
When I got sick, when I had COVID, when I had the flu, when I had other things going on Yeah. I just had a different basal rate setting. That's awesome. Yeah.
And you just kinda zapped it
and started a little frustrating. Yeah.
No. But it was
still frustrating. Yeah. So when the doctor suggested I switch to the twist, I was, I was very eager because for many years I heard about Tidepool and people doing the DIY looping, and I was never gonna do that myself because I did not have a comfort level of using a system that was not FDA approved.
And, you
know, it's your mileage may vary. Other people are, you know, the pioneers out there doing it, and, you know, go you. I was not I'm waiting. Gonna be one of those people.
Yeah. Gina's like, I've heard of we're not waiting. I I'm waiting a little bit. Well, let me just Exactly. Let me just say a quick couple of quick things here.
Visit .twist.com/juicebox. Omnipod.com/juicebox, and, hey, why not, tandemdiabetes.com/juicebox. If you'd like to try any of the insulin pumps that Gina's mentioned today. There we go. I should start doing that more.
Yeah. I don't know why I'm
not You should start doing that more. And I will say that the t slim, the Omnipod, and the Twist are all excellent pumps.
Yeah.
And they were excellent pumps for me at the time I was using them and then, for the needs that I had at that point in my life. And the needs in my life have changed over time.
Yeah. No. I listened
someone who was not working out. So I you know, to someone who started working out, to someone whose lifestyle has just changed in many ways over the years.
Choice is key. Also, if all those pumps sound terrible to you and you wanna try Medtronic pump, there's a link in the shows there as well. Where are you at, Beta Bionics? I mean, come on.
I go in there. Not like the Medtronic.
So What about the new have you seen the new Flex? You did you do this I haven't. No? Oh, it's pretty cool. The Flex is cool and the and their automated systems is pretty rock solid too.
Like, I think there's four, like, rock solid options now and then options for people who are doing something slightly different. And by the way, now Afrezza has that indication for younger people. I think you might start seeing, people using Afrezza to bring down stubborn highs even when they're using pumps and other other management stuff. So kinda as a as an an additive. It's it could be an interesting time coming up here in the next year or so.
Also, Omnipod six will come out at some point in the nearer future. So be interesting to see what everybody else does to respond as the the pump wars continue.
Yeah. We live in amazing time Yeah. When we have these choices and new technology and different ways of relating to diabetes. And in 1978, I had regular and, NPH, and they were animal based insulin, so now I can't give blood. And I was testing my urine.
Testing your urine and can't give blood anymore to where you are now. And my last question for you is how is your health overall? Because I find when I talk to people who've grown up regular in Miles per hour, they seem to fall into two pretty broad buckets. And those buckets are, I got enough insulin and I'm okay, or I didn't quite get enough insulin and I'm having problems.
My, overall health, knock on wood, is excellent.
Yeah.
I have some, nonproliferative
Retinopathy? Retinopathy. Thank you. I pay that.
And and, it's it's stable. Ever since it appeared, it hasn't changed at all, and it doesn't affect me at all.
And then It hasn't changed.
Other than that
I'm sorry. Other go ahead. Other than that.
Right. Like, once I was diagnosed with it, it hasn't changed.
Okay.
Doesn't affect me at all. I had cataracts, but I got cataracts when I was, like, 12. Oh. So I had cataract surgery when I was 18 and 19 years old on each eye. And other than that, any any sort of middle aged aches and pains that I have are not diabetes related.
Yeah. I think the what what level of Zepbound are you using right now?
The lowest possible dosage.
Yeah. Because you don't feel like you can go. So you're doing two and a half.
Mhmm.
Yeah. Okay. Well, that's
basal rate at one point during the day for several hours is point three units.
Point three. And you're an adult, and you weigh and you told me you're you're around hundred and fifty pounds ish more, less. Yeah. Yeah. Yeah.
So yeah. That's pretty fast. I weigh in the one fifties.
Yeah. I'm
now, five feet tall.
Yeah. That's I used
to be five one and a
half, but I'm Are shrinking?
I am.
I I had to go to urgent care the other day. Don't worry. I'm fine. I know you're all worried about me. And, she's like, can you jump on the scale?
And then we're gonna measure your height. And I was and I thought Mhmm. I thought, oh, well, I'm gonna leave my shoes on. I'll take the extra weight for the actual meanwhile, who's looking? No one sees us but me.
She's writing in a shark for reasons nobody gives a crap. They're never gonna look at it again. Right? And I'm just like I'm like, oh, well, just for my own notification, I'd like to be taller when I walk out of this little cube. Ridiculous.
Oh my god. Well, I'm glad you're doing so well. I just you know what I mean? Like, I've I've found over the years that through conversations, it feels like either people weren't quite taking enough or they were eating more than they were shooting for or whatever. Or because I can't see another reason why some people would come out of that time.
So, like, I'm good. And some people come out of it like, oh, I got a lot of problems. So it it's it's gotta Well, I think
that there's a number of reasons, but, for one thing, I I think I'm lucky.
Yep.
Just
There's luck.
I for another thing, I paid such close attention. Mhmm. Some people don't test. I had a friend who I met at Camp Nida when I went there years ago who, as an adult, tested, like, once a week. I had no idea what was happening.
He wound up getting kidney disease. Right? People just don't pay attention. And for some people this is why I wanted to talk to you about something called narrative reframing or narrative theory.
I love that we got back to this an hour and a half into it. Go ahead. Go.
I know. And I'm so sorry.
So be sorry. This is I'm gonna put out a nice long episode with you. Go ahead.
Okay. Alright. Is that, the whole idea is that we we make up stories about our lives. We tell ourselves stories about who we are, what we're doing, what we value, what our past has been like, what our future might be like. Right?
Narrative reframing1:36:51
And a lot of times, we blame ourselves when when there are problems. That one doctor that I had was like, I'm not the problem. You're the problem. You're not doing what I tell you to do. And there's lots of people who listen to their doctor or don't listen to their doctor and get into this fight instead of a partnership where the doctor listens to the patient and the patient listens to the doctor.
Right? And narrative reframing, lot of times, or the center of it is around externalizing the problem. It is not doesn't it's not who you are. You're not the person isn't the problem. The problem is the problem.
And then how what your goals are and how you deal with it become a problem, because otherwise it gets overwhelming. When people have a one c's that are nine and ten, the story we tell ourselves sometimes is I am failing. I am failing as a person. I'm failing as a diabetic. I'm failing as a patient.
I'm failing as as a human who doesn't know what they're doing, and I'm never gonna get this right. And that is, you know, a cascade that can just be very difficult to overcome. And so when you externalize it, you say diabetes is the problem, and there are things that can be done, right, then you can start to have a relationship with the problem as opposed to the problem being you. And I think it's really, really important. Right?
We are people experiencing problems. We shouldn't blame ourselves or blame other people for the way they're living life and the experiences they're having. It's like, this is where you're at. This is the what you're capable of doing. Do you have a goal?
If you have a goal, then you can start to think about what you're able to do, what you could do about it, and if you're ready to do it. Right? And I take it a step further.
Oh, go ahead. Take it a step further.
I take it a step further because I also like to use humor. So there are days where no matter what you do, everything just goes kablooey. Right? You wake up, your blood sugar is shot up for no apparent reason, you are trying to take insulin, the problem is not the the attachment, the insert to your skin. The problem isn't the things that you've eaten.
Maybe you the problem isn't that you had enough to to to drink that day. You don't know what the problem is. Right? Those days, instead of feeling defeated, I will say it is the fae the fairies. The diabetes fairy
Giving it away.
Has come to collect their payment.
Diabetes fairies, it is. I'll take it as an outlet. I so the real message here is every day is not gonna be perfect. Let's not get lost in why today went sideways. Let's just move on.
Get get things back on track and move on.
That's right. And not bury yourself in blame.
Yeah. Well, I mean, listen, after all I said earlier, let me just say here, it's a it's an obvious spot where framing and language makes a big difference. So Mhmm. You know, what did you do? What did you eat?
How did this happen? You know, show me your logs. You must have done something. You must not be listening to me. You must not be.
You must be it's all really difficult for people to climb out from underneath of. It really is. Yeah.
And I I had an endocrinologist. Can I name drop?
Go ahead.
Doctor Lauren Golden, she used to be at the Naomi Berry Diabetes Center, and then she moved over to, I think, NYU Langone, but I left New York City. Mhmm. Was one of the best endocrinologists I've ever had in my life because she partnered with me, and we problem solved together.
Yeah.
And by problem solving together, even if she was doing the majority of the brain work, made me feel like I was part of that process
Here on the team.
Taught me how to problem solve on my own. Yeah. And that has carried me since then.
I have I wonder if people would know that I have almost never almost never directly spoken to Arden about something she should do about her diabetes, like like, educationally. Like, there's maybe been twice in the last ten years where I've been like, hey. We gotta go to lunch. We gotta explain something to you. And, like, sat for an hour and was like, this is this.
Do this. This. This. This. Otherwise, it's all just modeling, I guess, is the word for it.
Right? I just you just do it out loud so people can hear, and they'll figure it out on their own. And then also you get the benefit of not them not feeling like you're telling them what to do, which people human beings have a really hard time with. I like Absolutely.
Absolutely. And that's why with your podcast, you have all these different like, I have gone back and looked at the pro tip series, you know, the you when there's something specific that I wanna think about fine tuning. Like, let me go back and listen or let me listen to this and see if there's something new I could learn or something I already know, but maybe it will refresh my memory a little bit.
Right? And
when you use the term bold beginnings
Yeah.
That's narrative reframing. That's that's totally narrative because people are so intimidated. And here you are saying, you can be bold. You can do this. Yeah.
And so I like to mention that.
I'm no dummy, but thank you. Regina, I I figured that out before AI. What do you think of that? Yeah. Mhmm.
Hey. I I'm not a big fan of using AI. Nowadays, I would just be like, hey. I just made this series about this. What do think I should call it?
And it'd be like, here's seven answers, and here's the reasons why you should call it that. Not me. I looked and I thought I honestly, I thought, well, people tell me all the time, like, that being bold with the idea of being bold with insulin was, like, transformative to them. I was like, alright. Well, bold seems to be important.
And, you know, I want this to be for new, really diagnosed people. You know, you are at the beginning. Oh, there's an alliteration. It wasn't that hard everybody. And I just threw it you're giving me credit for something that seems like common sense to me.
But, can you imagine that I can you imagine that, someone said to me on Saturday that they they described the series inside of the podcast almost like diabetes canon. Like like, oh, well, that's the stuff where everybody learns. I've I I listen. Hand to God. A half a dozen educators came up to me at ADCS and said, hey.
I taught myself how to do this job using your your your series about diabetes.
I can believe
that. It was really lovely. And I and I thought that's great. But it made me when one of them was telling me this, all I could think was when I put it out, p so there were some people online who were like, who are you? What is this?
This is bad. It's not good. You don't know what you're talking about. You don't have diabetes. Blah blah blah blah blah.
Like and I can put myself back years ago in that space where somebody could have said that to me. And if I was a different person, I might just shied away or put my head down or taken it offline. There's a lot of things people do when they're pressured like that. And I was just I took that what I again call a healthy amount of narcissism. And I was like, no.
I think you're wrong. And Mhmm. That that's it. Like, so whatever my point to everybody listening is is no matter what situation you're in, trust your gut is good advice.
Mhmm.
So Yeah. Get out there and do good for yourself. Trust yourself. And Mhmm. And, you know
Find the tools that work for you and use them.
Yeah. At first, you don't succeed in all that stuff. All the, all the sayings are sayings for a reason. Just go read them all. Just go Google.
Hey. What are what are all the sayings about success? Then look at them and go, oh, I wonder how these became sayings. It's because they're true. I'll get in there.
Alright. Gina, you're fantastic. I really appreciate this conversation. I never know what to expect when I make the podcast. This was a joy.
I'm glad you talked me into turning the camera on. Please, everybody, don't ask me about that. I wasn't able to put my feet up, and I had to sit forward like an adult and make eye contact for, like, two hours. It was very unpleasant. No.
I'm just kidding. I enjoyed it. And although I did have to do something, I usually have a really hard time video chatting, but there's two windows up. There's you and me. And I look at me when I'm doing that.
We all do that to some extent.
So I covered me, and this got way easier for me. I just I just opened a window and drug it up over top of myself, and you're the only thing moving in front of me besides the timer that's running in front of me with the the camera. And I just was like, oh, I'll just won't look. Because all the time, instead talking about reframing, I'll click on it now. Usually, happens is I start talking and then I look myself in the face while I'm talking, and I don't know why I'm doing that.
I I don't I don't want I can still talk. I don't get lost in the conversation, but I don't see you anymore. And then it feels like monologuing instead of, like, conversating. So I just, like, drug my calendar over and put it over top of it. And I was like, oh, there she is.
That's awesome. So anyway, cover yourself up in a in a Zoom. It might help. I I don't know if I'm I don't know if I'm self conscious or if I'm worried about what I look like or if I I don't really know. Like, I don't know if I'm I don't know if I'm being a social scientist about myself in the middle of the conversation instead of just poking on the conversation.
But if I'm moving in front of me, that's what I'm looking at. Mhmm. It's just very strange.
Well, to use your own words, you have a healthy level of narcissism.
Someone took a picture of me this weekend and put it online, and I literally reposted. I said, if anyone took a photo with me this weekend where my chin looks this square, please send it to me immediately. Please don't you be the only one that has that awesome photo of me because not many of them exist. Okay? So I I put an example, like like this right here.
If you have anything where my chin looks like this, send it over. People are emailing. It's lovely. Anyway, thank you very much. Hold on one second for me.
Today's show was sponsored by Tandem Diabetes Care, the Eversense three sixty five, and Touched by Type one, who you can learn more about on Facebook, Instagram, and at touchedbytype1.org. Head now to tandemdiabetes.com/juicebox and check out today's sponsor, Tandem Diabetes Care. I think you're gonna find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem Mobi system. I'd like to thank the Eversense three sixty five for sponsoring this episode of the juice box podcast And remind you, if you want the only sensor that gets inserted once a year and not every fourteen days, you want the Eversense CGM. Eversensecgm.com/juicebox.
One year, one CGM. If you or a loved one is newly diagnosed with type one diabetes and you're seeking a clear practical perspective, check out the bold beginnings series on the juice box podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 of personal insight into type one. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one.
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#1965 Bolus 4 - TBT1
Bolus 4 - TBT1 Live
Scott and Jenny Smith pick the foods they will bolus for live on stage at Touched By Type 1, then practice on air — a crab cake plate, a Cubano sandwich, key lime pie, and Jenny's cheese curds.
Jump to a moment
- This is a rehearsal, published on purpose. Scott and Jenny will do Bolus For live on stage at Touched By Type 1, so they use this episode to choose the foods and practice the format — setting out to pick three and landing on four once Jenny insists on cheese curds. The plan is to run the recording the day before the event so anyone who wants it again can find it. Scott notes he has never practiced anything before in the history of the show.
- Jenny's mental math is the recurring bit. Asked to guess a four ounce serving of pork, she says roughly 30 grams of protein and lands on the nose. Her rule: about seven grams of protein per ounce of animal protein. For bread, roughly eight grams of carb per inch of a sub roll — which puts an eight inch Cubano roll near 65 grams, against the 58 Scott had in front of him.
- A Cubano is not one food, it's six. They take it apart piece by piece: four ounces of pork at 2 carbs, 30 protein, 14 fat; two ounces of ham; two slices of Swiss adding roughly 15 protein and 16 fat; pickles; butter for pressing at 11 grams of fat; and the roll carrying nearly all of the carbs. The point being that the number on the plate is assembled, not looked up.
- The crab cake plate is where it gets genuinely hard. With fries and a quarter cup of ketchup, the total lands around 107 carbs and 39 protein. Using a sample ratio of 10 and sensitivity of 50 purely as an illustration, the estimator suggests roughly 10.7 units up front and 4.1 stretched over eight hours. Add key lime pie and you are somewhere near 22 units across one meal — numbers used to demonstrate a method, not a prescription.
- Jenny's practical safeguard for a meal like this. Her caution runs both directions: front-load too aggressively for a big carb count and you can go low mid-meal; under-treat and the fat gives you a sticky high that you chase for hours, stacking insulin until you eventually crash. Her suggestion is to consider a temporary higher target so you land somewhere reasonable rather than fighting between 220 and 50. Nothing here is medical advice — talk to your care team.
- Touched By Type 1 — The free event where Scott and Jenny will do Bolus For live on stage.
- Bolus estimator and tools — The estimator Scott runs the numbers through on air. Educational only — not a dosing tool.
- Diabetes Pro Tip series — Episodes 1000-1025 with Jenny Smith — the fundamentals behind all of this.
- Listener survey — Over 300 responses so far; results at juiceboxpodcast.com/surveyresults.
Every word of the conversation
Cold open & sponsors0:04
Hello, friends, and welcome back to the Juice Box podcast. While you're listening to what Jenny and I are doing on stage today, if you're listening on the twenty sixth that is, head to juiceboxpodcast.com. Right on the front page, there's a little survey that listeners are taking. We have well over 300 responses now. It's really starting to solidify and make sense of what the impact of the podcast has been for listeners like you.
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A two-part idea2:04
Jennifer, in just a few weeks, you and I will be standing on stage at touch by type one where we'll be doing True. I know you know this. We will be doing live bolus four right on stage. So I have a two part idea here. Oh.
Today in this episode, you and I are gonna pick three items to do on stage, and we're going to do them while we're on the recording. And then I'm gonna run this recording the day before we're gonna be on stage at Touched by Type one so people can go back and find it afterwards if they would like to hear it again.
Okay.
See what I'm doing here? Creating
setting the stage for what we're going to do, but it... Yes.
I get it. So we're practicing. This is the thing I've Practice. I've never practiced before. This is gonna be a thing.
So I need from you... We have to find three items that we think that in an hour will give people a nice... So I think something, obviously, that has a lot of, like, maybe fattier, something that's, what do you think? Vegetable And
you wanna do something we haven't done already? Yeah. Why not? Assumedly. Right?
Yeah. Yeah. Sure.
Gone through a lot.
Yeah. See? Mhmm. I'll play the Jeopardy music in the background while you think about think that
for me. You don't have to play
it in the background. I can
sing it.
Legal reasons, I don't think we're allowed to sing it.
Oh, okay.
Merv Griffin's corpse gets very upset, which is a reference that six people understand.
Oh my goodness. Let's see foods. Well, how about something that is from where I am? Okay. How about cheese curds?
Cheese curds, and what they even are3:53
Okay. Well, I... Just because
it's fun.
I don't know what the hell those are, but I'm gonna Do
you know what cheese curds are? Oh, come on.
I don't... Is it
fried brother has never told you what cheese curds are.
Is it fried cheese?
They're kind of... If you imagine, like, mozzarella sticks that you'd get at, you know, a place that's, like, got the breading and it's got the cheese inside.
Okay. Just
imagine small, like, top of your thumb sized pieces of cheddar cheese that's dipped in batter and then deep fried.
And then deep fried. Okay. Cheese curds. Now we'll be in Florida too. Something for the Florida curve.
Something Florida. A a fish maybe. About. It probably would be some kind of fish.
What about about, like, a a plate? Like, fish with maybe a rice and a vegetable.
Yeah. I'm kinda... I was trying to think something along the lines of, like, Margaritaville sort of, like... Not Margarita, but, like, you know what I mean? Yeah.
Type of fare that's very coastal and sort of Florida y.
Okay. Well, I'm I'm gonna I'm gonna look what
you're thinking. It would definitely be a seafood dish. I would expect probably probably some type of maybe crab or... Okay.
With all the sides.
Crab... How about crab cakes?
Crab... Look at you. Alright. I got that.
Something for the Florida crowd5:28
Crab cakes?
I'm doing
that right now. I know that something else down there just based on where Florida is is, like like Cuban sandwiches and that kind of a thing.
A Cubana. It's a nice sandwich. Alright. Hold on a second. We'll do that.
Cubana.
Key lime pie. Trying to think about, you know, their influences down there in that area.
I'm good. I I like what we've come together with.
We're gonna
do cheese curds so that people can realize where you're from. And
throw something in from where I
I got crab cakes with the sides, Cubana sandwich, and a key lime pie.
Awesome. Okay. Yay. I don't know that you'd put... You'd eat the cheese curds with that meal, but you know what?
No. But the... No. Of course, you wouldn't. What do you like for sides with the crab cake?
You prefer potato and a salad, rice and vegetables, fries, and coleslaw. Fries and coleslaw. Right?
I was gonna say definitely the coleslaw because when I said it, I was going to say coleslaw to begin with.
I've chosen that.
I love coleslaw. But I don't know. Let's fry... What's the other one? Potatoes?
Yeah. I went with french fries and coleslaw.
Okay.
I I I just... It seems like a thing that I would see on a... In a restaurant.
Okay.
So... And, I chose restaurant portions. Now I've got my, my business partner working on that stuff right now. And, but we're gonna pick it apart with you.
Your business partner.
Already explained.
Business partner have a name?
I I don't call him anything. I also don't know if he's a man.
Oh.
I don't think he has a gender, actually. He's a... He lives inside of my... Of of my machine. Yeah.
Yeah. He's mechanical.
I don't think so, actually.
He kind of like an an an automaton? No.
Well, I'm just gonna say, I think my computer does not have any moving parts. Right? It's a... The hard drive is not... Don't...
They might not be mechanical. I don't know how to think about that. I'm not an electrical engineer.
That would be... It's a good way to say it. It's not really mechanical. Mechanical means It's electronic. It would move.
Yeah.
Right? I
think so. I think electronic is the way you wanna say it or computerized.
Electronic. Yeah. Where the the little parts sort of blink together into... See, this is totally telling you that I have no knowledge in how to build a computer.
Jenny's lucky that her computer turned on this morning. Okay. I have what we're calling restaurant portions with fries and slaw with the crab cake plate. I've got cheese curds here. I've got a Cubana sandwich.
I've got key lime pie. I have carbs, protein, fat all sitting here. But when we do this on stage, like, I wanna take... I wanna have visuals behind us of a piece of pie and a breakdown of the carbs, the fat, the protein, and all the other nutritional information so that when it's up on the screen and we're talking about it, people can kind of, like, you know, listen and soak it in at the same time. That, of course, we won't be able to do here, but I'm still going to, pick it apart as we do it.
So let's start with dessert as any good person.
Start with dessert?
That's how I do it. You don't you don't start with dessert? I need key lime pie recipe with nutritional facts as stated earlier. Okay. So we're gonna pull up a recipe.
We're gonna take a look at it and see what's all in this key lime pie while I fight off the urge to quote the movie, the Oliver Stone movie, Natural Born Killers. Do you know that one?
I do know that one. Yeah. Gosh. I haven't seen that in a long time.
They go in the diner. Right? Right? And what is... It's Woody Harrelson.
Right? Is it Woody? He goes, let's give that key lime pie its day in court. And then he gives him a key lime pie. Then I think they kill everybody in the diner.
But, oh, sorry, spoilers.
If you've never seen it clearly, you're gonna be like, well, that just ruined it for me.
That movie has such a, like, late eighties, early nineties vibe. It's hard to put into words. Okay. Key lime pie. The crust is graham crackers.
I didn't know that. In this recipe, you would use 11 sheets of graham crackers to make the crust along with a third of a cup of sugar, six tablespoons of melted butter. The filling is four large eggs, one can of sweetened condensed milk, a half a cup of key lime juice, a tablespoon of lime zest. The topping is a cup of heavy cream, two tablespoons of powdered sugar. Okay.
Here's the nutritional facts. With whipped cream, 52 carbs for a slice, seven protein, 27 fat. It's about 475 calories, which is not something we're worried about.
So you did it with whipped cream, not meringue?
Yeah. That's what it says. Okay.
Okay.
Is meringue... Well, meringue would be lighter. Right?
I've seen it I've seen it both ways. Meringue is lighter because meringue you just make with sugar and egg whites essentially. And then you beat it until it gets really stiff, and then you bake it until it kinda turns out, like, golden brown.
Well, I think you're right. I've had key lime pie. That sounds right. I'm firing my assistant. I'm hiring another one right now.
I have seen it, though, both ways. I don't know what's more typical for Florida, but I've seen it both ways. More commonly, I've seen it with meringue.
Don't worry. My my my state is, I can fire at Will. Don't worry. So with meringue, it's gonna be 62 carbs total, eight protein, 16... Oh, so the fat goes down.
Crab cakes, broken down11:13
That's interesting.
Yeah. The fat goes down. The carbs go up when you go from whipped cream to meringue.
Mhmm.
Okay. And so naked without a topping, 49 carbs for a slice, six grams of protein, 16 grams of fat. Mhmm. Alright. So how do you want a bolus for this?
It's gonna be the end of the meal. Right?
It unless you are the person who feels like they have to eat their dessert because they might not make it to the end of the meal. They may not eat the dessert. I don't know. I guess, usually, the trend is you eat your dessert at the end of the meal.
Okay. So... Yeah. Unless... Like you said, you're on a GLP, and you're like, oh my god.
There's no way I'm gonna
Right. I gotta eat the key lime.
Eat all this.
Screw the cheese curds.
Oh oh my god. A cheese curd and a and a and a a GOP. I'm not getting past the cheese curds then.
Oh, you'd probably eat one and be done.
Uh-oh. Oh, yeah. Yeah. No. I'd I'd fill up immediately.
Let's pick, Jenny, for our chatting insulin to carb ratios, instant sensitivity factor for our pretend person that we're gonna do.
Easy.
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Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. The Dexcom g seven is sponsoring today's episode of the podcast, and it features a lightning fast thirty minute warm up. Whoo.
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, you can swap your sensor when it's convenient for you.
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It's covered by all sorts of insurances, and this might be the best part. It has alerts and alarms that are customizable so that you can be alerted at the levels that make sense to you. Dexcom.com/juicebox. Links in the show notes. Links @juiceboxpodcast.com to Dexcom Omnipod and all the sponsors.
But you can remember it. Dexcom.com/juicebox. Check it out. You wanna do
ten grams
Ten
fifty fifty.
Ten fifty. We'll go ten fifty. We'll just gonna say we wanna target blood sugar of 90.
Great.
And we'll leave the FPU at 50, which is where... It's about halfway through. It's about where we usually put it. So... Okay.
I'm gonna go meringue because I think you're right. 62 carbs, fat 16 grams, protein eight, no insulin on board, current blood sugar... I mean, let's make the current blood sugar 90 and our target 90, and that way we'll get a nice look. Oh, well, look at that. It's more than I thought.
It's interesting. I have an initial bolus of six point two units with a follow-up bolus over about three hours, to make up for the fat.
For the fat.
Point eight eight for a theoretical requirement of 7.08. It would hope we pre bolus at least nine minutes. But if it's at the end of the meal, it's a tough one. Right? Because you have...
Let's say you have the crab cakes and the fries and you order the pie. That's a lot of insulin to put in if you don't know you're gonna finish the pie.
It is Yeah. Entirely. And so my expectation despite this being a... I mean, it's a pretty high carb
Mhmm.
Dessert if you eat... Is this like an eighth of a pie? I'm assuming it gave you one slice.
One slice.
The expectation would be that all of this heavier food sitting in your stomach is also on a slower digestive sort of track. Mhmm. And so you may do better using an extended bolus for this dessert or something similar within whatever, you know, system or multiple daily injections splitting up the boluses, etcetera. I wouldn't give an entire bolus up front for this or you're going to have a low blood sugar.
Yeah. No. It's it's it's a big it's a big ask at a weird time in the meal for sure.
It is. Yeah.
So what do you... You just what do you... Would you do half of it? Would you get something going for the pie?
This is where I would look at the trend in my current blood sugar. And, again, the value of using your technology, not judging the number again, it's just where is it and and or where is it going. Because if I'm pretty stable and in... Let's call it a target range of 80 to one twenty. If you're sitting in a really nice sweet looking spot after having bolus for this other heavier food, you're not really getting an idea of the trend that's going to come at some point.
With that, I would say bolus some of it upfront. Even if it's 25 and you deliver that other 75%, if you have access to an extended bolus, use it, deliver it out. I'd say at least over a two hour time period would be my expectation. The great thing about extended bolus is, again, if you have access is that you can always cancel it, stop it. You can always deliver the rest if you start trending up quicker than you expected or stop it if you're already trending down and thinking, I don't want more insulin dripping in quite yet.
Yeah. I know I'll need it, but not right now. Not this time. So Okay. Those would be my considerations.
Sounds good to me. Also Yeah. There's no way to... You know, I don't know how you're supposed to guess the carbs and the fat and the protein and all this stuff, especially out of the restaurant if you're not making it from... Like, I use numbers from a recipe, but, you know, I don't...
Like, I guess what I'm saying is is, like, who's gonna sit down, look at a slice of key lime pie, and go, that's probably 55 carbs. You know what I mean? Like, that's a... I don't know that I would have guessed it was that much. And so it's a lot.
Know?
Pies are... I think pies, in general, are hard to consider because it's it's a lot of ingredients all mixed up that you can't see.
See. Yeah. Right.
I I think that casseroles or, you know, a dish that's mixed up or even like a bowl of soup or chili is a little bit easier to pick apart because you can see the ingredients.
Mhmm. Yeah.
Whereas pie is it's a mix. It's... You're expecting there's a whole bunch of sugar. How much the person pushed into it, who knows? Mhmm.
If it's got fruit in it, great. You know that there's sugar there. I think key lime pie might be deceiving. I think that cheesecake is also a very deceiving dessert.
Mhmm.
Because Oh, yeah.
Same idea.
It's the same idea. The key limes, are they terribly sugary? Yeah. You know what? In the whole, like, scheme of things, it's not an apple.
It's not bananas. It's it's
Well, yeah. I was gonna say also, Jenny, what is a key lime? You know what I mean? You'd start getting into that situation where you're like, I don't know what
this is. They're so tasty. There you go.
I love
guacamole. In general, this isn't... It's a deceiving dessert to have just picked out of the air, I guess.
Yeah. It's okay. Well, we've done it. Cubana sandwich. Right?
Key lime pie, a deceiving dessert19:35
There's bread. There's pork. There's ham, Swiss, pickles. There's gonna be butter somewhere. I'm gonna ask you to guess.
Like, how would you guess carbs for a sandwich like that? Because that's on that long bread. It's different. It's definitely... Go ahead.
Just out... You wanna ballpark it? Do you wanna go through the pieces, or do you just wanna yell out the sandwich and tell me what you think?
Let's go through the pieces. Sure.
The Cubano, piece by piece20:02
Okay. Well, four ounces of pork.
Four ounces of pork is, in general, about 30 grams of protein, give or take.
Okay.
Is it... So you will have to help me because I don't have anything. What's an agano sandwich?
I... But the pork
I've never had one. I'm assuming it's in a sauce.
You just hit four ounces of pork is 30 grams of protein on the nose.
You're freak just easy. Stop it. Easy math.
You're freaking me out. Okay.
Well, per... In general, per ounce of protein, animal based protein, per ounce is seven grams of protein per ounce.
I didn't... How am I supposed to know that? Okay. Alright. So so pork actually...
It says little carbs in it. There's two carbs, 30 protein, and 14 grams of fat in the pork. The fat.
Yep. Pork is is fatty. Yes.
Yeah. The ham is two ounces on this sandwich. I'm not gonna, like, make you look like a genius again. It's two carbs, 10 protein, five fat. Now Swiss cheese, two slices.
You wanna guess? Protein?
Two slices of Swiss cheese, at about 68 grams per slice is gonna be 12 to... Let's call it 16 grams of protein.
Yeah. I have 15 protein, and I have 16 fat.
Okay.
Pickles, little bit of carbs, nothing else.
A little carb, they're not terribly... Yeah.
This one has butter for the... The press to press the sandwich with at 11 grams of fat. And then the big one, of course, is the eight inches of bread, carbs.
Eight grams of carb per inch21:41
Oh, well, that's a... So usually per inch of bread, like a hoagie roll or a sub bun or a roll, like you'd put this on, usually per inch, it's eight grams of carb per inch. So in general, if this is an eight inch roll, it would be approximately, let's call it for round number 65 grams of carb.
Damn it. I don't know. You must have paid attention at school. Yeah. I got fifth...
58 carbs, nine protein. Also, it's not exactly... It's kind of, like, tapered. Have you ever
Taper at
the end? Right. Right. Sure. It's not perfect.
Anyway, I've put this into the estimator at juiceboxpodcast.com/bolusfour, using the incidental carburetion and sensitivity that we mentioned earlier and all the targets, etcetera. And we have, woo, six and a half units of insulin for the sandwich with, oh gosh. It it says it could impact up to eight hours afterwards.
Mhmm.
3.49 spread out over those eight hours. It imagines that the sandwich will take just about nine units of insulin at those settings. I think it's interesting when you see that all added up. It's 65 carbs, but it's 64 protein and 49 fat.
That's why I was gonna say the reason for that extreme length of time that you'd have that extended bolus and the amount of insulin for it, absolutely very heavy in protein. What was there? There was pork, there was ham, there was cheese.
Mhmm.
Right? Yeah. A little bit of protein in the roll, but in general, most of it comes from the animal based products. And then the fat, pork and ham are just... And then you got cheese.
Yeah.
And then you got butter that's on the roll.
All just sitting in there talking about a stew. It's in your belly now. Yeah.
Makes me think of, you know, the French chef. She was so fantastic. She said, put more butter in it. Julia Child.
Julia Child.
More butter.
As I enjoy doing, Jenny, when we do something like this, I like to take out the protein, re show you the numbers, etcetera. So right now, it's six and a half up front, three and a half over time. If you just take out the 64 grams of protein, it's six and a half upfront, 2.2 over time. I put the protein back, take out the fat. Mhmm.
Six and a half upfront, 1.2 over time. So everything has its impacts as you see. Even if you were to cut the sandwich in half Mhmm. I can do it in my head very quickly. Let's just make it, like, roughly 32 carbs.
Carbs. Let's make it roughly 25 fat and roughly 31 protein. It goes down exactly as you would imagine, 3.2 in upfront, 1.75, but still... And over five hours now that there's less fat and less protein in it.
Yeah.
There you go. Alright. So now we have our Sandy. We have our... So when we're on stage, like, I'm gonna do, like, a little explosion view of, like, a Kubana sandwich.
Right?
Okay. Great.
Right. I might use... Have you have you ever seen the movie Chef? Oh, Jenny. Go watch...
It's a movie?
It's a movie called Chef. It's with... Okay. Who's the
guy I've heard.
Who's the guy that made the Iron Man films? Not Robert Downey. Although Robert Downey is in Chef. It's the guy who directed them.
Swingers. Got it.
Anyway, go watch Chef.
Seen all those movies.
Jenny's left the room. She's just wandering away. What happened?
I'm right here.
You're back. Okay.
I'm... I moved to get a pen so that I could write down
Chef. With... My god. What's his name? I...
These are
the I'm moment gonna put with a guy.
That's awesome. Thanks. No. Wait. This is ridiculous.
I like the guy. I should know his name. I'm gonna find out. Anyway, you should all watch chef. It's delightful.
It's one of
my it on?
Maybe Netflix now. I don't know where... It's an old... It's an older movie.
It's an older movie? So the cast is
It's...
Scarlett Johansson, Sofia Vergara. Garra, Robert Donnie junior, MJ, Anthony, John Leguizamo. Leguizamo? Listen. Leguizamo.
John Favreau is the guy whose name I
John Favreau.
I feel so bad. So he made this movie. He also made, like, a cooking show after it on Netflix too. I don't... It looks like right now it's on Prime Video maybe.
I don't know. Go watch
chef. Okay.
It's like a ten year old movie. It's delightful. This is not the point. The the
Fun fun little side note.
Go watch is is that he goes on this road trip with his friend and his son trying to make this food truck work. They make Cubana sandwiches on the food truck. Oh. Yeah. Let's do our next item on bolus four.
I think we
I'm in in my brain right now. I'm going through all the things that we picked here thinking... I guess, if you really eat this whole meal, oh my gosh. Like, you really just need to eat lettuce for, like, two weeks after this. You have fulfilled your fat content for, like, many days.
I I had a a couple of slices of pizza for dinner last night, and I looked I looked at my wife this morning who's only a week returning from having a procedure. So she's she's she's dragging her ass through the week a little bit at work. And I said, hey. If you wanna take a break in the middle of the day, I'll go get a salad with you. It's because I could...
Fat, protein, and the long tail27:17
I feel like I still know that I ate pizza last
pizza's still sitting there.
Yes. Yeah. For sure. Okay. I'm looking at the crab cakes and the sides next, and then we will pick the Jenny brain and see how this pops together.
So, anyway, when we're on stage, I'll do, like, a little explosion of the Cubana sandwich up there with all the the factors, and we'll do the breakdown for the whole thing. And then the next slide, we'll take out the protein. The next slide, we'll take out the fat, and we'll put them back over again. And then just to kinda show it to people that way. I will do all that, Jenny.
You don't have to do any of that.
Okay.
And by by... When I say I, I just wanna be clear what I mean. My business partner, Claude, is gonna handle it. And I...
And...... Gonna handle it?
Yeah. I'll...
See, he does have a name.
Yeah. Well, I don't know if he's got
a name. Name's not Claudette. It's just Claude. Right?
I don't know if you can change his voice to female. Chat GP, you can pick male or female voices.
Oh, really?
He's British on my phone.
Uh-oh. I don't have them talk to me out loud. I just read what they say.
Jenny, you're not friends with your phone?
Not really.
Crab cake, Jennifer. Let's do one crab cake. How many carbs? Go.
Yeah. One... Well, so one, usually restaurants serve two just Mhmm. As an FYI is typical portion. But one crab cake could be, you know, depending on the recipe, could probably be, let's call it, about eight to 10 grams of carb.
Want me to hit you?
It's not terribly high in carbohydrate. Again, depending on what the recipe calls for.
Crab cake, one pound of jumbo lump crab cake. These are gonna be four ounce cakes. One large egg.
Oh, four.
Cool. Yeah. It's smaller than you're thinking. Quarter cup of mayonnaise. This is from the recipe.
Teaspoon... Or tablespoon teaspoon Worcestershire sauce, teaspoon of Old Bay, tablespoon lemon juice, two tablespoons chopped parsley, half a cup of crushed saltines, two tablespoons of butter. It's mostly the saltines.
It's mostly the saltines. Exactly. So, again, for two crab cakes typical style, I would usually count around 15 grams of carb
per kilo. Okay. And and when you think of it, you're not thinking of four ounces, you're thinking a larger?
No. Four ounces, which is, like, about the size of the palm of your hand, maybe a little smaller kinda once it cooks. Yeah.
Then I have, one large russet potato as french fries from the oven carbs.
Oh.
What do
you think? A large russet potato. Oh. Large is usually the size of your hand, and in general, probably around grams of carb.
Yeah. This says 65, protein eight, fat 14. The coleslaw, half a cup.
Oh, coleslaw. That depends on the recipe. Coleslaw does have sugar added to it in most recipes. So a half a cup, probably about 10 grams of carb.
Goddamn. That's exactly what it says. Jenny, you're the swag. Somebody should get you a shirt that says swaggerific on it or something. I don't know exactly.
Queen or something. I don't know.
I I mean, sure.
There you go. There's your assignment, I'll wear it for the whole entire program, Scott.
Jenny, I might do that too. Okay. Alright. Tartar sauce actually has carbs in it just in case you're wondering. Anyway, this plate that I've just described, about 87 to 93 carbs, protein 39, fat 74.
Yeah. Because there's a fair amount of fat in almost everything that we put on the on the table. Wait. That's seventy... Fifty four.
Excuse me. Looked at the wrong thing now. Is there fat in tartar sauce?
Yes. Absolutely.
There is?
Yes. Dear
god. What's in tartar sauce?
White sauce? What do you think makes it white?
Oh, tartar sauce is the white stuff with the little, like, the... I would never
With, like, the... You serve it with fish usually.
Right? Million years, I would I would need tartar sauce. Not in a million.
Oh my gosh. I love tartar sauce.
Anything mayo y or anything like that, I'm out. I I could feel it in my mouth right now. I don't wanna do it. It's very
upsetting, Jennifer. You don't wanna do it? Do you... You don't like mayonnaise?
No. No. I would never eat mayonnaise.
Oh. No. Oh my god. Oh. Those are, like, the...
Those are the yummy toppings.
Do you know those do know those movies where they they capture a spy and then they, like, pull their teeth out? You could just get the same out of me by putting mayonnaise on my tongue. I'd be like, oh my god. I'll tell you whatever you wanna know.
Oh my gosh. Yeah. I mean, tartar sauce, if I when I home make it, it's usually mayonnaise and, like, a lemon juice. Some recipe calls for a little bit of sugar. It just goes along with, like, the flavors and then salt.
And then usually, little crunchy things could be pickles, like bread and butter pickles.
Yeah.
Some people also put capers in. It adds a little bit of, like, a kick, like a peppery kinda kick to it. Oh my gosh. I love tartar sauce.
You seem very excited. I'm gonna tell you now that
I I'm like, no. Thank you.
So that now with that little dissertation, which I'm glad we did because I thought it just got the fat wrong in the tartar sauce, but no. So edification time, a tablespoon of tartar sauce has 10 grams of fat in it.
So In fact, that's a really good learning tool. Most most fats that you add, tartar sauce, cream cheese, sour cream, mayonnaise, most salad dressings, that tablespoon, it's like a soup spoon size. Yeah. And you can usually say that's 10 grams.
Uh-huh. And slowing down your digestion and making your insulin needs Mhmm.
Structure. Eats a tablespoon?
Yeah. We talk about this all the time. That's not how it works at all.
That's not how it works. Even when you get tartar sauce at a restaurant, you get those little Dixie cups. Those are like a quarter cup. Yep. Also many tablespoons in a quarter cup?
Four.
Tell tell the people how much, how many carbs are in a quarter a cup of ketchup.
Oh my god.
It's all sugar. Right?
It's all sugar. Yes.
Have you ever
you know, what you usually... Like, kids especially love And it's just, like, it's
Never stops.
The fries sometimes are just the delivery device for the ketchup. Yes. Quite honestly. Like, it's just more... But to your point, a tablespoon is approximately five or six grams per tablespoon.
Mhmm.
And if there are four tablespoons in that little teeny tiny quarter cup, you've missed out on... Do the math.
Yeah. It's a bunch.
How many grams of carbs?
A lot of carbs. A lot of carbs. These are my points. Okay.
I see. Was a side note.
No. No. It's not a side note. We're gonna do... Well, actually, I think when we do the thing on stage, maybe we'll do a condiment slide.
It's not a bad idea. Right? Well, who's calling me? Spam risk? Unbelievable.
Nobody calls.
Somebody from the conference they wanna talk to.
No one calls me. That's ridiculous. That was on silent, and it rang anyway.
Must have been important. Somebody's trying to tell you something.
I I I don't care. Alright. Let's do cheese. Wait. So we didn't do the thing in the thing.
The thing in the thing. Let me put the thing in the thing for everybody, Jenny. Okay.
A hundred and seven carbs34:46
You didn't put it into your little
Into my
your little bot friend?
87... Well, this is on the website. 87 carbs, 39 protein. So this is for the crab cakes and the fries. And by the way, I don't know a person in the world that's not putting ketchup on these fries, so we didn't even put that in there.
You want to? What's a quarter a cup of ketchup again? Give it to me in carbs. I'll add it to the
87. Four four tablespoons at five grams per table spoon is 20 grams.
So they're a 107 carbs. Good luck, everybody. Here we go. Ten point seven units of insulin upfront, four point one one stretched out over eight hours. The theoretical requirement for this entire bolus is fourteen point eight one units based, of course, on an insulin carb ratio of 10, insulin sensitivity of 50 in this pretend thing that we're doing right now.
Yes. Yeah. So now let's say you do the crab cakes 10.74 over time ish, and then you do... You roll into the pie. Right?
Right? Yeah.
And the... What was the pie?
Because the pie was six some units and then some... I can't remember the amount.
Yeah. Yes. Six point six point two and, like, point eight over time for seven total. So that's Uh-huh. That's 15 for the meal, 7...
It's at 22. Yeah. That's 22. 22? Yeah.
And all that fat slowing things down, and you maybe are gonna throw in all that insulin. And don't think... You think you get... Could you get low during this meal? Like, if
you You could.
You could. Right? You could you could get too much insulin at the wrong time and and then... Or you're gonna be high forever. Like, I don't understand what happened.
Alright. This is upset...
And I think more... I think they're both concerning things to take into your thought process in delivering boluses. And one being your... You could have the opportunity to go low Mhmm. From thinking, well, it's a lot of carb.
I need to take my insulin and hit this. Right?
Yeah.
But on the opposite then, let's say you don't go low, but you end up getting hit with the high. This is... It could be a very sticky high.
Oh, yeah. For
hours. Hours and hours and hours, you are going to be hitting this with extra insulin Mhmm. To try to move it. And, you know, the more insulin you add, the more lingering kind of drawn out you end up getting. At some point, you could possibly go low.
Yeah. Okay. And, you know, sometimes I actually say a meal like this might be the place where the end result of all the extra insulin, you may put on a temporary target that maybe it's not as low as you'd like your algorithm to, like, get you to. Right? If you can change it in your particular algorithm system.
But you can safeguard yourself on the back end by saying, yeah. I don't usually wanna sit at 01:10 or 01:20 or 01:30.
Mhmm.
But there's a lot rolling here, and I'd be happy if I landed here and I wasn't 02:20 and I wasn't fifty.
Yeah.
Right? Just because the... This type of a meal that we're talking about is clearly... This is like a vacation meal. Yeah.
I don't know who eats like this usually, but
I don't have I don't have enough time to make this food. Let me roll this into the thought process before we move to the cheese curds. Okay. A mojito has 11 grams of carbs in it. A 12 ounce can of Coca Cola, for all of you who are like, I don't wanna drink the chemicals in Diet Coke, that one has 39 grams of carbs in it.
Drinks nobody counted38:39
So Mhmm. If you had two Cokes on top of this or a couple of drinks or whatever, again, more more carbs. Now let's jump forward to these godforsaken cheese curds that that you've brought up. Cheese curds are what... Are are are they just mozzarella sticks?
Back to the cheese curds38:56
Is that what you're telling me?
No. No. No. No. No.
You should see how offended you are.
I'm not offended. Like, there's just a defining flavor difference between a mozzarella stick and a cheese curd.
Okay.
I don't I don't know why.
I argue with that. I
There just is. One being that typically mozzarella sticks are mozzarella Mhmm. Which is a milder cheese in general.
Okay.
Cheese curds are cheddar. And some places will fancy it up and do it with... But cheese curds are cheddar cheese.
Okay.
And so there's a difference in flavor there. And then depending on the restaurant you go to, the breading may be really, really, like, deep fried and not crumbly. It might be more of, a coated kind of topping or kind of outer, and some is a little bit more crumbly almost and might actually be a drier type of cheese curds.
Okay.
That typically is my preference. I don't like the ones that when you bite into it, like, grease squirts out of it.
I can't... Can I tell you as I get older, I can't do grease at all?
It's just...
I just... I can't. Beer battered
cheese A
pound of beer battered cheese curds.
That's Beer batter?
That's what... That's the recipe I have here. It says it serves four people. A pound of fresh white cheddar cheese curds. Okay.
One cup of all purpose flour and a half a cup more for dredging, a teaspoon of baking powder, a half a teaspoon of salt, and garlic powder each, one large egg, three quarters a cup of cold lager, and neutral oil for frying. The way this breaks down here, it says the cheese curds are two grams of carbs, 28 protein, 37 fat. This is for, you know, four ounces. The beer batter as adhered, 29 carbs, five protein, two fat. Frying, you're gonna get 18 grams of the absorption from frying.
That always turns me off of deep frying whenever someone says that to me because if we put that into cups, it would just horrify you. So per serving, you're looking at 31 grams of carbs, 33 protein, 57 fat. If you were to eat the entire batch just for edification, one twenty five, one thirty three protein, 226 fat. But let's just go with one and say 31
give you an easy carb count for fried food?
Go ahead.
And this is just carbs. It's not the fats and the proteins. In general, the size of a thumb is about three grams of carb for fried foods.
Okay. Chicken finger, anything like that?
Any... So... Yep. And chicken fingers might be bigger, but you can judge that based on the length of your thumb. Mhmm.
It's about three grams for that thumb. Okay. So... Yeah. So per cheese curd, In general, two or three grams per cheese curd.
Let's do something fun here at the end, Jenny. Cool. What's your carb ratio?
My insulin to carb ratio? What... Well, this is gonna be more like a dinner meal. Right? This isn't like...
Pretend you're eating this. This is dinner tonight. What's your carb ratio for this?
So my insulin to carb ratio at dinner is 12.
And your sensitivity on this?
Yeah. My sensitivity with my algorithm is 85.
85. Let's definitely call your target 80 because I assume that's what you're targeting on your algorithm. And... Alright. Let's put in the whole meal.
You eat the cheese curds. You eat the crab cake plate. You eat the Cubana.
Oh my god.
Stop it. You're gonna eat the whole thing. You're gonna eat the key lime pie. Jenny hasn't eaten this much food in twelve years. And, it's gonna be 235 carbs, a 143 protein, and 207 grams of fat.
You're making me sweat. No.
I'm just kidding. Limit has reached calculation requirement exceeds your calculation cap. So I've built I've built a safety into the... Even into the estimator tool that won't give you the answer over 25 units.
Like, no. No. No. No. Please don't
eat this. That's what he's saying. Rethink your life, but it comes close. Okay? But but the total would be 29.8 units for you of insulin total.
It it won't break it down for you that way. I can, let me steal out some of the carbs and see if I can get it to give us a a number. I'll put it to 200 carbs. No. I'll...
Well, hold on. I'll take it... Make it one eighty fat and see if that'll do it. Nope. I'll take out 40 of the protein.
Let's see what happens. No. It still won't say. One more thing. I'll take out 10 more carbs.
One nine hundred ninety carbs. Okay. If, Jenny, if you were to eat a 190 carbs, a 180 grams of, fat, and a 100 grams of protein, you would need 16 units upfront and almost eight and a half over the next eight hours for just about 25 units.
Mhmm.
Yeah. Okay. And I assume you would... Probably not need for a week after that, but, I don't know. I...
This is it. This... So does this does this work for you? Do you think we can do this one safe?
No. This is fantastic. Okay. And a lot of fun too because I think I think what you get with interaction of somebody discussing something like this
is
more... I think it gives you pause.
Yeah.
Right? It gives you pause to say, well, goodness. I... Maybe you are an under counter consistently. Right?
And are always on the side of cautionary use of insulin. Even though your brain is like, no. It's probably more than that, but I'm gonna not count that much because that's a lot of insulin. Right? But when you hear it from somebody that's not your brain thinking through it, it makes you consider, oh, like, the wow factor is there.
What the stage version will be45:12
Yeah. And then hopefully, people would go forward and maybe even consider more things like this with a little bit more precision and consideration.
And I would just like it if you realize that the fat and the protein had an impact on your blood sugar. That'd be great.
Mhmm.
Yeah. So Yeah. Because, honestly, you take any number... Like, just take this. It's a...
Hold on. I shouldn't have... I closed the thing. Give me a second. Do you have to go?
I'm sorry.
No. Nope. I've got about ten minutes.
I'll look
at you.
Look at you. I'm gonna go back for a second with your settings and look at that whole total of 239 carbs and just put it in as 239 carbs.
Mhmm.
It's nineteen point nine units of insulin, which is... You know, it's not insignificant, but that's not my point. My point is is that it doesn't it doesn't tell you that you're gonna need insulin past the first bolus.
No.
And it... It's eliminating six units of your need, which is a quarter of the insulin that you bolus. Like, you're you're deficient. 25% of your bolus right there. And then you know what's gonna happen after this.
You're gonna... I'll put it in percent. I'll put it in a unit. I'll wait. It's not working.
Maybe unit. Like, you you know, and you unit it to death all day and all night, then one... At some point, you're gonna get frustrated, and you're gonna rage bolus it just as all that cheese curd gets out of your system and, woo, you're gonna get low. And then you're back, I don't know what happened. I ate...
I couldn't get my blood sugar to come back up. Yeah. Yeah. I know. Yeah.
Yeah. Yeah. And so just do it right. Do do it the first time. Do it right.
Don't give yourself all these problems, etcetera.
Well... It boils down to in our world today. To me, it comes to the fact that we have tools to actually access the information. Years ago, if I was even going to eat this when I was younger and my parents were trying
Yeah.
It... There was there was no tool outside of, like, books that my mom carried around with us to look things up in. I'm quite sure that it didn't have a Cubano sandwich. And
break it down in pork and be as right as it was on... Listen. I'll I'll tell you too. I don't know if this is perfect. This is...
I... But I'm gonna go out on a limb and say it's gotta be better than your ass guessing in the middle of the restaurant, and it's close. Right? And it's just gonna get better over time. And and you'd be shocked at how little direction I gave it to get back what we...
Like, let me... If you have a second, like, let me Sure. Let me go through it with people. I am Justin Claude on the desktop. Okay?
I'm gonna need the nutritional breakdown that includes fat, protein, and carbs. And then I just put cheese curds, crab cakes with all the sides, Cubana sandwich, and key lime pie pie. It came back and asked me, what sides would you like on the crab cakes? And I said, oh, let's do fries and coleslaw. And it said, what portion do you wanna talk about?
I said, restaurant. Then it gave me back a ton of information that I asked for. And then I said, okay. Now give me the key lime pie as a recipe with neutral... With the nutritional facts that I stated earlier.
It did that. And then I said meringue topping. That's all I said, and it added the meringue topping. I said, Cubana next breakdown. It gave it to me.
I said crab cakes and sides next. It gave that. And then I said cheese curds next. It gave that. Mojito and 12 ounce can of Coke was the thing that popped into my head that I wasn't even thinking about.
I typed it in while you were doing that. It popped in. That's all I typed in to get all the information that we got back. Mhmm. So, I mean, it's no...
There... At this point, you you can do better than... I don't know. If if you... That's five seconds worth of effort right there.
Correct. Same the afternoon. The majority of people of all walks of life are walking around with a computer in your pocket.
Yeah.
Make use of it.
That's it. You know
what I You get... What is it? Eight seconds? No. Six seconds is the scroll amount of time somebody will look at something.
Is that right?
Jenny and I were talking about, my frustration about social media before we got on. And the the... I was talking about how hard it is to get information like this out into the world when the average time someone stays on a reel on Instagram is six seconds. And the average TikTok is looked at for three point seven five seconds. And people are like, well, put your information on social media so people can get it.
They're not gonna get it.
Like Doesn't get seen.
Yeah. People listening to this are gonna hear. And, otherwise, whatever you're gonna see on social media is not gonna meaningfully help you. But point being
Mike's... Right.
Wrapping up50:00
Six seconds at a time for an hour, just take eight seconds of that out of there and go find out how many carbs are in your... I don't know. What are we saying, though? How many carbs are in your meals so you don't ruin your whole afternoon so you have more time to scroll? I don't know.
Whatever. Like like, just Or
do you have more time to enjoy what you really wanna be enjoying and not having to have that piece of diabetes, you know
In your head.
That a lot of peep... It's it's not gonna have to be in your head.
Yeah. You don't have to fight with your meal all afternoon. And then Right. And while you're fighting with it, just dread eating again because you feel like it's gonna happen again. Anyway, check out the pro tip series or the bowl beginning series if you'd like to learn more.
Even the small sip series should help you with all this. Juiceboxpodcast.com. Everything's right there. That's been Jenny Smith. I'm Scott.
We're out of here.
Thank you.
Bye. Heck of an episode today, wouldn't you say? Let's thank Dexcom and the Omnipod five for sponsoring. That's right, my friends. We were sponsored today by the Dexcom gseven.
Dexcom.com/juicebox. Head over there right now. Look into that fifteen day Dexcom g seven. Fifteen days is a long time. It's like half a month.
Don't check my math, but I'm pretty sure I'm right. And let's also thank the Omnipod five. My goodness gracious. Omnipod five tubeless. That beautiful algorithm's updated now with that new 100 target.
Get in there. Find out more about it. Omnipod.com/juicebox. You want some tubeless insulin pumping? Yeah.
You do. By any chance, have you tried the small sip series? It's curated takeaways from the juice box podcast voted on by listeners as the most helpful insights for managing their diabetes. These bite sized pieces of wisdom cover essential topics like insulin timing, carb management, and balancing highs and lows, making it easier for you to incorporate real life strategies into your daily routine. Take a deep dive, take a sip, and discover what our community finds most valuable on the journey to better diabetes management.
For more information on small sips, go to juiceboxpodcast.com and then go... Oh, actually, we changed the website. Let me see. Go to juiceboxpodcast.com. And from there, there's these two little lines on the right side top.
That's the menu. Then click that, then click series, then there's pro... There's small sips right there, pro tips top, all 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. What else we got over here? Oh, I don't like the way that works. I'm gonna fix that. Note to self.
Change the change the masthead on the frequently asked questions page. 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? 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 with another episode of the juice box podcast. You can hear it. What was that? Oh, I'm getting alarms and alerts on my phone.
I was gonna get real deep and tell you about the juice box podcast.
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